MRA Service Coordination for Home and Community-Based Services

1. MRA Service Coordination for Home and Community-Based Services Transition Information for HCS Providers Spindletop MHMR Services January 28, 2010

2. Introductions Toye Babb, Program Administrator, MRA Service Coordination Email: toye.babb@stmhmr.org Office: 409-784-5564 Cell: 409-926-2116 Fax: 409-784-5531 Lisa Gibbs, Director, IDD Services Email: lisa.gibbs@stmhmr.org Office: 409-838-3494 Ext. 222 Cell: 409-656-4632 Fax: 409-833-8437 Gary Hidalgo, COO Email: gary.hidalgo@stmhmr.org Office: 409-784-5557

3. Meeting Agenda • Introductions • Purpose of the Transition • Timelines & Activities 1. DADS 2. MRAs • Clarifying Roles 1. HCS Provider, MRA SC, & DADS Responsibilities 2. Comparison of MRLA & MRA SC for HCS 3. DADS Frequently Asked Questions (FAQs) 4. Home and Community-based Services (HCS) Case Management Transition Initiative Website • MRA Transition Summary • Meeting Evaluation & Next Steps

4. Purpose of Transition to MRA SC SB 1, Section 48 (81st Session) • Provides $207 million General Revenue for home and community-based programs for people with intellectual and developmental disabilities and for reshaping the system of services. • 7,832 people on interest lists will receive waiver related community services by August 2011. • Additionally, HCS services will be provided to people leaving large & medium ICFs, children aging out of foster care, and children & adults at risk of institutionalization. • The funding for increased community services is contingent, in part, on the transfer of case management from the HCS Provider to the MRA.

5. DADS Transition Timeline September 2009 • DADS stakeholder meeting on draft HCS and Service Coordination rules held 9/14/09. January 2010 • Proposed HCS and SC rules > Medical Care Advisory Committee (MCAC) & DADS Council for approval to publish in Texas Register. February 2010 • Proposed rules published in Texas Register for 30 days. March 2010 • Public comments on proposed rules received and reviewed. April 2010 • Proposed rules revised as needed, response to public comment. • Training for HCS Providers and MRAs begins. May 2010 • Training for HCS Providers and MRAs continues. June 2010 • Implementation of HCS & SC rule changes – HCS Case Management becomes MRA Service Coordination.

6. DADS Transition Activities DADS preparation priorities prior to transfer of HCS case management: • Develop Program Handbook, forms & templates – includes PDP & Implementation Plan (IP) • Make changes to CARE information system • Communicate changes to individuals receiving HCS services & their families • Develop training for MRAs and HCS Providers • Support flexibility of HCS Provider transitional case management requirements (TBD)

7. DADS 2010 Spring Training Locations • Region 20 ESC, 1314 Hines Avenue San AntonioApril 5 & 6 • United Way of Greater Houston, 50 Waugh Drive HoustonApril 13 & 14 • The Resource Connection, 1400 Circle Drive Fort WorthApril 19 & 20 • Lubbock Memorial Civic Center, 1501 Mac Davis Lane Lubbock April 29 & 30 • The Power Center, 12401 Post Oak Road HoustonMay 11 & 12 • The Resource Connection Fort Worth May 18 & 19

8. MRA Transition Timeline December 2009 • Schedule Provider Meeting • Develop Transition Timeline January 2010 • Provider Meeting – January 28, 2010 • Schedule Future Provider Meetings February 2010 • Assign Local Case Numbers • Develop dedicated webpage/link to Transition Plan • Create Job Descriptions April 2010 • Attend DADS training for HCS Providers and MRAs • Revise Policies and Procedures as needed • Develop training plan, curriculum and manual May 2010 • Training for HCS Providers and MRAs continues. • Hire/Train Staff • Develop process to manage May & June PDPs and IPCs • Create contact lists • Assign Caseloads • Host Meet & Greet June 2010 • Implementation of HCS & SC rule changes – HCS Case Management becomes MRA Service Coordination. http://www.stmhmr.org/

9. Clarifying MRA, Provider & DADS Roles 3 approaches to explain fundamental roles & responsibilities after the transfer to MRA SC effective June 1, 2010: • Draft HCS rule amendments (subject to change before final adoption) • Comparison of MRLA & draft HCS rule requirements • DADS Frequently Asked Questions (FAQs) about the HCS Case Management Transition

10. Draft HCS Rule: MRA Service Coordinator • SC, person/LAR form Services Planning Team (SPT) with other participants selected by person/LAR including provider. • Continue enrollment of people into HCS program. • Conduct person-directed planning and completes PDP specifying needed services to achieve desired outcomes identified by person/LAR. • Update PDP annually or as needed. • Coordinate IPC completion with HCS provider, person/LAR. • SC, person/LAR or provider may request revision to IPC and/or PDP. SC agrees or disagrees with IPC renewals & revisions. • Monitor provision of individual’s program services.

11. Draft HCS Rule: MRA Service Coordinator MRA SC monitoring must: • Document person’s progress towards achieving outcomes in PDP. • Ensure concerns with implementation of PDP are communicated to Provider & attempts are made to resolve. • Notify Provider if SC becomes aware emergency necessitates an HCS service to ensure health & safety and service is not on IPC/exceeds IPC amount. • Assist with transfers and approving discharges. NOTE: SC monitoring frequency will vary based on the needs of the person. Minimum frequency of contact is quarterly; monthly contact may be necessary for some people. The Discovery process for PDP development or renewal includes determination of frequency.

12. Draft HCS Rule: HCS Provider • Complete assessments & submit LON requests to DADS. • Coordinate completion of the IPC with MRA SC, person/LAR & submit to DADS for approval. • Develop Implementation Plan (IP) for delivery of person’s HCS program services, with the person/LAR, based on the PDP. • Deliver services according to IPC authorized by DADS. • Monitor the delivery of services on IPC in accordance with HCS Program Certification Principles. • Monitor progress related to program services in accordance with IP.

13. Draft HCS Rule: DADS • Conduct residential & certification reviews of HCS Providers to evaluate compliance with HCS Principles (WS & C) . • Continue to approve IPCs & LONs (Utilization Review – UR) . • Expand current role to oversee Service Coordination for individuals in the HCS Program (MRA Contract Accountability and Oversight unit).

14. Comparison: MRLA & MRA Service Coordination MRLA Draft HCS Rule MRA conducted survey/certification Service Coordination provided by the MRA Service Coordinator facilitated PDP and documented the outcomes Provider submitted strategies to the MRA for approval MRA responsible for initial IPC & entered IPC into CARE. DADS conducts survey/certification Service Coordination provided by the MRA Service Coordinator facilitated PDP and documented the outcomes Provider develops Implementation Plan based on PDP MRA responsible for initial IPC & enters IPC into CARE.

15. Comparison: MRLA & MRA Service Coordination MRLA Draft HCS Rule MRA responsible to complete IPC renewals & revisions & enter in CARE. MRA completed initial ICAP & renewed every 3 years. MRA completed initial MRRC & entered MRRC in CARE. Provider responsible to complete IPC renewals & revision in coordination with MRA & enter in CARE. MRA agrees or disagrees and signs in CARE. MRA completes initial ICAP; Provider completes renewed ICAP every 3 years. MRA agrees or disagrees and signs in CARE. MRA completes initial MRRC & enters MRRC in CARE.

16. Comparison: MRLA & MRA Service Coordination MRLA Draft HCS Rule MRA completed annual MRRCs & entered in CARE. DADS assigned LON. MRA submitted UR for DADS approval. Provider completes annual MRRC & enters in CARE. MRA agrees or disagrees and signs in CARE. DADS assigns LON. Provider submits UR for DADS approval.

17. DADS Frequently Asked Questions (FAQs) DADS published & updates FAQs to explain the transfer of HCS case management to the MRA: www.dads.state.tx.us/providers/HCS/faqs/casemanagementtransitionfaq.html FAQ topics include: • PDP, IPC & IP – relationships between planning tasks, participants, processes & timeframes • Monitoring responsibilities of MRA SC & HCS Provider • Coordination & communications between MRA SC & HCS Provider • Various topics including emergency response, CARE system, program handbook, funding changes, etc. For FAQ updates, sign up for “Email Updates” through GovDelivery at DADS website.

18. Home and Community-based Services (HCS) Case Management Transition Initiative Website • DADS has issued the following Provider Alerts or Bulletins: • Home and Community-based Services (HCS) Case Management Transition Initiative Website • The Home and Community-based Services (HCS) Case Management Transition Initiative website is now available at this link: http://www.dads.state.tx.us/hcscmtransition/

19. MRA Service Coordination for HCSTransition Summary Primary MRA goals prior to June 1, 2010 implementation: • Clear delineation and common understanding of fundamental functions of the MRA Service Coordinator & HCS Provider • Staffing, training & equipping MRA operations to provide qualified and consistent Service Coordination for HCS participants • Productive communications with the HCS Provider network to ensure effective long-term working relationships • Support for HCS participants & families to minimize service disruption and promote progress towards each person’s desired outcomes

20. Meeting Evaluation & Next Steps What worked this meeting? What should change in the next meeting? What do we know now that will need to be discussed at next meeting (Agenda Items)?