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HCS Enrollment

HCS Enrollment . The Gulf Coast Center. Home and Community Based Services - HCS. Home and Community Based Services (HCS) is a Medicaid waiver program. Its purpose is to . . . Support individuals in their chosen living environment Meet the individual’s specific needs

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HCS Enrollment

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  1. HCS Enrollment The Gulf Coast Center

  2. Home and Community Based Services - HCS Home and Community Based Services (HCS) is a Medicaid waiver program. Its purpose is to . . . • Support individuals in their chosen living environment • Meet the individual’s specific needs • Maximize natural community supports • Provide services that assist the individual with living in the community

  3. Daily Living Services and Supports Adaptive Aids Devices, controls or appliances which enable a person to retain or increase their abilities to perform daily living activities or control their environment($10,000 per service plan year)

  4. Daily Living Services and Supports Case Management toassist with . . . • Eligibility • Coordinating and developing the service plan • Monitoring the quality and deliver of services • Advocating for the individual • Identifying resources • Making community referrals • Providing crisis intervention • Safe guarding individual’s rights

  5. Daily Living Services and Supports Counseling and Therapies Audiology • Assessment • Intervention • Training • Consultation with individual, family & provider Dietary • Assessment • Consultation • Staff training related to basic or special nutritional needs

  6. Daily Living Services and Supports Counseling and Therapies, continued Occupational Therapy – Assists with achievement of independent functioning skills plus . . . • Assessment • Development of treatment plans • Training • Consultation • Assistance with adaptive aids

  7. Daily Living Services and Supports Counseling and Therapies, continued Physical Therapy – assist with . . . • Increasing range of motion • Improving physical functioning • Retaining physical conditioning Speech Therapy – assist with . . . • Assessing • Developing treatment plans • Training • Consulting • Providing adaptive aids

  8. Daily Living Services and Supports Day HabilitationDay program designed to assist in learning, retaining and improving self-help, socialization and adaptive skills necessary to successfully and safely reside in the community Dental $1,000 per plan year for . . . • Emergency, preventive, and therapeutic dental treatment • Regular exams

  9. Daily Living Services and Supports Nursing Licensed nurse to . . . • Monitor health conditions • Monitor medication administration • Refer for medical services • Training of families and staff Prescription Drugs • Unlimited prescriptions for individuals with Medicaid only • Individuals eligible for both Medicaid and Medicare must obtain prescription medications through Medicare Part D Plan

  10. Daily Living Services and Supports Respite • In-home or out-of-home temporary relief • Limited to 30 days per plan year SupportedEmployment Assistance to sustain paid employment for those who require intensive on-going supports to perform in a work setting

  11. Daily Living Services and Supports Minor Home Modifications Modifications to living quarters which ensure safety, security, and accessibility in order to live in the community(Lifetime maximum = $10,000) • Determining what is needed • Arranging for someone to do the work • Paying for the work Social Work • Assessing needs • Directing the meeting of the needs • Training/consultation with individual, family or provider

  12. Residential Services and Supports Supported Home Living For those who chose to live in theirown or family home Includes support in learning, retaining, or improving skills related to activities of daily living Supervised Living For those who chose to live in a group home setting; assistance available during normal sleeping hours if needed Includes habilitation, supervision and availability of staff

  13. Residential Services and Supports Residential Support For those who chose to live in a group home settingand need assistance during normal sleeping hours Awake staff provides . . . • Supervision • Supports for needs such as • Special medical conditions • Maladaptive behaviors • Assistance with daily living activities

  14. Residential Services and Supports Foster/Companion Care Services For those who chose to live inahome-like setting(family’s or other’s) Provides . . . • Habilitation • Supervision • Supports

  15. HCS Eligibility Requirements • Mental retardation or a related condition • Deficits in adaptive behavior and a Full Scale IQ of 75 or below • Eligible for Medicaid • No age limit for enrollment • Have a service plan costing no more than • $86,313.38 for Level of Need (LON) 1, 5, or 8, • $98,773.56 for LON 6 • $173,876.88 for LON 9

  16. Medicaid Eligibility Supplemental Security Income(SSI) • Contact your local Social Security Administration office Medicaid Assistance Only (MAO) • Complete Form 1200 which is available at http://www.dhs.state.tx.us/Forms/Form1200.html • Contact TexasDepartment of Health and Human Services Medicaid office 713-696-7155 Your Service Coordinator needs to assist in this process

  17. Documentation Required for Enrollment • Determination of eligibility • Medicaid approval • ICAP (Inventory for Client & Agency Planning) Used to determine a Level of Need (LON)

  18. Documentation Required for Enrollment Completed During Enrollment • Verification of freedom of choice • Medicaid estate recovery program • MR/RC assessment form • Documentation of provider choice • Person directed plan (PDP) • Individual HCS plan of care (IPC

  19. HCS Providers (Companies) Texas Department of Aging and Disability Services (DADS) authorizes 148 companies to provide HCS in Brazoria & Galveston Counties. Each company is required to offer* the full array of services and supports. * May contract services from others

  20. HCS Providers (Companies) Who Are They? How Can They Be Contacted? • You will be given a current list of providers • This list includes names, phone and fax numbers, addresses and number of people served by county • The Gulf Coast Center also has available provider brochures

  21. HCS Providers (Companies) Selecting an HCS Provider • Decide what is important to you and develop a list of questions to ask. Gulf Coast Center will provide a list of typical questions. • Review provider brochures and other materials

  22. HCS Providers (Companies) Selecting an HCS Provider • Attend Provider Fairs. • Ask Providers for References. • Visit Provider Facilities, Day Habilitation Sites and Homes • Talk With Individuals and Families Who Are Already Participating in HCS

  23. Important Resources • The Arc of the Gulf Coast, 281-388-1161 • Gulf Coast Center, 888-839-3229Leigh Saunders Donna Dean • Medicaid Eligibility 713-696-7155 • Provider List

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