MRA Service Coordination for Home and Community-Based Services

1. MRA Service Coordination for Home and Community-Based Services Transition Information for HCS Providers Heart of Texas Region MHMR Center November 18, 2009

2. Introductions

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) • 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 waiting 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 > MCAC & DADS Council for approval to publish in TX 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 November 2009 • Begin HCS CM transition meetings between Providers and MRAs – completed November 18, 2009 • Develop local case numbers for HCS consumers identified in DADS report – completed December 28, 2009 • Obtain access to Electronic Data Transfer System (EDTS) – completed December 2009 • Develop MRA dedicated webpage to post information and updates on local transition planning – dedicated page up December 7, 2009 January 2010 • Educate local Advisory Boards, PNAC and Center Board of Trustees – PNAC presentation made November 2009 • Determine staff requirements – HCS service coordinators, supervisors & support • Create Provider/MRA contact lists • Select MRA HCS SC Supervisor – selection completed December 29, 2009

9. MRA Transition Timeline (con’t) January, continued • Create Job Descriptions for HCS-MRA Service Coordinators • Revise Policies & Procedures as needed • Develop HCS-MRA Service Coordination Training Plan, Curriculum, and Manual February 2010 • Encourage provider sponsored consumer/family relation meetings with the MRA March 2010 • Post positions, interview and prepare for hire MRA HCS SCs

10. MRA Transition Timeline, (con’t) April 2010 • Begin training HCS SCs, including training provided by DADS • With DADS and Providers, develop a process to manage May and June PDPs and IPCs • Create Provider/MRA contact lists • Assign SCs to HCS participant caseloads • Begin establishing MRA consumer records May 2010 • Consumer Relations—HCS-MRA SC to begin building relationships with providers and consumers

11. 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

12. 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.

13. 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.

14. 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.

15. 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).

16. 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.

17. 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.

18. 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.

19. 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.

20. 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

21. 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)?