MRA Service Coordination for Home and Community-Based Services

1. MRA Service Coordination for Home and Community-Based Services Transition Information for HCS Providers Meeting 2 Heart of Texas Region MHMR Center January 21, 2010

2. Introductions

3. Agenda • Review Packet Information • Recap of November Meeting 1. Meeting Outcome 2. Review of Power Point • Revisiting Timelines & Activities 1. DADS *Timeline *Training *Review of draft documents 2. HOTR-MRA • Review of Draft Provider Activities for April and May • Consumer/Family Communication • Transition Summary • Meeting Evaluation & Next Steps

4. Outcome of November Meeting The initiation of a collaborative local process for transition of HCS CM to MRA SC

5. Initial MeetingPower Point Topics • DADS Transition Timeline • DADS Transition Activities • DADS Spring Training Locations (NEW) • MRA Transition Timeline • Clarifying MRA, Provider and DADS Roles (from draft rule) • Differences between MRLA and MRA SC • FAQs

6. Updated DADS Transition Timeline January 2010 • Proposed HCS and SC rules > MCAC & DADS Council for approval to publish in TX Registry. – was approved by MCAC and sent to DADS Council (January 20?) 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.

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. DADS Transition Activities DADS preparation priorities prior to transfer of HCS case management: • Develop Program Handbook, forms & templates – includes PDP & Implementation Plan (IP); draft PDP and IP documents were distributed for comment at the P/P Coalition meeting in December; a number of documents, including MRA-SC Responsibilities section of the handbook, an HCS Contact information form for consumers, and a Notification of SC Disagreement form were distributed for comment at the January P/P meeting. • Make changes to CARE information system • Communicate changes to individuals receiving HCS services & their families – done through letter with consumer distribution date no later than December 7, 2009 • Develop training for MRAs and HCS Providers -- scheduled • Support flexibility of HCS Provider transitional case management requirements – letter dated December 28 authorizing contracted Case Management

9. Short Review of Draft Documents • Person Directed Planning Template • Implementation Plan Template • MRA Service Coordination responsibilities draft

10. PDP Template: MRA Comments • The document requires a section that gives you a broad overview of the person, including likes and dislikes, strengths and successes. • The action plan section should also include DISCOVERY, with a summary of the process, what was learned through discovery, identification of appropriate outcomes, and barriers to outcomes. • Additional section for justification of Service Coordination. • Additional section for justification of contraindications (no day hab because of retirement/home schooling because of medical issues, etc.) and deliberations (agreements/disagreements).

11. IP Template: MRA Comments Despite a desire to have a template that would promote a consistent format, the draft document is wide open. Our opinion is that it would benefit providers and the MRA equally to have a format that is not as wide open, remains individualized, and meets the needs outlined in the instructions to the draft template. • HOTRMHMR Action Plan template – review and comment.

12. There is a tremendous amount of work still to be done in all areas of this transition.

13. MRA SC Responsibilities:Making sense of what is in the rule. EXAMPLES: 2. II. B. Recommends that the SC be familiar with billing guidelines to facilitate “justifying supports and services” Comment: This is a key area of confusion for delineating SC and Provider functions. The draft rule infers that the SC justify the type of service to be provided based on a desired outcome; the provider then justifies the amount of the service provided. Clarification is needed.

14. MRA SC Responsibilities:Making sense of what is in the rule. (continued) EXAMPLES: 3. IV. A. bullet 4 States that the SC must monitor to determine whether an individual’s health and safety is ensured in the environments in which the individual frequents. Comment: The SC should not be accountable for monitoring an individual in environments that are not related to HCS of non-HCS services and supports.

15. MRA SC Responsibilities:Making sense of what is in the rule. (continued) EXAMPLES: 5. IV. D. 4 States that the SC is not responsible for providing the provider with a written review of their monitoring activities and documentation. Comment: This implies that the MRA and the Provider are monitoring the same services separately, without input from each other. This is costly and inefficient duplication.

16. MRA SC Responsibilities:Making sense of what is in the rule. (continued) EXAMPLES: 11. IX. B. C. States that the SC must ensure the HCS provider enters the suspension data in CARE screen C18. Comment: This requirement, as worded here and in the draft rule, appears contradictory to the SC role to monitor the individual, not the provider.

17. MRA TRANSITION ACTIVITY

18. 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 at www.hotrmhmr.org 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

19. 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

20. MRA Transition Timeline, (con’t) April 2010 • Begin training HCS SCs, including training provided by DAD • Develop local training(s) for provider and MRA staff • With DADS and Providers, develop a process to manage May and June PDPs and IPCs • 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

21. With DADS and Providers, develop a process to manage May and June PDPs and IPCs(April, 2010) • No later than April 30, 2010, HCS Providers must complete annual MRRC Assessments, renewal IPCs and ISPs for all individuals who have MRRC and IPC expirations between June 1, 2010 and June 30, 2010. • No later than May 31,2010, HCS Providers must complete annual MRRC Assessments, renewal IPCs and ISPs for all individuals who have MRRC and IPC expirations between July 1, 2010 and July 31, 2010. • For ISPs beginning August 1, 2010 or later, HCS Providers and MRAs must conduct service plan renewal activities in accordance with the new process. (Beginning June 1, 2010 HCS providers must notify the MRA of individuals who have IPCs expiring in August and September to get the process started.) • All individuals receiving HCS services will be transitioned into the new service planning documentation process by August 31, 2011.

22. Encourage provider sponsored consumer/family relation meetings with the MRA(to begin February, 2010) • Provider facilitation of consumer meetings to jointly discuss transition issues with the MRA. • Development of a “talking points” document to communicate a consistent message across the state 1. January 28, 2010 stakeholder focus group (tentative schedule). 2. Brochure similar to the “Making Good Choices” brochure that explains available community services. • Where does clarity need to be provided? (Take notes)

23. Things to think about and remember: • 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 For FAQ updates, sign up for “Email Updates” through GovDeliveryat DADS website. • Dads has developed a webpage specific to the HCS transition issue that can be accessed at: http://www.dads.state.tx.us/hcscmtransition • Consumer lists: pulled directly from information in CARE; we used this list to create local case numbers; verify that these are ALL of your consumers; might be a good time to update info in CARE

24. 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

25. 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)?