HCS case management transition FAQs
Note: The purpose of this document is for the Texas Department of Aging and Disability Services (DADS) to provide interested parties with responses to questions regarding the planned transition of Home and Community-based Services (HCS) case management services from the HCS provider to local authorities (LAs). Responses to questions throughout this document have been developed based upon roles and responsibilities outlined in draft amendments to the HCS rule, located at 40 Texas Administrative Code (TAC), Chapter 9, Subchapter D, and the Service Coordination rule, located at Title 40, Chapter 2, Subchapter L. As these rule amendments are still in the DADS rule-making process, please note there is a possibility that some of this information may change in the event edits are made to the rule amendments.
Please note questions added to this document after the date of its initial creation are indicated following the new question with the date the question and response was added indicated in parenthesis.
Question 1: What is a Person-Directed Plan (PDP) and who participates in its development?
The PDP is a written plan that documents an exploration of the individual's goals, desires and needed supports to achieve desired outcomes identified by the individual or legally authorized representative (LAR) and to ensure the individual's health and safety. Outcomes included in the PDP are identified by the individual, LAR or others who know the individual best. Using the person-directed planning process, the PDP is developed by the Service Planning Team (SPT). At a minimum, the SPT includes the individual, the LAR if there is one, and the LA service coordinator (SC). The individual or LAR may wish to include other participants such as the HCS Program provider, an interested family member, a teacher or a friend. The development of the PDP is the first part of three required service planning tasks for individuals in the Home and Community-based Services (HCS) Program.
Question 2: What is an Individual Plan of Care (IPC) and who participates in its development?
The second service planning task for individuals in the HCS Program is development of the IPC. The IPC is a document that specifies the HCS services to be provided, the number of program service units needed to address the individual's needs and the cost of those HCS services. The IPC also lists the non-program services to be accessed by the individual. The HCS provider, the individual or LAR and the LA SC work together to develop the IPC based on the outcomes identified in the individual's PDP. The provider is responsible to complete the hard copy IPC document and to submit the IPC to DADS electronically via the Client Assignment and Registration system (CARE). The time frame for the LA SC to note their agreement or disagreement with the IPC in CARE is outlined in the draft rule.
Question 3: What is an Implementation Plan (IP) and who participates in its development?
Following authorization of the IPC by DADS, development of the IP is the last required service planning task in this process. The IP is developed by the program provider with input from the individual or LAR. The IP justifies service units on an individual's approved IPC and details the strategies the provider will use to deliver the HCS services on the IPC. The IP will include how any training associated with the delivery of a program service will be accomplished. For example, if a PDP outcome is for John S. to improve his money management skills and supported home living (SHL) units have been allocated for this on the IPC, the IP will detail the strategies, the amount, frequency and duration of service delivery in order to meet this outcome. The IP does not require agreement from the LA SC. However, the individual or LAR and the HCS Program provider will have to agree on how services will be delivered and this will be indicated by the individual or LAR signing the IP after it is completed.
Question 4: How does the person-directed planning process support the service planning process in the HCS Program?
The SC uses a person-directed planning process to gather information for the development of the PDP. The person-directed planning process:
- empowers the individual, or LAR on behalf of the individual to direct the development of the plan of services and supports that meet the individual's personal outcomes;
- identifies existing supports and services necessary to achieve the individual's desired outcomes;
- identifies natural supports available to the individual and negotiates needed service system supports;
- occurs with the support of a group of people chosen by the individual or LAR; and
- accommodates the individual's style of interaction and preferences.
The LA SC, using the PDP Discovery Tool as a basis for information gathering, conducts interviews with the individual, LAR, family members, friends, provider staff or others who know the individual well. The results of these information-gathering interviews are compiled into the PDP that:
- is prioritized by the individual or LAR in terms of what outcomes and needs are included on the PDP; and
- identifies which outcomes and needs will be met through waiver services and which will be met through non-waiver services.
The LA SC, individual or LAR, and the HCS provider develop the IPC based on the PDP. The provider is then responsible for developing the IP with the individual or LAR that identifies how HCS services will be implemented to accomplish the outcomes identified in the PDP.
The LA SC is expected to implement an ongoing person-directed planning process, not a single event planning process. In order to accomplish this, the LA SC will be responsible for monitoring and updating the PDP based on topic-focused interviews with the individual and people who know the person best. The LA SC can also use observations of the individual throughout the plan year as an information resource. The purpose of the person-directed planning process is to determine if the individual is accomplishing identified outcomes or if the identified outcomes need to be revised.
Question 5: Does the development of the PDP and IPC need to take place at two separate meetings or can they be done at the same meeting?
There is no requirement in the draft HCS rule amendment that these service planning tasks take place in separate meetings. Individuals or LARs, LAs and providers have the flexibility to organize service planning tasks in accordance with the preferences of the individual or LAR; the draft rule is purposefully written to allow this flexibility in how meetings are scheduled.
Question 6: How will the LA SC communicate their agreement or disagreement with the IPC and MR/RC?
DADS anticipates screens will be developed in the CARE system for the LA SC to indicate their agreement or disagreement regarding information entered on either document. The Program Handbook will provide a form on which the LA SC will communicate any disagreement with a submitted IPC for consideration by the DADS utilization review staff. The LA SC is responsible for communicating any disagreement with MR/RC or a proposed IPC to the program provider and attempting to resolve the disagreement. The LA SC does not have a role in authorizing a proposed IPC or approving an MR/RC for an individual; this will continue to be the responsibility of DADS.
Question 7: What avenues are available to program providers for adding services to the IPC in an emergency?
The HCS rule amendment includes provisions that address procedures for revising an individual's IPC in an emergency. As they do currently, program providers will have latitude to provide the necessary support to an individual in the event of an emergency that necessitates the provision of program services not currently on the IPC or that exceeds the amount currently on the IPC.
Question 8: Can the LA SC can authorize an increase in services on the IPC when it is submitted? How will DADS processes for reviewing changes in IPCs and requests for increases in LON work following this transition? (Added 12/7/09)
Following this transition, the LA SC will not have the ability to authorize an increase in services on the IPC; DADS' processes for review of IPCs and Level of Need (LON) increases will not change. Please note that DADS will continue to be responsible for authorizing an IPC and approving an LON increase. The LA SC is responsible for reviewing the IPC and MR/RC and agreeing or disagreeing with the information documented on these forms.
Question 9: Who is responsible for justifying the services on the IPC and where should the justifications be documented? How will DADS review HCS Program service component justification information following this transition? (Added 2/2/10)
Following this transition, justification for HCS Program service components included in an individual's IPC must continue to be documented. The LA SC develops the PDP, which documents justification for the HCS Program service components the individual requires to meet his or her desired outcomes. The HCS Program provider develops the IP, which documents justification for the amount of each HCS Program service component included on the IPC. As in the current model for developing an IPC, amounts of service components in an IPC are based on assessments and recommendations completed by the HCS Program provider. DADS Billing and Payment reviewers, Waiver Survey and Certification (WS&C) reviewers and Utilization Review staff will review justification for HCS Program services in accordance with this service planning methodology. All HCS Program provider service delivery documentation must continue to reflect the justification for HCS Program services outlined in an individual's PDP and IP.
Question 10.How will HCS Program transfers be handled after this transition?(Added 2/2/10)
Individuals and LARs have freedom of choice among all qualified HCS Program providers serving the area in which they live. Starting June 1, 2010, the LA SC will be responsible for managing all HCS Program transfers. If an individual or LAR wishes to transfer to a different HCS Program provider, the LA SC will offer choice of HCS Program providers and will assist the individual or LAR as needed with a transfer request. Specific procedures regarding transfer processes will be included in the HCS Program handbook.
Question 11.How does the LA SC assist the individual in choosing an HCS Program provider? (Added 2/2/10)
The LA SC may not influence the individual's or LAR's selection of provider. Individuals and LARs have freedom of choice among all qualified HCS program providers serving the area in which they live. As required in the LA performance contract, during the enrollment process the LA SC must explain to the individual or LAR that he or she may choose any contracted HCS Program provider in the local service area. The LA SC must also provide the individual or LAR with a current list from CARE (XPTR HC062096) of all qualified HCS Program providers in the LA's local service area. The LA SC arranges for meetings and visits with potential HCS Program providers as desired by the individual or LAR. Once the individual or LAR has chosen an HCS Program provider, the LA SC must obtain documentation of the selection of the HCS Program provider on the Documentation of Provider Choice form and submit a copy of the completed form to DADS, along with a copy of the completed Verification of Freedom of Choice form.
It is the responsibility of the LA SC to be objective in assisting an individual or LAR in selecting an HCS Program provider and not allow any of the LA's HCS Program provider staff to initiate contact with the individual or LAR prior to the completion of the Documentation of Provider Choice form.
Question 12.Who will be responsible for maintaining an individual's LOC/LON, including completing the MR/RC and ICAP?(Added 2/2/10)
The draft HCS rule assigns this function to the HCS Program provider and explains the process the HCS Program provider will take to renew an individual's LOC/LON. The HCS Program provider will complete, sign, and electronically transmit to DADS the MR/RC Assessment. The HCS Program provider ensures that the LA SC receives a copy of the signed MR/RC within three days after the HCS Program provider transmits to DADS (that is, enters the data in CARE). Within seven (7) calendar days after the HCS Program provider transmits to DADS, the LA SC is responsible for reviewing the MR/RC in CARE and entering in CARE their name, date of review, and whether or not they agree with the information entered as the MR/RC Assessment.
After the seven-day timeframe, the MR/RC is available for authorization by DADS regardless of whether the LA SC reviewed it in CARE or agrees or disagrees with the information entered. DADS approves the recommended LOC/LON assignment.
If the LA SC does not agree with the LON, the LA SC will notify DADS Utilization Review (UR) of their disagreement using a form provided by DADS. DADS UR will consider the LA SC's disagreement and will determine whether an LON review is necessary. If DADS conducts an LON review, DADS may consult with the LA SC and the HCS Program Provider.
Current processes will continue for completing the ICAP, which requires the HCS Program provider to complete a new ICAP every three years or when changes in the individual's functional skills or behavior occur that are not expected to be of short duration or cyclical in nature.
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Monitoring (HCS provider and LA SC)
Question 1. What is the LA SC's role in monitoring HCS Program providers? (Added 12/7/09)
The role of the LA SC is to monitor the results of the provision of an individual's program services; not to assess provider compliance with HCS principles. Following transition, evaluating provider compliance with HCS principles will continue to be a DADS' function. DADS Waiver Survey and Certification (WS&C) will continue to conduct residential and certification reviews of HCS providers and will adjust existing processes as necessary to accommodate the transition of case management processes to the LA SC. DADS LA Section Contract Accountability and Oversight (CAO) will continue to conduct performance contract reviews of LA and will expand this function to include assessing the performance of LA related to service coordination in HCS.
Question 2. If the HCS provider is not in the setting monthly to conduct a face-to-face case management visit, whose responsibility is it to ensure individuals' health and safety and to conduct quality assurance related to the provision of foster/companion care? (Added 12/7/09)
As the HCS provider typically contracts with foster/companion care providers, it is the provider's responsibility to ensure that foster/companion care services are provided by the provider's contractors or employees in compliance with the HCS Certification Principles. HCS providers will continue to be responsible to conduct both initial and at least annual inspections of all settings in which an individual receives an HCS residential assistance service to ensure that the individual's needs are being met, the environment is healthy, comfortable, safe, appropriate and typical of other residences in the community, is suited for the individual's abilities, and is in compliance with applicable federal, state, and local regulations for the community in which the individual lives. The LA SC will monitor an individual's progress toward outcomes identified in the PDP, as described in question three of this section.
Question 3. Please explain the responsibilities for monitoring in the HCS Program for the LA SC and the HCS provider. (Added 12/7/09)
The LA SC will be responsible to monitor an individual's progress toward the outcomes identified in the individual's PDP. The LA SC will monitor an individual's services to determine whether or not HCS Program services are provided and will also monitor the delivery of an individual's non-HCS Program services. The frequency in which an LA SC will monitor an individual's progress toward outcomes will vary, based on the need of the individual. The LA SC is not responsible to monitor the implementation plan developed by HCS providers and the individual or LAR.
HCS providers will retain the responsibility to monitor the delivery of services on the IPC in accordance with the HCS Program Certification Principles. Providers will be responsible to monitor an individual's progress or lack of progress related to the provision of program services in accordance with an individual's implementation plan and to communicate needed changes to the LA SC, the HCS provider's service providers, or other relevant individuals or entities as identified during the delivery of program services.
Question 4: How will LAs who are also HCS Program providers be monitored and how will the division of responsibilities be applied in these situations?(Added 2/2/10)
LAs are required to have separate management structures for HCS Program provider functions and authority functions. The LA SC is employed within the management structure for the authority function and is prohibited from performing any tasks related to the LA's HCS Program provider function. LAs that operate an HCS Program will continue to be monitored by DADS WS&C for compliance with the HCS Program Certification principles for HCS Program providers. DADS CAO will continue to monitor LAs for compliance with their authority functions and will include oversight of the service coordination responsibilities as described in the HCS rule, the Service Coordination rule and the LA Performance Contract in their process.
Question 5: Following the transition, will the LA SC or the HCS Program provider be responsible for routinely reviewing the individual's plans such as quarterly reviews? (Added 2/2/10)
The HCS rule does not require quarterly reviews. After the transition, the LA SC will monitor the delivery of HCS program and non-HCS program services to an individual and document progress toward the desired outcomes identified on the individual's PDP. It will be the HCS Program provider's responsibility to monitor for progress or lack of progress toward objectives on the IP. There is no timeframe identified in the certification principles for the HCS Program provider to complete this documentation. It is the HCS Program provider's responsibility to determine how frequently the objectives will be monitored in order to ensure that the IP continues to be effective and meets the needs of the individual.
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Coordination between an HCS provider and LA SC
Question 1. How does DADS plan to accommodate circumstances beyond a provider's control when performing certification reviews? For example, will providers be cited for missing paperwork if the reason for the missing paperwork is that the LA SC did not provide it in a timely fashion?
When performing a certification review, DADS WS&C will look for and consider evidence of attempts by the provider to obtain necessary paperwork from the LA SC. DADS LA Section CAO will expand their performance contract reviews to include assessing the performance of LA related to service coordination in HCS, providing another level of accountability. In the event an LA SC does not adhere to required timelines outlined in the program rules, this will not affect the provider's ability to submit IPCs or MR/RCs to DADS for review. The proposed HCS rule draft includes timelines for both the program provider and the LA SC to follow in coordinating development of the IPC and to obtain LOC and Levels of Need (LON). This is intended to provide clear guidelines for each party to follow when providing the other with necessary information. LA SCs and program providers will have the program handbook available as a resource tool to guide both entities with coordination efforts and will have avenues by which to report problems or concerns with either entity.
Question 2. How will DADS assist the LA SCs and program providers in maintaining productive working relationships and help to resolve complaints should they arise?
Both the draft HCS and the LA SC rule amendments include requirements regarding communication between parties. However, operational procedures related to communication, caseloads, use of resources, and scheduling of meetings will not be prescribed by DADS. DADS encourages program providers and LAs to resolve issues that arise amongst themselves. The draft HCS rule revision includes the requirement that the LA have a process for resolving the complaints from HCS providers. If either party reaches a point where they believe the issue must be
elevated to DADS, complaints about either party may be directed to Consumer Rights and Services at DADS. In addition, DADS is expanding existing communication processes between the oversight section of the LA and HCS provider.
Question 3. How will documentation be shared between the HCS provider and LA SC regarding the provision and monitoring of an individuals' program services? Will the LA SC share PDP progress reviews with the HCS provider?(Added 12/7/09)
The LA SC may request a copy of a document from an individual's HCS provider record. Typically, it will be unnecessary for an LA SC to maintain copies of documents from an individual's provider record other than those the HCS draft rule prescribes. The LA SC will be able to obtain information about progress from the individual or LAR and may review the provider record if necessary. The LA SC should communicate concerns about the provision of an individual's HCS Program services to the provider and work with the provider as necessary toward resolution of an identified concern. The LA SC has no prescribed PDP monitoring documents that must be shared with the HCS provider.
Question 4. The rules require specific time frames for the program provider to notify the LA SC of certain occurrences. For example, the program provider must:
- notify the LA SC of a suspension within one business day after services are suspended;
- notify the LA SC as soon as possible but no later than 24 hours after the program provider reports or is notified of an allegation of abuse, neglect , or exploitation involving an individual; and
- if an emergency situation occurs, attempt to notify the LA SC as soon as the emergency situation allows.
Will the LA SC be "on call" to receive this notification? What type of response or support is the LA SC going to provide in such instances? What forms of notification are acceptable? Can we use e-mail?(Added 12/7/09)
The draft rule does not require the LA SC to be "on call." Notification to the LA SC is for the purpose of conveying information and may or may not necessitate an immediate response. The program provider and the LA SC are responsible for establishing the mode of communication for required notifications (for example, phone call, fax, text or e-mail).
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Consumer Directed Services (CDS)
Question 1. How will the new service planning process work for those individuals who have IPCs that include only services being self-directed?(Added 03/17/10)
When the IPC for an individual includes only services the individual or LAR has chosen to self-direct using the CDS option, the LA SC will complete the MR/RC Assessment and will develop the IPC with the individual or LAR. The LA will enter the MR/RC Assessment and the IPC into CARE. In these cases the individual is not required to choose an HCS provider unless at some point the individual's IPC is revised to include a provider-managed service. At that time, service planning processes will take place using the same process in place for individuals with provider-managed services. For individuals who have provider-managed services and CDS services on the IPC, the HCS provider will participate in the development of the IPC, will complete the MR/RC Assessment, and will enter this information into CARE on behalf of the individual.
Question 2. If an individual chooses to self-direct supported home living (SHL) and chooses to receive respite from the HCS provider, will the HCS provider have access to administrative reimbursement beyond that included in the respite reimbursement rate to cover the cost of having to provide emergency back-up services to an individual when their CDS SHL provider is not able to work? (Added 03/17/10)
HCS providers are limited to reimbursement for valid claims submitted for program services provided. There is no separate administrative reimbursement for HCS provider responsibilities in a situation such as described above.
For individuals who choose to self-direct SHL and for whom this service has been deemed a critical service by the service planning team, the CDS employer is required to develop a service back-up plan to describe how the individual's needs will be met in the absence of the regularly scheduled service provider. In cases where the individual has provider-managed respite on the plan, this service most likely will be part of the service back-up plan for the individual. The development of the service back-up plan for a critical service should be a process negotiated and agreed to by all parties included in the plan.
If a program service, including respite, is included on an individual's IPC, the HCS provider is responsible to provide emergency respite services to that individual, the same as for any other individual receiving program services. If there is no respite included in the individual's IPC and the individual experiences circumstances that indicate a need for additional supports, both the provider and LA SC are expected to communicate this identified need to one another to determine how to most appropriately respond to this unmet need.
Anyone, at any time, may request a corrective action plan from a CDS employer who appears to be experiencing difficulty managing HCS Program services they have elected to self-direct.
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Question 1. Who is responsible for responding to an emergency? (Added 12/7/09)
The HCS provider is responsible for responding to emergency situations that occur when an individual is receiving HCS program services. Depending on the nature of the emergency, the program provider representative may need to arrange for additional staff support, facilitate the individual's transport to an emergency room, etc. In addition, any suspicion of abuse, neglect or exploitation must be reported to the Department of Family and Protective Services (DFPS) by the person who suspects an individual has experienced abuse, neglect or exploitation. In some instances, this person could be the individual's LA SC or program provider staff. This topic will also be discussed during training prior to implementation of service coordination in HCS.
Question 2. Will LA SC staff be able to see information entered into CARE by providers? (Added 12/7/09)
Changes are being made to CARE to allow LA staff access to inquiry screens that will allow LA SCs to view IPCs, MR/RCs and other necessary information related to an individual's program services. Planned changes to the system include the addition of functionality to allow the LA SC to indicate agreement or disagreement with IPCs and MR/RCs.
Question 3. What topics will be covered in the program handbook currently in development? (Added 12/7/09)
This handbook will be available prior to the transition of case management to the LAs. The handbook will include an overview of service planning, information regarding person-directed planning, and operational details surrounding required processes, some of which are listed below. This list is not all-inclusive but is merely intended to highlight processes that are currently planned for inclusion.
- MR/RC and PDP elements;
- Implementation plans;
- Monitoring service delivery;
- Suspensions and terminations;
- Adaptive Aid and Minor Home Modification processes and procedures;
- Required notifications; and
- Reports and information in CARE for providers and LAs.
Question 4. Currently individuals and LARs have a choice of HCS providers and if they don't like their case manager they can transfer to another provider. Is that same process available for LA service coordination?(Added 12/7/09)
Each LA is designated to serve a specific county or counties within the state. Therefore, transferring to another LA is only an option if the individual moves to another LA's service area. However, an individual or LAR will be able to request to change their LA SC. An LA is required to inform the individual or LAR orally and in writing of the processes for filing complaints with the LA about the provision of service coordination. The LA is also required to have a process for addressing an individual's or LAR's concerns or dissatisfaction through a review process. The review process is described in rules governing notification and appeal process (40 TAC, Chapter 2, Subchapter A).
Question 5. Is there a maximum caseload for an LA SC? (Added 12/7/09)
The rule does not prescribe a maximum caseload for an LA SC because the Medicaid rate governs payment for service coordination provided to eligible Medicaid recipients (i.e., Targeted Case Management). The rate is currently based on a caseload ratio of 1:45.
Question 6. How will funding change in the HCS Program when case management is no longer provided by the HCS provider?(Added 12/7/09)
The 2010-11 General Appropriations Act (Article II, Special Provisions relating to all Health and Human Services Agencies, Section 48, Contingency Appropriation for the Reshaping of the System for Providing Services to Individuals with Developmental Disabilities, 81st Legislature, Regular Session, 2009) appropriated $55.7 million to fund rate increases for the residential support, supervised living, foster/companion care and supported home living services in the HCS program. To implement these increased appropriations, HCS rates for these services were increased effective October 1, 2009. These increases were allocated across the direct and indirect portions of each service rate as appropriate and are intended to be used by providers to cover their various costs including the costs of program coordination.
Effective June 1, 2010, when the case management function is moved from the HCS program to the LA, 80 percent of HCS case management funds will be moved to pay for the LA service coordination.Twenty percent of HCS case management funds will be allocated to reimbursement rates for the following HCS services: residential support, supervised living, foster/companion care, supported home living, respite, day habilitation, supported employment and social work. For this reason, rates for these services will increase effective upon the transfer of case management to the LA. Since there will not be a case management service in the HCS program any more, the funds left with the program for program coordination activities must be attached to existing services in the HCS Program service array in order for HCS providers to access them. HCS rates to be effective upon the transfer of the case management function to the LAs can be accessed at the following website: http://www.hhsc.state.tx.us/medicaid/programs/rad/Mhmr/Hcs.html Once you access this website, scroll down to the heading "Payment Rate Information" and click on the link entitled "2010 - Effective June 1, 2010."
Question 7. How will HCS providers cover the costs associated with the provision of program coordination responsibilities following this transition?(Added 12/7/09)
The indirect portion of each HCS Program service rate is for the purpose of paying for administrative and overhead activities, including program coordination responsibilities that will be retained by the HCS provider following this transition. HCS providers have flexibility with regard to how they allocate reimbursement they receive through the indirect portion of their payment rates to cover the cost of doing business.
Question 8: Following this transition will the HCS Program provider continue to be required to manage the individual's personal funds upon the written request of the individual or LAR? Can the HCS Program provider charge the individual or LAR a fee for handling the individual's funds? (Added 2/2/10)
The HCS certification principles will still require the HCS Program provider to handle the finances of an individual upon the written request of the individual or the LAR. The HCS Program provider may not charge for this service.
Question 9. Is Targeted Case Management funded by contact or by month? (Added 2/2/10)
Targeted Case Management funds service coordination for an individual enrolled in the HCS Program and uses a monthly case rate for reimbursement. For the LA to be eligible for reimbursement the LA SC must conduct a face-to-face contact with the individual during which time a covered service coordination activity occurs. In addition to the face-to-face contact, other service coordination activities that occur in that month are covered by the case rate. An individual who is eligible for service coordination must be seen by the LA SC at least once every ninety days. The frequency of service coordination contact is determined by information gathered through the Person-Directed Planning Process.
Question 10.What process is in place to ensure an HCS Program provider may enter billing for services if the LA SC is late reviewing the IPC in CARE for agreement or disagreement? (Added 2/2/10)
The process allows for an HCS Program provider to bill for services even if the LA SC is late reviewing the IPC in CARE. If the LA SC is present when the document is completed and signed by the HCS Program provider and individual or LAR, the LA SC should also sign the IPC although the LA SC's signature is not required before the HCS Program provider enters the IPC in CARE. The HCS Program provider ensures that the LA SC receives a copy of the signed IPC within three days after data entry. Within seven (7) calendar days after the HCS Program provider enters the data in CARE, the LA SC is responsible for reviewing the IPC in CARE and entering their name, date of review and whether or not they agree with the information entered. After the seven-day timeframe, the IPC is available for authorization by DADS regardless of whether the LA SC reviewed it in CARE or agrees or disagrees with the information entered.
Question 11. Current IPCs may include up to 12 units of case management. As this service will no longer be included in the HCS Program service array providers will not be able to submit claims for the provision of this service beginning June 1, 2010. What will happen with any excess units on the plan? Should providers do something to handle these extra units? (Added 3/17/10)
Providers will not be able to enter claims for the provision of case management with a service date after May 31, 2010. Providers have the option to remove any remaining units of this service from IPCs, but this is not required. The CARE system will not remove case management units left on IPCs that are unused as of June 1, 2010.
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For individuals, legally authorized representatives (LARs) and actively involved family members
Note: Effective Feb. 2, 2010, this is a new section of the FAQ to respond to questions from individuals and families. As with the rest of this document, this section will be updated as necessary through the time of this transition.
Beginning June 1, 2010, individuals who receive services in the HCS Program will no longer receive case management services from their HCS Program provider. Instead, the Mental Retardation Authority (LA) will assign an LA service coordinator (LA SC) to assist individuals, their legally authorized representatives (LAR), and family members with service planning. The LA will assist an individual, LAR, and family member in working with the HCS Program provider to meet the individual's service needs. Other HCS Program services will not be affected by this change. Individuals will continue to receive services from his or her HCS Program provider of choice. This change was directed by the Texas Legislature during its 2009 legislative session. DADS is working with HCS Program providers, LAs, and other key stakeholders to develop procedures for ensuring a smooth transition. Individuals should not experience any disruption to their HCS Program services during this transition.
Question 1. Can an individual or LAR choose their LA? How will the LA assign LA SCs to individuals? Can an individual change their LA SC if they want to?
LAs are designated to serve a specific county or counties within the state. If you would like to know the LA that services your local area you can enter the name of your county or city on the following DADS website to find out: http://www.dads.state.tx.us/services/index.cfm. Transferring to another LA is only an option if an individual moves to another LA's service area.
After June 1, 2010, the HCS provider will no longer have case management staff and LA staff called service coordinators (LA SC) will be assigned to each HCS participant.
If the individual or LAR wants a different LA SC, they may request that the LA assign a different LA SC. An LA will be required to inform an individual or LAR orally and in writing of the process for filing a complaint with the LA about the provision of service coordination. An LA may or may not be able to assign a different LA SC depending on the LA's staffing levels and caseload assignments."
Question 2. How will an individual, LAR, or actively involved family member access the LA SC to request assistance? If the LA SC assigned to an individual is away from work for an extended period how will the individual receive needed service coordination?
The LA is responsible for assigning an LA SC to every individual enrolled in the HCS Program in the LA's local service area. At the time of assignment and when changes occur, the LA SC is responsible for notifying the individual, LAR, and HCS Program provider of how to contact the LA SC. In the event an LA SC is away from work for an extended period, the LA is responsible for having a back-up system in place to ensure individuals continue to receive necessary service coordination. Information about this back-up system must be provided to the individual or LAR so that an LA SC can be contacted as necessary.
Question 3. What are the minimum education and experience requirements for an LA SC? For an LA SC Supervisor?
The rules governing Service Coordination for Individuals with Mental Retardation (40 TAC, Chapter 2, Subchapter L, §2.559) describe the minimum education and experience for an LA SC. Please note that service coordination may only be provided by an employee of an LA. Currently, the rule states a staff person providing service coordination must have:
- a bachelor's or advanced degree from an accredited college or university with a major in a social, behavioral, or human service field including, but not limited to, psychology, social work, medicine, nursing, rehabilitation, counseling, sociology, human development, gerontology, educational psychology, education, and criminal justice; or
- a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma and:
- two years of paid experience as a case manager in a state or federally funded Parent Case Management Program or have graduated from Partners in Policy Making; and
- personal experience as an immediate family member of an individual with mental retardation.
The rule also allows, at the discretion of the LA, a staff person who was authorized by an LA to provide service coordination prior to April 1, 1999, to provide service coordination without meeting the education and experience qualifications described above.
DADS has proposed revisions to the rule that would allow an LA, between June 1, 2010, and December 31, 2011, to hire a person to provide service coordination who was employed as a case manager for an HCS Program provider for any period of time prior to June 1, 2010, even if the person did not meet the education and experience qualifications described above. Additionally, beginning January 1, 2012, an LA would be allowed to hire a person to provide service coordination who had been hired by another LA as permitted by the previous sentence.
DADS does not prescribe the minimum education and experience for an LA staff who supervises or oversees the provision of service coordination. However, the rules governing Service Coordination for Individuals with Mental Retardation (40 TAC, Chapter 2, Subchapter L, §2.560) describe the training requirements for staff who supervise or oversee the provision of service coordination.
Question 4. What size caseload will each LA SC be required to carry? How many LA SCs can an LA have in a single unit?
Service coordination rules do not include a required caseload size for an LA SC. The reimbursement rate to the LA for service coordination is currently based on a caseload ratio of one LA SC to forty-five individuals. Each LA is responsible for determining how to organize and manage their resources to provide all needed service coordination activities to individuals in the HCS Program. DADS does not prescribe limits to the number of LA SCs LAs manage.
Question 5. Will there be a complaint process with appeals if an individual or LAR is dissatisfied with the service coordination they receive from the LA or HCS Program service provision by the HCS Program provider?
LAs are required to address all concerns or dissatisfaction related to the LA's services reported to them by an individual or LAR through a review process. At the time an individual is enrolled into an LA service (in this case, service coordination) and then annually thereafter the LA is required to provide written notification to the individual or LAR of the LA's policy in a manner the individual or LAR can understand.
HCS Program providers are required to have a process for accepting complaints reported to them by an individual or LAR and for making that process public. They must also maintain a record of how all complaints are addressed.
In addition, at any time an individual or LAR has the option of contacting DADS Consumer
Rights and Services (CRS) to file a complaint and to request assistance in resolving concerns
related to the provision of service coordination or the provision of HCS Program services.
DADS CRS can be contacted toll-free at 1-800-458-9858.
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May 3, 2013