Part 2: Demonstration Design
12. Using IT Systems to Identify Participants
Texas will use three existing primary automated systems for registering and tracking consumers and services. These systems are: the Claims Management System (CMS), used for all nursing facility and related community services programs; the Client Assignment and Registration System (CARE), used for tracking community and institutional services for persons with psychiatric, intellectual and/or developmental disabilities; and the Behavioral Health Integrated Provider System (BHIPS), used for tracking substance abuse services.
Each of these systems registers all individuals who request or receive services, records basic functional assessment information and eligibility for specific programs and services including amount of services, and identifies the amount paid to providers for services. All systems have specific reporting capabilities. Data from CARE and CMS is periodically loaded into a common database to increase statistical and reporting capabilities. For the purposes of this grant, DADS will: 1) add an identifier in both systems in order to be able to readily identify grant participants; 2) add a new funding type to ensure that provider claims for services delivered under the grant are reimbursed at the proper rate; and 3) add new programs within both systems and the Data Mart to generate the reports required by CMS and DADS program management. Edits will be added to ensure that individuals served under this Grant: 1) have been in an institutional setting for at least six months; and 2) do not allow services to be authorized in a residential setting that is not consistent with the definition in the solicitation. The behavioral health conditions pilot will use existing data elements from CARE and BHIPs to report on pilot activities.
The automated HMO payment system for those receiving services through MCOs will also be modified to identify grant recipients and ensure the appropriate level of reimbursement.
The Quality Assurance and Improvement Data Mart will compile data currently located in multiple automated systems. Information from the Data Mart and/or MDS will be used to identify and track demographic information of prospective MFP grant participants. MFP grant participants will be assigned a unique identifier so that their status and progress can be tracked and analyzed throughout this demonstration project. This will include information to be reported for services eligible for enhanced matching funds.
Texas will establish a data system to track individuals who transition using enhanced grant funds. Data, at a minimum, will be collected on individuals regarding the success of the transition, length of the transition, and any critical incident that ended the transition.
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April 24, 2009