Part 2: Demonstration Design
6. Targeting and Recruitment of Participants
Nursing Facility Residents
As described in more detail in the Pre-Implementation Phase section above, Texas currently contracts with the relocation specialists using general revenue dollars. Under the grant, the relocation specialists’ pre-transitional activities will be funded at the administrative match rate. Relocation specialists will assist in the identification of eligible individuals and prepare them for community transition. Relocation specialists will work in conjunction with the area agency on aging, long-term care ombudsmen and nursing facility social workers. The Family-Based Alternatives contractor will work with permanency planners and relocation specialists to assist in the identification and transition of children from nursing facilities to their homes or to support families.
In addition, information from the Preadmission Screening and Resident Review (PASRR) process and DSHS data system will be used to assist in the identification of persons with behavioral health needs. Individuals who have been admitted from a managed care system will be monitored by the managed care organization (MCO) for four months after nursing facility admission and will be assisted to relocate back into the community. After a four-month period, the nursing facility resident is disenrolled from the MCO and becomes a regular nursing facility resident who will then be primarily assisted by the relocation specialist.
Transition from an institutional setting will be voluntary and with informed consent. Individuals in nursing facilities will be informed of all options and rights. They will also be offered the opportunity for self-direction through the CDS option for both Medicaid State Plan and waiver services as described in the gap analysis. Individuals who want to transition to the community will be referred to DADS’ regional case managers to coordinate all necessary assessments and begin the data changes to reflect community services. Individuals who live in a managed care service area will be referred to a third party enrollment broker in order for them to choose an MCO to be their service provider. Upon selection of an MCO, DADS and the relocation specialist will work with that MCO to ensure that all necessary paperwork has been coordinated.
During the Pre-implementation Phase, Texas will develop criteria to target nursing facility residents with complex supportive needs and those with behavioral health conditions. These criteria will be the basis for a “transition” assessment. Identification of and outreach to adult nursing facility residents with co-occurring behavioral health conditions will also be accomplished through collaboration with the DSHS system and DADS contracted relocation specialists.
Residents of ICFs/MR
Texas’ current efforts to support individuals who choose to move from State Mental Retardation Facilities and 14-plus bed ICFs/MR will continue under the Promoting Independence Priority Populations Initiative. Under this initiative, individuals living in ICFs/MR are informed of the different types of alternative living arrangements through the Community Living Options (CLO) process. The CLO process guides the individual through a discussion about their preferences and choices for daily living for receiving their services. The CLO process will be a basis for helping the individual to determine if the individual or Legally Authorized Representative (LAR) is interested in seeking an alternative living arrangement. If the individual or LAR chooses a home and community-based living arrangement, staff from the MRA will work directly with the individual or LAR to determine their eligibility for waiver services; will conduct a level of care assessment (as outlined in the approved waiver); and will assist with enrollment into a community-based waiver program. Staff from the MRA provide permanency planning for children in ICFs/MR, and will often work with the family-based alternatives contractor to assist in the transition of children to their homes or to support families. Individuals residing in State Mental Retardation Facilities and ICFs/MR will be informed of all options and rights. They will also be offered the opportunity for self-direction through the CDS option.
Under the proposed program, community ICF/MR providers may select to voluntarily close. DADS will work with facilities that have expressed an interest in closing to ensure that approximately 133 individuals are transitioned to the community each year. Using the CLO process, the facility Qualified Mental Retardation Professional will assist each individual in development of a transition plan for their preferred living arrangement, as currently done under the Promoting Independence Plan.
Texas law requires all children in institutions to receive ongoing permanency planning coordinated by individuals unaffiliated with the facility where the child resides. The state's Family-Based Alternatives Project works with permanency planners in MRAs to assist children to return home to their birth families. If this is not possible, the project recruits alternate families, called "Support Families", who are carefully matched with children and their birth families to care for children on a long-term basis. The Family-Based Alternatives Project will continue to assist with transitions when needed.
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April 24, 2009