Section I, Part B – Demonstration Implementation Policies and Procedures
Describe the target population(s) that will be transitioned, and the recruitment strategies and processes that will be implemented under the demonstration. Specifically, please include a narrative description that addresses the issues below. In addition, the OP must include samples of all recruitment and enrollment materials that will be disseminated to enrollees.
Texas administers a hugely successful MFP policy for individuals living in nursing facilities and expedited access for individuals with intellectual developmental disabilities living in large community ICFs/MR and state supported living centers. Since 2001, over 13,337 individuals have left nursing facilities while 1315 individuals have moved from large community ICFs/MR and state supported living centers to the HCS 1915(c) waiver program. While there are many formal mechanisms that have been established during the six year period, the programs are now enculturated with Texas’ consumers, advocates, providers, and government officials. This knowledge base is the result of previous outreach and education, individual experiences and word of mouth. The state will build upon its current outreach systems and general community awareness.
Nursing Facilities. The target population is individuals who have been residing in an institutional setting for at least ninety days, excluding any days of rehabilitative services funded through Medicare, are enrolled in Medicaid, and are currently living in a nursing facility. The MFP Demonstration specifically will target individuals with:
- Complex functional support needs who have not been able to transition out of nursing facilities.
- Co-occurring behavioral health conditions – mental illness or substance abuse problems – that live in nursing facilities in the San Antonio area.
- Individuals with a cognitive impairment or physical disability with a medical need for specific tasks required to be performed during normal sleeping hours (Overnight Companion Services in Region 4 and all fee for service areas in Region 11).
The second and third target populations will receive new MFP Demonstration services (which will be discussed Part 2, Section 5 of this Operational Protocol).
ICFs/MR and State Supported Living Centers. The target population consists of individuals who have been residing in an institutional setting for at least ninety days or less, excluding any days of rehabilitative services funded through Medicare, are enrolled in Medicaid, and are living in:
- Medium (9-13 beds) and large (fourteen beds or more) Community ICFs/MR and State Supported Living Centers.
- Community ICFs/MR if the owner voluntarily chooses to close the facility.
- Children under the age of 22 residing in community ICFs/MR who will relocate to families.
Nursing Facilities. Texas currently contracts with relocation contractors who employ relocation specialists that assist in the outreach and identification of individuals interested in relocation and then prepare them for community transition. Relocation Contractor services are available throughout Texas. If an individual chooses to transition, the relocation specialist coordinates the transition with the facility and the individual’s case manager or service coordinator. In addition, representatives from the following organizations also provide information and help to recruit individuals into the MFP program:
- DADS case managers or Managed Care service coordinators (if the individual resides in a location where managed care services are available).
- Local Area Agencies on Aging.
- Local Long-Term Care Ombudsmen.
- Nursing Facility Social Workers.
- Nursing Facility Family Councils
- Local Long-Term Services and Supports Providers
- Community Transition Teams
ICFs/MR and State Supported Living Centers. Recruitment occurs by ensuring that residents are informed about alternative living arrangements. This occurs through the Community Living Options (CLO) process which occurs on an annual basis, or more often if requested, through the individual’s interdisciplinary team (IDT). IDT membership includes the individual, the legally authorized representative (LAR) and at the request of the individual, family members, and other persons who are actively involved in the individual’s life. The CLO process goal is to identify the following:
- The individual’s personal preferences for living arrangements.
- The LAR/family preferences for living arrangements.
- Identification of medical, behavioral/psychiatric issues.
- Quality of life issues.
- The Mental Retardation Authority (MRA) recommendation, if an alternative living arrangement is requested. (NOTE: Due to recent legislation, MRAs will be working with individuals residing in state supported living centers to conduct the CLO process.)
Additional recruitment also occurs from a variety of different organizations listed in the Outreach/Marketing/Education section of the Operational Protocol. One of these organizations is Texas’ federally mandated protection and advocacy agency, Advocacy, Inc. This organization has a program, Texas Community Integration Collaborative (TCIC), which assists individuals with disabilities of all ages to move from state supported living centers, ICFs/MRs and nursing facilities. The TCIC offers:
- Training and technical assistance on individual choices and living options.
- Planning for an individual’s future and identification and development of resources to support living in the community.
- Training and technical assistance to family members, facility staff, community service and support providers and others.
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December 14, 2010