Section I, Part B – Demonstration Implementation Policies and Procedures
2. Informed Consent and Guardianship
Provide a narrative describing the procedures used to obtain informed consent from participants to enroll in the demonstration. Specifically include the State’s criteria for who can provide informed consent and what the requirements are to “represent” an individual in this matter. In addition, the informed consent procedures must ensure all demonstration participants are aware of all aspects of the transition process, have full knowledge of the services and supports that will be provided both during the demonstration year and after the demonstration year, and are informed of their rights and responsibilities as a participant of the demonstration. Include copies of all informed consent forms and informational materials.
a. Procedures for Providing Informed Consent
i. Criteria and requirements to provide informed consent and represent an individual.
Texas will require that all individuals participating in the MFP Demonstration or their Legally Authorized Representative (LAR) -- i.e., parent, guardian, or managing conservator of a minor individual, or a guardian of an adult -- be informed of all their rights and options for long-term services and supports and that participation is voluntary. This includes acceptance of services and the consent to participate in the evaluation component of the grant. The Informed Consent Form (Appendix E) will be signed only by the individual being transitioned or those who have legal authorization to act in the individual’s behalf.
DADS case managers, home health agency service coordinators, MCO service coordinators, and MRA staff will secure the appropriate signatures on the Informed Consent form (Appendix E) which indicates that they have been informed and are voluntarily choosing to participate in the MFP Demonstration without coercion.
ii. Awareness of Transition Process/Knowledge of the services and supports
Section1, Part B1 of the Operational Protocol identifies the transition process and information provided to the individual/LAR for both nursing facility and ICFs/MR and state school transitions.
As noted previously, a significant number of individuals self-identify as candidates for transition. In many cases, the initial contact for a nursing facility transition is through the relocation specialist who provides information on the transition process and conducts an assessment of the individual’s transition needs. The relocation specialist then contacts the nursing facility social worker about the possible transition, followed by a contact to a DADS case manager or Managed Care service coordinator who begins the assessment process for medical eligibility (HHSC’s eligibility workers collect information to determine financial eligibility) and explains the transition process, the type of long-term services and support and consumer directed options available, and begins development of the plan of care.
For the individuals in an ICF/MR or state school who have not self-identified the desire to move into a community setting, the awareness of the transition process begins with the Community Living Options process. It is during this process that the individual’s desires and choices for their preferred living arrangement are determined and information is gathered to effect a successful transition. The local MRA further discusses the transition process, assists in locating the preferred living arrangement, and develops a plan of care that takes into consideration the individual’s need and choice for services and supports.
iii. Information about Rights and Responsibilities
Informed consent under this MFP Demonstration will include two components: 1) the acceptance of services and; 2) the consent to participate in the evaluation component of the project.
The consent for waiver services will follow current 1915(c) waiver practices (as dictated by CMS) and will be obtained during the care planning phase of the transition but prior to the delivery of home and community-based services. Risks of receiving certain services, the range of services that are available, and any restrictions on amount, duration and scope because of cost caps will be included in the informed consent process. Additional supports necessary to carry out the service plan will be fully explained to the prospective MFP Demonstration participant or representative, particularly with regard to self-directed services and supports.
The Informed Consent form will include the provision that participation in the MFP Demonstration is voluntary and protects project-related information that identifies individuals. The document will state that the information is confidential and may not be disclosed directly or indirectly, except for purposes directly related with the conduct of the project. The document will also indicate that the state will obtain written consent of the individual prior to disclosure of individual level information.
Finally, the Informed Consent form advises the individual that they can withdraw from the project at anytime, the MFP Demonstration period is for one year, the special demonstration services are available for one year, and that their existing Medicaid 1915(c) services will continue after the MFP Demonstration period as long as they continue to meet the eligibility requirements for the program.
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December 14, 2010