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Part C - Organization and Administration

Provide a description of the organizational and structural administration that will be in place to implement, monitor, and operate the demonstration.  Please include the following:

Organizational Structure

 Provide an organizational chart that describes the entity that is responsible for the management of this grant and how that entity relates to all other departments, agencies and service systems that will provide care and services and have interface with the eligible beneficiaries under this grant.  Show specifically the relationship of the organizational structure to the Medicaid Director and Medicaid agency.

Staffing Plan

Provide a staffing plan that includes:

1. A written assurance that the Project Director for the demonstration will be a full-time position and provide the Project Director’s resume.

Texas assures that the Project Director for the MFP Demonstration is a full time position.  A copy Mr. Ashman’s resume is located at Attachment _.

2. The number and title of dedicated positions paid for by the grant. Please indicate the key staff assigned to the grant.

Mr. Ashman’s position title is MFP Project Director and the only position paid for by this grant.

3. Percentage of time each individual/position is dedicated to the grant.

Please see below narrative.

4. Brief description of role/responsibilities of each position.

Please see below narrative.

5. Identify any positions providing in-kind support to the grant.

There are no positions providing in-kind support for the MFP Demonstration.

6. Number of contracted individuals supporting the grant.

The only contracted individuals supporting the grant are providers of MFP Demonstration 1915(c) services.

The relocation contract is held in DADS Provider Services Division.  However, the Director of the Promoting Independence Initiative (PII) is also part of the Executive Staff which provides significant interaction.  PII provides leadership in the area of the relocation contractor activity and conducts monthly scan calls with the contractors to ensure that contract benchmarks are being met and to provide a forum to discuss common issues.  PII will participate during any re-procurement of the relocation contract.

Relocation contractors are paid on a cost reimbursement basis so any additional caseload increase will be compensated and they are being trained on Demonstration requirements.

7. Provide a detailed staffing timeline.

All staff have been hired for the MFP Demonstration.

8. Provide in a timeline format a brief description of staff that have been hired and staff that still need to be hired.

Please see below for the responsibilities of the staff member that has been hired for this position.  No additional staff are anticipated.

9. Specify the entity that is responsible for the assessment of performance of the staff involved in the demonstration.

Texas has reconfigured its health and human services system to an organizational umbrella with an oversight agency, the Health and Human Services Commission (HHSC) that also functions as State Medicaid Agency.  HHSC has direct authority over four HHSC operating agencies; DADS is one of these agencies.  HHSC has delegated the operational activities of the MFP Demonstration to DADS. 

Marc Gold, Director of the Promoting Independence (PI) Initiative for Texas, has overall responsibility for the PI Initiative and the MFP Demonstration and will assess the performance of staff involved in the MFP Demonstration.

Responses to questions c and d.

All necessary staff for successful operation of the MFP Demonstration have been hired.  Marc Gold, Director of the Promoting Independence Initiative for Texas, will dedicate 50 percent of his time to managing the project director, providing overall leadership for the MFP Demonstration, and assessment of the performance of the staff involved in the MFP Demonstration. 

Steve Ashman has been hired as the MFP project director and will dedicate 100 percent of his time to the MFP Demonstration.  Mr. Ashman’s duties and responsibilities include:  daily management of the MFP Demonstration activities; preparation of the Operational Protocol; liaison with the Centers for Medicare and Medicaid Services in all grant-related activities; preparation and submittal of all CMS and state required reports; convening and monitoring the internal and external workgroups; staff support to the MFP Demonstration Advisory Committee; support for all Promoting Independence Initiative activities; analysis of state/federal legislation and public policy; preparation of internal communications; present information to internal/external stakeholders.  The position will also be the liaison with the Texas Department of Housing and Community Affairs and function as the health and human services housing coordinator.  A copy of Mr. Ashman’s resume is located at Appendix H.

The chief liaison with the State Medicaid Director’s Office will be Larry Swift, HHSC Policy Analyst, who will dedicate five percent of his time to ensure coordination and State Medicaid Office oversight.  Dena Stoner, Senior Policy Advisory to the Assistant Commissioner for the Department of State Health Services, Mental Health and Substance Abuse Services, will dedicate five percent of her time to ensure the coordination of behavioral health supports.  Tommy Ford, Section Director for Institutional Services, DADS Provider Services Division, will dedicate five percent of his time for working with facility closures and resident community transfers.  Jeff Kaufmann, Manager of Policy Analysis and Support, and Terri Richard, Manager of Quality Assurance and Improvement, within the Center for Policy and Innovation, will each dedicate five percent of their or their staff’s time for this project.  Mr. Kaufmann will be involved in MFP evaluation while Ms. Richard will be responsible for the MFP quality assurance and improvement activities.  Many other DADS and HHSC staff that oversee current operation of 1915(c) waivers and programs will continue their current roles and contribute support for the MFP Demonstration on an as needed basis.  DADS will continue its current contracts with relocation specialists to assist individuals with transitioning from nursing facilities to the community.

Billing and Reimbursement Procedures

Describe procedures for insuring against duplication of payment for the demonstration and Medicaid programs; and fraud control provisions and monitoring.

The state uses the MMIS claims processing system to verify that the participant was Medicaid-eligible on the date of service delivery specified in the request for reimbursement and allows payment only on claims for services provided within the eligibility period.

Prior to processing claims, the automated claims management system edits claims for validity of the information and compliance with business rules for the service/program, and calculates the payment amount and applicable reductions for claims approved for payment.  For example, unless the system verifies that a participant’s current authorized plan of care has sufficient units in the plan of care to cover amounts claimed or that an authorized level of care is registered in the claims management system, the claim will be rejected.

Texas uses a fiscal review process to ensure that providers for the various Medicaid 1915(c) waivers are complying with program requirements.  The methods used in the fiscal review process include: examination of financial and service records as well as plans of care and other records; comparison of provider billings to service delivery and other supporting documentation.

Current procedures provide for on-site fiscal reviews to examine the provider agency’s service delivery and financial records and verify that all payments made to the provider agency were supported with documentation.  Typically, a one-month sample of the provider’s records is reviewed unless an increase in the review is deemed necessary.  Examples of records reviewed include assessment documents, service delivery documents, and complaints.

The provider must maintain documentation that supports the claims.  If the provider fails to maintain the required documentation, all improper payments are recovered.  The state also recovers payments when it verifies the provider was overpaid because of improper billing.  The state may take adverse action against the provider’s contract or require a corrective action plan for any fiscal review finding.

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Updated: December 14, 2010