Targeted Case Management Monthly Documentation Pilot Texana Center Sheri Talbot, Authority Services Carin Shuford, Information Services

Why Monthly Documentation Summary? Expectations of state for progress/lack of progress/satisfaction/lack of satisfaction every 90 days Documentation burden to TCMs (turnover) Compliance challenge – missing outcome/missing service in 90 day reviews Expectations for transition to managed care: Maximize the use of data to drive decision making

Steps Taken… Researched model TCM documentation for Managed Care Identified Tennessee Format http://www.tn.gov/assets/entities/didd/attachments/80.3.4_-_ISC_CM_Monthly_Doc_Form.pdf The Support Coordination Monthly Documentation Form is used to summarize information gathered from the monthly face-to-face visit; interviews with the person, family members and conservators or guardians; interviews with provider staff; and other information and documentation relevant to the implementation of the ISP that is received during the month. The ISC must complete this form at least monthly to document review of ISP implementation status, including monitoring and narrative documentation of the progress made with respect to each action step and outcome. Contact with the person’s guardian/conservator or an involved family member may be required to complete the form, particularly if the person is unable to communicate responses to interview questions.

Steps Taken… Reviewed with the Local Authority Workgroup Molly Hurst, Tarrant County, presented to the IDD Consortium, September 2016 Implemented Pilot at Texana Center, October 2016

Texana Center Pilot Implementation Purpose Introduce a Monthly Summary Documentation Test and improve format prior to requirement Promote user feedback Implementation October 2016 Participation Voluntary for Waiver Service Coordinators (9 TCM, 6 TCM Supervisors) Participation Mandatory for Enhanced Community Coordination (Format provided data for mandatory quarterly ECC report) (4 TCM, 1 TCM Supervisor)

Texana Center Pilot Implementation Developed the Monthly Documentation Summary in Cerner (Anasazi), preceded by Extensive Training on Outcomes July - August August implemented revision to the PDP Action Plans categorized by 9 life areas (not services) Outcomes for Non Waiver services moved to the Action Plans Desired Outcomes of the Monthly Documentation Summary Improved time management Improved compliance Improved quality of Service Coordination

Texana Center Pilot Implementation Challenge with Tennessee Model: Tennessee Single Monthly F/F = Billing Requirement; Texas 1 F/F and 2 Collaterals = Billing Requirement Desired components of the Monthly Summary: Capture Billable Face to Face Services Capture Billable Collateral Services Include PDP Review as a billable event that provides reportable data Include 90 Day Review with Outcomes populating from the PDP Allow for Quality Review (Final Approval) by the TCM Supervisor

Demonstration Carin Shuford, Information Services Specialist Dedicated position to assist with IDD documentation Focus on IDD Electronic Health Record Focus on Staff Training IMC Systems Policy Workgroup Liaison to Local Authority Workgroup

Implementation Challenges Timeliness Benchmark – Final Approval is for the complete summary TCM Supervisor Time Management – Final Approval at the end of the billing period Time management for Targeted Case Managers – procrastination, end of month documentation Narrative to include indicators of the matching billing strip Communication of changes to pilot participants

Implementation Opportunities Facilitated quick identification of issues requiring follow up for both the TCM and TCM Supervisors Relayed the individual’s ‘story’ in a more concise, meaningful format Facilitated improved time management by the TCM Tracking of F/F and Collaterals for Benchmarks Reduced time required to complete contact notes Collateral PDP Review 90 Day Review with populated Outcomes

Moving Forward CAP Review week of January 30th – Present Modification to the PDP Action Plan Mandatory format for all Service Coordinators beginning February 1, 2017 Continued flexibility in the format for ease in use by Service Coordinators Revision to the Final Approval process to allow for timeliness benchmarks and time management by the TCM supervisor

Questions, Suggestions and Discussion Questions on the Texana Center Monthly Documentation Summary Suggestions for improving the Monthly Documentation Summary Discussion of statewide support for the use of a TCM Monthly Documentation Summary

Texana Center Contacts Sheri Talbot, Director IDD Authority Services Sheri.talbot@texanacenter.com 281-239-1386 Carin Shuford, Information Services Specialist Carin.shuford@texanacenter.com 281-239-1447 Utude Akposheri, Diversion Coordinator Utude.akposheri@texanacenter.com 281-239-1397