~ Community First Choice ~ Overview & Recent Changes in HCS and TxHmL April 14, 2016

Community First Choice Implementation Timeline Rule Amendments Transportation CFC PAS/HAB Provider Qualifications Utilization Review Thanks for joining us today to talk about the CFC rule changes. This webinar will summarize the changes made in this very large rule project and provide an overview. Please access the rules and review them yourselves to ensure compliance. (A comprehensive list of sections changed is at the end of this presentation) Feel free to submit your questions throughout the webinar and we will address them at the end as time allows.

CFC Implementation Timeline March 2015: The Centers for Medicare and Medicaid Services (CMS) approved the states 1915 (b) (4) waiver, allowing STP providers to be the sole provider of individuals enrolled in a DADS IDD waiver. April 2, 2015: CMS approved a state plan amendment to implement CFC. April 27, 2015: DADS released ILs to implement CFC until rules were adopted. June 1, 2015: HHSC rules governing CFC became effective. June 1, 2015: HHCS and DADS implemented CFC.

CFC Implementation Timeline August & September 2015: MCAC & DADS Council recommended Texas Register publication of the DADS proposed CFC rules. November 1, 2015: Transportation related to “habilitation services” to be billed to the respective waiver rather than CFC. March 2016: HHSC adopted of DADS CFC rules; begin conducting CFC PAS/HAB assessment. April 2016: Computer based training Form 8510 June 1, 2016: CFC PAS/HAB qualifications change.

Oversight Statutory Authority HB 3523, (84th Legislature) amended Texas Government Code, §534.152(g) to provide DADS regulatory and oversight authority concerning providers participating in the HCS, TxHmL, CLASS, and DBMD Programs for the delivery of CFC services. To allow DADS oversight of CFC services in the same manner in which DADS has oversight and regulatory oversight of the waiver services. The CFC rule project amended multiple sections of the Texas Administrative Code including Chapters 49, 41, 42, 45, 2, 9 Subchapter D and 9 Subchapter N

Amended & New Adopted March 20, 2016 Title 40, Part 1 Chapter 9, Subchapter D, Home and Community-based Services (HCS) Program and Community First Choice (CFC). Title 40, Part 1 Chapter 9, Subchapter N, Texas Home Living Program and Community First Choice (CFC). Title 40, Part 1 Chapter 2, Local Authority Responsibilities 40 TAC Chapter 2, Local Authority Responsibilities, effective This webinar will focus on the changes which affect the CLASS and DBMD program. As you can see we have added Community First Choice to the title of the Chapters.

Rule Topics Affected by CFC Definitions Program Descriptions Eligibility Service Planning Termination Fair Hearing Staff Training Service Planning: Development of the IPC and IPP

New Rules Related to CFC Emergency Response Services; Person-Centered Planning Training Requirements; Transportation as an activity of habilitation and residential habilitation; and Adds the federal qualifications and training requirements for a service provider of CFC PAS/HAB. In the rules you will find a few totally new sections/topics The new rules outlines requirements for ERS services including The new rules require a program provider to allow the individual or LAR to train a CFC PAS/HAB service provider, and ensure the service provider attends HHSC or DADS training to meet any additional qualifications desired by the individual or LAR. The proposed amendment requires a program provider to ensure that a staff member responsible for completing the IPP completes HHSC approved person-centered training within the timeframes set out in the rule.

Non- CFC Rule Changes Dental Treatment Service Limit for individuals in the HCS Program. The proposed amendments increase the dental treatment service limit from $1,000 to $2,000 during an IPC year to comply with the 2016-17 General Appropriations Act (Article II, Department of Aging and Disability Services, House Bill 1, 84th Legislature, Regular Session, 2015), which provided additional funds to increase the HCS Program dental treatment service limit.

Information Letters to be Retired The new rules replace the following HCS/TxHmL information letters: IL 2015-29 Implementation of CFC Through the CDS Option for HCS and TxHmL Programs; and IL 2015-28 Implementation of CFC in HCS and TxHmL Programs. NOTE: IL 2015-52 Providing Transportation in HCS and TxHmL will remain in effect. These ILs will be pulled from the DADS website on 3/20/16. Please be sure to replace them with the rules in your offices etc as well to ensure the most current information is used.

Rule Adoption Timeline Published as proposed in the Texas Register on November 27, 2015. Adopted rules were published in the Texas Register on March 11, 2016. Effective as of March 20, 2016 - Adopted rules can be found be in the March 11, 2016 issue on the Texas Register archive page. Formatted rules on the DADS website Two column formatted rules to be added to HCS and TxHmL webpages on March 20 or shortly thereafter. The links to the Texas Register pages are on slide 33 towards the end of this presentation.

Definitions §9.153 & §9.553 Adds definitions to address the addition of CFC services to these Chapters (i.e. alarm call, managed care organization, MAO Medicaid). Amends definitions to address CFC (i.e. activities of daily living, IPP, service provider). amendment to §9.153 adds definitions of "ADLs," "alarm call," "CFC," "CFC ERS," "CFC ERS provider," "CFC FMS," "CFC PAS/HAB," CFC support consultation," "CFC support management," "good cause," "health-related tasks," "IADLs," "managed care organization," "MAO Medicaid," "public emergency personnel," "responder," and "system check," because those terms are related to the provision of CFC services. also adds a definition of "transportation plan." amends the definitions of "implementation plan," "IPC," "microboard," "revised IPC," and "service provider" as needed to address the addition of CFC services to this subchapter. reformats the section, makes an editorial change in the definition of "HHSC," and corrects a rule reference in the definition of "condition of a serious nature."

Definitions §9.153 & §9.553 AT ADOPTION: Changes were made in §9.153(44) and §9.553(34) in the definition of “implementation plan” to clarify that an implementation plan is not required for transportation provided as a supported home living activity or as a community support activity because they require a transportation plan.

Definitions §9.153 & §9.553 AT ADOPTION: Changes were made to the definition of “health-related tasks” for clarification that some health maintenance tasks do not require delegation.

Description of the HCS and TxHmL Programs: §9.154 & §9.554 Adds CFC services which consist of: CFC personal assistance services/habilitation (CFC PAS/HAB), which replaces HCS supported home living and TxHmL community support, except transportation services are provided as residential habilitation; CFC emergency response services (CFC ERS), which is provided as a distinct CFC service instead of as an adaptive aid; and CFC support management. Essentially CFC PAS/HAB is added throughout the rule wherever HCS SHL or TxHml CS are mentioned in order to implement CFC in these waiver programs. In most cases the CFC service is to be provided in the same manner as the aforementioned services were provided. The CFC services must meet the same specified criteria as each waiver services including utilization review. amendment to §9.154 reformats the section and changes the title from "Description of the HCS Program" to "Description of the HCS Program and CFC." The amendment states that a program provider may provide CFC services only to persons residing in the counties specified for the program provider in DADS automated enrollment and billing system.

Description of the HCS and TxHmL Programs - § 9.154 & §9.554 FMS and support consultation are services available only if the individual's IPC includes at least one HCS or TxHmL Program service delivered through the CDS option. A program provider may only provide and bill for supported home living or community support if the activity provided is transportation. FMS and support consultation are services available under the HCS Program only if the individual's IPC includes at least one HCS Program service to be delivered through the CDS option program provider may only provide and bill for supported home living if the activity provided is transportation because all of the other activities of supported home living will be provided through the state plan service of CFC PAS/HAB. Remember the waiver is the provider of last resort, state plan services are to be used first.

Eligibility: §9.155 & §9.556 An applicant or individual is eligible for HCS or TxHmL Program services if he or she requires the provision of (1) at least one HCS or TxHmL Program service per month or a monthly monitoring visit by a service coordinator; and (2) at least one HCS or TxHnL Program service per IPC year. for HCS Program services if he or she requires the provision of (1) at least one HCS Program service per month or a monthly monitoring visit by a service coordinator; and (2) at least one HCS Program service per IPC year. The proposed amendment states that an applicant or individual is eligible for a CFC service if the applicant or individual meets the criteria for HCS Program services and requires the provision of the CFC service; and, in addition to these criteria, an applicant or individual receiving MAO Medicaid, must receive an HCS Program service at least monthly, as required by 42 CFR §441.510(d), which may not be met by a monthly monitoring visit by a service coordinator.

Eligibility: §9.155 & §9.556 Applicant or individual is eligible for a CFC service if the applicant or individual meets the criteria for HCS or TxHmL Program services and requires the provision of the CFC service. An applicant or individual, receiving MAO Medicaid, must receive an HCS or TxHmL Program service at least monthly, a requirement which is not met by a monthly monitoring visit by a service coordinator. An applicant or individual receiving MAO Medicaid, must receive an HCS Program service at least monthly, as required by 42 CFR §441.510(d), which may not be met by a monthly monitoring visit by a service coordinator. amendment states that if an individual is temporarily admitted to a setting listed in the rule, the individual's HCS Program services and CFC services are suspended during that admission. For more information about MAO Medicaid please reference IL

Eligibility: §9.155 AT ADOPTION: Changes were made clarify that an individual is not eligible for a CFC service if the individual is receiving host home/companion care, supervised living, or residential support. Changes were made reference the CFC eligibility criteria in §9.155(c), including the requirement that the individual is not receiving host home/companion care, supervised living, or residential support, instead of restating the criteria in §9.155(d).

Enrollment: §9.158 & §9.567 Service coordinator is required to provide the individual or LAR written and oral explanation of ; HCS or TxHmL and CFC services; and eligibility requirements for the HCS or TxHmL program and, if identified on the PDP, CFC. Service coordinator is required to inform the individual and LAR: If a nursing assessment is required, refusal to include a sufficient number of RN nursing units for an assessment on the initial proposed IPC will result in the individual not receiving CFC PAS/HAB; and Reasons CFC services may be terminated. If nursing assessment is requuired put enough hours on the initial IPC for an asssessment.

Enrollment: §9.158 & §9.567 Requires a program provider to develop: an implementation plan for CFC services other than CFC support management; and, a transportation plan if transportation as a supported home living activity is included on the IPC. o

Enrollment: §9.158 & §9.567 AT ADOPTION: Changes were made to §9.158(j)(4), §9.166(a)(1)(B) and (b)(3) to require an applicant's or individual’s service planning team, if CFC PAS/HAB is included on the PDP or if the IPC needs to be revised for CFC PAS/HAB, to complete DADS HCS/TxHmL CFC PAS/HAB Assessment form to determine the number of CFC PAS/HAB hours the applicant or individual The agency is requiring completion of the form to help ensure a consistent method for determining the number of CFC PAS/HAB hours an applicant or individual needs. An editorial change was made in §9.158(k)(15)(A)(i) to delete the title of §9.155 because the title is included earlier in the section. Changes were made in §9.158(o) and §9.567(s) to require the local intellectual and developmental disability authority (LIDDA), if CFC PAS/HAB is included on the PDP, to provide a copy of the completed DADS HCS/TxHmL CFC PAS/HAB Assessment form to the selected program provider and financial management services agency (FMSA).

IPC§9.159 & 9.558 IPC must specify the type and amount of each CFC service, other than CFC support management, and non-CFC services to be provided to an individual during the IPC year. If an individual's IPC includes only CFC PAS/HAB to be delivered through the CDS option, include CFC FMS in the IPC instead of FMS The proposed amendment requires the type and amount of each CFC service in the IPC to meet the same criteria as each HCS Program service. The proposed amendment requires the service coordinator, if an individual's IPC includes only CFC PAS/HAB to be delivered through the CDS option, to include CFC FMS in the IPC instead of FMS and, if the individual will receive support consultation, CFC support consultation instead of support consultation.

DADS review of a proposed IPC: §9.160 & 9.558 DADS may review supporting documentation specified in the rules to determine the appropriateness of the type and amount of CFC services specified in a proposed IPC. Before DADS authorizes a proposed HCS IPC that exceeds 100 percent of the estimated annualized average per capita cost for ICF/IID Program services, DADS reviews the IPC to determine if the type and amount of CFC services and HCS Program services specified in the proposed IPC are appropriate and supported by documentation specified in the rules.

Renewal and Revision of an IPC: §9.166 & §9.568 Requires the program provider to: develop an implementation plan for CFC services, except for CFC support management; develop a transportation plan, if transportation as a supported home living activity is included on the IPC; and provide CFC services in accordance with the implementation plan and HCS or TxHmL Program services in accordance with the transportation plan. proposed renewal IPC includes non-CFC services in addition to non-HCS Program services.

Renewal and Revision of an IPC : §9.166 Allows provision of a CFC service in an emergency and requires the program provider to follow the process for providing an HCS Program service in an emergency In addition, if transportation as a supported home living activity is added to or modified on the IPC because of an emergency, the proposed amendment requires the program provider to develop or revise a transportation plan. The proposed amendment requires the service coordinator or program provider to determine whether, in addition to an HCS Program service, an individual's IPC needs to be revised to add a new CFC service or change the amount of an existing service and requires the program provider to revise the transportation plan if transportation as a supported home living

Consumer Directed Services Option: §9.168 Adds CFC PAS/HAB to the list of services that, if included in an applicant's or individual's PDP, can be provided through the CDS option. Requires the service planning team (SPT) to develop a transportation plan if an individual's proposed IPC includes transportation as a supported home living activity to be delivered through the CDS option. adds CFC PAS/HAB to the list of services that, if included in an applicant's or individual's PDP, require the service coordinator to inform the applicant, individual, or LAR of the right to participate in the CDS option and have CFC PAS/HAB provided through the CDS option. Further, the proposed amendment requires the service planning team (SPT) to develop a transportation plan if an individual's proposed IPC includes transportation as a supported home living activity to be delivered through the CDS option.

Terminations: 9.570 describes the reasons DADS may terminate CFC services; if an individual is temporarily admitted to a setting listed in the rule, the individual's HCS or TxHmL Program services and CFC services are suspended during that admission. The proposed amendment adds CFC services throughout the description of the termination process, including the requirement for DADS to provide an individual with notice of the right to request a fair hearing if an individual's CFC services are terminated, suspended, denied, or reduced by DADS

Fair Hearing:§9.169& 9.571 an applicant whose HCS or TxHmL Program services or CFC services have been terminated, suspended, denied, or reduced by DADS receives notice of the right to request a fair hearing. Only a service coordinator may "recommend" (instead of "request") that DADS terminate an individual's HCS Program services or CFC services.

Reimbursement: §9.170 & §9.573 DADS pays a program provider for CFC PAS/HAB in accordance with the reimbursement rate and pays for CFC ERS based on the actual cost of the service, not to exceed the reimbursement rate ceiling for CFC ERS. The proposed amendment states that, if an individual's CFC services are suspended or terminated, the program provider must not submit a claim for services during the suspension or after termination, except for a claim for CFC PAS/HAB for the first day of the individual's suspension or termination. The proposed amendment states that DADS does not pay the program provider for a service or recoups payments made to the program provider if certain requirements in the CFC Billing Guidelines for HCS and TxHmL program providers are not met or the service is transportation as a supported home living activity and it is not provided in accordance with a transportation plan. The proposed amendment states that DADS does not pay the program provider or recoups any payments made if the program provider provides CFC services to an individual receiving host home/companion care, supervised living, or residential support. The proposed amendment states that DADS conducts billing and payment reviews to monitor compliance with the CFC Billing Guidelines for HCS and TxHmL program providers and conducts the reviews in accordance with a review protocol set forth in those guidelines.

Reimbursement:§9.170 & §9.573 DADS does not pay a provider: if CFC services are suspended or terminated, except for the first day of the suspension or termination; If Billing Guidelines requirements are not met; If transportation is not provided according to the transportation plan; or CFC services are provided to an individual in HCS receiving host home/companion care, supervised living, or residential support.

Certification Principles: Services Delivery: §9.174 Adds CFC services to this principle; requires a program provider to develop a service backup plan for a CFC service identified on the PDP as critical to meeting the individual's health and safety; and establishes the requirements for the provision of CFC ERS requires a program provider to provide or obtain CFC services without delay. The proposed amendment also requires that HCS Program services identified in a transportation plan and CFC services be provided in an individualized manner, and based on assessment results, the individual's and family's goals, and the individual's needs. The proposed amendment requires a program provider to ensure the coordination and compatibility of CFC services with non-HCS Program and non-CFC services. The proposed amendment states that supported home living must be provided in accordance with the individual's transportation plan. The proposed amendment adds CFC services in the limits on the number of individuals a program provider can serve when providing respite in the residence of another individual in which host home/companion care, supervised living, or residential support is provided. The proposed amendment requires a program provider to ensure that employment assistance or supported employment is not provided to an individual with the individual present at the same time that CFC PAS/HAB is provided. The proposed amendment requires a program provider to ensure that CFC PAS/HAB is available only to an individual who is not receiving an HCS residential service and is provided in accordance with the individual's PDP, IPC, and implementation plan. The proposed amendment requires a program provider to ensure that CFC support management is provided to an individual or LAR if the individual is receiving CFC PAS/HAB and the individual or LAR requests to receive CFC support management. The proposed amendment requires a program provider to maintain a system of delivering CFC services that is responsive to changes in the individual as identified by the SPT and maintain a single record related to HCS Program services and CFC services that includes a required transportation plan and documentation related to the suspension of an individual's CFC services. The proposed amendment requires a program provider to notify the service coordinator if the provider has reason to believe that an individual is no longer eligible for CFC services or requests termination of CFC services. The proposed amendment requires a program provider to develop a service backup plan for a CFC service identified on the PDP as critical to meeting the individual's health and safety. The proposed amendment states that a program provider may suspend CFC services due to an individual's temporary admission to a setting described in the rules and requires the program provider to notify DADS and the service coordinator of the suspension. The proposed amendment states that a program provider may not suspend CFC services for more than 270 calendar days without DADS approval. The proposed amendment adds CFC PAS/HAB to the services the program provider must not provide if an individual or LAR refuses a nursing assessment, unless conditions specified in the rules are met. The proposed amendment establishes the requirements for the provision of CFC ERS, including a description of the criteria for an individual to receive the service and qualifications of the CFC ERS provider and also requirements regarding installing equipment, initiating the service, obtaining responders, conducting system checks, responding to alarm calls, providing certain notifications, informing an individual of an equipment failure, replacing equipment, responding to low battery signals, replacing batteries, and documenting information. AT ADOPTION: removed the licensing requirement for ERS

Certification Principles: Service Provider Requirements: §9. 177 & §9 Requires providers to: employ or contract with a qualified and willing person or entity of the individual's or LAR's choice to provide a CFC service; and ensure that a staff member who is responsible for completing the implementation plan completes person-centered service planning training approved by HHSC within specified timeframes. The proposed amendment requires a program provider to employ or contract with a person who oversees the provision of HCS Program services and CFC services to an individual and adds CFC services in the work experience requirements for this person. The proposed amendment requires the program provider to ensure, if the service provider of CFC PAS/HAB is employed by or contracts with a contractor of a program provider, that the contractor complies with §49.312 of this title, which requires a certain base wage to be paid to personal attendants, including a service provider of CFC PAS/HAB.

Certification Principles: Service Provider Requirements: §9. 177 & §9 Requires providers to: to ensure that a service provider of CFC PAS/HAB meets the qualifications listed in the billing guidelines, including any qualifications requested by the individual or LAR based on the individual's needs and preferences; if requested by an individual or LAR, to allow the individual or LAR to train a CFC PAS/HAB service provider in the specific assistance the individual needs. if requested by an individual or LAR, to allow the individual or LAR to train a CFC PAS/HAB service provider in the specific assistance the individual needs and have the service provider perform CFC PAS/HAB in a manner that comports with the individual's personal, cultural, or religious preferences. The proposed amendment also requires the program provider to ensure that a CFC PAS/HAB service provider attends training by HHSC or DADS if needed to meet any additional qualifications desired by the individual or LAR. The proposed amendment also makes minor editorial changes.

LIDDA Requirements: §9.190 & §9.583 Requires a LIDDA to: employ service coordinators who receive training about CFC and CFC services; to inform an applicant or LAR, during enrollment, of the process for filing complaints. to ensure that the PDP states, for each CFC service, whether the service is critical to the individual's health and safety Related to service coordination The proposed amendment requires a service coordinator to ensure that the PDP states, for each CFC service, whether the service is critical to the individual's health and safety as determined by the SPT, and to monitor the delivery of CFC services and non-CFC services to an individual. The proposed amendment requires a service coordinator, together with the program provider, to ensure the coordination and compatibility of CFC services with other services. The proposed amendment requires a service coordinator to immediately notify the program provider if the service coordinator becomes aware that an emergency necessitates the provision of a CFC service not on the IPC or that exceeds the amount on the IPC. The proposed amendment requires the service coordinator, if informed by the program provider that an individual's CFC services have been suspended, to follow the process used if notified that an individual's HCS Program services have been suspended.

LIDDA Requirements §9.190 & §9.583 Requires a LIDDA to: notify an individual if HCS or TxHmL Program services have been suspended; manage the process to transfer an individual's CFC services; to inform the individual, who has requested termination, that CFC services through a managed care organization is a possible service resource Related to service coordination The proposed amendment requires a service coordinator to immediately notify the program provider if the service coordinator becomes aware that an emergency necessitates the provision of a CFC service not on the IPC or that exceeds the amount on the IPC. The proposed amendment requires the service coordinator, if informed by the program provider that an individual's CFC services have been suspended, to follow the process used if notified that an individual's HCS Program services have been suspended. The proposed amendment requires the service coordinator to inform the individual or LAR of the consequences of refusing a required nursing assessment, including that the refusal will result in the individual not receiving CFC PAS/HAB. The proposed amendment requires the service coordinator, if he or she determines that an individual's CFC services should be terminated or the individual requests termination, to follow the process used if an individual's HCS Program services should be terminated or the individual requests termination. The proposed amendment also requires the service coordinator to manage the process to transfer an individual's CFC services. The proposed amendment requires a service coordinator, when informing an individual or LAR who has requested termination of all CFC services of possible service resources upon termination, to inform the individual that CFC services through a managed care organization is a possible service resource. The proposed amendment replaces "request" with "recommendation" in the context of the service coordinator sending DADS a recommendation to terminate the individual's HCS Program services or CFC services. The proposed amendment requires a service coordinator, at least annually, to use a DADS form to provide an explanation to the individual or LAR of (1) the eligibility requirements for HCS Program services; (2) if the individual's PDP includes CFC services, the eligibility requirements for CFC services for individuals who receive and individuals who do not receive MAO Medicaid; and (3) all HCS Program services and CFC services. The proposed amendment also updates section titles and rule references.

Local Authority Responsibility Amendments to Chapter 2: expand the eligibility criteria for service coordination to include an individual enrolling in CFC services provided through an MCO and certain individuals receiving CFC services through an MCO; require person-centered service planning training in accordance with the CFC state plan amendment; and update terminology and clarify existing processes.

All HCS Sections with Changes §9.151, concerning purpose, §9.153, concerning definitions, §9.154, concerning description of the HCS program, §9.155, concerning eligibility criteria and suspension of HCS program services, §9.158, concerning, process for enrollment of applicants, §9.159, concerning IPC, §9.160, concerning DADS review of a proposed IPC, §9.161, concerning LOC determination,, As it is not practical to review every single change in this webinar format, we only focused on the changes that are expected to have the greatest impact on our providers. Here is a list of all sections touched for your reference.

All HCS Sections with Changes §9.162, concerning lapsed LOC, §9.166, concerning renewal and revision of an IPC, §9.168, concerning CDS option, §9.169, concerning fair hearing, §9.170, concerning reimbursement, §9.171, concerning DADS review of a program provider and residential visit,

All HCS Sections with Changes §9.173, concerning certification principles: rights of individuals, §9.174, concerning certification principles: services delivery, §9.177, concerning certification principles: staff member and service provider requirements, §9.178, concerning certification principles: quality assurance,

All HCS Sections with Changes §9.185, concerning program provider compliance and corrective action, §9.188, concerning DADS approval of residences, §9.190, concerning LIDDA requirements for providing service coordination in the HCS program, and §9.192, concerning service limits

All TxHmL Sections with Changes §9.551, concerning purpose, §9.553, concerning definitions, §9.554, concerning description of the TxHmL program, §9.555, concerning description of TxHmL program services, §9.556, concerning eligibility criteria for TxHmL program services,

All TxHmL Sections with Changes §9.558, concerning individual plan of care (IPC), §9.567, concerning process for enrollment, §9.568, concerning revisions and renewals of individual plans of care (IPCs), levels of care (LOCs), and levels of need (LONs) for enrolled individuals,

All TxHmL Sections with Changes §9.570, concerning termination and suspension of TxHmL program services, §9.571, concerning fair hearings, 9.573, concerning reimbursement, §9.576, concerning DADS review of a program provider, §9.577, concerning program provider compliance and corrective action,

All TxHmL Sections with Changes §9.578, concerning program provider certification principles: service delivery, §9.579, concerning certification principles: qualified personnel, §9.580, concerning certification principles: quality assurance, §9.583, concerning TxHmL program principles for LIDDAs.

Implementing the New Rules Share key changes with all staff. Ensure all staff have a copy or know where to access a copy of the new rules: http://www.sos.state.tx.us/texreg/index.shtml http://www.sos.state.tx.us/texreg/archive/index.shtml. Replace any copies of previous rules in internal manuals with the new rules. The top link is to the Texas Register and the bottom link is to the archive. The adopted rules can be reviewed on the Texas Register website until tomorrow Friday, March 18, 2016. After that, you can find the March 11, 2016 issue on the Texas Register archive page.

Transportation

SHL or CS/Transportation PAS/HAB expected to provide transportation in same manner as before CFC Bill activity to state plan CFC June 1, 2015 – October 31, 2015 Transportation is the only activity under SHL or CS Bill the waiver for hours spend transporting the individual November 1, 2015

Transportation IL 15-52 To allow providers to deliver transportation in the same manner they did before CFC initiated on June 1, 2015: DADS created separate service codes (TR and TRV) to allow billing to the waiver service rather that CFC PAS/HAB; Number of hours authorized based on the Individual Transportation Plan

Transportation on the IPC For a renewal or initial IPC that has a begin date of November 1, 2015 or later: the service planning team (SPT) must determine whether an individual requires transportation; if the individual requires transportation, the service coordinator must include transportation and outcomes for transportation on the PDP;

Transportation on the IPC For a renewal or initial IPC that has a begin date of November 1, 2015 or later: If transportation is included on the PDP: the program provider must develop a transportation plan for an individual who receives transportation from a program provider

Individual Transportation Plan Describes how transportation will be delivered to support an individual’s desired outcomes for transportation and identifies the appropriate number of transportation hours, based on the individual’s needs, necessary to enable the individual’s independence and integration into the community. Must documented on DADS Form 3598

CFC PAS/HAB Provider Qualifications

DADS Utilization Review

UTILIZATION REVIEW The amount of CFC PAS/HAB included in an IPC must be justified and based on an individual’s identified need for this service, just like the amounts of waiver services included in the plan.

HCS Program In accordance with DADS rule at 40 TAC §9.160(c), DADS may review supporting documentation at any time to determine if the type and amount of HCS Program services and CFC services specified in a proposed IPC are appropriate. If requested by DADS: (1) the LIDDA must submit to DADS documentation supporting a proposed initial IPC; and (2) the program provider must submit to DADS documentation supporting a proposed renewal or revised IPC.

TxHmL Program In accordance with DADS rule at 40 TAC §9.558(f), DADS may review an IPC at any time to determine if the type and amount of each TxHmL Program service and CFC service specified in the IPC are appropriate. The service coordinator must submit documentation supporting the IPC to DADS in accordance with a request from DADS for documentation. For a revised or renewal IPC entered into the Client Assignment and Registration System (CARE) on or after February 15, 2016, CARE may display messages requiring the LIDDA to submit the IPC and supporting documentation to DADS for review.

UTILIZATION REVIEW DADS requests IPCs for review in 2 ways: During data entry of an IPC in CARE, the system issues a message requiring the submission of an IPC packet to DADS for review. DADS sends a fax notice to the LIDDA or provider, instructing the LIDDA or provider to submit an IPC packet to DADS for review. DADS calls these requests “call backs.”

UTILIZATION REVIEW When an IPC includes CFC PAS/HAB, form 8510 must be submitted along with other service planning documentation when DADS requests submission of an IPC packet for review. Form 8510 is required in accordance with DADS Information Letter no. 2016-04.

Service Coordinator Training

Required CFC Training A service coordinator who provides service coordination to an individual receiving HCS or TxHmL services must complete DADS web-based training on CFC in the HCS and TxHmL Programs as follows: for a service coordinator hired before the date of this IL, complete the web-based training by March 20, 2016; • for a service coordinator hired after the date of this IL, complete the web-based training within the first 90 days of performing service coordination duties. The link to DADS web-based training is: http://www.dads.state.tx.us/providers/LA/training/index.html

Required Form 8510 Training A service coordinator who provides service coordination to an individual receiving HCS or TxHmL services must complete DADS training on completing DADS Form 8510, HCS/TxHmL CFC PAS/HAB Assessment.

Required Form 8510 Training For a service coordinator hired before February 11, 2106, do one of the following by March 20, 2016: listen to a recording of the webinar training held on February 9, 2016, at: http://www.dads.state.tx.us/providers/LA/training/index.html; or complete a web-based training available beginning April 1, 2016 at http://www.dads.state.tx.us/providers/LA/training/index.html; or the date of this IL feb 11 Information Letter No. 16-04 Changes to Community First Choice in the Home and Community-based Services and Texas Home Living Programs DADS is also scheduling in face-to –face training across the state.

Required Form 8510 Training For a service coordinator hired after February 11, complete within the first 90 days of performing service coordination duties, a web-based training available beginning April 1, 2016 at http://www.dads.state.tx.us/providers/LA/training/index. Information Letter No. 16-04 Changes to Community First Choice in the Home and Community-based Services and Texas Home Living Programs released Feb 11

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