DADS Local Authorities Section Updates IDD Directors’ Consortium September 10, 2015 Piecing Together A Better Future

LIDDA Community Services Appropriations DADS 84th Legislative Session-HB 1 Highlights LIDDA Community Services Appropriations

Additional Funding for Waiver Slots: 3,040 waiver slots for individuals on waiver program interest lists ($51.5m General Revenue (GR) / $122.2m All Funds (AF) 104 slots for Medically Dependent Children Program ( MDCP) 752 slots for Community Living Assistance and Support Services (CLASS) 2,134 slots for Home and Community-based Services (HCS) 50 slots Deaf Blind with Multiple Disabilities (DBMD) 1,261 slots for Promoting Independence related to HCS ($29.7m GR / $81.8m AF) 500 slots for movement from large/medium intermediate care facilities for individuals with an intellectual disability or related condition (ICF/IID) 216 slots for children aging out of foster care 400 slots for prevention of institutionalization/crisis 120 slots for movement of individuals with intellectual or developmental disabilities (IDD) from state hospitals 25 slots for Department of Family and Protective Services (DFPS) children transitioning from general residential operations facilities   1,300 HCS slots to comply with federal preadmission screening and resident review (PASRR) requirements relating to individuals transitioning or being diverted from entering a nursing facility ($29.1m GR / $84m AF) 700 slots for persons with IDD moving from nursing facilities 600 slots for persons with IDD diverted from nursing facilities

Community IDD Services for Persons with Complex Medical and/or Behavioral Needs Crisis respite and behavioral intervention programs ($18.3m GR / $18.6m AF) ICF/IID and HCS rate add-ons for individuals with high medical needs ($5.9m GR / $13.8m AF) Intensive service coordination for state supported living center (SSLC) residents transitioning to the community ($3.5m GR / $8.2m AF) Intensive service coordination for nursing facility residents ($8.8m GR / $20.4m AF) Increased utilization of specialized services in nursing facilities ($5.3m GR /$13.2m AF) 

Money Follows the Person (Demonstration) Local Intellectual and Developmental Disability Authority Medical, Behavioral and Psychiatric Support Teams Money Follows the Person (Demonstration) Provide enhanced services for individuals with intellectual and developmental disabilities (IDD) that are being relocated for institutional settings, including state supported living centers (SSLCs) and Nursing Facilities (NFs). Eight medical, behavioral and psychiatric support teams to serve 254 counties. Local Intellectual and Developmental Disability Authorities (LIDDAs) will provide educational activities and materials quarterly to increase the expertise of LIDDAs and private providers in supporting these individuals. LIDDAs will provide technical assistance upon request from LIDDAs and private providers on specific disorders and diseases, with examples of best practices and evidence-based services for individuals with significant challenges. Case studies and peer review support will be available to ensure effective care for individuals.

Fiscal Years 2016 – 2017 Performance Contract

Overview of Changes Performance Contract Document: OIG Notification LTSS Screen Attachment B: PASRR Performance Measures Attachment G: Individual in the Community Long Term Services Online Portal One Year Requirement

Overview of Changes (continued) Attachment K: CAP Increase Procedure CFC moved to Attachment Q Attachment O: Designated LIDDA for CFC. Attachment Q: New Attachment related to CFC. Attachment Y: Moved from Attachment I. Form S: Excel version and CFC contacts.

Pre-Admission Screening and Resident Review (PASRR)

What’s New? Rules – Chapter 17 and Chapter 19 PASRR rule revisions effective July 7, 2015 Automation Enhancements – IDT Tab implemented June 26, 2015 Trainings Webinars – PASRR TA and QSR

New Rules Effective July 7, 2015 Chapter 17 Description of responsibilities of LIDDAs in PASRR process including service planning and transition planning Requires assignment of a service coordinator for PASRR individuals 21 years of age and older Lists additional LIDDA specialized services

News Rules Effective– July 7, 2015 Chapter 19 (for NFs) Requirements for entry of IDT meeting information on the LTC portal Include specialized services in the resident’s comprehensive care plan Role/responsibilities of NF during service planning and transition planning

Automation Enhancements June 26, 2015 – IDT tab on the PL1 August 28, 2015 – New question on the IDT tab August 28, 2015 – ICD-10 link on PL1 and PE December 2015 – SPT tab to document meetings In Process - Change of Ownership PL1 migration – Functional Design completed 11/2015

Training Webinar PASRR Technical Assistance Monthly PASRR technical assistance webinars DADS and DSHS PASRR SMEs available for technical assistance Third Wednesday each month, 3:00 – 4:00 p.m. Minutes and call for agenda items/discussion points prior to meeting

Training Webinar QSR A webinar was conducted July 20, 2015 to educate LIDDA staff on the outcomes and outcome measures used to determine compliance, discussion of the QSR processes and a live question and answer session with the expert reviewer, Kathryn du Pree. Attendance in this webinar was mandatory for LIDDA IDD Program Directors, Diversion Coordinators, Service Coordinator Supervisors and Service Coordinators. DADS developed outcomes and outcome measures to determine if individuals with positive PASRR eligibility service needs are being met

Training Webinar QSR Reviews are currently being conducted by an expert reviewer consultant and team of independent reviewers, hired by DADS. QSR includes a full record review, onsite visits, telephone interviews, team discussion and discovery, review of findings and report. LIDDAs, Nursing Facilities, community-based providers, individuals and Legally Authorized Representatives are active participants in the QSR process.

QSR Webinar A copy of the outcomes and outcome measures and a frequently asked questions document created from the live was distributed to all webinar participants. For questions or concerns regarding the QSR process please contact Heather J. Cook at 512-438-5413 or Heather.Cook@dads.state.tx.us.

Local Procedure Development and Support Updates

HCS/TxHmL Enrollments as of August 31, 2015 Program Slots Released (Since 9/1/13) Enrolled (Since 9/1/13) Pre-enrolled/ Pending August 31, 2015 Net Total Enrolled Target HCS 8,191 4,645 1,320 375 24,575 24,006 TxHmL 17,373 3,196 1,687 156 7,365 10,373 HCS/TxHmL Enrollments as of August 31, 2015

FY 16 Waiver Slot Releases Promoting Independence (PI) Initatives for HCS Slot Description FY 16 Slot Data FY 16-17 Slot # FY 16-17 Allocation Budget's Ramp Up Total # to be Released FY-16 Monthly Release Rate FY-16 # To Be Release in August 2015 Released by Request HCS Diversion from SSLC #82 400 Total Slots 350- SSLC Diversion 50 -Risk of Imminent 416 183 15 45 X Risk of Imminent Institutionalization #92 25 2 6 Persons moving from a SSLC #83 500-Total Slots 400- SSLC 50-LG ICF 50- Sm/Med ICF 460 230 19 57   Persons moving from Lg ICFs #84 80 40 3 9 Persons under 22 moving from Sm-Med ICF #85 4 12 Children Aging out of CPS #86 216 238 119 10 30 Children moving from a CPS-General Residential Operation #87 *** 14 1 Persons under 22 moving from Nursing Facilities (Child) #88 20 26 13 Persons moving from Nursing Facilities (Adult) #89 680 948 474 418 HCS Diversion from NF #90 600 636 318 27 81 Persons Transitioning from State Hospital (MDU) #91 120 140 70 18 HCS PI Sum Total: 2,561 3,024 1,526 128 682 Interest List (IL) Reduction for HCS Persons on Statewide HCS IL #80 (FY16) #81 (FY 17) 2,134 3,326 1,108 92 900 Attrition Slots N/A 2,880 1,373 114 HCS IL Sum Total: 6,206 2,481 206 HCS (PI & IL) Grand Total: 4,695 9,230 4,007 334 1,582 Interest List (IL) Reduction for TxHmL Persons on Statewide TxHmL IL #78 (FY16) #79 (FY17) 816 8400 700 300 TxHmL IL Sum Total: 8,400 TxHmL Grand Total: * This is a projected release plan and is subject to change on a monthly basis.

Interest List Biennial Contacts There is a discrepancy between the date the LIDDA entered in CARE and what the XPTR reports are showing. A programming error occurred in CARE and is currently being addressed by DADS IT. We are uncertain of the impacts on the reporting at this time.

Contract Accountability and Oversight Updates

REVAMPING OF CONTRACT ACCOUNTABILITY & OVERSIGHT REVIEW PROCESS

LIDDA’s identified the following concerns: The LIDDAs feel that DADS currently has a system of measurement for monitoring that does not allow for a standard variance of “imperfection”. There is also concerns of inconsistency in the review process across the state. DADS need to bring the focus back to the individual.

LIDDA’s recommendations: Changing the Current System – Two Perspectives: DADS should consider adjusting the system of measurement for monitoring to allow for a standard variance from “perfect”. DADS should develop a system of monitoring that brings the focus back to the individual.

ADDRESSING THE LIDDAS CONCERNS DADS has taken on the task for a review process as recommended by the LIDDAs. The new tool will tally the total number of services to be reviewed based on the charts chosen at random (denominator), and then tally the total number of services that were accurately reviewed (numerator).

ADDRESSING THE LIDDAS CONCERNS The new tool also includes a methodology for allowing an error rate during the review. Specific corrections will still be required for individual findings.

CALCULATING COMPLIANCE BASED ON INDIVIDUAL EXPECTATIONS NEW REVIEW TOOL CALCULATING COMPLIANCE BASED ON INDIVIDUAL EXPECTATIONS

INDIVIDUAL RECORD REVIEWS

INDIVIDUAL RECORD REVIEWS Compliance with monitoring has been an issue for several years. The previous process would not allow for a single missed service or quarter. When it was determined that monitoring did not occur for one then monitoring was out for the entire record. The new tool will allow the review to determine compliance for monitoring based on each individual service (waiver and non-waiver) during each quarter separately. The overall score will be determined based on the activities completed correctly verse the all or nothing method used in the past years.

Calculating Monitoring

Changes for individual record reviews The overall average calculation at the top of each worksheet will provide the percentage of compliance based on each individual record reviewed.

Changes for Individual record reviews

Changes for individual record reviews This percentage is calculated at the bottom of the individual worksheet for each record reviewed.

Changes for Individual record reviews

New Review Tool CALCULATING COMPLIANCE OVERALL PERCENTAGES FROM ALL RECORDS REVIEW FOR EACH PROGRAM VERSES MET /NOT MET METHOD

Report of Finding Changes The new tool will take the total percentages for each record reviewed and provide averages based on each element from those records. The tool will then provide an overall average for each element and provide an overall compliance score for the program.

New Look for Report of Findings

What has changed Report of Findings have a brand new look! The LIDDA’s will receive a ROF for all four programs (HCS, TxHmL, QA and PASRR) that looks like the previous slide. The report will show an overall percentage of compliance instead of the previous columns indicating the areas of “Met”, “Not Met” and “N/A”. The ROF’s will still have the required elements for review, the expectations and the finding/comments areas.

What has changed Report of Findings (ROF) have a brand new look! The bottom of the ROF will provide the LIDDA with information on what elements will require systemic and monitoring corrective actions. This is auto populated based on the overall score of all records reviews. When an overall score of 90% is reached there will not be a requirement of a systemic and monitoring corrective action plan.

What has changed Report of Findings (ROF) have a brand new look! When an overall score meets the 90% requirement there will not be a systemic and monitoring corrective action plan. The column will be auto-populated with “YES” and highlighted in a light red when a systemic and monitoring corrective action is required.

Changes in systemic and monitoring corrective action plans

Changes in systemic and monitoring corrective action plans

What’s new This same table will indicate if the LIDDA will require a cap compliance review for the year. This is calculated by the overall score for all elements reviewed. Cap compliance review will not be conducted for LIDDA’s with an overall compliance of 90% or above.

Changes in systemic and monitoring corrective action plans