1. Texana Center Provider Meeting Agenda February 18, 2010  Introductions  Information for HCS Participants & Families Purpose of Transition Impact, Goals and Timeline for Texana Center Changes Effective June 1, 2010 Resources for Additional Information  Review of FAQs  DRAFT Brochure for Families  Next Meeting – May 20, 2010 – 2 p.m. – 4 p.m. 13100 Southwest Freeway, Suite 130 Sugar Land, Texas 77478

2. Information for HCS Participants & Families and Involved Stakeholders Texana Center February 18, 2010 Transition of HCS Case Management to MRA Service Coordination

3. Information Overview Purpose of Transition Impact, Goals and Timeline for Texana Center Changes Effective June 1, 2010 Resources for Additional Information

4. Purpose of Transition to MRA SB 1, Section 48 (81 st Session): Provides $207 million General Revenue for home and community- based programs for people with intellectual and developmental disabilities and for reshaping the system of services. 7,832 people on waiting lists to receive waiver related community services by August 2011. Additionally, HCS services to be provided to people leaving large & medium ICFs, children aging out of foster care, and children & adults at risk of institutionalization. Funding for increased community services contingent, in part, on transfer of case management from the HCS Provider to the MRA.

5. Purpose of Transition to MRA SC Texas Legislature’s goals to increase: Oversight of community-based services quality Person-directed planning of services & supports to increase efficiencies and satisfaction Accountability of HCS program – approximately:  16,800 HCS Participants (current), over 20,000 with expansion  500 HCS Providers Texas Legislature considered that these goals could be best met with Case Management being provided by a local authority separate from the entity, or agency, providing services.

6. Purpose of Transition to MRA SC Texas Legislature chose the MRA as the Local Authority entity most experienced and best equipped to assume HCS Service Coordination. Texana Center, as the MRA, Is mandated by law to function as the local authority for developmental disability services. Has experience providing Service Coordination as the local authority. Has expertise in Person Directed Planning processes through its history with QAIS and state contract. Has structure to separate Authority and Provider functions to avoid conflicts of interest within provider network.

7. Impact for Texana Center Currently As an HCS provider, we provide HCS Case Management to the individuals enrolled in the Texana Center HCS program Effective 6/1/2010 Texana Center Authority Services will provide HCS-MRA Service Coordination to approximately 840 individuals, served by all HCS Programs in the Texana Center local service area

8. Impact for Texana Center Currently Provider relations limited to Provider Fairs, Provider Meetings and enrollments. 201 Certified HCS Providers for the Texana area: 32% (65) serve persons in Texana counties 33% (66) serve persons in same Waiver Contract Area: Brazoria Galveston, and Harris counties 8% (16) serve persons statewide, but not in our Waiver Contract Area 27% (54) serve zero persons Effective 6/1/2010 Provider relations expands to estimated 65 HCS Provider Agencies serving persons in Texana counties. Trends Growth in Provider Base: 24% (49) during FY’09 and FY’10

9. Texana Center Goals for June 1, 2010 Understand the new roles for HCS Providers and HCS-MRA SC, and set up systems for these functions Hire, train and equip staff to provide qualified and consistent Service Coordination for HCS participants Communicate with all HCS Provider agencies about changes, new roles and Texana Center processes Inform and support HCS participants & families to minimize disruption to services

10. Texana Transition Timeline As the MRA, Texana must locally plan to transition successfully on June 1, 2010. Our planning began in November and will continue through May. November 2009 Conduct initial HCS Case Management transition meetings between Providers and Texana MRA December 2009 Access information for all HCS consumers through DADS Locate office space for HCS-MRA SCs January 2010 Begin HR processes to hire for the HCS-MRA SC unit Initial planning for the March-May Interim Period

11. Texana Transition Timeline February 2010 Continue HR processes to hire for the HCS-MRA SC unit Plan for HCS-MRA SC unit equipment: Computers, Phones, Vehicles, Furniture & Supplies Implement Texana Center webpage for HCS-MRA SC Transition Conduct Second HCS-MRA SC transition meeting between Providers and Texana MRA Educate Advisory Boards, PNAC, Texana Board of Trustees

12. Texana Transition Timeline March 2010 Complete HR processes to hire for the HCS-MRA SC unit Receive documents from HCS Providers April 2010 Create HCS-MRA SC record for each HCS Participant Notify Providers, HCS Participants and their families of caseload assignments Hold informational meetings with HCS Participants and their families Train staff

13. Texana Transition Timeline May 2010 Train staff Notify each HCS participant of the name and phone number of the assigned HCS-MRA Service Coordinator Continue to hold informational meetings with HCS Participants and their families Conduct Third HCS-MRA SC Transition meeting between Providers and Texana MRA, to include HCS-MRA SC introductions

14. Fundamental Changes Effective June 1, 2010 HCS Provider Agencies will no longer provide Case Management. The MRA will provide Service Coordination to all HCS participants. The HCS Provider will continue to provide all other HCS services. HCS Interdisciplinary Team will be replaced by the Service Planning Team, to include the HCS participant, LAR and Service Coordinator. “a planning team consisting of an applicant or individual [HCS Participant], LAR, service coordinator, and other persons chosen by the applicant or individual or LAR on behalf of the applicant or individual (for example, a program provider representative, family member, friend, or teacher).”

15. Fundamental Changes Effective June 1, 2010 There will be three elements for Service Planning: Person-Directed Plan by the MRA Service Coordinator is the ongoing planning process for services & supports The Individual Plan of Care (IPC) by the HCS Provider is the budget document for each participant The Implementation Plan by the HCS Provider is the plan defines the detail for service delivery: how often, how long, training objectives and activities, and measures for progress.

16. Fundamental Changes Effective June 1, 2010 Both the HCS-MRA Service Coordinator and the HCS Provider will have monitoring responsibilities, and be responsible for communicating monitoring results with each other. The HCS-MRA Service Coordinator will monitor Did the HCS and non-HCS services identified in the PDP occur? Did the person make progress towards desired outcomes? Is the person/family satisfied with progress? Are the expectations for health and safety being met? The HCS Provider will monitor Were the services delivered in compliance with HCS Principles? Is progress occurring per the Implementation Plan?

17. Changes: Service Coordination Accessibility SC monitoring frequency will vary based on the needs and preferences of the person Minimum frequency of face-to-face contact is quarterly SC monitoring includes communication with families and providers Discovery process for PDP development or renewal addresses frequency

18. Changes: Additional MRA Responsibilities The HCS-MRA Service Coordinator will be involved when: Emergency HCS services are needed Level of Need assessments are completed(agree/disagree) Suspension of HCS services occur Termination of HCS services are recommended Transfers between HCS Providers are requested Consumer Directed Services option are requested Permanency Planning for persons under age 22 is required

19. Changes: Rights and Complaints HCS-MRA SC must inform/assist HCS participant/LAR regarding: Exercising legal rights as citizen & person with disability Process for filing complaints with MRA about SC provision Process for filing complaints about HCS services to MRA DADS DFPS to report allegation of abuse, neglect or exploitation

20. Resources for Additional Information Refer to the DADS website for transition www.dads.state.tx.us/hcscmtransition/ Refer to Texana Center website for transition www.texanacenter.com Participate in Information Meetings to be conducted in April and May Contact Texana Center Authority Services at 281- 342-0090, or by e-mail Tamra.lang@texanacenter.com Sheri.talbot@texanacenter.com

21. Transition FAQs-Service Planning Question 1: What is a Person-Directed Plan (PDP) and who participates in its development? Question 2: What is an Individual Plan of Care (IPC) and who participates in its development? Question 3: What is an Implementation Plan (IP) and who participates in its development? Question 4: How does the person-directed planning process support the service planning process in the HCS Program? Question 5: Does the development of the PDP and IPC need to take place at two separate meetings or can they be done at the same meeting? Question 6: How will the MRA SC communicate their agreement or disagreement with the IPC and MR/RC?

22. Transition FAQs-Service Planning Question 7: What avenues are available to program providers for adding services to the IPC in an emergency? Question 8: Can the MRA SC can authorize an increase in services on the IPC when it is submitted? How will DADS processes for reviewing changes in IPCs and requests for increases in LON work following this transition? (Added 12/7/09) Question 9: Who is responsible for justifying the services on the IPC and where should the justifications be documented? How will DADS review HCS Program service component justification information following this transition? (Added 2/2/10)

23. Transition FAQs-Service Planning Question 10.How will HCS Program transfers be handled after this transition? (Added 2/2/10) Question 11.How does the MRA SC assist the individual in choosing an HCS Program provider? (Added 2/2/10) Question 12.Who will be responsible for maintaining an individual’s LOC/LON, including completing the MR/RC and ICAP? (Added 2/2/10)

24. Transition FAQs-Monitoring Question 1. What is the MRA SC’s role in monitoring HCS Program providers? (Added 12/7/09) Question 2. If the HCS provider is not in the setting monthly to conduct a face-to-face case management visit, whose responsibility is it to ensure individuals' health and safety and to conduct quality assurance related to the provision of foster/companion care? (Added 12/7/09) Question 3. Please explain the responsibilities for monitoring in the HCS Program for the MRA SC and the HCS provider. (Added 12/7/09)

25. Transition FAQs-Monitoring Question 4: How will MRAs who are also HCS Program providers be monitored and how will the division of responsibilities be applied in these situations? (Added 2/2/10) Question 5: Following the transition, will the MRA SC or the HCS Program provider be responsible for routinely reviewing the individual’s plans such as quarterly reviews? (Added 2/2/10)

26. FAQs-C OORDINATION B ETWEEN AN HCS PROVIDER AND MRA SC Question 1. How does DADS plan to accommodate circumstances beyond a provider’s control when performing certification reviews? For example, will providers be cited for missing paperwork if the reason for the missing paperwork is that the MRA SC did not provide it in a timely fashion? Question 2. How will DADS assist the MRA SCs and program providers in maintaining productive working relationships and help to resolve complaints should they arise? Question 3. How will documentation be shared between the HCS provider and MRA SC regarding the provision and monitoring of an individuals’ program services? Will the MRA SC share PDP progress reviews with the HCS provider?(Added 12/7/09)

27. FAQs-C OORDINATION B ETWEEN AN HCS PROVIDER AND MRA SC Question 4. The rules require specific time frames for the program provider to notify the MRA SC of certain occurrences. For example, the program provider must: notify the MRA SC of a suspension within one business day after services are suspended; notify the MRA SC as soon as possible but no later than 24 hours after the program provider reports or is notified of an allegation of abuse, neglect, or exploitation involving an individual; and if an emergency situation occurs, attempt to notify the MRA SC as soon as the emergency situation allows. Will the MRA SC be "on call" to receive this notification? What type of response or support is the MRA SC going to provide in such instances? What forms of notification are acceptable? Can we use e- mail? (Added 12/7/09)

28. FAQs- M ISCELLANEOUS Question 1. Who is responsible for responding to an emergency? (Added 12/7/09) Question 2. Will MRA SC staff be able to see information entered into CARE by providers? (Added 12/7/09) Question 3. What topics will be covered in the program handbook currently in development? (Added 12/7/09) Question 4. Currently individuals and LARs have a choice of HCS providers and if they don’t like their case manager they can transfer to another provider. Is that same process available for MRA service coordination? (Added 12/7/09) Question 5. Is there a maximum caseload for an MRA SC? (Added 12/7/09)

29. FAQs- M ISCELLANEOUS Question 6. How will funding change in the HCS Program when case management is no longer provided by the HCS provider? (Added 12/7/09) Question 7. How will HCS providers cover the costs associated with the provision of program coordination responsibilities following this transition? (Added 12/7/09) Question 8: Following this transition will the HCS Program provider continue to be required to manage the individual’s personal funds upon the written request of the individual or LAR? Can the HCS Program provider charge the individual or LAR a fee for handling the individual’s funds? (Added 2/2/10)

30. FAQs- M ISCELLANEOUS Question 9. Is Targeted Case Management funded by contact or by month? (Added 2/2/10) Question 10.What process is in place to ensure an HCS Program provider may enter billing for services if the MRA SC is late reviewing the IPC in CARE for agreement or disagreement? (Added 2/2/10)

31. Q UESTIONS ABOUT THE HCS C ASE M ANAGEMENT T RANSITION FOR I NDIVIDUALS, L EGALLY A UTHORIZED R EPRESENTATIVES (LAR S ) AND A CTIVELY I NVOLVED F AMILY M EMBERS Question 1. Can an individual or LAR choose their MRA? How will the MRA assign MRA SCs to individuals? Can an individual change their MRA SC if they want to? Question 2. How will an individual, LAR, or actively involved family member access the MRA SC to request assistance? If the MRA SC assigned to an individual is away from work for an extended period how will the individual receive needed service coordination? Question 3. What are the minimum education and experience requirements for an MRA SC? For an MRA SC Supervisor?

32. Q UESTIONS ABOUT THE HCS C ASE M ANAGEMENT T RANSITION FOR I NDIVIDUALS, L EGALLY A UTHORIZED R EPRESENTATIVES (LAR S ) AND A CTIVELY I NVOLVED F AMILY M EMBERS Question 4. What size caseload will each MRA SC be required to carry? How many MRA SCs can an MRA have in a single unit? Question 5. Will there be a complaint process with appeals if an individual or LAR is dissatisfied with the service coordination they receive from the MRA or HCS Program service provision by the HCS Program provider?