Support Consultation • An optional service • Provides a level of training, assistance, and support • Does not duplicate or replace financial management services (FMS), case management services, or other available program or non-program service or resource • Provides practical skills training and assistance to successfully manage CDS employer responsibilities • Must be budgeted
Support Consultation: Delivery Support consultation is delivered to: • An employer • An employer's designated representative (DR) • An individual receiving services through the CDS option if that individual will be the employer within six months of the initiation of support consultation services to the individual
Support Consultation: Basics • Skills training and assistance can include: • Recruiting, screening, and hiring workers • Developing and documenting job descriptions • Verifying employment eligibility and qualifications • Completing documents required to: • Employ an individual • Retain a contractor or vendor • Manage service providers
Support Consultation: Basics (cont.) • Skills training and assistance can include: • Communicating effectively, solving problems, and documenting employer responsibilities in the CDS option • Developing, revising, and implementing service back-up plans • Performing employer responsibilities • Complying with the individual's program and CDS rules • Developing ongoing decision making skills for employer-related and employment-related situations.
Support Consultation: Availability Available in the follow ing program s: • Community Living Assistance and Support Services (CLASS) • Deaf Blind with Multiple Disabilities (DBMD) • Home and Community-Based Services (HCS) • Texas Home Living (TxHmL) • Community Care for Aged and Disabled (CCAD)
Support Consultation: Budgeting • An employer or DR may budget and initiate support consultation services while the individual is participating in the CDS option. • Before initiation of the service, the employer or DR must: • Identify the person or persons (the employer, the DR, or the individual within six months after becoming the employer) to receive the service and establish goals specific to the service;
Support Consultation: Budgeting (cont.) • Before initiation of the service, the employer or DR must (cont.): • Obtain approval of the goals established for the service from the individual's service planning team; • Develop a budget for support consultation; and • Obtain approval of the budget from the FMSA.
Support Consultation: Budgeting (cont.) • An employer or DR, a case manager or service coordinator, an FMSA, or an HHSC representative may recommend that the individual's service planning team approve support consultation services for an individual if: • The individual receiving services through the CDS option will become the employer within six months after the service is initiated; • The employer or DR demonstrate a need for the service;
Support Consultation: Budgeting (cont.) • An employer or DR, a case manager or service coordinator, an FMSA, or an HHSC representative may recommend that the individual's service planning team approve support consultation services for an individual if: • The individual's health and welfare may regress without additional support for managing and directing service providers; or • Other reasons that the service planning team has determined justify the need for the service.
Support Consultation: Budgeting (cont.) • If the individual's service planning team authorizes support consultation, the team must: • Approve the funds, the duration, and the frequency of the service; • Assist with development of goals and ensure that the activities required to meet the goals through support consultation comply with this chapter; • Approve the goals for support consultation and the person or persons who will receive the service (the individual, employer, or DR); and • Terminate the service when goals are met.
Employer Responsibilities • An employer or DR must ensure that a support advisor meets service provider requirements, including: • Obtaining documentation required to verify the applicant's qualifications and eligibility to provide support consultation services • Submitting documentation to the FMSA for review of the person's eligibility • Obtaining approval from the FMSA of the person's eligibility to provide support consultation services • Maintaining documentation to verify continued eligibility during service delivery
Resources Texas Rules Governing CDS and FMSAs: • Texas Administrative Code: Title 40, Part1, Chapter 49,effective September 1, 2014 relating to Contracting for Community Services • Texas Administrative Code: Title 40, Part1, Chapter 41,effective March 20, 2016 relating to Consumer Directed Services CDS Option Employer Manual: • https: / / www.dads.state.tx.us/ services/ cds/ employer/ CDS Forms and Handbook: • https: / / hhs.texas.gov/ doing-business-hhs/ provider- portals/ long-term-care-providers/ consumer-directed- services-cds/ cds-forms-handbooks
Questions? CDS@hhsc.state.tx.us 44
Thank you
Frequent Contract Monitoring Citations
Contract Compliance & Performance Management Sarah Schmidt August 22, 2017
CLASS Contract Management & Monitoring Update on Contract Compliance and Frequent Citations 48
Contract Compliance Points to Remember: TAC §49.302: (c)- ensure that an employee, subcontractor, or volunteer can effectively communicate with an individual/ LAR concerning service planning and the provision of services, which may require the contractor to provide an interpreter for the individual (d)- must not allow an individual to perform services under the contract or perform other work that benefits the contractor 49
Contract Compliance (cont.) Points to Remember: TAC §49.302: (e)- comply with the terms of the contract, which requires compliance with federal and state laws, rules, and regulations, including TAC Chapter 49, rules governing services provided under the contract, and applicable reimbursement rules in TAC Chapter 355 (g)(1)- subscribe to receive HHSC e-mail updates, using the link provided at the HHSC website https: / / service.govdelivery.com/ accounts/ TXHHSC/ s ubscriber/ new 50
Contract Compliance (cont.) Points to Remember: TAC §49.302: (h)- notify HHSC of a change of ownership or change in legal entity in accordance with § 49.210(a)(1) (i)(1-2)- notify HHSC of a change to contract’s contact information (mailing, physical, e-mail address, phone, fax numbers, etc) At least 30 days before the change Within 3 days after the change if a natural disaster or unforeseen disaster prevents compliance with above 51
Contract Compliance and Performance Management Monitoring Review Schedule and Timelines • If a contract is serving individuals, it will be scheduled for a formal monitoring review every 21-24 months. • If a contract scores below a 90% on a formal monitoring review, an additional intermittent review will be conducted within 11-13 months from the most recent formal monitoring review. • A contract could potentially be reviewed three • times within a 2 year period based on overall • compliance scores.
CLASS Contract Monitoring Frequent Citations- Case Management Agency Please see CLASS CMA Monitoring Workbook for reference information https://hhs.texas.gov/Doing-Business-HHS/Provider- Portals/Resources/Contract-Fiscal-Compliance- Monitoring-Tools 53
Contract Compliance and Performance Management Standard I I I .5 . Renew al SPT • The CMA must explain to the individual/ LAR or person actively involved with the individual, orally and in writing the mandatory participation requirements of an individual as described in §45.302. • The SPT meeting must be convened at least annually, between 30 and 90 calendar days before the end of the IPC period.
Contract Compliance and Performance Management Standard I I I .6 . Renew al SPT • Within 10 business days of HHSC notification of approval, the case manager must provide copies of the HHSC authorized IPC, IPPs, habilitation plan/ habilitation training plan, SPT notes and ID/ RC to all members of the SPT and to any additional CLASS service providers (FMSA, Continued Family Services [ CFS] , and Support Family Services [ SFS] ), as necessary.
Contract Compliance and Performance Management Additional Docum ents • Therapy Justifications (8606As) and Request for Adaptive Aids, Medical Supplies, or Minor Home Modifications (3660) must also be provided with the HHSC authorized IPC, IPPs, habilitation plan/ habilitation training plan, SPT notes and ID/ RC, if applicable.
Contract Compliance and Performance Management Standard I I I .8 . Revision SPT • The CMA must submit revision documentation to HHSC at least 30 calendar days before the proposed effective date. • Within five business days of HHSC transmission of the authorized IPC, the case manager must provide copies to the individual/ LAR and any additional CLASS service providers (DSA, FMSA, CFS, and SFS), as necessary.
Contract Compliance and Performance Management Standard I I I .9 . I PP Service Review s • The CMA must in accordance with the CLASS Provider Manual meet with the individual/ LAR to complete Form 3595, IPP Service Review, reviewing the individual’s progress toward achieving the goals and objectives as described on the IPP .
Contract Compliance and Performance Management Standard I I I .9 . I PP Service Review s ( cont.) • That includes the following documentation for all services on the IPC: • Documentation of progress or lack of progress toward goals/ objectives as identified on the IPPs / IPC; • Assess the individual’s satisfaction with the provision of CLASS program services; • Identify any changes to the individual’s needs, if applicable; and • If applicable, FMS option.
Contract Compliance and Performance Management Standard I I I .9 . I PP Service Review s ( cont.) • That includes the following documentation for all services on the IPC: • Refer to Appendix X: Quarterly Due Dates Chart • The CMA must provide a copy of the IPP Quarterly/ 90-Day Service Review to the individual/ LAR, DSA, and FMSA (if applicable) within 5 business days of the review date.
Contract Compliance and Performance Management Standard I I I .1 0 . Medicaid Eligibility • The CMA must verify the individual’s Medicaid eligibility monthly. Standard I V.7 Billing • The CMA must complete Form 3625 supported by written documentation or case note. • Timekeeper must sign Form 3625.
CLASS Contract Monitoring Frequent Citations- Direct Service Agency Please see CLASS DSA Monitoring Workbook for reference information https://hhs.texas.gov/Doing-Business-HHS/Provider- Portals/Resources/Contract-Fiscal-Compliance- Monitoring-Tools 62
Contract Compliance and Performance Management Standard I I .2 : Staff Qualifications / Training • Habilitation/ CFC Habilitation staff must receive orientation before the first date of service delivery. Standard I I .3 : Staff Qualifications / Training • All DSA staff must receive annual training every 12 months on A/ N/ E, Rights and Responsibilities, and review of the CLASS rules in TAC Chapter 45.
Contract Compliance and Performance Management Standard VI .2 : Renew al • Annually, the DSA must explain orally and in writing to the individual and LAR or person actively involved with the individual: • Rights and responsibilities including complaint procedures • How to report an allegation of abuse, neglect, or exploitation • How to make a complaint
Contract Compliance and Performance Management I PP Service Sum m aries Section 3 3 5 0 IPP Service Summaries required for the following: • Auditory enhancement training • Behavioral support • Dietary services (nutritional services) • Habilitation training • Occupational therapy • Physical therapy • Prevocational services
Contract Compliance and Performance Management I PP Service Sum m aries Section 3 3 5 0 IPP Service Summaries required for the following (cont.) : • Specialized therapies • Speech therapy • Supported employment services Copies of the completed IPP Service Summaries must be provided to the CMA within five business days of completing the IPP Service Summary.
Contract Compliance and Performance Management I PP Service Sum m ary • The DSA quarterly review/ 90-Day Service Summary must include the following elements: • Current observable/ measurable goals and objectives • Frequency and duration of sessions attended • Rationale for missed sessions Refer to Appendix X: Quarterly Due Dates Chart
Contract Compliance and Performance Management I PP Service Sum m ary • The DSA quarterly review/ 90-Day Service Summary must include the following elements: • Progress or lack of progress • Actions taken, as applicable (e.g., in-servicing, counseling, etc.) • Revisions of goals and objectives, as applicable Refer to Appendix X: Quarterly Due Dates Chart
Contract Compliance and Performance Management Transfers • Copies of the identified records must be delivered to the receiving DSA within five calendar days of notification by the case manager of the individual's decision to transfer to a different DSA. • The transferring DSA is required to maintain documentation of the specific records that were delivered to the receiving DSA, as well as the date of the delivery.
Contract Compliance and Performance Management Corrective Action Plans ( CAP) • There is no HHSC form for Corrective Action Plans (CAP). • Each contract must decide what format works best for their business practices. • CMAs and DSAs must continue to adhere to any CAP approved by HHSC .
Who To Contact? • Contract Enrollment and Administration • Fax Number (512) 438-5528 • Email: communityservicescontracts@dads.state.tx.us • Unit Voicemail Box (512) 438-3550 • Contract Compliance and Performance Management • Sarah Schmidt, Manager (512) 438-5370 • Tinia Collins, Contract Specialist (512) 438-2232 • Angie Campos, Contract Specialist (512) 438-2544 • Joseph Cantu, Contract Specialist (512) 438-4300 • Max Pachl, Contract Specialist (512) 438-4784 • Fax Number (512) 438-3639 71
IDD Operations Portal Update
IDD Program Eligibility & Support (IDD PES) Fabian Aguirre, Unit Manager
Presentation Topics • IDD Operations Portal Update • Coordination of smooth transition from STAR+ PLUS Waiver (SPW) & MDCP STAR Kids (SK) into CLASS
IDD Operations Portal W hat is the I DD Operations Portal? • An efficient online submission system where long term care providers and Local Intellectual/ Developmental Authorities (LIDDA) can electronically submit and receive documents to and from IDD PES and IDD UR. • The IDD Operations Portal is scheduled for release this fall.
IDD Operations Portal W hy is this better? • Improves secure document transmission. • Reduces need for follow-up calls, emails, and faxes. • Ability for CMAs and DSAs to check submission status at any time. • Receive status updates on submissions.
IDD Operations Portal W ho w ill use the portal? HHS contractors that provide IDD services in the following programs: • Community Living Assistance and Support Services • Case Management Agencies • Direct Services Agencies • Deaf Blind with Multiple Disabilities Providers • Home and Community-based Services Providers
IDD Operations Portal W ho w ill use the portal ( cont.) ? HHS contractors that provide IDD services in the following programs: • Texas Home Living Providers • Intermediate Care Facility for Individuals with Intellectual Disabilities Providers • Community First Choice Non-Waiver
IDD Operations Portal W here do I register? • HHSC will be providing more information about how to register for and use the online portal prior to implementation this fall. • This information will come in the form of email alerts, information letters, training webinars, computer-based training and in-person communications via existing stakeholder meeting events. • HHSC will also make available a dedicated troubleshooting email address, and is in development of a user guide for this new resource.
Coordination of Smooth Transition from STAR+PLUS Waiver (SPW) & MDCP STAR Kids (SK) into CLASS
SPW & MDCP SK closures Coordination of sm ooth transition from STAR+ PLUS W aiver ( SPW ) & MDCP STAR Kids ( SK) into CLASS: • Inform the individual/ LAR they have the option of selecting CLASS or remaining in SPW/ MDCP SK. • The CMA must ensure… • There are no gaps in needed services or overlaps in enrollment • All relevant parties are aware of the transition. • Enrollment IPC includes a projected CLASS state date in the future . • If the previous program is SPW/ MDCP SK, IPC start date must be for the 1 st of the m onth .
Message Lines Table CLASS DBMD I DD PES : Eligibility 512-438- 2 4 8 4 N/ A (ID/ RCs and Programmatic) I DD PES : Enrollments (Enrollment IPCs, Pre-Enrollment 512-438- 2 4 8 4 N/ A Assessments) I DD PES : Transfers, Suspensions, N/ A 512-438- 2 4 8 4 Terminations I DD UR : IPCs 512-438- 4 8 9 6 512-438- 4 8 9 6 (Revisions, Renewals) I DD UR : DBMD 512-438- 4 8 9 6 (Eligibility, Enrollments, Transfers, N/ A Suspensions, Terminations)
Thank you
Requirement for DSAs to Deliver All Services on the IPC
DSA Provide Services on IPC CLASS rules in 40 TAC §45.805 specify the DSA must ensure CLASS services are provided in accordance with the individual's IPC and the individual's IPP .
DSA Provide Services on IPC • A DSA must ensure that a DSA staff person participates as a member of an individual's service planning team (SPT). • The SPT is minimally composed of the individual/ LAR, the case manager, and the DSA. • The IPC is signed as evidence of agreement by the individual/ LAR, the case manager, and the DSA.
DSA Provide Services on IPC • An individual wanted to transfer to another DSA. • The DSA that the individual wanted to transfer to explained that the agency only provided CFC PAS/ HAB and skilled nursing care. • Can a DSA only provide certain services under the CLASS program (for example nursing or CFC PAS/ HAB)?
DSA Provide Services on IPC Each DSA enters into a Provider Agreement with HHSC. The contract lists the CLASS services that must be provided. Here is the specific language: • PAGE 1 Section 1 Service Codes- a list of CLASS service codes is included here.
DSA Provide Services on IPC • PAGE 2 Section 2: Health and Human Services Commission (“System Agency”) and the legal entity (Contractor) named in Section I (Department and Contractor, collectively, the “parties,” each a “party) hereby enter into this contract (provider agreement) (“the contract”) for the provision of services under the contract type specified in Section I for the considerations set forth herein. The contract begin date specified in Section I is not valid until this contract is signed by both parties.
DSA Provide Services on IPC • CLASS TAC allows a DSA to refuse an individual in 45.212(e) If DSAs serving the catchment area in which the individual resides are not willing to provide CLASS Program services or CFC services to an individual because they have determined that they cannot ensure the individual's health and safety, the CMA must provide to HHSC, in writing, the specific reasons the DSAs have determined that they cannot ensure the individual's health and safety.
CMA Role as Advocate for Individual
CMA Role as Advocate for Individual Per 40 TAC 45.103 Case management is a service that assists an individual in the following: • Assessing the individual's needs • Enrolling into the CLASS Program • Developing the individual's IPC • Coordinating the provision of CLASS Program services and CFC services
CMA Role as Advocate for Individual Per 40 TAC 45.103 Case management is a service that assists an individual in the following (cont.) : • Monitoring the effectiveness of the CLASS and CFC services and the individual's progress toward achieving the identified outcomes • Accessing non-CLASS Program services and non-CFC services • Resolving a crisis that occurs regarding the individual • Advocating for the individual's needs
CMA Role as Advocate for Individual • A CMA must ensure that a case manager participates as a member of an individual's service planning team. • A CMA must ensure that during the service planning team meeting the proposed IPC is reviewed, signed as evidence of agreement, and dated by: • The individual or LAR; • The case manager; and • The DSA.
Habilitation Service Codes Deactivated
Habilitation Service Codes Deactivated • Information Letter 17-15, titled “Removal of Service Codes for Habilitation and Residential Habilitation” was issued 6/ 29/ 17. • Announced service codes 10, 10A, and 10V for CLASS were deactivated effective 7/ 10/ 17. • CLASS DSA or FMSA will not be able to submit a service claim that includes any of these service codes. • CLASS DSA must use service code 10 CFC. • FMSA must use service code 10 CFV.
Habilitation Service Codes Deactivated • CLASS Form 3621, CLASS/ CFC — Individual Plan of Care, and CLASS Form 3621-T, CLASS/ CFC – IPC Service Delivery Transfer Worksheet have been revised to remove service code 10, Habilitation, service code 10 A, Habilitation – Delegated and 10V, Habilitation. • CLASS CMAs and CLASS DSAs must use the applicable, revised IPC form for any IPC, including one concerning a transfer, with an effective date of Nov. 1, 2017 or later. • The revised forms are available on HHSC’s website with a revision date of July 2017.
Providing Transportation in CLASS
Providing Transportation in CLASS • Transportation is an activity included as CLASS habilitation. • Transportation may be provided by CFC PAS/ HAB staff, if authorized on IPC. • Funding for taxi services or public transportation is available as an adaptive aid.
Providing Transportation in CLASS • SPT must determine whether an individual requires transportation as a service of habilitation; • Case manager must include transportation on the IPC; • If transportation is included on the IPC, the SPT must: • Develop a transportation plan for an individual who receives transportation from DSA or through CDS option; and • Develop IPP for transportation with goals based on transportation plan.
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