LONG TERM SUPPORTS AND SERVICESInformation Current as of October 1, 2014
Why You Need to Know TO ENSURE • That consumers are empowered to reach full independence in all areas of life. • Consumers are making meaningful and informed choices about employment and the impact of working on other benefits. • Consumers needing extended services after closure are able to get their needs met through appropriate funding sources. • Appropriate usage of DRS funding and comparable benefits. Source: Rehabilitation Act of 1973 as Amended
What are Long Term Supports and Services (LTSS)? • Inpatient, comprehensive services in an institutional setting. • A full array of quality services provided in the community to which people with disabilities and chronic conditions have choice, control and access that assure optimal outcomes, such as independence, health and quality of life. Source: Centers for Medicare and Medicaid Services: Background and Milestones/Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID)
What DADS Programs Provide Employment LTSS? • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) including State Supported Living Centers (SSLCs). • State General Revenue funds. • 1915(c) Home and Community Based Waivers.
Other Departments/Divisions Providing Employment LTSS • HHSC Medicaid/CHIP through STAR+PLUS LTSS 1115 waiver. • DSHS MH/SA through YES 1915 (c) waiver and Medicaid State Plan Mental Health Rehabilitation Option.
WHAT’S THE DIFFERENCE? DRS • Based on disability and ability to achieve employment in an integrated setting at minimum wage or above. • Services are, by comparison, immediate but time-limited and related to an employment goal. • Funding through state general revenue and (primarily)Social Security Act Title XX through the Rehabilitation Services Administration located in the Office of Special Education and Rehabilitative Services in the Department of Education. LTSS • Primarily based on Level of Need. • 1915(c)Waiver services and STAR+PLUS Waiver are comprehensive lifetime services. If someone qualifies due to disability, financial criteria he/she gets services “for life”- at some point in their life. • MHSA Rehab Option can be an LTSS. Employment is considered ‘active treatment’ in the MH world. • Funding (primarily) through state general revenue and Social Security Act Title XIX match through the Centers for Medicare and Medicaid Services.
LTSS DRS Family/friends/advocates SGR DRS
LTSS DEFINITIONS • The EMPLOYMENT ASSISTANCE service component helps an individual to locate or develop paid employment in the community by assisting the individual to identify his or her employment preferences, his or her job skills, his or her requirements for the work setting and work conditions, and prospective employers offering employment compatible with the individual’s identified preferences, skills, and requirements. This service component facilitates the individual’s employment by contacting prospective employers on behalf of the individual and negotiating the individual’s employment. • Documentation is maintained in the file of each individual receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.).
LTSS DEFINITIONS • SUPPORTED EMPLOYMENT means assistance provided, in order to sustain competitive employment, to an individual who, because of a disability, requires intensive, ongoing support to be self-employed, work from home, or perform in a work setting at which individuals without disabilities are employed. Supported employment includes employment adaptations, supervision, and training related to an individual's assessed needs. Individuals receiving supported employment earn at least minimum wage (if not self-employed). • Transporting an individual to support the individual to be self-employed, work from home, or perform in a work setting is billable within the service.
LTSS DEFINITIONS • SUPPORTED EMPLOYMENT (continued) In the state of Texas, this service is not available to individuals receiving these services under a program funded under section 110 of the Rehabilitation Act of 1973. Documentation is maintained in the individual’s record that the service is not available to the individual under a program funded under the Individuals with Disabilities Education Act (20 U.S.C. §1401 et seq.). SOURCE: DADS Information Letter (IL) 2012-60 Change in Policy Regarding Supported Employment Referrals to the Department of Assistive and Rehabilitative Services; current DADS-DARS Memorandum of Agreement (MOA).
LTSS DEFINITIONS DRS AND DBS DO NOT PROVIDE SUPPORTED EMPLOYMENT AS IT IS DEFINED IN LONG TERM SUPPORTS AND SERVICES!
LTSS DEFINITIONS • Day Habilitation is assistance with acquiring, retaining, or improving self help, socialization, and adaptive skills necessary to live successfully in the community and to participate in home and community life. Individualized activities are consistent with achieving the outcomes identified in the person-directed plan and are designed to reinforce therapeutic outcomes targeted by other service components, school, or other providers. • Day habilitation is normally provided in a group setting (not in the person's residence) on a regular basis and includes personal assistance for those who cannot manage their personal-care needs during day habilitation, and assistance with medications and performing tasks delegated by a registered nurse in accordance with state law.
ICF/IID • The primary purpose of the ICF/IID is to furnish health and rehabilitative services to a group of people with intellectual disabilities or persons with related conditions. • ICF/IIDs may be “state or non-state”; that is privately operated or part of the community Local Authority or a State Supported Living Center. • In general, small ICF/IIDs serve up to eight people; medium between nine and 13 and large 14 or more. There are slight differences in these numbers depending on whether the facility is state or non-state operated. • Rates for ICF/IIDs cover 24 hours of service.
ICF/IID • A program provider must not charge an individual or require an individual to expend personal funds for items and services that are the program provider’s responsibility to provide …These items and services include: • Training and habilitation services, e.g., vocational training, congregate training, and day activity services • Transportation costs to and from: (A) an activity included in an individual’s IPP, including health care services, congregate training, day activity services and supported employment, except for competitive employment. SOURCE: Department Of Aging And Disability Services (DADS); 40 TAC, Chapter 9, Subchapter E: ICF/IID Programs – Contracting
ICF/IID PEOPLE AND PLANS YOU NEED TO KNOW ABOUT! • The Interdisciplinary Team (IDT) is responsible for the consumer’s Individual Program Plan (IPP). • The IDT must prepare an IPP which includes opportunities for individual choice and self management and identifies: the discrete, measurable, criteria based objectives the individual is to achieve; and the specific individualized program of specialized and generic strategies, supports and techniques to be employed. The IPP must be directed toward the acquisition of the behaviors necessary for the individual to function with as much self-determination and independence as possible and the prevention or deceleration of regression or loss of current optimal functional status. SOURCE: 42 CFR 483.440(c))
FINDING A CONSUMER’S ICF/IID TEAM MEMBERS • Ask the consumer or the referral source (with the proper release records) for a copy of the IPP and all current medical records, psychological evals, etc. • Find the ICF/IID contact information at: http://www.dads.state.tx.us/providers/ICF/icfiid.pdf • Contact DADS Regional Director for Community Services. Find yours at http://cfoweb.dads.state.tx.us/ReferenceGuide/guides/FY13ReferenceGuide.pdf; page 127: “Regional Directors for Community Services” • You may want to ask for the initial functional assessment if the consumer is relatively new to the ICF/IID. If the consumer has lived in the ICF/IID for a while you can just ask for the IPP. SOURCE: DADS IL 2010-122: Referral to DARS for Individuals Who Are Interested in Employment; TAC, Title 40, Chapter 90; DADS website
ICF/IID/SSLC • SSLCs are the largest ICF/IIDs. • SSLCs all have employment units who find residents jobs in the community while living in the SSLC, or who are transitioning into a community living setting. • Contact your local SSLC and ask for the Supervisor of the Supported Employment Unit.
ICF/IID and DARS • Codes: • 08 = Determined ineligible for services • 26 = Successfully Rehabilitated • 28 = Unsuccessful Closure • 30 = Closed after eligibility but before IPE • Statewide calendar year 2012 out of 5,599 individuals in small and medium ICFs and 3,875 in SSLCs • 08 = 19 • 26 = 42 • 28 = 51 • 30 = 21 • Statewide calendar year 2013 out of (budgeted)5,625 individuals in small and medium ICFs and (budgeted)3,628 in SSLCs • 08 = 18 • 26 = 46 • 28 = 40 • 30 = 20 Source: DADS/DARS 02 & 08/2014 Data Run; DADS 2014-2015 Long-Term Care Plan for Individuals with Intellectual Disabilities and Related Conditions
STATE GENERAL REVENUE • SGR-funded services are primarily intended to help people remain in their own or their family's homes. These services are provided by or through a local authority(LA). • Consumers receiving services through SGR have a Service Coordinator (SC). The SC is an LA staff whose job it is to help people access medical, social, educational, and other appropriate services and supports that will help them achieve an acceptable quality of life and community participation. • For information about the availability and type of employment services funded, if any, through SGR contact the Director of Employment Services or Director of Access and Intake at your LA.
TEXAS1915 (c) WAIVERS • Operated by DADS, administered by HHSC Medicaid/CHIP: • Home and Community-Based Services (HCS) • Community Living Assistance and Support Services (CLASS) • Texas Home Living (TxHmL) • Medically Dependent Children’s Program (MDCP) • Deaf Blind with Multiple Disabilities (DBMD) • Operated by DSHS/MHSA, administered by HHSC Medicaid/CHIP: • Youth Empowerment Services (YES) SOURCE FOR ALL 1915(C) WAIVER PROGRAM INFORMATION: HHSC Medicaid/CHIP Approved Waiver Applications: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.html
HCS Menu of Services Adaptive Aids (ESPS) Respite Audiology (ESPS) Social Work Behavioral Support Speech and Language Pathology Day Habilitation Support Consultation (CDS) Dental Treatment Supported Employment Dietary Services Supported Home Living EMPLOYMENT ASSISTANCE Financial Management Services (CDS) Minor Home Modifications Nursing Occupational Therapy (ESPS) Physical Therapy (ESPS) Prescribed Drugs (ESPS) Residential Assistance (Host Home/Companion Care, Supervised Living, Residential Support Services) ESPS= Extended State Plan Services CDS = Consumer Directed Supports
(Some) HCS Services That Have “Caps” Adaptive Aids: Adaptive aids may not exceed $10,000 per service plan year and is subject to the individual total annual service cost limit of the waiver. Dental Treatment: The total amount allowable for the dental treatment service is limited to a maximum expenditure of $1,000 per individual per service plan year. Minor Home Modifications: The maximum lifetime expenditure for this service is $7,500. Once that maximum is reached, $300 per service plan year per individual will be allowed for repair, replacement, or additional modifications. Prescribed Drugs: Unlimited prescribed medications beyond the three per month limit available under the Texas Medicaid State Plan unless the individual is eligible for both Medicaid and Medicare (dually eligible). An individual who is dually eligible must obtain prescribed medications through the Medicare Prescription Drug Plan or, for certain medications excluded from Medicare, through the Texas Medicaid State Plan.
HCS Day Habilitation • HCS Day Habilitation service definition is the same as the slide entitled “LTSS Definition”- Day Habilitation, except for these additions for HCS participants: If the individual’s personal goals or current needs as they may relate to long term employment goals can be met through day habilitation, this choice is an option. These environments might be facilities, but if justified by the preferences of the individual the service can be provided in a non-facility environment. Individuals aged 17 or older may choose to discontinue school and participate in day habilitation.
HCS Plans/Staff You Need to Know About! • The Person Directed Plan (PDP) identifies supports and services necessary to achieve the individual's desired outcomes; existing supports, including natural supports and other supports, available to the individual and negotiates needed services system support. The PDP is the foundation for the Individual Plan of Care. • The Individual Plan of Care (IPC) documents an individual's Home and Community-based Services (HCS) program services and non-HCS services. • Among other duties the HCS Service Coordinator (SC) is responsible for coordinating the development of the initial IPC with the Service Planning Team (SPT) and assisting the individual in accessing non-waiver services. The SC is an employee of your Local Authority. • The HCS Direct Service Agency (DSA) provider is responsible for providing all waiver services identified in the IPC.
HCS and DARS Statewide budgeted number of HCS recipients for State Fiscal Year 2014 : 20,471 Interest List as of July 2014 for HCS: 71,802. Time on list is maximum of 12 years. HCS recipients served by DARS in calendar year 2013 08 = 49 26 = 132 28 = 142 30 = 86 • Codes: • 08 = Determined ineligible for services • 26 = Successfully Rehabilitated • 28 = Unsuccessful Closure • 30 = Closed after eligibility but before IPE • Source: DADS/DARS 08/2014 Data Run and http://www.dads.state.tx.us/services/interestlist/
CLASS Menu of Services (as of 8/31/2014) Adaptive Aids/Medical Supplies(ESPS) Respite In/Out of Home (CDS) Adult Day Health Skilled Nursing Services(CDS & ESPS) Behavioral Support Specialized Therapies Case Management Speech/Hearing/Language (CDS & ESPS) Continued Family Services Support Consultation(CDS) Dental Services(ESPS) Supported Employment Dietary Services/Nutritional Services Support Family Services Financial Management Services (CDS) Transition Assistance Services Minor Home Modifications Occupational Therapy (CDS & ESPS) Physical Therapy (CDS & ESPS) Pre-Vocational Services Prescriptions(ESPS) Residential Habilitation (CDS) ESPS= Extended State Plan Services CDS = Consumer Directed Supports
(Some) CLASS Services That Have “Caps” • Pre-Vocational Services: Maximum cost of $13,965 per service plan year. Exceptions to the service limit will be granted on an individual basis if justified by the service planning team. • Dental Treatment and Adaptive Aids/Medical Supplies: Combined annual service limit of $6,935 not to exceed $10,000 per IPC Year. • Minor Home Modifications: $7,515 lifetime maximum with $300 for repairs every year thereafter when such repair or replacement is not covered by warranty. • The individual cost limit or “cap” for all CLASS waiver services is $114,736.07 per plan year.
CLASS Plans/Staff You Need to Know About! • Consumers receiving CLASS have two service plans: • An Individual Plan of Care (IPC) and • An Individual Program Plan (IPP). Both the IPC and IPP address non waiver funded services. • CLASS Case Managers are responsible for coordinating Service Planning Team (SPT) meetings to develop the IPC and IPP. • Find the CLASS Case Management Agencies at http://www.dads.state.tx.us/providers/CLASS/choicelist/index.html.
CLASS and DARS Statewide budgeted number of CLASS recipients for State Fiscal Year 2014 : 4,655. Interest List as of July 2014 for CLASS: 51,360. Time on list can be up to 10 years. CLASS recipients served by DARS in calendar year 2013 08 = 16 26 = 36 28 = 39 30 = 28 • Source: DADS/DARS 08/2014 Data Run and http://www.dads.state.tx.us/services/interestlist/
TxHmL Menu of Services Adaptive Aids (CDS) Prescription Medications (ESPS) Audiology (CDS) Respite (CDS) Behavioral Support (CDS) Skilled Nursing (CDS) Community Support (CDS) Speech/Language Therapy (CDS) Day Habilitation (CDS) Support Consultation Services (CDS) Dental (CDS) Supported Employment (CDS) Dietary (CDS) Employment Assistance (CDS) Financial Management Services (CDS) Minor Home Modifications (CDS) Occupational Therapy (CDS) Physical Therapy (CDS) ESPS= Extended State Plan Services CDS = Consumer Directed Supports
TxHmL Community Support Service • Community Support: Habilitative or support activities are provided that foster improvement of or facilitate an consumer’s ability and opportunity to participate in typical community activities, including activities that lead to successful employment, to access and use available non-waiver program services or supports for which the consumer may be eligible, and to establish or maintain relationships with people who are not paid service providers that expand or sustain the individual's natural support network. Transportation or assistance in obtaining transportation is provided by this component, the cost of which is included in the rate paid to the program provider.
(Some) TxHmL Services with “Caps” • Adaptive Aids: The maximum amount available is $6,000 per consumer per year. • Dental treatment: Limited to a maximum expenditure of $1,108.06 per individual year. • Minor Home Modifications: Limited to a maximum lifetime expenditure of $7,500. Once that maximum is reached, $300 per year will be allowed for repair, replacement, or additional modifications. • “Cap” for all TxHmL services is $17,000 per year
TxHmL Plans/Staff You Need to Know About! • Consumers receiving TxHml have two plans: • A Person Directed Plan (PDP) and • An Individual Plan of Care (IPC) . Both the PDP and IPP address non waiver funded services. • Among other duties the TxHmL Service Coordinator (SC) is responsible for coordinating the development of the initial IPC with the Service Planning Team (SPT) and assisting the individual in accessing non-waiver services. • The SC is an employee of the Local Authority (aka MHMR/Community Center).
TxHmL and DARS Statewide budgeted number of TxHmL participants for State Fiscal Year 2014: 5,738. Interest List as of July 2014 for TxHmL is same as HCS: 71,802. TxHmL draws from HCS interest list and time on TxHmL interest list should be shorter than HCS. Individuals receiving a TxHmL slot remain on HCS interest list. Individuals may also have the opportunity to enroll in TxHmL through refinancing of his/her general revenue services. TxHmL recipients served by DARS in calendar year 2013 08 = 21 26 = 58 28 = 56 30 = 22 • Source: DADS/DARS 08/2014 Data Run and http://www.dads.state.tx.us/services/interestlist/
MDCP Menu of Services • Adaptive Aids • Flexible Family Support Services • Minor Home Modifications ($7,500 lifetime limit) • Financial Management Services • Respite • Transition Assistance Services • Employment Assistance • Supported Employment
MDCP Plans/Staff You Need to Know About! • Consumers receiving MDCP have an IPC that is developed by: (1) the individual; (2) the individual's parent or guardian; (3) the case manager; (4) a DADS RN; and (5) any other person who participates in the individual's care, such as the provider, a representative of the school system, or other third-party resource. • To Find the MDCP Case Manager go to this link and call the appropriate DADS Regional Office for assistance: http://www.dads.state.tx.us/contact/regional_facility/index.html.
MDCP and DARS • Statewide number of MDCP participants in 2012: 976. • Interest List as of July 2014 for MDCP : 27,278. Time on list can be up to 6 years. • MDCP participants served by DARS in calendar year 2013 • 08 = 4 • 26 = 6 • 28 = 4 • 30 = 12 • Source: DADS/DARS 08/2014 Data Run and http://www.dads.state.tx.us/services/interestlist/
DBMD Menu of Services Adaptive aids and medical supplies Residential habilitation Assisted living (licensed up to six beds) Respite care Audiology Speech, hearing and language therapy Behavior support services Supported employment Case management Transition assistance services Chore provider Outdoor Camping Experience* Day Habilitation Family Training* Dental treatment Dietary services Employment Assistance Intervener Minor home modification Nursing services Occupational therapy Orientation and mobility Physical therapy Prescription drugs, if not covered through Medicare * These services not funded through Medicaid
DBMD Plans and Staff You Need to Know About…and some more info! • Texas is the only state in the U.S. to have a Medicaid Waiver Program specifically for persons who are deaf-blind with multiple disabilities! • DBMD consumers have an Individual Plan of Care (IPC) developed and facilitated by a DADS Case Manager and a support team. • To Find the DBMD Case Manager go to this link and call the appropriate DADS Regional Office for assistance: http://www.dads.state.tx.us/contact/regional_facility/index.html.
DMBD and DARS • Statewide budgeted number of DBMD participants in State Fiscal Year 2014: 158. • Interest List as of July 2014 for DBMD: 435. Time on interest list can be up to 4 years. • DBMD recipients served by DARS in 2013 • 08 = 0 • 26 = 0 • 28 = 0 • 30 = 0 • Source: DADS/DARS 08/2014 Data Run and http://www.dads.state.tx.us/services/interestlist/
YES Menu of Services A DSHS/MHSA 1915 (c) Waiver • Adaptive Aids and Supports and Minor Home Modifications: $5,000 collective annual limit • Community Living Supports • Family Supports • Non-Medical Transportation • Paraprofessional Services • Specialized Therapies (Art Therapy- Music Therapy- Animal-assisted Therapy- Recreational Therapy- Nutritional Counseling) • Supportive Family-based Alternative • Transitional Services SOURCE: YES Approved Waiver Application: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.html
More YES Information • YES currently covers individuals 21 and under who meet a Level of Care for inpatient psychiatric facility for as provided in 42 CFR §440.160. • Cost of all services cannot exceed100% of the cost of the level of care specified. • Currently YES is provided in the following counties: Bexar, Brazoria, Cameron, Galveston, Hidalgo, Fort Bend, Harris, Tarrant, Travis, and Willacy. SOURCE: YES Approved Waiver Application: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.html
STAR+PLUS Waiver (SPW) Formerly known as Community Based Alternatives or CBA • As of 09/01/2014 the CBA 1915(c) waiver was terminated and all “CBA-like” services are being provided through SPW only. • SPW services are provided through Managed Care Organizations (MCO). As with all Home and Community Based Waivers, HHSC Medicaid/CHIP is the Administrator of the SPW. • At this time, MCO “members” must meet a nursing facility level of care to participate in SPW. • An MCO Service Coordinator (MCO SC) brings together acute care and long term supports and services. Service coordination includes development of an Individual Service Plan (ISP, aka Form H1700-1) with the individual, family members and provider. • You will need to ask the consumer to provide the name of his/her MCO SC or have the consumer locate the MCO SC by contacting his/her MCO health plan.
SPW Menu of Services CONSUMERS MUST MEET A NURSING FACILITY LEVEL OF CARE Adaptive Aids& Medical Supplies Minor Home Modifications Adult Foster Care Nursing Services Assistive Living Occupational Therapy Cognitive Rehabilitation Therapy Personal Assistance Services Dental Services Physical Therapy Emergency Response Systems Prescribed Drugs Employment Assistance Respite care (in-home) Financial Management Services Speech Pathology Services Home Delivered Meals Supported Employment Transition Assistance Services All Other Medicaid State Plan Services including Day Activity and Health Services and Primary Home Care, if eligible. SOURCE: HHSC STAR+PLUS Handbook: http://www.dads.state.tx.us/handbooks/sph/index.htm
SPW • Our CRPs continue to be contacted by MCOs to contract with the MCOs to provide Employment Assistance and Supported Employment*. • It is the CRP’s decision whether to contract with an MCO. MCO contracts have nothing to do with DRS services. • All DRS employment services provided through CRPs will stay the same. DRS rates paid to CRPs will stay the same. If an MCO gives the CRP or you different information, please contact a Program Specialist in Central Office! *Remember that SPW Supported Employment is not a service DRS provides.
SPW Estimated number of people receiving SPW services in calendar year 2013: 133,000. CBA 1915(c) recipients only served by DARS in calendar year 2013 (Prior to all CBS services moving under SPW): 08 = 8 26 = 19 28 = 27 30 = 20 Source: DADS/DARS 08/2014 Data Run
Sara Kendall Program Specialist Texas Department of Assistive and Rehabilitative Services Division for Rehabilitation Services (512) 424-4156