Barbara Davis, MSW, Assistant Deputy DirectorIntellectual and Disability Authority Services

MHMRA of Harris County

Change of HCS Case Managementto Service Coordination by

the Local Authority

Texas Legislature (SB 1, Section 48,81st 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 state-wide waiting lists will receive waiver related community services by August 2011.

‣ Additionally, HCS services will be provided to people leaving largeand medium ICF/MRs, children aging out of foster care, and children and adults at risk for institutionalization.

‣ The funding for increased community services is contingent, in part, on the transfer of case management from the HCS Provider to the Mental Retardation Authority.

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Purpose of Transition

Texas Legislature’s goals to increase:

Oversight of community-based services quality

Person-directed planning of services & supports

Accountability of HCS program – approximately:

Statewide-16,800 HCS Participants (current); over 20,000 with expansion for 500 HCS Providers.

Harris County- 2,450 participants (current); 2,800 with expansion for 207 HCS providers

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Purpose of Transition to Service Coordination by Local Authority

Primary Intellectual and Disability Authority goals prior to June 1, 2010 implementation:

‣ Clear delineation and common understanding of fundamental functions of the Intellectual and Disability Services Coordinator and HCS Provider.

‣ Staffing, training and equipping MRA operations to provide qualified and consistent Service Coordination for HCS participants.

‣ Productive communications with the HCS Provider network to ensure effective long-term working relationships.

‣ Support for HCS participants and families to minimize service disruption and promote progress towards each person’s desired outcome.

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Service Coordination for Home and Community Based Services

‣ September 2009 - DADS stakeholders meeting on draft HCS and ServiceCoordination rules held on 9/14/09.

‣ January 2010 – Proposed HCS and SC Rules sent to MCAC & DADS Councilfor approval to publish in Texas Register.

‣ February 2010 – Proposed Rules published in Texas Register for 30 days.

‣ March 2010 – Public comments on proposed rules received and reviewed.

‣ April 2010 – Proposed rules revised as needed, response to publiccomment.

‣ Training for HCS Providers and Intellectual Disability Authority Servicesbegins.

‣ May 2010- Training for HCS Providers and MRAscontinues.

‣ June 2010 – Implementation of HCS and SC rule changes-HCS CaseManagement becomes MRA Coordination.

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DADS’ Transition Timeline

Primary DADS efforts:

Develop new procedures, handbook, forms, etc. (Person-Directed Plan & Implementation Plan)

Make changes to agency management information system (CARE)

Communicate changes to HCS Participants & families

Develop & provide joint training for MRA and HCS Providers

Establish HCS Provider transitional case management requirements (flexibility)

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DADS’ Transition Activities

‣ October 2009 – Plan and schedule Provider & Intellectual Disability Transition meetings.

‣ December 2009 – Obtain access to Electronic Data Transfer System (EDTS).

‣ January 2010- Begin establishing Intellectual Disability consumer records.

‣ February 2010- Develop a SC for HCS transition webpage on Center’s website.

‣ March 2010- Educate local Advisory Boards, PNAC, and Center Board of Trustees.

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Local Authorities’ Transition Timeline

‣ April 2010

• Plan and schedule Consumer/Family information meetings• Determine staff requirements- HCS SCs, supervisors and

support• Develop HCS service coordination job duties and job

descriptions• Develop methodology for establishing and assigning HCS SC

caseloads • Revise policies and procedures as needed • Develop HCS SC training plan and curriculum• Begin process of hiring HCS SCs • Begin process of hiring HCS SCs • Begin training HCS SCs, including training provided by DADS• Assign SCs to HCS participant caseloads• Create Provider/Intellectual Disability contact lists

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Local Authorities’ Transition Activities

Infrastructure and Number of Service Coordinators NeededNumber of staff persons - 83 Number of service coordinators – 61; including one Service Coordinator Floater (February and March, 2010) Service coordinators will be home-based; except Waiver Enrollment service coordinatorsNumber of Program Directors-2Number of Team Leaders - 4 Number of Support Staff - 15

Factors Considered:Number of HCS providers – 243 as of March 15, 2010Number of active HCS Providers – 152 as of March 15, 2010Number of inactive HCS Providers – 91as of March 15, 2010Number of persons enrolled in HCS program – estimated 2,800 by June 1, 2010)Average Caseload size - 45 consumers per service coordinator Frequency of face-to-face contacts- Initially, monthly contacts will be made to determine an individual’s level of need. Thereafter; contacts will be based on the level of need, but no less than every three (3) months.

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Local Authority: Infrastructure and Number of Service Coordinators Required

September 2009 – Determined SC:HCS infrastructure requirements ( Service coordinators , SC floaters, SC mentors, management andsupport staff).

October 2009 – Provider & Intellectual Disability transition meetings were initiated and are being held on a monthly basis.

To ensure a smooth transition, HCS Provider Network agreed to establish Intellectual Disability SC/HCS CM Transition work group (schedule for both meetings posted on Intellectual and Disability Services (IDS) website).

December 2009 – Began process of interviewing and hiring management and support staff for SC:HCS.

January 2010 - Made Presentation on “Transition of HCS Case Management to MRA “at The Arc of Greater Houston’s annual meeting on January 19, 2009.

Transition Activities for Harris County

January 2010 - Began scanning 2,300 GR consumer records to accommodate the incoming HCS records.

January 2010 – Held first Intellectual Disability SC/HCS CM Work group meeting

January 2010 – Began process for reviewing HCS Provider/consumer information in DADS Electronic Data Transfer System (EDTS).

February 2010 – Completed interviewing and hiring of management and support staff.

January 2010 – Assigned HCS Providers to SC:HCS teams by Provider.

February 2010- Participated in meeting with MHMRA Case Management Advisory Board

Transition Activities for Harris County

February 2010- Completed interviewing, and hiring process for 60 service coordinators with start dates scheduled February through March.

February 2010 – Develop a “Service Coordination for HCS” webpage on (MRSD) website. (www.mhmraharris.org)February 2010 – MHMRA required training of service coordinators and other SC:HCS staff.

February 2010 – Developed policies and procedures based on draft Revised HCS Rule; will modify as necessary upon approval of Revised HCS Rule.

February 2010- Began process of developing SC:HCS training plan & curriculum

Transition Activities for Harris County

February 2010- Currently, Intellectual Disability & Providers are in the process of to pairing service coordinators with case managers for introduction to HCS participants, their families, and providers.

February 2010 – Currently, Intellectual Disability receiving HCS Providers’ contact information to coordinate meetings for Intellectual Disability to meet with HCS participants and theirfamilies.

February 2010 - Developed PowerPoint presentation for HCS participants and families regarding HCS case management transfer(based on template by Texas Council for MHMRA Community Centers).

February 2010 - Developed brochure on “Transition of HCS case Management to Intellectual Disability Service Coordination” to mail to all HCS participants and families; brochure approved by TexasCouncil for MHMR Centers.

Transition Activities for Harris County

February 2010- Currently, the Local Authority & Providers are in the process of to pairing service coordinators with case managers for introduction to HCS participants, their families, and providers.

February 2010- Currently, the Local Authority & Providers are in the process of to pairing service coordinators with case managers for introduction to HCS participants, their families, and providers.

March 2010 – Continue training of service coordinators and other SC:HCS staff.

March 2010 - Continue assignment of HCS participants to the remaining 30 service coordinators (SCs).

March 2010 – Obtain Consumer information from HCS Provider not available in DADS’ Electronic Data Transfer System (EDTS).

Transition Activities for Harris County

March 2010 - Transfer of Provider records; completion date by April 1st.

April 2010 – Training provided by DADS.

May 2010- Quality Assurance staff for SC:HCS to be hired.

May 2010 – Training provided by DADS continued.

June 2010 - Implementation of SC:HCS.

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Transition Activities for Harris County

Major areas of change:‣ Case Management service component removed from HCS

service array – Intellectual Disability Service Coordination to be provided to HCS participants.

‣ HCS Interdisciplinary Team no longer used by HCS Provider –Services Planning Team members to be chosen by the HCS Participant/LAR and coordinated by the Intellectual Disability Service Coordinator.

‣ Person-directed planning by Intellectual Disability becomes ongoing foundation of services & supports from HCS enrollment until discharge.

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Fundamental Changes Effective June 1, 2010

‣ Service Planning Team per HCS rule:

“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).”

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Service Planning Team

‣ Empowers person or LAR to direct development of services & supports to meet personal outcomes

‣ Identifies existing supports & services necessary to achieve desired outcomes

‣ Identifies natural supports available to person & negotiates needed services

‣ Occurs with support of a group of people chosen by person or LAR

‣ Accommodates person’s style of interaction and preferences

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Person Directed Planning Process

1. Person-Directed Plan (PDP)

2. Individual Plan of Care (IPC)

3. Implementation Plan (IP)

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Planning Elements for HCS Participants

Services Planning Team responsible for writing a Person-Directed Plan (PDP) that describes the services and supports necessary to achieve desired personal outcomes identified by the person or LAR and to ensure person’s health and safety. PDP development guided by a process of discovering the person’s desires and needs over time. PDP is updated annually and as necessary.

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Person Directed Plan

HCS provider, person or LAR and SC coordinate to develop the IPC based on outcomes identified in PDP. IPC lists the services to be provided, amount of services, and cost of those services. IPC also lists non-HCS services person will access. HCS provider must complete and submit IPC to DADS electronically. Intellectual Disability SC agrees or disagrees with IPC based on its match to the PDP. DADS must approve IPC. IPC is renewed annually and revised as necessary.

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Individual Plan of Care

After DADS approves IPC, IP is developed by HCS provider (unless CDS) with input from the person or LAR. IP describes and directs the delivery of services and supports, including when, where and who will provide services. IP strategies serve as a justification for units of service on the IPC. IP must contain a list of the outcomes identified in PDP to be addressed with HCS services. IP does not require SC agreement but requires person or LAR to agree on how services will be delivered and to sign completed IP.

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Implementation Plan

Intellectual Disability SC to monitor provision of individual’sprogram services:

‣ Document person’s progress towards achieving outcomes in PDP.‣ Determine whether HCS services are being delivered by HCS

provider or CDS provider‣ Determine whether non-HCS services are being delivered‣ Ensure coordination and compatibility of HCS/non-HCS

services with HCS provider‣ Communicate concern about PDP implementation to Provider,

ensure attempts to resolve.

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Monitoring: Service Coordination by the Local Authority

‣ Frequency of SC monitoring will vary based on the needs of the person.

‣ Minimum frequency of contact is quarterly – more frequent contact based on the person’s level of need

living environment/caregiverdaily living skillsphysical, emotional, or behavioral health safety & rights/legal status

‣ Discovery process for PDP development or renewal includes determination of frequency.

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Service Coordination Frequency

Monitor delivery of services on IPC in accordance with HCS Program Certification Principles.

Monitor progress related to program services in accordance with IP.

Communicate need for changes to Intellectual Disability SC, HCS provider’s service providers, relevant others.

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Monitoring: HCS Program Provider

‣ Conduct residential & certification reviews of HCS Providers to evaluate compliance with HCS Principles – DADS Regulatory

‣ Continue to approve IPCs & Levels of Need – DADS Utilization Review

‣ Conduct reviews of Service Coordination for individuals in the HCS Program – DADS Intellectual Disability Compliance

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Oversight: DADS

Intellectual Disability SC must inform and assist HCS participant/LAR regarding:

‣ Exercising legal rights as citizen & person with disability

‣ Process for filing complaints with Intellectual Disability aboutSC provision

‣ Process for filing complaints about HCS services to Intellectual DisabilityDADSDFPS to report allegation of abuse, neglect or exploitation

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Local Authority: Rights and Complaints

Manage, review and/or ensure informed choice as applicable:

Emergency HCS services/related plan changes Level of Need assessments (agree/disagree)Suspension of HCS servicesTermination of HCS servicesTransfers between HCS ProvidersRight to participate in Consumer Directed Services optionPermanency Planning for persons under age 22

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Local Authority: Additional Responsibilities