IDD Directors’ Consortium September 14-15, 2017

HOTEL

Embassy Suites Central

5901 N IH-35

Austin, TX 78759

512-454-8004

OFFICERS

Chair: Jennifer Farrar, Betty Hardwick Center

Vice-Chair: Janet Brunette, Bluebonnet Trails

Secretary: Kevin Barker, Texana Center

Treasurer: Ronnie Cardenas, Center for Life

Resources

Liaisons ED Consortium: Barbara Tate, Susan

Garnett

TX Council of Community Centers: Erin Lawler

AGENDA

Day 1: Thursday, September 14, 2017

Time Topic Speaker and Desired Outcomes

8:00am Conference room open

8:30am Welcome *First Timer Intros.

*Agenda Review

Jennifer/Janet

Erin Lawler asked for new members to introduce themselves.

Darlyn Sustaita – Gulf Bend

Diana Lara – El Paso

Analuara McCrae – Hill Country Rebecca – Starcare

Donna Pack – Pecan Valley Valissa Woodard – Pecan Valley

Amanda – Harris Center

Jerome – Emergence

Erin reviewed the agenda for Thursday and Friday.

Disaster Response call was cancelled due to meeting. We will have discussion

with Haley regarding any issues and concerns the local authorities are experiencing.

Contact information spread sheets were distributed.

8:45 am

Texas Council and

Executive Directors’

Update

Erin Lawler, Director of Intellectual and Developmental Disability

Services, Texas Council;

Good News!

There is a new IDD Provider Focused Workgroup. Erin reviewed the list of

members. It is primarily focused on IDD Provider Services issues and

concerns regarding sustainability of services and navigating the transition

of services to managed care.

Disaster Response

14 LIDDA’s affected

30,000 people affected

300,000 Homes affected.

Texas Council acting as connector for the LIDDA’s

HHSC has a Hurricane Harvey FAQ website.

There is a Texas Council Hurricane Harvey Resource Page on the website.

HCS/ TxHmL

Effective August 1, 2017 reimbursement rates went from $22.41 per hour to

$17.73 per hour which was a 21% reduction in the base rate.

One provider at Gulf Bend has decided to terminate their TxHmL contract.

Tarrant County terminated their HCS Contract. 124 individuals were

affected and 66 staff was affected. Resources are being focused on the

service coordination services to support the people served by providers

willing to accept the clients. Day habilitation services will continue to be

provided. They will work with providers to transition the clients to the new

provider.

Process was:

• Speak to Board and PNAC.

• Meet with Stakeholders and families.

• Meet with staff.

• Held a provider fair. Many providers and families participated.

Tri-County is cancelling the Texas Home Living contract. 19 people will be

affected.

Heart of Texas is experiencing losses in Texas Home Living and possibility

of closing programs. There is concern about the impact on private providers

absorbing the clients from providers who are terminating their contracts.

Bluebonnet stated that families in TxHmL that have moved to new

providers in their area are now terminating their contracts causing issues

with continuity.

Incremental cuts in many areas have made it difficult over time to sustain

services.

Three centers are working with Texas Workforce for employment but

response remains very low.

There is concern that the costs will rise due to people moving to services

that are more costly than CFC such as foster care or group home.

There was a concern raised that would the PASRR rates follow the path of

the CFC rates and be reduced.

Texas Legislature reduced HCS Promoting Independence slots and did not

fund HCS and TxHmL Interest List Reduction.

HHSC requested LIDDA’s assist in timely completing pending HCS

enrollments as any HCS enrollments left pending as of August 31, 2017 will

carry forward and reduce HCS slot allocation for the current Biennium.

Enrollment staff should read the HHSC Enrollment Plan for FY 2018-

2019.

Performance Contract

Performance Contracts distributed September 1, 2017. Many centers have

not received information regarding their allocations.

Expect update on Quarter 1 Allocations from HHSC today.

Budget: Funding for Transition Support Teams and Enhanced Community

Coordination will end December 1, 2017.

LIDDA’s will not be required to submit an IDD Crisis Respite Plan update

or revision on annual basis. It is required to maintain an HHSC approved

plan that meets the contract requirement and must revise approved crisis

respite plans, as needed, based upon reassessment of local needs or

changes.

Are children under CPS conservatorship using IDD Crisis Respite?

Tarrant County has had one instance. They have reached out to HHSC if

there is a diversion available and there has been no response. In the past

there has been pushback by CPS to compensate the provider because they

are not licensed in accordance with other licensed providers. Bluebonnet

and Texana Center has also had these issues. Texana Center had an

incident where CPS contracted with an HCS Provider and clients that did

not have waiver services were referred for crisis respite services were

referred.

IDD System Redesign

IDD Managed Care Pilot

There are two vendors who were awarded contracts for the IDD Pilot for

the following counties contingent upon CMS approval:

Molina HCT: Bexar, Atascosa, Dallas

United Healthcare Community Plan of Texas: Brazoria, Harris, Galveston,

Fort Bend, Matagorda, and Wharton.

HCBS Settings

There is a requirement for compliance by March 2022. The state needs to

submit a plan by March of 2018 and implementation by March of 2019.

August 2017 HHSC released the HCBS Assessment Results IDD Program

External Assessment

Areas of Concern Identified:

Individual Autonomy

Access to transportation

Individualized community integration activities in residential programs

LAW and Texas Council came up with recommendations for addressing the

findings and developing the compliance plan.

Discussion Items

PASRR Lawsuit: CPR/DOJ/DRTx Visits discussion to the members.

The visits by CPR/DOJ/DRTx for PASRR in which Attorneys are meeting

with staff are very overwhelming. It was stated that staff should be directed

to respond to all questions honestly and truthfully.

State has requested that the Plaintiffs provide any information discovered.

Staff is not legally required to participate in meetings, but each center

would have to make the determination as to whether they will participate or

not. The centers can ask for time to seek guidance when participating.

There was a concern that service coordination staff are being asked

questions that are at a knowledge base of an administrator. There are

concerns that requests asked by the nursing facility to meet are not

disclosing that an attorney would be present or what the reason for the

meeting is.

There were concerns raised that the ways the questions are asked leads the

staff provide information that places blame on HHSC. They ask leading

questions. Many service coordinators are being contacted directly.

One center took the approach that the legal counsel for the center contacted

Disabilities Right to notify them that they were the point of contact for the

center for any requests for information they are requesting.

Centers can limit the amount of time they can meet with the staff. Centers

can make the decision to refuse audio or video recording of the meetings.

The crux of the PASRR Lawsuit is to claim the State of Texas has not

provided resources to serve individuals in nursing facilities in the

community.

Emphasis of questions is the process of early intervention to identify

individuals being admitted in nursing facilities that can be diverted and

served in the community.

PASRR Updates

Habilitation Coordination: Local IDD Authority as exclusive provider.

PASRR Specialized Services: Open to other provider types. IF CMS

approves the entities eligible would be providers of:

• HCS

• TxHmL

• CLASS

• DBMD

HHSC and Texas Council developed a survey to evaluate Habilitation

Coordination rates.

Results reflected an enhanced case rate due to the expertise and training

staff would require.

It has been stated that the Habilitation Coordination would be a case rate

and not set by A and B contacts.

The plan regarding the ICAP being replaced by a comprehensive

assessment is on hold.

9:45 am BREAK

10:00 am PASRR Panel Haley Turner, Deputy Associate Commissioner, Intellectual and

Developmental Disability Services HHSC; Michelle Dionne, Vahahlik,

QSR HHSC

1st Quarter allocations have been approved and will sent by next week.

HHSC Plan for PASRR has been submitted.

Habilitation Coordination is being proposed to be paid as a case rate.

PASRR 1915 B 4 Waiver was submitted to request the choice would be

limited to one person for Habilitation Coordination.

Question: How would the monthly case rate is earned? Face to face contact

with the individual is documented. The documentation would need to

include the required activities being documented.

There was not a 1915 B 4 Waiver submitted to request for Specialized

Service.

Question: Which providers would be eligible? All certified providers

currently providing services (Waiver Providers)

Question: Would there be a no refusal clause for those providers? No

information current.

Question: Would there be a process implemented that would require an

IPC? This is still work being completed.

PASRR now has portal where the nursing facility can complete the required

paperwork through the portal and the LIDDA have access to review the

status of the process and monitor activities. One issue that has come up is

many nursing facilities use the 3rd party provider Simple LTC. It has limited

functionality and nursing facilities need to be directed to use the portal.

There is work being completed to combine the IDT and PSS forms into one

form.

There will be a PASRR FAQ website set up as a result of questions gathered

from the PASRR Conference.

PASRR Evaluator Competency Assessments are being developed and

HHSC will be asking for feedback from stakeholders regarding what the

competency assessments should include.

Michelle Dionne Vahahlik –QRS

Cross Winds was the third party provider previously providing the QRS

Audit services. It is now being operated internally. The centers should not

have any interface with a Cross Winds representative. The first challenge

was developing the structure and training internal staff to implement the

processes.

Feedback provided to LIDDA’s and Nursing Facilities will be integrated in

the exit process from an audit. The processes and procedures are being

developed. One part of the process may be the results of the audit being

provided in a document form to the LIDDA and other providers so they are

aware of deficiencies and areas needing correction.

In a situation where the PE was developed in 2013 and prior to the

implementation of Specialized Therapies, should the fact that the services

were not available at the initial plan be considered in compliance with the

PE if they were not considered. It was stated that the information would be

provided to Martha Diasse for consideration.

Waivers as a result of Harvey will need to be considered for a 12 month

period by the audit team.

The Quality Monitoring Program is not a part of QRS.

QMP is not regulatory but is given monitoring capabilities for facilities. It is

to assist nursing facilities that are out of compliance with current

regulations to become compliant. They are to find what systems are broken

or non-existent that need to be developed and create those systems and

correct those systems. The LIDDA’s interface with the nursing facility will

be providing information needed to develop a PE. They may also need to

assist with developing processes. Providing signature sheets collected by the

service coordinator. QMP is not auditing a LIDDA.

Nursing homes are ranked by a Risk system. High risk facilities are seen

more frequently.

There will be a 2 day face to face PASRR training for nursing facilities. It is

to assist them to operationalize the requirements. The computer based piece

for the PASRR training will not available publicly. The training is free. It is

recommended that the administrators and nursing mangers attend. Most

nursing facilities are operated through a corporate structure and those

representatives would also be required to attend as well.

74% Turnover of staff in Nursing Facilities which affects implementation

and continuity issues. Turnover issues were found to be due to not being

supported by DON, Administrator, etc. The pressure of non-compliance

results creates a high stress level and results in people terminating their

employment or being terminated by the facility. Nursing Facility Survey

1. Limited Knowledge of Processes 2. Not being Supported by Management 3. No Knowledge of Services

11:00 am Top 10 Risk Areas

for Centers

Pam Beach, Attorney, Texas Council Risk Management Fund

Pam presented the top ten risk issues:

10. Don’t sleep with the clients. Upsurge in sexting incidents due to clients

with cell phones. The staff and clients are recording and filming on their

phone and incidents are being proven by recordings.

9. You Bought What? Failure to follow legal procurement procedure.

8. You said what? HIPAA and other consent and disclosure issues. Fines

are being implemented. Regardless of threats by attorneys, you follow

procedures.

7. Make My Day!

Not having a binding arbitration agreement can cost you big dollars. There

were 7 overtime cases presented. One resulted in a cost of 1 million from

one large center due to practice of requiring people to get billable hours in

and there were emails to support the case of the plaintiff.

6. Just suck it up and get back to work!

Failing to properly address ADA and FMAL issues. Staff can have a service

animal that is certified trained.

5. No, I didn’t write it down.

Failing to properly supervise and failing to document enough.

4. The Zombie Apocalypse and other Compliance Issues

Follow your compliance plans.

3. I’ve fallen and I can’t get up!

Avoid decision making leave.

2. Acts of God

Fires, Floods, Hail, Tornados, Hurricanes

Hail damage to vehicles has been a great cost to centers and the fund.

1.Get a horse!

Car accidents are the number 1 cost. Cell phone usage contributes to

vehicle accidents.

77 general liability claims at an average cost of $2,500.

86 professional liability claims at an average cost of $11,500 per case.

5 sexual misconduct cases

10 claims for licensing board complaints at average cost of $17,000 each

for defending allegations. If staff gets a complaint from their licensing

board they should notify the center to engage the Risk Management

representative.

170 claims over 6 years for discrimination with an average cost of $33,000

each.

FLSA Class action was $100,000 each case.

FLSA non Class Action was $37,000 each case.

Vehicle Accident claims are the number one cost. Cases have involved

death of employees and citizens due to negligence. One case resulted in a

$500,000 claim. Statistics will be sent out to members.

12:00 pm

LUNCH

1:15 pm Legislative

Advocacy

Presentation

Colin Rowan; Public Information-Special Interest Group

Provided information about a group that was developed to coordinate

ways to communicate the needs of communities and the implications

of legislative decisions made by the legislature on the individual

legislator districts.

Spoke about working with local media on presenting stories about the

services being provided to individuals with intellectual and

developmental disabilities. Large news markets have experienced

knowledgeable staff that seeks news stories. In smaller communities

you will have less experienced staff who will have limited knowledge

of our population and the service needs in the community.

There are efforts to work in conjunction with Texas Council to

coordinate targeted coverage of needs for people with intellectual and

developmental disabilities. Identifying community organizations who

can help share the information of the needs for our population.

We have to look at the level of understanding the legislators have

regarding our services. There are affordable ways to target

populations and regions where the centers can communicate their

message.

Some suggestions were having legislative forums with your local

representatives to educate them about the needs of individuals with

intellectual and developmental disabilities and the impact of reduced

funding. It is developing impactful stories by families and making a

connection with legislative staff.

We need to coordinate with other entities such as law enforcement,

county and city officials, the Arc and the two Private Provider

Associations with existing advocacy agencies to develop unified

messages to present to the legislative staff.

Types of messages:

Feel Good Stories

Families in Need

Community Involvement/ Community Resource

Stories from Other Centers who have engaged legislators in

conversations regarding services for people with IDD.

Denton met with Representative Stuckey and provided information

about the services and supports for people with IDD.

Tarrant County discussed their experience with engaging legislators

and touring facilities. It is important to have a unified message.

Community Healthcore had two opportunities. One to speak to

legislators regarding the importance of continuing the DSRIP

Projects and share information provided by Texas Council to their

legislators. The second was the Increasing of the transportation rates

being charged which did allow them to discuss with families the

reason for the increase and the reduction in funding that lead to the

increase.

Engage legislators on twitter and other social media.

PI-SIG is working on 2 things:

1. Message 2. Talking Points targeting a specific theme.

The IDD Consortium will keep this as a standing item.

Public Forum to discuss the impact of Harvey and lead into issues

with people with IDD.

Coordinated Messages that we all share with our legislators.

2:30 pm Provider Services

Update

Wendy Ivy, Assistant Director, Waiver Survey and Certification

HHSC Regulatory

Erin recognized Wendy and her staff on their disaster response by

coordinating efforts to track individuals affected by the hurricane. They

were making phone calls and getting updates on those affected.

Wendy stated that 1000 individuals were relocated. Approximately 1/3 has

not been able to return home. There are waivers for people that are staying

in homes.

A provider letter will be sent out to describe what the requirements for the

waivers will be and what will be required to request a waiver. For those

centers whose Certifications will end before their audit, WSC will request

continuation of Certification until they can be surveyed. WSC has lost 18

staff and the department is struggling. The main scheduler was a position

that was lost and so staff is trying to schedule as well as conduct surveys.

DFPS Provider Investigation Reports: 8628 (reviewed by 5 staff)

Complaints: 174

Deaths: 382 were reviewed. (Previously 2 RN’s reviewing, now just 1)

On-Site: 80 reviews that were a result of cases reviewed.

Residential Surveys –Scheduled for FY 18

15,131 – Residential Surveys Scheduled. The reviewers are allowed to

coordinate their visits throughout the year instead of having them

scheduled for the reviewer.

27- WSC Residential Reviewers for the state.

Certification Surveys scheduled for FY18: 1400

Quality Assurance: FY 2017

A QA team is sent to ensure consistency and accuracy of application of

TACS by Waiver Survey and Certification.

Two Part Approach:

QA Compliance Reviewers included as a part of the WSC team to ensure

compliance with WSC policies and procedures.

QA Look Behind Compliance Reviewers completes QA surveys per

Information Letter No. 16-37 and report findings to the QA Manager. QA

Managers assigned in the Valley Area, Houston, Dallas, Austin, San

Antonio. They rotate assignment of the staffs so that managers are not

getting the same information from the same staff.

Most Cited:

9.177(d)(1)(A) – Staff Training/ 250 Citations – 23 of a serious nature

9.174(a)(31)(B) – Monitoring of Medication / 245 Citations – 43 of a

serious nature

9.178(y) – Critical Incident Data/ 224 Citations

9.178(c)(2) – Onsite Inspection provided to Service Coordinator/ 197

Citations

9.174(a)(31)(J)(ii) – RN Documenting information from Nursing

Assessment/ 189 Citations/ 10 of a serious nature

9.177(n) – Background Checks/ 174 Citations/ 3 of a serious nature.

9.177(d)(1)(B) – Staff Knowledgeable of Identifying and Reporting ANE/

154 Citations- 2 of a serious nature

9.174(a)(31)(C) – monitoring health risks, data ensuring unlicensed

providers is performing nursing tasks identified from nursing

assessment./ 117 Citations – 22 of a serious nature

9.174(a)(3) – ensure no delay of services for HCS and CFC/ 87 Citations –

9 of a serious nature

9.178(g) – make all records available to all DADS, HHSC related to

service delivery of HCS, TxHL and CFC to authorized agencies/ 113

Citations – 1 of a serious nature.

3:00 pm BREAK

3:15 pm HHSC Update – Authority Services

Haley Turner, Deputy Associate Commissioner, Intellectual and

Developmental Disability Services HHSC;

Anthony Jalomo, Director, Local IDD Authority Section, HHSC, and

staff

Rebecca Logans – Hurricane Harvey Update from Friday of last week

was provided to the members. 11 LIDDAs evacuated out of their homes

or facilities. 2561 individuals are displaced.

Harvey Team set up to gather information from and disseminate

information to the LIDDA’s. Coastal Plains stated that they were no

longer displaced and have returned.

FY 18-19 Contracts Sent Last Week and also Letter to Proceed.

Continuing to work with partners to continue ECC and Transition

Teams through FY 18. Quarter 1 Allocations have been approved and

will be received within 5-7 days. Danette thanked Hayley and her Staff

for their work on getting the contracts and first quarter payments

processed.

Anthony Jalomo – Discussed the PASRR Code for Day Habilitation and

ICM Code for Day Habilitation to be rolled up into one code. The change

will be completed October 16, 2017. There will be only one Day Hab

code going forward after October 16.

Stacy Lindsay – HCS and Texas Home Living Enrollment. 5299 slots and

2985 people were enrolled. Included 2 ICF Closures for 76 people. 393

people prevented from institutionalization. 382 prevented nursing home

placement and 492 people transitioned from nursing facilities to the

community.

HCS and TxHL Slots for FY18-FY19. No new TxHL slots. HCS slots

allocated that were projected to be carried over 179 were funded and 29

were not funded. The total rolled over is 225 for funded slots and 13 for

non-funded slots. There will be a release of 25 slots per month for those

that are funded. There will be a number of attrition slots that are vacant

due to declines but are currently funded. These attrition slots will be a

Crisis Diversion Placement slots to be used to prevent people from being

institutionalized. SSLC will receive 11 per month, Large ICF 1 per

month and Small /Medium ICF up to 3 per month, CPS Transition 6 per

month, NF Transition 3 per month and NF diversion slots 1 per month.

The list of people requesting diversions will be collected as received. If

attrition slots are available, then the list will be presented and the first

people on the list will be allocated first.

Lindsay stated that of the slot monitors Jennifer has 30 packets for

diversion requests and Mindy has fewer.

Judy Southaw – QA Review process for the past FY Year. Some of the

LIDDA’s affected by Harvey were delayed and will go back to the

regular schedule for FY 19. The sample size will be the same for all

LIDDA’s 5 records for PASRR, 2 SC refusal and 1 interview, 5 records

HCS, 5 records for Texas Home Living, 5 records, for GR 5. First 120

day review some will have a desk review. If the LIDDA is out of

compliance and below 90 there will be a second 120 day review will be

desk review only on those items that were out as of the last review to

focus on coming into compliance. The check list for the review and the

names to be reviewed will be provided in advance.

Statewide Compliance Scores:

QA-92%

TxHmL – 85.26%

HCS – 87.37%

PASRR – 89.25%

CFC – 88.68%

Data Verification

Permanency Planning Information on Line Next Week. The forms are on

the website.

Duretha Robinson – Corrective Action Plan

Elements for Review

Specific rule / regulation

Expectation of authority requirement

What is out of compliance.

Specific Correction – Address the finding for an individual record. What

will be done to address the issue with the individual person. I.e. Changing

Service Statements to Outcome Statements

N/A can be used if there is no feasible opportunity to correct the finding

for the specific record (individual moved out of catchment area or I no

longer in services.

Systemic Correction – What will you change in your processes to ensure

the citation does not occur again? Should include all LIDDA staff

involved in the finding. Describe training to be provided. Description of

Evidence to support systemic correction.

Monitoring Correction – What monitoring system you will implement to

verify systemic change is measurable and ensures deficiency is not

repeated.

Type of Quality Oversight

Specific Number of Records Monitoring

Frequency of Records Monitored

Specific Element Monitored

LIDDA staff responsible

Supervisory Staff designated

Projected Completion Date would be submitted after the Systemic

Correction is completed.

The template had problems last year and those templates are being

corrected.

Wesley Jarvanoski – Disaster Response

Share Hurricane broadcasts to Service Coordinator staff. Commissioner

Gaines will be sending out a broadcast for LIDDA contract requirements

that are approved by her to be waived the first quarter of FY 18.

5:00pm Adjourn

Day 2: Friday, September 15, 2017

8:00 am Conference room open

8:30 am Business Meeting

• Financial Report

Jennifer

Ronnie

Update on Financial Report for the IDD Consortium was presented by

Ronnie. $16,400 in the account. $7,400 is the expense for this meeting and

the remaining balance will be $9,000.

Next Meeting Topics:

We have a panel on Hurricane Harvey response and what we learned for

the next meeting. Also develop recommendations.

ABLE Program update.

Massachusetts PASRR Lawsuit

Arc work on person centered planning.

Next meeting: January 11, 12 2018.

Ongoing discussions on stories we can share with legislators. Identify

how we can implement the success for the BH legislatively for the IDD.

HHSC Representative to speak on the HCBS Settings Rules

Panel Discussion on how private and public providers are faring with the

rate cuts. Have a representative from the Private Provider associations.

The direction of Day Habilitation

Invite waiver survey and certification as a regular guest.

Current state of CFC and the low utilization of CFC due to delayed

authorizations.

Discussion regarding Employment services and what providers are

doing. Invite Monty Chamberlain to present again.

Invite Enrique Marquez who took the position previously held by Gary

Jessee to discuss LIDDA Authority and Provider Services.

Have Judy Southaw speak about Outcomes and the vision of how

Outcomes should be developed.

8:45 am Monthly TCM

Documentation

Update

Carin Shuford and Sheri Talbot, Texana Center – Kevin Barker Intro

Sheri and Carin presented the piloted Targeted Case Management Monthly

Documentation Notes Updates on the challenges.

Why Texana wanted to do it:

Continued citations for documentation for progress, lack of progress,

satisfaction, lack of satisfaction every 90 days.

Maximize the use of data to drive decision making.

Focus on people and not the documentation.

Process:

Developed a modified Tennessee Format for the monthly documentation.

Challenges with Tennessee Model:

Tennessee Single monthly FF = Billing Requirement;

Texas 1 FF and 2 Collaterals = Billing Requirement

Matching Billing Strips with Monthly Summary Elements is difficult.

Populating Outcomes – Developing Outcomes for life domains rather than

services.

Service Coordinators omitting elements vs. requiring all elements monthly.

Final approval and billing at the end of the month.

Texana Center Monthly Progress Note

Components of Monthly Summary:

• Billable Face to Face Narrative

• Billable Collateral Services Narrative

• Provider Summary of a review of Billable Services with the provider that includes structures data fields

• Outcomes/ Service Review with Outcomes populating from the PDP and structured data fields which provide reporting options

• Flexibility to add other elements based upon client needs required for reporting (E.g. Enhanced Case Coordination)

Recommendations to the State:

Prepare for Managed Care environment

Simplify billing processes and advocate Monthly Case Rate

Implement Service Component Codes to capture measurable data elements.

Add reporting options to define the purpose of the contacts.

Retain ability to demonstrate the value of IDD Targeted Case Management

which included Frequency of Face to Face with clients and Frequency of

contacts with families and providers.

Prepare for Reimbursement based upon performance outcomes.

Assessments

Health and Safety Risks

Participation in Planning

PDP Meeting Needs and Preferences

PDP Implemented within Timelines

Protection of Individual in Emergency

Participant Choice

Participant Satisfaction

Participant Needs Met

Participant is Safe

Need to lessen the documentation workload for TCM to prevent:

• Burnout

• Non-Compliance with CAO Expectations

• Fraudulent documentation

• Terminations both voluntary and involuntary.

Turnover impacts quality and continuity for individuals care. It is also very

costly to the LIDDA’s with regards to hiring and training of new staff.

Suggestions:

Monthly Case Rate

Monthly Case Note that documents the contacts and activities completed.

Use structured data fields to describe the activities the service coordinators

are doing for the client.

Carin presented the Cerner Monthly Billing Form developed by Texana

Center.

The monthly notes would allow continuity of documentation even if the

individual is not seen. The service coordinator would be able to document a

reason why they were not seen and activities they took to contact the

provider.

The purpose of the discussion is to take this information back to the CEO’s

to advocate for changes in Targeted Case Management to improve the

process and improve the monitoring, continuity and coordination of

services. It will also reduce turnover.

There was positive feedback presented by the members regarding the

monthly format. Concerns were raised to be prepared to answer questions

regarding the frequency of contacts for the reimbursement through a

monthly documentation note and the activities completed with the

individual.

Carey brought up the issue of justifying why people are satisfied with

services or why the services are meeting the needs of the individuals.

Sheri stated that one of the elements to be added to the Monthly note is

Outcomes and have data elements to target progress towards outcomes. The

biggest issue is interpretation of the requirements by the states.

Erin asked to receive feedback regarding Outcomes. She was contacted by a

Private Provider Association Representative regarding changes to the

outcomes by the Authority on the PDP and the literal interpretation of what

should be stated as the outcome for the person in the PDP. Erin asked if

there was inconsistency in audits and the interpretation of the

requirements. Auditors want documentation of why the person wants the

outcome.

The auditors required detailed information about the satisfaction as to why

they are satisfied, how satisfied they are, how much more satisfied are they

now than they were previously.

Outcomes should reflect the desire of the person and is at times over

complicated and is a frustrating process for the individual.

The consensus was that HHSC needs to provide LIDDA’s and Providers

training on outcomes.

There was a question as to whether the two page document provided by the

LIDDA Authority staff is the training tool that needs to be used in training

staff.

It was recommended we have Judy Southaw to speak about Outcomes and

the vision outcomes. It was requested we re-establish an Outcomes

Subcommittee.

10:00 BREAK

10:30 am IDD Operations

Portal

Rhonda Kay Richie, Eligibility Verification and Program Support

(EVPS) Manager, HHSC;

Angie Hutchison, PS V, Intellectual/Developmental Disabilities Program

Eligibility and Support (IDD PES) Program Enrollment & Support

Medicaid and CHIP Services

The presenters handed out a one page flyer regarding the IDD Operations

Portal that will begin in late 2017.

Angie Hutchinson shared information regarding the Portal. It is intended

to replace faxes and mailings. It will allow the LIDDA to see what was

submitted and whether it was received. The CARE System and MBOW will

continue to be used.

The Portal will be used by the LIDDA to communicate directly with the

reviewer. Information provided to the reviewer will be verified and

communication that the review is completed will be sent to the provider.

Documents to be sent through the Portal:

IDRC’s

IPC’s

Transfer Requests

Suspension and Termination of Suspension

Terminations

The staff of the portal will contact the LIDDA if they do not know the staff

assigned to the individual and will then set up the staff to receive the packet.

There will be a primary portal key provided to each LIDDA and the person

responsible for the provider key. The LIDDA representative that will be

designated to receive the provider key will receive the instructions to set up

the access to the portal. The provider staff assigned as the point person for

the provider key will be responsible for controlling access. After 90 days is a

person does not access the provider key the account will be deactivated.

There was a clarification of what level of staff is needed to be the portal key

keeper. It was recommended the IT Systems Administrator be the person

responsible for the portal key to control authorization of staff that will have

access to the portal key.

FAQ’s, Trainings, Webinars will be stored on the Provider Portal for easy

access.

Implementation will be late fall.

There will 4 types of registration. The two used most would be

Community Provider Single User

Community Provider

To register as a user you will provide basic information.

Four Role Choices:

Owner

Authorized Representative

Security Authority

Staff

The provider will be required to input the Provider Key and Enter a

Security Code. The registration must be completed in 2 days or it will be

resent and the person will need to register again.

Once a person had registered the request for access will be sent to the

Security Authority of the Provider to execute access to the portal. The

Security Authority will grant access. If staff is terminated, the Security

Authority will need to terminate the staff access.

Question was raised as to whether there are more than one Security

Authority and if so how would the communication of the request for access

or termination of access be coordinated within a provider with more than

one Security Authority.

When a packet is submitted a primary contact must be completed so that

information and communication can be coordinated with the person

assigned.

The portal will auto populate information of the individual whom the

packet is being submitted. The submission types are controlled by who is

designated to submit certain items. LIDDA’s can only submit items

authorized for the LIDDA to submit.

There is a tracking system and history of packets submitted and comments

made.

Once the packet has been submitted it will be assigned to a reviewer by

HHSC. Email correspondence will occur if packets are incomplete or there

are additional documents being requested. There will also be notes placed

in CARE if there is a need for additional documents and the documents

need to be submitted to the provider portal.

11:00 am Texana- Behavior

Treatment and

Training Center

Kate Johnson-Patagoc, Director of Specialized Services, Texana Center –

Kevin Barker Intro

Kate presented information about a statewide program that is operated by

Texana Center for individuals with IDD or Autism under the age of 18 at

risk of institutionalization due to challenging behavior.

It is a short term residential program located in Richmond, Texas.

Applied Behavior Analysis Intervention is provided.

25-30 children are served per year.

The program is a 3-6 month program that can be extended up to one year.

Kate presented the information that is on the Texana Center website to

provide information about the program and the forms.

It is required that the child be a US Citizen or a Legal Resident for 5 years.

Admissions can be delayed if all the required information is not received.

The first step is a Pre-Admission Medical and Behavioral Assessment

Parent/ LAR and Child are required to attend.

The child has a problem behavior that can be addressed in the setting.

BCBA assigned and provides direct observation during the assessment. The

BCBA develops the behavior plan based upon a functional assessment.

Child must be medically stable, up to date immunizations and medications

must have written prescription by physician.

A contracted psychiatrist works with the individuals to monitor and control

medications.

Parent/Guardian participation is required to ensure the transition back to

the home is successful.

There was feedback provided regarding the needed supports once the

person returns to the community and refusal for support services when a

person returns home. Applied income is also a challenge to many families.

When transitioning to the home, prior to discharge to assist with the

training of family and staff supporting the individual.

12:00 pm Adjourn ALL