ESBD_401953_1743429295290_MHDD Provider Manual_FY25.pdf

LIDDA Community Services LCS (LCS)

Pre-Admission Screening

Resident Review (PASRR)

Provider Manual FY25

Effective 04/01/25

Version 2025.03

INDELLECTUAL &

DEVELOPMENTAL

DISABILITIES SERVICE

Hill Country IDD Provider Manual FY25

Contents

I. INTRODUCTION 3

II. THE LOCAL INTELLECTUAL & DEVELOPMENTAL DISABILIITES AUTHORITY (LIDDA) 8

III. ACCESS TO CARE 10

IV. DOCUMENTATION 14

V. CONFIDENTIALITY 18

VI. TRAINING REQUIREMENTS 21

VII. SERVICE ARRAY DESCRIPTIONS 22

VIII. SERVICE CODES 47

IX. FORMS 49

I. INTRODUCTION

Who are we?

In the Beginning

Hill Country Community Mental Health and Developmental Disabilities Centers began operation in September of

1997. Prior to that date, components of six different State Facility Community Service divisions were merged to form a State Operated Community Service organization in September of 1996. As part of the initial foundation, staff met to develop the Mission, Values and Workplace Principles as a foundation for the newly formed organization, Hill Country Mental Health and Developmental Disabilities Centers (Hill Country MHDD Centers).

Hill Country serves the following counties: Bandera, Blanco, Comal, Edwards, Gillespie, Hays, Kendall, Kerr, Kimble, Kinney, Llano, Mason, Medina, Menard, Real, Schleicher, Sutton, Uvalde, & Val Verde

Today

Today, Hill Country MHDD Centers is one of 39 agencies that delivers mental health and developmental disability services in communities across Texas. Hill Country MHDD Centers has 38 locations, including 15 mental health clinics and 6 Local IDD Authority locations serving a population of approximately 816,000 within a 22,714 square mile area.

Advisory Council

The Board of Trustees and Community Advisory Council for Hill Country MHDD Centers represent population areas of the catchment region that are relatively equal. Some Board members represent one county, and others represent multiple counties, depending on the population of the counties. The Community Advisory Council takes an active role in obtaining community input into the strategic direction of the agency.

Diversity

Hill Country MHDD Centers serves a region of Texas that cannot be narrowly defined. There are pockets of the

Greater Texas Hill Country Region with high rates of population growth particularly in those counties contiguous to Travis and Bexar counties, such as Hays, Comal and Kendall counties. Some of the region is sparsely populated with few, if any, alternative resources for behavioral health and intellectual and developmental disability services. A section of the region is on or close to the border of Mexico where we face the challenge of ensuring a provider network that is culturally diverse.

Challenges

Increased pressures on the financial well-being of the local authority, particularly around the expense of medications, has led to use of cost saving opportunities such as “‘Patient Assistance Programs”, improved access to third party pharmacy benefits and improved management of the local authority pharmacy benefit.

The overarching challenge facing Hill Country MHDD Centers is the need to be responsive and open to the needs of the hundreds of communities in the 19-county service region while ensuring an efficient and cost-effective operation with use of public funding. As the Local Mental Health Authority (LMHA) and Local Intellectual and

Developmental Disability Authority (LIDDA), Hill Country remains committed to evaluating the behavioral health and intellectual developmental disability needs of communities by collaborating with community partners and developing innovative programming using available local resources.

Hill Country MHDD Centers remains committed to:

Ensuring people who need services can exercise individual choice by helping persons decide on their services, service provider and location of services.

Ensuring the best use of public money to create a network of service providers.

Making recommendations on the most appropriate services available to individuals who need services.

Hill Country MHDD Centers will meet this challenge with the support of our diverse staff, the Citizens’ Advisory

Committee, our community providers, stakeholders, and Board of Trustees.

Shift in Care

Shifting toward a culture of evidenced-based care, corporate compliance has been the focus of Hill Country

MHDD Centers’ strategic efforts. As the LMHA and LIDDA provider, Hill Country MHDDC actively uses performance-based data for decision making to provide quality services that transform access to care in the local communities. By increasing access to behavioral health and substance use treatment, expanding capacities to address the opioid crisis and establishing viable stakeholder partnership with local hospitals, law enforcement, jails, prisons and schools, Hill Country MHDD Centers’ qualified personnel have been able to provide individualized and compassionate care to the individuals served.

What is a LIDDA?

House Bill 3 of the 59th Legislature (1965) created the structure now known as the local intellectual and developmental disability authority (LIDDA). In the 1960s, the state moved to provide mental health and intellectual disability services in the community rather than in institutions. Community centers were created to provide community-based services and address the needs of persons returning to their communities from state supported living centers (SSLCs), Medicaid-certified nursing facilities and state hospitals. Each center has a designated local service area comprised of one or more Texas counties.

The LIDDA was developed as a means for the state to delegate its authority and responsibilities related to planning, policy development, coordination, resource allocation, resource development, and oversight of community intellectual and developmental disability (IDD) services throughout the state. The state is required to contract with the designated LIDDAs and provides funding for the delegated functions and for required community-based services to be provided in each service area.

In the Texas Health and Safety Code, Title 7, Subtitle A, Chapter 533A, §533A.0355, and in Texas Administrative

Code, Title 40, Part 1, Chapter 2, Subchapter G, §2.305 (LIDDA’s Role and Responsibilities), each LIDDA serves as the single point of access to certain publicly funded services and supports for the residents within the LIDDA's local service area.

A LIDDA's responsibilities include:

providing information about IDD services and supports;

ensuring a person’s access into IDD services and supports by:

conducting intake and eligibility activities for persons seeking services and supports; and enrolling or admitting an eligible person into IDD services and supports, including the following Medicaid programs:

Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID), which includes SSLCs;

Home and Community-based Services (HCS);

Texas Home Living (TxHmL); and

Non-Waiver Community First Choice (CFC);

conducting interest list management functions for HCS and TxHmL;

performing safety net functions;

ensuring the provision and oversight of general revenue services by:

developing and managing a network of general revenue services providers; and establishing processes to monitor the performance of general revenue services providers;

providing service coordination;

conducting utilization management for general revenue services;

planning for the local service area and ensuring involvement by a local advisory committee and other stakeholders;

conducting permanency planning for certain persons under 22 years of age;

conducting Preadmission Screening and Resident Review (PASRR) evaluations;

protecting the health, safety and rights of a person; and for institutional residents:

presenting community living options to SSLC residents; and providing a continuity of services for persons who are leaving an SSLC;

for nursing facility (NF) residents, ensuring the provision of:

specialized services;

habilitation coordination; and community living options (CLOs).

HHSC LIDDA Handbook Section 1000, LIDDA Overview

Hill Country welcomes you as a provider of IDD services. This manual is made available to supplement the current contract and is officially part of your contract. As a contract provider, you and your staff are required to follow and meet all provisions of this manual. Furthermore, this manual is an educational tool for the IDD Service

Delivery System.

II. THE LOCAL INTELLECTUAL & DEVELOPMENTAL DISABILIITES AUTHORITY

(LIDDA)

Hill Country’s MISSION

Caring People Dedicated to Quality Service.

Hill Country’s VISION

Empower people, foster hope, support choice and celebrate success.

Hill Country’s VALUES

Hill Country’s values are:

We respect all people at all times

We are open to new ideas and change

We care about people and what is important to/for them

We act with integrity

We are committed to quality

INDIVIDUAL CHOICE

Hill Country continually strives to offer access and choice to adults and children with intellectual and developmental disabilities and their families:

Choice of services and supports

Choice of providers

PROGRAM OVERVIEW

LIDDA Community Services (LCS)

Hill Country’s General Revenue funded program is its LIDDA Community Services, or LCS, program. General

Revenue (GR) funded services are primarily intended to help persons remain in their own home or their family’s home. GR refers to state funds and GR funded services are paid by state funds and not federal funds.

Individuals receiving LCS services live in a community setting (either their own home or family’s home), and may be either a Medicaid recipient or non-Medicaid. General Revenue-funded services may vary across the state, and available services are subject to the LIDDA’s discretion.

An LCS recipient is assigned a Service Coordinator, who is an employee of the LIDDA. The Service Coordinator develops the Person Directed Plan (PDP) and Individual Plan of Care (IPC) which authorizes services and units.

Pre-Admission Screening and Resident Review (PASRR)

The Pre-Admission Screening and Resident Review (PASRR) program refers to services available to individuals with IDD living in Nursing Facilities. PASRR is a federal requirement documented in the Code of Federal

Regulations, Title 42, Part 483, Subpart C. PASRR is a process to identify people with a mental illness (MI), intellectual disability (ID), or developmental disability (DD), which is also known as a related condition (RC), who apply to, or reside in, a Medicaid-certified nursing facility (NF) to ensure that NF admission is appropriate. PASRR is also intended to ensure that people with MI, ID or DD are receiving all the necessary specialized services. In

Texas, local intellectual and developmental disability authorities (LIDDAs), local mental health authorities

(LMHAs) and local behavioral health authorities (LBHAs) play key roles in the PASRR process.

Some specialized services are provided by the Nursing Facility, and some must be provided or obtained by the

LIDDA. These are called IDD Habilitative Specialized Services.

Individuals receiving PASRR services reside in Nursing Facilities. A person’s Service Planning Team, or SPT, makes decisions regarding which specialized services they wish to receive.

A PASRR recipient is assigned a Habilitation Coordinator, who is an employee of the LIDDA. The Habilitation

Coordinator develops the Habilitative Service Plan (HSP) which identifies the specialized services the person wishes to receive.

III. ACCESS TO CARE

INTAKE ACTIVITIES (PERFORMED BY Hill Country STAFF ONLY)

Interviews, referrals for assessments and services, and initial paperwork associated with eligibility activities are necessary when a person requests services or is referred for services. Eligibility determination consists of an assessment or endorsement conducted to determine if an person has intellectual or developmental disabilities or is a member of the Texas Health and Human Services Commission (HHSC) defined intellectual and developmental disabilities priority population (which includes some related conditions).

Examples of these Eligibility activities include:

Gathering background information for referrals or evaluations

Preparing evaluation summaries

Coordinating testing sessions and meetings where the need for referral to community services will be determined

Participation in meetings in which a temporary service plan is developed

Referring the person for community services

Referring the person to Service Coordination for development of the Person Directed Plan

PRIORITY POPULATION

a) The determination of eligibility for priority population must be made through the use of assessments and evaluations performed by qualified professionals. Persons who are members of the priority population are eligible to receive IDD services identified as appropriate for the persons’ level of need, eligibility for a particular service, and the availability of that service.

ELIGIBILITY GUIDELINES

b) For a person to be determined eligible for the IDD Service Array, he/she must be identified as part of the

Priority Population through the Determination of Intellectual Disability (DID formerly known as DMR) and testing process. The priority population for IDD services consists of persons who meet one or more of the following descriptions:

c) A person with an intellectual disability, as defined by Tex. Health and

a. Safety Code §591.003(15-a);

d) A person with autism spectrum disorder, as defined in the Diagnostic

a. and Statistical Manual of Mental Disorders;

e) A person with a related condition, listed in https://hhs.texas.gov/stites/hhs/files/documents/lawsregulations/ handbooks/dbmd/res/icd10-codes-1.pdf, who is eligible for, and enrolling in services in the ICF/ID Program, Home and

Community-based Services (HCS) Program, or Texas Home Living (TxHmL) Program

f) A nursing facility resident who is eligible for specialized services for intellectual disability or a related condition pursuant to Section 1919(e)(7) of the Social Security Act;

g) A child who is eligible for Early Childhood Intervention services through the System Agency; and

h) A person diagnosed by an authorized provider as having a pervasive developmental disorder through a diagnostic assessment completed before November 15, 2015.

i) Since resources are insufficient to meet the service needs of every person in the priority population, services should be provided to meet the most intense needs first. Intense needs are determined as follows:

a person is in danger or at risk of losing his or her support system, especially the living arrangement or supports needed to maintain self;

a person is at risk of abuse or neglect;

a person's basic health and safety needs not being met through current supports;

a person is at risk for functional loss without intervention or preventive or maintenance services; or a person demonstrates repeated criminal behavior.

Determinations of IDD, pervasive developmental disorders, and related conditions must be made through use of assessments and evaluations performed by qualified professionals licensed by HHSC as Psychological

Associates.

EXPECTATIONS OF THE PROVIDER

After receiving a referral with the attached plan documents (PDP,IPC or HSP), the Provider is expected to initiate service delivery within 5 business days. In situations where there are extenuating circumstances (i.e. Provider’s

Day Habilitation facility has reached capacity via ISS licensure) or where the Provider is otherwise unable to assume service delivery for the referred individual, the Provider is expected to communicate this information in writing to the Service Coordinator or Habilitation Coordinator. Case by case decisions will be made by Hill

Country regarding exceptions to service delivery referrals.

After receiving a referral, the Provider reviews the Person Directed Plan (PDP), or Habilitative Service Plan (HSP) to develop the Implementation Plan (IP) detailing how LCS or PASRR services are used to achieve personal outcomes. The development of the IP will always be coordinated with the person, LAR and/or others may participate if desired by the person/LAR. The IP describes and directs the delivery of services including “when, where, how and by whom” services are provided. The implementation strategies serve as justification for the number of authorized units of services. The IP must be outcome-based and quantifiable, and shall be provided to

Hill Country as defined in the Documentation Requirements section of this manual. Once the IP is developed the

Provider starts the services as specified in the PDP/HSP. It is incumbent upon the direct-service staff to document person’s responses to interventions by progress notes, stipulating, in quantifiable terms, the progress or lack of progress each person makes toward accomplishing targeted goal(s).

It is required that Providers have Internet capabilities, including downloading mandated software provided by Hill

Country for system access, updated PC’s, printers, fax or scanning capabilities, as well as current e-mail addresses. Hill Country does not provide IT support services. Providers must be able to address their own IT issues. All Providers must maintain appropriate staff ratios at all times.

The Provider cannot deliver services to any person prior to receiving both the Individual Plan of Care (IPC) and a current Person Directed Plan (PDP) or Habilitative Service Plan (HSP). In urgent situations, alternative temporary approval may be obtained via e-mail by the Service Coordinator, their supervisor, or the LIDDA Director. This must be in writing for service billing to be paid.

All Provider staff must remain current on all required trainings as outlined in this manual.

SERVICE COORDINATION ACTIVITIES (PERFORMED BY Hill Country STAFF ONLY)

Service Coordination is the process of assisting persons to access social, educational, vocational, medical, and other appropriate services and supports that help a person achieve quality of life and community participation acceptable to the person.

Examples of Service Coordination activities include:

Developing the person’s Person Directed Plan (PDP) based on the results of the service coordination assessment and the person’s wishes

Authorizing services through the Individual Plan of Care (IPC)

Revising the PDP and/or IPC, as appropriate

Visiting with the person to monitor the service delivery system

Service Coordination and reviews are conducted based on each persons need, and to document the persons progress toward the desired

EMERGENCY PLAN REQUIREMENTS

The Provider shall have an Emergency Plan that addresses specific types of emergencies and disasters that pertain to the area of the county in which the Provider is located, including natural disasters, fire, equipment failure, a pandemic, and terrorism. The Providers plan must include:

clearly identify the roles and responsibilities of specific staff during each type of emergency addressed in the plan;

include a process for a program site staff to contact the Hill Country IDD administrative office (Analaura McCrae, LIDDA Director at (830) 258-5446) in a timely manner with details of an emergency, action taken, and any future plans (e.g., a plan to evacuate the person to another location) include an evacuation plan for each type of emergency addressed by the plan, which ensures reliable and available transportation, an appropriate destination, that staff are knowledgeable about the persons’ needs, and allows for person to have access to their assistive devices; and

An exemption for the Emergency Plan requirement for a program site that is accredited/certified/licensed through a certifying body provided Hill Country has evidence that the program site has an emergency plan that has been reviewed and approved by the certifying body.

The Provider must provide Hill Country with such evidence upon request by the Hill Country LIDDA Department.

IV. DOCUMENTATION

DOCUMENTATION/GENERAL REQUIREMENTS

Services must be initiated within five (5) business days of receipt of a service referral.

Documentation must be legible. Illegible documentation potentially will not be paid.

The Provider is responsible for completing the Direct Service, Single Person/Single Server Progress Note (progress note) (unless prior written authorization is obtained, all direct service notes will be in the “single server/single person” format).

The Provider will complete documentation of each encounter with or on behalf of the person on the appropriate Progress Note.

All staff providing a service must sign each progress note. Each service Provider’s signature must include the printed name and credentials (title), Providers are required to submit documentation of services provided as outlined in the Claims section of this manual. No payment will be made for service documentation submitted later than five (5) business days. Providers are prohibited from billing the person for LCS/PASRR/Crisis services. Documentation should be completed by staff within 24 hours of the date of service. The date of service counts as day 1 in regards to claims being submitted in 5 business days.

Hill Country is not authorized to accept late submissions without prior approval from the Hill Country Quality Manager, or Hill Country LIDDA Director. If a situation occurs where claim submission will be late it is imperative to notify the Hill Country Quality Manager, or Hill Country LIDDA Director.

Hill Country staff will enter the summarized late encounter data in Hill Country’s data management system on behalf of the Provider. Hill Country will notify Providers of any change to this procedure.

For LCS, the Provider will notify the Service Coordinator that a person’s service units have been exhausted; once the Service Coordinator has met with the family and signed the revised PDP/IPC, the Provider will be notified via Service Coordinator

Prior to discharge, the Service Coordinator will notify the Provider of the person’s discharge from services in writing via email.

Within three days of notification of discharge, the Provider will ensure all required documents are completed, to include the progress note of the person’s last encounter with the Provider’s staff. The original document(s) will be stored in the secured records area at the provider site for a minimum of six

(6) years.

Hill Country retains ownership and control of required information generated by the Provider on behalf of the person served. Therefore, upon discharge from services and/or termination of the Provider Agreement, all original documents (records) in the possession of Provider will be stored and available upon written request made by Hill Country to provider.

The Hill Country Quality Manager will conduct periodic monitoring of documentation, focus reviews, utilization reviews of Provider-generated and/or-maintained files and documents to ensure compliance with all applicable requirements. Hill Country has a three (3) year audit recovery period.

Documentation of services provided under the Hill Country Service Array must be completed prior to submission of a payment claim. Each type of service has specific documentation guidelines, that must be followed. Each service unit requires at least minimal documentation of certain key elements, although time frames for documentation may vary from service to service.

IMPLEMENTATION PLAN (IP)

Once the program provider receives the proposed PDP or HSP, they are responsible for developing the Implementation Plan (IP) to meet the outcomes/goals identified on the PDP or HSP within the amount and type of services indicated on the IPC. In the event the provider is unable to proceed with development of the implementation strategies due to vague or inadequate development of the PDP or HSP, the provider must request in writing from the Service Coordinator, a revised/clarified PDP or HSP. Furthermore, if the Provider cannot locate/contact the person after three (3) contact attempts, they must e-mail the Service Coordinator, via Hill Country email, regarding the inability to deliver services.

Specific responsibilities for coordination of non-LCS services (e.g., , completion of applications, filing forms, etc.)

will be negotiated between the Service Coordinator, the person, their family, and the program provider.

The Provider is responsible for ensuring the IP is developed, completed and provided to the Service Coordinator or Habilitation Coordinator. This is accomplished by:

1. The implementation strategies are individualized and must allow for evaluation and measurement of progress achieving each PDP personal outcome; during service coordination meetings with the person (and/or LAR), the IP is used to determine whether services are provided as planned. Every IP must have at least one implementation strategy objective. An objective is a specific goal for reaching a desired personal outcome. The IP contains one or more strategies leading to the skill acquisition.

2. Provider will follow timeline for development of the implementation strategies. When dealing with existing person (from the previous fiscal year), the implementation strategies should be developed and completed together with the Service Coordinator and the family/person. The Service Coordinator will give notice to the Provider requesting he/she attend the annual planning staffing (either in person or by phone). A copy of the completed PDP will be sent to the Provider via email .

3. Request for PDP clarification from the Provider will be directed to the Service Coordinator.

PASRR Specific Requirements

Each service planning team (SPT) member that is a provider of specialized services must:

submit to the habilitation coordinator a copy of all assessments of the person completed by the provider;

at least five calendar days before a quarterly or annual SPT meeting, submit to the habilitation coordinator a written report describing the person’s progress or lack of progress;

provide the habilitation coordinator with a copy of the provider’s implementation plan for the person’s specialized service if requested; and actively participate in an SPT meeting, in person or by phone, unless the habilitation coordinator determines active participation by the provider is not necessary.

SERVICE MONITORING AND UPDATING THE PDP, IPC and HSP

Changes to the IPC

The Service Coordinator must ensure that the PDP and the IPC are current and appropriate.

The Service Coordinator must contact the person or LAR to discuss changes and obtain approval from the person or LAR within seven (7) business days of request.

Revisions to the IPC must be based solely on changes in the persons’ needs and, therefore, must reflect services and supports that are justified.

Once a need has been identified, the Service Coordinator initiates a change in the IPC; provides documentation to justify the change; informs the person, LAR and the Provider of the status of the change; and revises the PDP

*Note: Service Coordinators are responsible for notifying (via email) the Provider of any PDP revision (having an

IPC or not). The PDP/IPC shall be shared with Provider within ten (10) business days of the revision.

ELEMENT DOCUMENTATION CONTENT KEY

1 With whom the contact occurred (person and/or other person). If the contact was with a person other than the person, the note should identify for and/or with whom the contact was made.

2 Description of the service provided

3 The date the service was provided.

4 The time the service was provided. The Provider must record both start and stop times.

Who provided the service. This is indicated by the signature(s) of the service provider on the progress note. The signature should include the name and title of staff.

6 The setting in which the service was provided (home, shelter, job site, school, etc.)

7 The Service Plan goal or objective the intervention was designed to address.

8 Progress or lack of progress in achieving planned goals/objectives.

Service-Specific Documentation Guidelines (Elements 1 – 8 refer to the above table)

Community Supports - A progress note, including elements 1 through 8, that verifies each instance a service was delivered during the specified month.

Day Habilitation (Site-Based Habilitation) – A progress note, including elements 1 through 8, that verifies each day a service was delivered during the specified month.

Respite – A progress note, including elements 1 through 8, that verifies each instance a service was delivered during the specified month for either In- or Out-of-Home Daily or Hourly Respite.

Behavioral Support - A progress note, including elements 1 through 8, that verifies each instance a service was delivered during the specified month. Please be sure to check Behavioral Support service section for acceptable providers of this service.

* The initial assessment must be submitted in typed form attached to the service note.

Speech & Language Services - A progress note, including elements 1 through 8, that verifies each instance a service was delivered during the specified month.

*The initial assessment must be submitted in typed form attached to the service note.

Nursing- A progress note, including elements 1 through 8, that verifies each instance a service was delivered during the specified month

Monitoring Performance

The Quality Manager will conduct periodic monitoring of documentation, focus reviews, utilization reviews of Provider-generated and/or-maintained files and documents to ensure compliance with all applicable requirements.

Quality Manager will perform scheduled administrative on-site audit per fiscal year with focus areas such as: fire safety, infection control, environmental hazards and cleanliness, access to services, maintenance (including vehicle maintenance), HR and training records, rights, records, policy and procedures and medication practices.

Quality Manager will review documentation, billing, and data criteria audit. Throughout the year, random audits/visits may occur.

Providers receive a written report detailing all findings/issues identified during the administrative on-site review.

Providers are required to correct all non-compliance findings/issues within 30 days after issuance of the review report. A corrective action plan will be typed on official letterhead, signed by the executive director and mailed to Hill Country IDD Quality Management Review Staff for review. You will be notified of acceptance with your corrective action plan and further follow up audit. All findings may be subject to monetary sanctions.

V. CONFIDENTIALITY

As of April 20, 2005, Federal Security regulations adopted administrative, technical, and physical safeguards required to prevent unauthorized access to protected health care information. The Department of Health &

Human Services has published instructions on security requirements in the Federal Register.

Any information which identifies a person is considered confidential and cannot be disclosed to anyone except for Hill Country staff without prior written consent from the person or legally authorized representative. Violation of confidentiality may subject the violator to prosecution under applicable federal and/or state laws.

Additional clinical records access and security measures will either be maintained in a designated room:

Access to clinical records is limited to authorize personnel only. A list of names and titles authorized personnel will be posted within the record room at each provider site.

At no time can unauthorized employees or others be left alone in any area with unsecured HIPAA information. When unauthorized persons are in an area where clinical information is accessible, every attempt will be made to cover up easily readable information (open folders will be closed, typed material covered up or turned over, etc.).

All providers must have a procedure for transferring the clinical record to any permanent storage; with accountability mechanism built in, must be maintained and authorized by Hill Country prior to implementation.

In the course of a record transfer, safeguards will be followed to ensure that confidentiality of person’s record data is maintained.

Written release of information requests will be forwarded to the Service Coordination staff at the Hill Country site.

No clinical or person identifying information will be released verbally or in writing to unauthorized persons, except in life or death/emergency situations.

Hill Country also requires all Providers and their direct-care staff to complete HIPAA training by logging on https://www.dads.state.tx.us/providers/hipaa/privacy/index.cfm annually and complete the on-line test. Once this is completed, the certificate of completion must be printed and filed in the staff personnel records. This requirement is subject to on-site administrative audits.

TEXAS STATE REPORTING OF ABUSE AND NEGLECT

Abuse, Neglect and Exploitation: Reporting and Investigation

The purpose of this procedure is to define abuse, neglect and exploitation of the person according to Texas

Statutory Regulations and to establish procedures for reporting, investigating, and preventing such, in conformance with Texas statutes (40 TAC, Chapter 4, Subchapter L).

Abuse – Types and Classes of Abuse

Class I

Sexual Abuse / Sexual Exploitation

Physical Abuse

Class II

Exploitation

Class III

Emotional / Verbal Abuse

Agent – Any person not employed by a Provider or Provider program but working under the auspices of the

Provider, such as volunteers, consultants, etc.

Designee – An person immediately available, who is temporarily appointed to fulfill duties and assume responsibilities of the Provider in terms of reporting of allegations of abuse, neglect, or exploitation to proper authorities.

Exploitation – The illegal or improper act or process of a Provider, an employee or agent, using the resources of a person for monetary or personal benefit, profit, or gain.

Person – A person receiving services from the Provider network and his family if a minor.

Negligence – To do something that a person of ordinary prudence would not do under the same or similar circumstances, or the failure to do something that a person of ordinary prudence would do under the same or similar circumstances.

If you have seen or been notified of Abuse, Neglect or Exploitation contact the Department of Family Protective

Services (DFPS) by calling Toll Free 1-800-252-5400 within one (1) hour, complete an incident report and notify:

Client Rights Office

Phone: 1-888-393-3609 Office: 1-830-258-5441

Email: bolden@hillcountry.org

Texas Health and Human Services Commission

IDD Ombudsman

Toll Free 1-800-458-9858

Monday through Friday 8:00 am – 5:00 pm www.txabusehotline.org

Abuse in MH/MR Facility

Toll Free 1-800-647-7418

Abuse/Neglect Hotline

Toll Free 1-800-252-5400

Monday through Friday 8:00 – 5:00 pm

Hill Country INCIDENT REPORTING

All Providers and their staff are obligated to report all incidents involving any person served under the Contract.

The Hill Country Incident Report Form is provided below. Failure to report an incident may result in contract sanctions. All Hill Country incident report forms must be emailed directly to the IncidentReport@hillcountry.org

Within 5 business days of an Incident occurring, each Provider must submit their Critical Incident Reporting Form

(CIR) via e-mail, . Compliance with the procedure is subject to audits.

VI. TRAINING REQUIREMENTS

Providers will complete training sessions and keep signed records of all training for audit/review purposes. Staff must have the necessary training and demonstrate the necessary skills to ensure persons’ health, safety, and support needs are met. The Training Matrix is outlined below for Direct Services Staff and In-Direct Staff.

VII. SERVICE ARRAY DESCRIPTIONS

LIDDA Community Services (LCS)

Community Support - 530

Individualized activities that are consistent with the individual’s plan of services and supports and provided in the individual’s home and at community locations, (e.g., libraries and stores). Supports include:

habilitation and support activities that foster improvement of, or facilitate, an individual’s ability to perform functional living skills and other daily living activities;

activities for the individual’s family that help preserve the family unit and prevent or limit out-of-home placement of the individual;

transportation for an individual between home and the individual’s community employment site or day habilitation site; and transportation to facilitate the individual’s employment opportunities and participation in community activities.

Required activities:

a) Face-to-face contact to assist, train, and support the individual’s participation in home or community activities to achieve outcomes in the individual’s plan of services and supports;

b) Face-to-face support services provided to the individual’s family member to preserve the family unit/prevent or limit out-of-home placement, or as necessary to achieve outcomes in an individual’s plan of services and supports;

c) Individualized, habilitation or support services (including transportation) identified in the individual’s plan of services and supports (which is the plan in place at the time the service was delivered);

d) The monthly contact is accomplished face-to-face with the individual or family member unless the activity meets the criteria listed under Optional Activities #3. D; and

e) Functional living skill assessment done face-to-face with the individual if the purpose of the assessment is to focus on how best to approach a community living skill (e.g., using a bus).

Optional activities:

a) Crisis intervention.

b) Participation in service planning team meetings.

c) Providing transportation for an individual to/from home directly to the individual’s community employment site or day habilitation/vocational training site and transportation to facilitate the individual’s employment opportunities and participate in community activities as specified in the plan of services and supports (e.g., individual will receive Supported Employment services once a week with transportation provided daily to the job site).

d) Telephone contact with the individual or family member when an emergency arises that directly affects the individual (for example, seizure, injury or other major crises) and that is more expediently handled by telephone than in person.

e) Providing assistance with medications and the performance of tasks delegated by a registered nurse in accordance with state law.

Prohibited activities:

a) Services provided to individuals residing outside their own home or family home or receiving residential services.

b) Services provided to individuals receiving IDD PASRR.

c) Habilitation activities provided and reported as part of Day Habilitation.

d) Community Support may not be reported simultaneously with Hourly Respite or on the same calendar day that Daily Respite is provided. Community Support may not be reported simultaneously with Day Habilitation, Employment Assistance, Supported Employment, and Vocational Training.

e) Providing transportation for individuals from one Day Habilitation/Supported Employment/Vocational Training site to another.

f) Community Support may not be reported when the purpose of the service is to provide planned or emergency relief of the unpaid caregiver (this is respite).

g) Community Support (including transportation) provided by someone who lives with the individual.

h) Community Support may not be used to pay for tuition for a day camp.

i) Community Support may not be used to pay for bus or public transportation passes.

j) Except for transportation, services provided to individuals who are eligible for Community First Choice (CFC) Services through an MCO.

Clarifications:

a) Transportation reported under this service includes:

i) Transportation of an individual to a Day Habilitation/Vocational Training site to begin or end Day Habilitation/Vocational Training services and

ii) Transportation of an individual to provide a Community Support, Employment Assistance or Supported Employment service.

b) Community Support does not include payment for room or board.

c) For individuals attending public school, Community Support must be delivered outside the individual’s public school day.

d) Community Support is provided to individuals living in their own home or family homes. The services include provision of assistance, training and support necessary for the individual to complete personal care, health maintenance, and independent living tasks; participate in typical community activities, and develop, retain and improve community living skills. Crisis intervention activities provided in the home setting are also captured in this category.

e) Community Support can include habilitation activities that include, but are not limited to, training in self-help skills and independent living skills, implementation of programs developed by a licensed therapist, and implementation of programs to develop appropriate social behaviors, as identified in the person-directed plan.

f) Community Support may not be reported when staff assistance is not needed by an individual to achieve goals or outcomes, complete personal care, maintain health and independent living skills, participate in community activities, or develop, retain, and improve community living skills.

g) Volunteer work must be consistent with the Fair Labor Standards Act. Volunteering should be in positions that were created and exist for “people without disabilities” as well. Volunteering to determine if a person likes or is qualified for a job is not acceptable as an R021 activity.

h) A day camp that meets the definition of Day Habilitation should be coded as Day Habilitation (R053) and not Community Support. If an individual needs support to participate in a summer camp, Community Support could be used, on an hourly basis, to provide support for the person to be integrated into camp activities. Community Support cannot be used to pay for tuition to a day camp.

i) A host home is consistent with family home and therefore not considered residential services.

Required Documentation Elements

a) A written narrative for each service event that describes the service and, when appropriate, includes information pertaining to the individual’s progress toward goals or outcomes. Each written narrative must include:

i) Name of individual;

ii) Local case number

iii) Type of Service;

iv) Date of Service (month, day, year);

v) Place of service;

vi) Actual begin and end time of each reported service event;

vii) Detailed description of the service event;

viii) Name and title of the service provider; and

ix) ix. Signature of service provider (including credentials or job title as appropriate).

b) Elements noted above do not necessarily have to be contained within the narrative describing the service event so long as they are contained within the progress note that also contains the narrative (e.g., billing strip).

c) A service delivery log may be used for documentation purposes, providing it contains all the required elements in 13.a). A sample can be found in the Forms section of the Texas Home Living Program Service

Definitions and Billing Guidelines Revision 09.0. (Service Delivery Log with Written Narrative/Written

Summary).

d) When documenting transportation, a billing log may be substituted for a written narrative. A sample of a transportation log can be found in the Forms section of the Texas Home Living Program Service

Definitions and Billing Guidelines Revision 09-0.

Respite – Out-of-Home 904, 905

In-Home 902,903

Planned or emergency short-term relief services provided to the individual’s unpaid caregiver when the caregiver is temporary unavailable to provide supports. This service provides an individual with personal assistance in daily living activities (e.g., grooming, eating, bathing, dressing and personal hygiene) and functional living tasks. The service includes assistance with: planning and preparing meals; transportation or assistance in securing transportation; assistance with ambulating and mobility; reinforcement of behavioral support or specialized therapies activities; assistance with medications and the performance of tasks delegated by an RN in accordance with state law; and supervision of the individual’s safety and security. The service also includes habilitation activities, use of natural supports and typical community services available to all people, social interaction and participation in leisure activities, and assistance in developing socially valued behaviors and daily living and functional living skills.

Required activities:

a) Relieve primary unpaid caregivers of responsibilities on a planned or emergency short-term basis.

b) Care and supervision of individuals outside of their residence (i.e., out of home).

c) The need for a Respite service must be documented on the plan of services and supports or Respite Plan (if no other R0 assignments) with an exception allowed in an emergency situation with unplanned respite needs.

d) Face-to-face contact with the individual to provide respite care.

Optional activities:

e) Transportation during the course of respite service.

f) Transportation from respite service to another service such as Day Habilitation.

Prohibited activities:

a) Continuous out of home placement for more than 30 consecutive days.

b) Respite Care provided to individuals who live independently.

c) Hourly Respite (3122) may not be reported for the same time that Day Habilitation, Vocational Training, Community Support, Supported Employment or Employment Assistance are reported.

d) The service provider may not have the same residence as the individual receiving the service.

Clarifications:

a) Out-of-Home Respite provides care to and supervision of individuals out of their usual residence. This service is intended to relieve family members or other primary unpaid care providers of their responsibilities for providing care on a planned or emergency short-term basis. It may be provided at a variety of locations, e.g., the home of a relative or a family friend, a home specifically for respite, a location usually considered a Residential Service, or a private facility, e.g., a hospital. Duration of this service may be for a part of one day or for several consecutive days, but it is intended that it be temporary and brief. Continuous out of home overnight placement in a Respite situation for more than 30 consecutive days usually requires assignment to a Residential Service. Appropriate standards for an out-of-home situation (e.g., Respite, Residential) will apply.

b) In-Home Respite provides care to and supervision of individuals based at their usual residence. This service is intended to relieve family members or other primary unpaid care providers of their responsibilities for providing care on a planned or emergency short term basis. Duration of this service may be for a part of one day or for several consecutive days, but it is intended that it be temporary and brief. Continuous overnight placement in a Respite situation for more than 30 consecutive days usually requires assignment to a Residential Service. Appropriate standards for an out-of- home situation (e.g., Respite, Residential) will apply.

c) “Non-routine” is intended to allow for regularly scheduled respite services. Respite may be provided regularly but is not intended to provide caregiver relief during routine caregiver working hours (e.g., Day Care).

Required Documentation Elements

a) A written narrative for each service event that describes the respite service and, when appropriate, includes information pertaining to the individual’s progress toward goals or outcomes. The written narrative must include:

i) Name of individual;

ii) Local case number

iii) Type of service;

iv) Date of service (month, day, year);

v) Place of service;

vi) Actual begin and end time of service event;

vii) Detailed description of the service provided;

viii) Name and title of the service provider; and

ix) Signature of service provider (including credentials or job title as appropriate). b) Elements noted above do not necessarily have to be contained within the narrative describing the service event so long as they are contained within the progress note that also contains the narrative (e.g., billing strip).

b) A service delivery log may be used for documentation purposes, providing it contains all the required elements in 13. a) above. An example can be found in the Forms section of the TxHmL Program Service Definitions and Billing Guidelines Revision 09-0. (Service Delivery Log with Written Narrative/Written Summary).

Employment Assistance – 535

Assistance to an individual in locating paid, individualized, competitive employment in the community, including:

helping the individual identify employment preferences, job skills, work requirements and conditions; and identifying prospective employers offering employment compatible with the individual’s identified preferences, skills, and work requirements and conditions.

Required activities:

a) Assistance in choosing and obtaining employment.

b) Services and supports are identified in the individual’s plan of services and supports (which is the plan in place at the time the service was delivered).

c) Services and supports provided longer than a 180-calendar day period should be justified by the service planning team in the individual’s record.

d) Contacts are accomplished face-to-face or by phone contact with the individual or collateral (i.e., prospective employer or LAR/family member with whom they live) by Supported Employment staff to provide employment assistance that identifies the individual’s skills, preferences, and requirements for employment and on behalf of the individual to negotiate employment.

Optional Activities:

Participation in service planning team meetings.

Prohibited Activities:

a) Employment Assistance provided when an individual is independently employed or competitively employed in the community, unless the plan of services and supports has identified outcomes for the individual to find additional or more suitable employment.

b) Habilitation activities (e.g., teaching/training to complete applications).

c) Providing transportation to an…