dads’dadscfo.dads.state.tx.us/bluebook/guides/fy10bluebook.pdf · 2 dads’ blue book is...

DADS’

BLUE BOOK

February 2010

2

DADS’ Blue Book is published by the Texas De-partment of Aging and Disability Services (DADS), Office of Budget and Data Management to provide a standard, comprehensive, and easily accessible source of budget and program information. Data in the February 2010 publication are based on the DADS’ FY2010 Operating Budget. submitted to the Legislative Budget Board on December 1, 2009.

DADS MISSION The DADS mission is to provide a comprehen-sive array of aging and disability services, sup-ports, and opportunities that are easily ac-cessed in local communities. Our key responsibilities to the citizens of Texas include:

Working in partnership with consumers, caregivers, service providers, and other stakeholders.

Developing and improving service options that are responsive to individual needs and preferences.

Ensuring and protecting self-determination, consumer rights, and safety.

For Additional Copies of the Blue Book: Texas Department of Aging and Disability Services Office of Budget and Data Management (W-421) Attn: Teri Beck P O Box 149030 Austin TX 78714-9030 Phone: (512) 438-2252 E-Mail: [email protected]

3

Table of Contents Page GOAL 1 Long-Term Services and Supports 1.1.1 Intake, Access and Eligibility to Services and Supports 6 1.1.2 Guardianship 8 1.2.1 Primary Home Care (PHC) 10 1.2.2 Community Attendant Services (CAS) 12 1.2.3 Day Activity and Health Services (DAHS) 14 1.3.1 Community Based Alternatives (CBA) 16 1.3.2 Home and Community-Based Services (HCS) 18 1.3.3 Community Living Assistance and Support Services (CLASS) 20 1.3.4 Deaf-Blind Multiple Disabilities (DBMD) 22 1.3.5 Medically Dependent Children Program (MDCP) 24 1.3.6 Consolidated Waiver Program (CWP) 26 1.3.7 Texas Home Living Waiver (TxHmL) 28 1.4.1 Non-Medicaid Services 30 1.4.2 Mental Retardation Community Services 32 1.4.3 Promoting Independence through Outreach, Awareness, and Relocation 34 1.4.4 In-Home and Family Support – Regional and Local Services (IHFS-RLS) 36 1.4.4 In-Home and Family Support – Mental Retardation (IHFS-MR) 38 1.5.1 Program of All-Inclusive Care for the Elderly (PACE) 40 1.6.1 Nursing Facility Payments 42 1.6.2 Medicare Skilled Nursing Facility 44 1.6.3 Hospice 46 1.6.4 Promote Independence by Providing Community-Based Client Services 48 1.7.1 Intermediate Care Facilities - Mental Retardation (ICF/MR) 50 1.8.1 MR State Supported Living Center Services 52 1.9.1 Capital Repairs and Renovations 54 GOAL 2 Regulation, Certification and Outreach 2.1.1 Facility and Community-Based Regulation 56 2.1.2 Credentialing / Certification 58 2.1.3 Long-Term Care Quality Outreach 60 GOAL 3 Indirect Administration 3.1.1 Central Administration 62 3.1.2 Information Technology Program Support 62 3.1.3 Other Support Services 62 Toll-Free Hotline Numbers 64

5

DADS’ DADS’

PROGRAMS

AND

SERVICES

6

Strategy 1.1.1 Intake, Access and Eligibility to Services and Supports

The Department of Aging and Disability Services (DADS) provides functional eligibility determina-tion, development of individual service plans that are based on consumer needs and preferences, assistance in obtaining information, and authoriz-ing appropriate services and supports through effective and efficient management of DADS staff. DADS provides these services through Regional and Local Services (RLS) staff located in offices around the state, and through contracts with local Area Agencies on Aging (AAAs) and Mental Re-tardation Authorities (MRAs). DADS RLS staff determine functional eligibility for Title XIX, and functional and financial eligibility for Title XX community services and supports pro-grams to enable individuals to remain in the most integrated community settings, and delay or pre-vent institutionalization. MRAs determine eligibility for General Revenue (GR) funded services and assist consumers in accessing appropriate ser-vices and supports. AAAs assist older persons, their family members, or other caregivers by providing information and assistance in accessing services and supports. AAAs are also a part of the State Health Insur-ance Assistance Program (SHIP) in Texas, a national program funded by the Centers for Medicare and Medicaid Services. Through Le-gal Assistance services, AAAs provide informa-tion, counseling, and assistance to Medicare beneficiaries of any age and/or their representa-tives regarding Medicare, Medicaid, public bene-fits, entitlements, and other types of health insur-ance. To determine the location and phone number for a DADS office, visit DADS website at: http://www.dads.state.tx.us/contact/index.html

7

Str

ateg

y 1.

1.1

In

take

, A

cce

ss a

nd

Elig

ibili

ty t

o

Ser

vice

s a

nd

Su

pp

ort

s F

Y 2

008

FY

200

9 F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 1

O

C

4 P

erce

nt o

f Lon

g-t

erm

Car

e P

erso

ns

Ser

ved

in C

omm

unity

S

ettin

gs

72.7

3%

73.5

2%

73.7

0%

1 1

1 O

P

5 A

vera

ge M

onth

ly N

umbe

r of

Indi

vidu

als

with

MR

Rec

eivi

ng

Ass

essm

ent a

nd S

ervi

ce C

oord

ina

tion

8,72

1 8,

846

8,82

3

1 1

1 O

P

6 A

vera

ge N

umbe

r of

Per

sons

Elig

ible

per

Mon

th:

Com

mun

ity

Ser

vice

s an

d S

uppo

rts

165,

281

170,

805

173,

487

1 1

1 E

F

3 A

vera

ge M

onth

ly C

ost p

er in

divi

dual

s w

ith M

R R

ece

ivin

g A

s-se

ssm

ent a

nd S

ervi

ce C

oord

inat

ion

$174

.20

$174

.20

$174

.20

1 1

1 E

F

4 A

vera

ge M

onth

ly C

ost p

er C

ase:

Com

mun

ity S

erv

ices

and

S

uppo

rts

$29.

70

$29.

75

$29.

79

T

ota

l $1

38,6

42,5

92

$147

,826

,60

9 $1

82,0

87,3

33

S

tate

$5

1,64

1,71

3 $5

2,75

7,64

0 $7

6,49

7,61

4

F

eder

al

$84,

824,

504

$89,

951,

316

$101

,814

,35

6

O

ther

$2

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,375

$5

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,653

$3

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,363

F

TE

Po

siti

on

s 1,

637.

0 1,

831.

0 1,

857.

4

8

Strategy 1.1.2 Guardianship Services

A guardian is a court-appointed person or entity (such as a state agency) responsible for making decisions on behalf of a person with diminished capacity. Chapter 13 of the Texas Probate Code defines the purpose, laws, and responsibilities of a guardian. Depending upon the powers granted by the court, guardianship responsibilities may in-clude, but are not limited to:

Providing or arranging for services for adults with diminished capacity which otherwise qualify for guardianship services under the laws of the state of Texas;

Arranging for placement in facilities, such as long-term care facilities, hospitals or foster homes;

Managing estates; and

Making medical decisions.

The DADS Guardianship Program provides guardianship services, either directly or through contracts with local guardianship programs to indi-viduals referred to the program by the Texas De-partment of Family and Protective Services; or referred to the program by courts under certain circumstances outlined in statute; and who have been adjudicated as lacking capacity by a court with probate authority and are in need of a guard-ian.

DADS staff who provide guardianship services are required to be certified by the Texas Guardianship Certification Board.

9

Str

ateg

y 1.

1.2

Gu

ard

ian

sh

ip

FY

200

8 F

Y20

09

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 1

2 O

P

1 A

vera

ge N

umbe

r of

indi

vidu

als

Rec

eivi

ng G

uard

ian

ship

Ser

-vi

ces

from

DA

DS

sta

ff

871

741

856

1 1

2 O

P

2 A

vera

ge N

umbe

r of

AP

S D

AD

S C

onsu

mer

s R

ecei

ving

Gua

rdi-

ansh

ip S

ervi

ces

thro

ugh

Con

trac

ts w

ith P

rivat

e G

uard

ians

hip

Pro

gram

s 19

8 38

7 30

0

T

ota

l $6

,149

,588

$7

,093

,384

$6

,995

,223

S

tate

$1

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,899

$1

,589

,478

$3

,609

,340

F

eder

al

$5,0

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$7,0

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$6,9

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O

ther

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$0

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TE

Po

siti

on

s 10

2.9

10

8.0

108.

0

10

Strategy 1.2.1 Primary Home Care (PHC)

PHC provides non-skilled, personal care services for individuals whose chronic health problems im-pair their ability to perform activities of daily living (ADL). Personal attendants assist individuals in performing ADLs, such as arranging or accompa-nying individuals on trips to receive medical treat-ment, bathing, dressing, grooming, preparing meals, housekeeping, and shopping. On average, individuals are authorized to receive approxi-mately 16.6 hours of assistance per week. The Consumer Directed Service option is available with PHC.

Eligibility Requirements. An individual must:

be at least 21 years of age,

have a monthly income that is equal to or less than 100% of the monthly income limit for Sup-plemental Security Income (SSI) ($674/month*),

have countable resources of no more than $2,000,

have a functional assessment score of 24 or greater, and

have a medical practitioner’s statement that the individual’s medical condition causes a func-tional limitation for at least one personal care task.

* SSI levels are adjusted at the federal level each year based upon the annual increase in the Con-sumer Price Index.

11

Str

ateg

y 1.

2.1

Pri

mar

y H

om

e C

are

(PH

C)

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 2

O

C

1 A

vera

ge N

umbe

r of

Indi

vidu

als

Ser

ved

Per

Mon

th:

Med

icai

d N

on-w

aive

r C

omm

unity

Ser

vice

s an

d S

uppo

rts

110,

318

111,

738

114,

573

1 2

1 O

P

1 A

vera

ge N

umbe

r of

indi

vidu

als

Ser

ved

Per

Mon

th:

Prim

ary

Hom

e C

are

51

,574

52

,660

54

,347

1 2

1 E

F

1 A

vera

ge M

onth

ly C

ost P

er in

divi

dual

Ser

ved:

Prim

ary

Hom

e C

are

$682

.15

$757

.55

$834

.01

T

ota

l $4

22,5

07,1

94

$479

,096

,18

5 $5

43,9

12,6

13

S

tate

$1

30,6

80,9

16

$113

,763

,48

2 $1

35,9

42,6

28

F

eder

al

$201

,388

,44

7 $2

49,3

75,3

87

$269

,819

,45

8

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0 0

12

Strategy 1.2.2 Community Attendant Services (CAS)

CAS provides non-skilled personal care services for individuals whose chronic health problems im-pair their ability to perform activities of daily living (ADL) and whose income makes them ineligible for Primary Home Care (PHC). Personal attendants provide services to assist individuals in performing ADLs such as arranging or accompanying the indi-vidual on trips to receive medical treatment, bath-ing, dressing, grooming, preparing meals, house-keeping, and shopping. On average, individuals are authorized to receive approximately 16.4 hours of assistance per week. The Consumer Directed Service (CDS) option is available with CAS.

(Note: The term Frail Elderly is still used in federal language to refer to the legal authority located in the Social Security Act.)

Eligibility Requirements. An individual may be of any age, and must:

have a monthly income that is within 300% of the monthly income limit for SSI ($2,022/month*),


have a functional assessment score of 24 or greater, and

have a medical practitioner’s statement that the individual’s medical condition causes a functional limitation for at least one personal care task.

* SSI levels are adjusted at the federal level each year based upon the annual increase in the Consumer Price Index.

13

Str

ateg

y 1.

2.2

Co

mm

un

ity

Att

end

an

t S

ervi

ces

(C

AS

) F

Y 2

008

FY

200

9 F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 2

2 O

P

1 A

vera

ge N

umbe

r of

indi

vidu

als

Ser

ved

Per

Mon

th:

Com

mun

ity

Att

enda

nt S

ervi

ces

42,1

41

42,9

38

42,5

23

1 2

2 E

F

1 A

vera

ge M

onth

ly C

ost P

er in

divi

dual

s S

erve

d: C

om

mun

ity

Att

enda

nt S

ervi

ces

$654

.70

$719

.42

$795

.18

T

ota

l $3

32,0

69,3

63

$363

,138

,86

9 $4

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62,0

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S

tate

$1

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80,9

16

$113

,763

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2 $1

35,9

42,6

28

F

eder

al

$201

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7 $2

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87

$269

,819

,45

8

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0

0

14

Strategy 1.2.3 Day Activity and Health Services (DAHS)

Licensed adult day-care facilities provide daytime services five days a week (Monday-Friday). Ser-vices are designed to address the physical, mental, medical, and social needs of individuals, and must be provided or supervised by a licensed nurse. Ser-vices include nursing and personal care; noontime meal; snacks; transportation; and social, educa-tional, and recreational activities. Individuals re-ceive services based on half-day (three to six hours) units of service; an individual may receive a maxi-mum of 10 units of service a week, depending on the physician’s orders and related requirements.

Eligibility Requirements. An individual may be of any age*, and must:

be a full Medicaid recipient,

have a physician’s order requiring care or su-pervision by a licensed nurse because the individual has a need for skilled or restorative nursing that can be met at the facility,

prior approval granted by a DADS Regional Nurse, and

the need for assistance with one or more per-sonal care tasks.

Note: For Title XX funded DAHS, the income limit is 300% of SSI and the resources limit is $5,000 or less for an individual if not SSI eligible or $6,000 or less for a couple if not SSI eligible.

* Individuals under 18 are not ineligible; however, those under age 18 are not able to attend DAHS due to licensure issues.

15

Str

ateg

y 1.

2.3

Da

y A

cti

vity

an

d H

ealt

h S

ervi

ces

(D

AH

S)

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 2

3 O

P

1 A

vera

ge N

umbe

r of

indi

vidu

als

Ser

ved

Per

Mon

th:

Da

y A

ctiv

ity

and

Hea

lth S

ervi

ces

16,6

03

17,1

40

17,7

03

1 2

3 E

F

1 A

vera

ge M

onth

ly C

ost P

er in

divi

dual

Ser

ved:

Da

y A

ctiv

ity a

nd

Hea

lth S

ervi

ces

$496

.88

$508

.38

$524

.25

T

ota

l $9

8,99

7,46

5 $1

04,5

62,4

43

$111

,371

,46

1

S

tate

$3

5,52

0,35

9 $2

8,73

8,76

6 $3

2,68

9,75

1

F

eder

al

$60,

010,

875

$71,

672,

576

$78,

681,

710

O

ther

$3

,466

,231

$4

,151

,101

0

F

TE

Po

siti

on

s 0

0 0

16

Strategy 1.3.1 Community Based Alternatives (CBA)

The CBA Program provides services and supports for aged and disabled individuals as an alternative to residing in a nursing facility. Services include case management by DADS staff, adaptive aids, medical supplies, dental, adult foster care, as-sisted living/residential care, emergency re-sponse, nursing, minor home modifications, occu-pational therapy, personal assistance, home de-livered meals, physical therapy, respite care, speech pathology, and transition assistance ser-vices. Consumer Directed Services (CDS) option is available for this program.


be 21 years of age or older, meet the medical ne-cessity for nursing facility admission, be Medicaid eligible, have a monthly income that is within 300% of the Supplemental Security Income (SSI) monthly income limit ($2,022/month*), have count-able resources of no more than $2,000, have an Individual Service Plan (ISP) that does not exceed 200% of the reimbursement rate that would have been paid for that same individual to receive ser-vices in a nursing facility, and choose waiver ser-vices instead of nursing facility care based on an informed choice.


Integrated Care Management (ICM) program. Beginning February 1, 2008 individuals began receiving services in the Dallas and Tarrant ser-vice areas through the ICM program, a Medicaid managed care program for people who are 65 years of age and older or who have disabilities.

17

Str

ateg

y 1.

3.1

Co

mm

un

ity

Bas

ed A

lter

nat

ive

s (C

BA

) F

Y 2

008

FY

200

9 F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 3

1 O

P

1 A

vera

ge N

umbe

r of

indi

vidu

als

Ser

ved

Per

Mon

th:

Med

icai

d C

omm

unity

B

ased

Alte

rnat

ives

(C

BA

) W

aive

r 25

,049

25

,995

25

,927

1 3

1 E

F

1 A

vera

ge M

onth

ly C

ost P

er in

divi

dual

Ser

ved:

Med

icai

d C

omm

unity

B

ased

Alte

rnat

ives

(C

BA

) W

aive

r $1

,379

.85

$1,4

56.4

2 $1

,550

.92

T

ota

l $4

16,1

35,9

88

$455

5,77

,14

2 $4

83,8

96,3

60

S

tate

$1

62,9

12,7

37

$141

,918

,88

1 $1

42,3

15,7

08

F

eder

al

$251

,956

,11

2 $3

13,0

39,6

71

$342

,580

,65

2

O

ther

$1

,267

,139

$6

18,5

90

0

F

TE

Po

siti

on

s 0

0 0

18

Strategy 1.3.2 Home and Community-Based Services (HCS)

The HCS Program provides services and supports for individuals with mental retardation or a related condition as an alternative to residing in an ICF/MR. Individuals may live in their own or family home, in a foster/companion care setting, or in a residence with no more than four individuals who receive similar services. Services include case management, and, as appropriate to the individ-ual’s needs, residential assistance, supported em-ployment, day habilitation, respite, dental treat-ment, adaptive aids, minor home modifications, and/or specialized therapies such as social work, behavioral support, occupational therapy, physical therapy, audiology, speech/language pathology, dietary services, and licensed nursing services. The CDS option is available for those who live in their own or family home for supported home living and respite. Eligibility Requirements. An individual may be of any age, and must:

have a determination of mental retardation made in accordance with state law or have been diagnosed by a physician as having a related condition;

meet the ICF/MR Level of Care I criteria, have a monthly income that is within 300% of

the SSI monthly income limit ($2,022/month*),

be Medicaid eligible, and have an Individual Plan of Care (IPC) that does

not exceed 200% of the reimbursement rate that would have been paid for that same individual to receive services in an ICF/MR, or 200% of the estimated annual-ized per capita cost for ICF/MR services, whichever is greater.


19

Str

ateg

y 1.

3.2

Ho

me

and

Co

mm

un

ity-

Bas

ed

Ser

vic

es (

HC

S)

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 3

2 O

P

1 A

vera

ge N

umbe

r of

Indi

vidu

als

Ser

ved

Per

Mon

th:

Hom

e an

d C

omm

unity

-Bas

ed S

ervi

ces

(HC

S)

Wai

ver

13,3

86

15,1

07

17,2

55

1 3

2 E

F

1 A

vera

ge M

onth

ly C

ost P

er In

divi

dual

Ser

ved:

Hom

e an

d C

om-

mun

ity-B

ased

Se

rvic

es (

HC

S)

Wai

ver

$3,4

21.6

3 $3

,442

.93

$3,4

49.7

1

T

ota

l $5

49,6

23,2

59

$624

,137

,74

0 $7

31,8

44,6

33

S

tate

$2

13,4

41,4

96

$195

,278

,72

9 $2

14,7

24,9

12

F

eder

al

$333

,206

,02

8 $4

25,8

70,4

11

$517

,119

,72

1

O

ther

$2

,990

,735

$2

,987

,600

0

F

TE

Po

siti

on

s 0

0 0

20

Strategy 1.3.3 Community Living Assistance and Support Services (CLASS)

The CLASS Program provides services and sup-ports for individuals with related conditions as an alternative to residing in an ICF/MR. Individuals may live in their own or family home. Services include adaptive aids and medical supplies, case management, consumer directed services, ha-bilitation, minor home modifications, nursing ser-vices, occupational and physical therapy, behav-ioral support services, respite, specialized thera-pies, speech pathology, pre-vocational services, supported employment, support family services, and transition assistance services. The CDS op-tion is available for habilitation, respite, nursing, physical therapy, occupation therapy and speech/hearing therapy.




have an Individual Service Plan (ISP) that does not exceed 200% of the estimated an-nualized per capita cost of providing ser-vices in an ICF/MR to an individual qualify-ing for an ICF/MR Level of Care VIII.


21

Str

ateg

y 1.

3.3

Co

mm

un

ity

Liv

ing

As

sis

tan

ce a

nd

Su

pp

ort

Ser

vice

s (C

LA

SS

)

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 3

3 O

P

1 A

vera

ge N

umbe

r of

Indi

vidu

als

Ser

ved

Per

Mon

th:

Com

mun

ity

Livi

ng A

ssis

tanc

e &

Sup

port

(C

LA

SS

) W

aive

r

3,78

1 3,

897

4,38

5

1 3

3 E

F

1 A

vera

ge M

onth

ly C

ost P

er In

divi

dual

Ser

ved:

Com

mun

ity L

iv-

ing

Ass

ista

nce

& S

uppo

rt (

CLA

SS

) W

aive

r

$3,1

01.3

2 $3

,427

.25

$3,6

50.4

7

T

ota

l $$

140,

694,

488

$1

60,2

75,1

89

$192

,090

,65

4

S

tate

$5

4,89

7,41

6 $4

9,97

7,98

7 $5

6,38

2,44

9

F

eder

al

$85,

662,

043

$110

,297

,20

2 $1

35,7

08,2

05

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0

0

22

Strategy 1.3.4 Deaf-Blind Multiple Disabilities (DBMD)

The DBMD Program provides services and sup-ports for individuals with deaf-blindness and one or more other disabilities as an alternative to re-siding in an ICF/MR. Individuals may reside in their own or family home or in small group homes. Services include adaptive aids and medical sup-plies, dental services, assisted living, behavioral support services, case management, chore ser-vices, minor home modifications, residential habili-tation, day habilitation, intervener, nursing ser-vices, occupational therapy, physical therapy, ori-entation and mobility, respite, speech, hearing and language therapy, supported employment, em-ployment assistance, dietary services, financial management services for the consumer directed services option, and transition assistance. The CDS option is available for day habilitation, res-pite, and intervener services.

Eligibility Requirements. An individual may be any age and must:

have deaf blindness with one or more other disabilities that impairs independent function-ing,



have an ISP that does not exceed 200% of the estimated annualized per capita cost of providing services in an ICF/MR to an individ-ual qualifying for an ICF/MR Level of Care VIII.


23

Str

ateg

y 1.

3.4

Dea

f-B

lind

Mu

ltip

le D

isa

bili

tie

s (D

BM

D)

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 3

4 O

P

1 A

vera

ge N

umbe

r of

Indi

vidu

als

Ser

ved

Per

Mon

th:

Med

icai

d D

eaf-

blin

d w

ith M

ultip

le D

isab

ilitie

s W

aive

r 14

7

152

150

1 3

4 E

F

1 A

vera

ge M

onth

ly C

ost P

er In

divi

dual

Ser

ved:

Med

icai

d D

eaf-

blin

d w

ith M

ultip

le D

isab

ilitie

s W

aive

r $3

,941

.24

$3,8

73.2

5 $4

,082

.78

T

ota

l $7

,052

,639

$7

,184

,808

$7

,347

,798

S

tate

$2

,780

,150

$2

,277

,239

$2

,156

,726

F

eder

al

$4,2

72,4

89

$4,9

07,5

69

$5,1

91,0

72

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0

0

24

Strategy 1.3.5 Medically Dependent Children Program (MDCP)

The MDCP provides a variety of ser-vices and supports for families caring for children who are medically depend-ent as an alternative to residing in a nursing facility. Specific services in-clude adaptive aids, adjunct support services, minor home modifications, respite, and transition assistance ser-vices. The CDS option is available for respite and adjunct support services provided by an attendant or by a nurse.


be under 21 years of age,

meet the medical necessity re-quirements* for nursing facility ad-mission,

have a monthly income that is within 300% of the monthly income limit for SSI ($2,022/month**),

have countable resources of no more than $2,000, and

have an Individual Plan of Care (IPC) that does not exceed 50% of the reimbursement rate that would have been paid for that same indi-vidual to receive services in a nurs-ing facility.

* * SSI levels are adjusted at the federal level each year based upon the annual increase in the Consumer Price Index.

25

Str

ateg

y 1.

3.5

Med

ical

ly D

epe

nd

ent

Ch

ildre

n P

rog

ram

(M

DC

P)

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 3

5 O

P

1 A

vera

ge N

umbe

r of

Indi

vidu

als

Ser

ved

Per

Mon

th:

Med

ical

ly

Dep

ende

nt C

hild

ren

Pro

gra

m

2,46

9 2,

745

2,69

9

1 3

5 E

F

1 A

vera

ge M

onth

ly C

ost P

er In

divi

dual

Ser

ved:

Med

ical

ly D

e-

pend

ent C

hild

ren

Pro

gram

$1

,323

.93

$1,4

49.2

5 $1

,517

.96

T

ota

l $3

9,22

2,81

8 $4

7,74

5,63

7 $4

9,15

9,84

8

S

tate

$1

5,45

5,39

1 $1

4,56

4,87

6 $1

4,42

9,39

9

F

eder

al

$23,

761,

183

$33,

180,

761

$34,

730,

449

O

ther

$6

,244

$0

$0

F

TE

Po

siti

on

s 0

0

0

26

Strategy 1.3.6 Consolidated Waiver Program (CWP)

CWP was implemented as a pilot program in September 2001 in Bexar County. It serves individuals drawn from interest lists for the following 1915 (c) waiver programs: Home and Community-based Services (HCS), Commu-nity Living Assistance and Support Services (CLASS), Deaf Blind Multiple Disabilities (DBMD), State of Texas Access Reform (STAR+PLUS), and Medically Depend-ent Children Program (MDCP). CWP provides an alter-native to residing in a nursing facility or in an ICF/MR. CWP provides the following services: adaptive aids/medical supplies, adult foster care, assisted living/residential care, audiology, behavioral support, dental, dietary, emergency response services, day habilitation, home-delivered meals, independent advocacy, inter-vener, minor home modifications, nursing, orientation and mobility, personal assistance, transportation, respite, social work, employment assistance, supported employ-ment, physical and occupational therapy, and speech/language therapy. The CDS option is available for day habilitation, personal assistance services, and respite.

Eligibility Requirements. An individual may be of any age, and must: reside in Bexar County, be on the interest list in Bexar County for STAR+PLUS 1915(c), HCS, CLASS, DBMD, or MDCP waiver services, have a monthly income that is within 300% of the monthly in-come limit for SSI ($2,022/month*), have countable re-sources of no more than $2,000, have an ISP that does not exceed 200% of the reimbursement rate that would have been paid for that same individual to receive ser-vices in a nursing facility, 200% of the reimbursement rate that would have been paid for that same individual under age 21 to receive services in a nursing facility, or 200% of the estimated cost of providing services in an ICF/MR, as applicable; and, meet medical necessity (MN) requirements for nursing facility services; OR meet the requirements for service in an ICF/MR.


27

Str

ateg

y 1.

3.6

Co

ns

olid

ate

d W

aive

r P

rog

ram

(C

WP

) F

Y 2

008

FY

200

9 F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 3

6 O

P

1 A

vera

ge N

umbe

r of

Indi

vidu

als

Ser

ved

Per

Mon

th:

Med

icai

d C

on-

solid

ated

Wai

ver

Pro

gram

17

9

171

159

1 3

6 E

F

1 A

vera

ge M

onth

ly C

ost P

er In

divi

dual

Ser

ved:

Med

icai

d C

onso

li-da

ted

Wai

ver

Pro

gram

$1

,824

.80

$1,9

13.8

4 $1

,904

.05

T

ota

l $3

,923

,317

$3

,934

,852

$3

,632

,923

S

tate

$1

,538

,439

$1

,229

,741

$1

,066

,336

F

eder

al

$2,3

84,8

78

$2,7

05,1

11

$2,5

66,5

87

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0

0

28

Strategy 1.3.7 Texas Home Living Waiver (TxHmL)

The TxHmL Program provides essential services and supports for individuals with mental retarda-tion or a related condition as an alternative to re-siding in an ICF/MR. Individuals must live in their own or family homes. Service components are comprised of the Community Living Service cate-gory and the Technical and Professional Supports Services category. The Community Living Service category includes community support, day habili-tation, employment assistance, supported employ-ment, and respite services. The Technical and Professional Supports Services category includes skilled nursing, behavioral support, adaptive aids, minor home modifications, dental treatment, and specialized therapies. Coordination of services is provided by the local mental retardation authority service coordinator. The CDS option is available for all services.


have a determination of mental retardation made in accordance with state law or have been diagnosed by a physician as having a related condition;

live in his/her own home or in his/her family’s home,

be Medicaid eligible,

meet the requirements for ICF/MR Level of Care I,

have an Individual Service Plan (ISP) that does not exceed $18,135, and

not be assigned a Pervasive Plus Level of Need (LON) 9.

29

Str

ateg

y 1.

3.7

Tex

as H

om

e L

ivin

g W

aive

r (T

xHm

L)

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 3

7 O

P

1 A

vera

ge N

umbe

r of

Indi

vidu

als

Ser

ved

Per

Mon

th:

Tex

as H

ome

Livi

ng W

aive

r 1,

243

1,05

2 99

4

1 3

7 E

F

1 A

vera

ge M

onth

ly C

ost P

er In

divi

dual

Ser

ved:

Te

xas

Hom

e Li

ving

W

aive

r $5

86.8

9 $6

00.6

4 $9

17.6

9

T

ota

l $8

,750

,476

$7

,581

,877

$1

0,94

6,15

1

S

tate

$3

,442

,166

$2

,392

,937

$3

,212

,915

F

eder

al

$5,3

08,3

10

$5,1

88,9

40

$7,7

33,2

36

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0

0

30

Strategy 1.4.1 Non-Medicaid Services

Adult Foster Care. Provides a 24-hour living ar-rangement with supervision in an adult foster home for individuals who, because of physical, mental, or emotional limitations are unable to continue inde-pendent functioning in their own homes. Providers of Adult Foster Care must live in the household and share a common living area with the individual(s). With the exception of family members of the foster care provider, no more than three individuals may live in the foster home unless DADS licenses it as an assisted living facility. Services may include help with activities of daily living, and provision of or ar-rangement for transportation. The individual pays the provider for room and board.

Consumer-Managed Personal Attendant Services. Provides services for individuals with physical dis-abilities who are mentally competent and willing to supervise their attendant or who have someone who can provide supervision of the attendant. Individuals interview, select, train, supervise, and release their personal attendants. The CDS option is available for this service.

Day Activities and Health Services. Provides nurs-ing, nutrition, and supportive services in adult day care facilities that are licensed by DADS.

Emergency Response Services. Provides a 24-hour electronic emergency call system for function-ally impaired elderly or disabled individuals who live alone or are physically isolated from the community.

Family Care. Assists individuals who are function-ally limited in performing activities of daily living. Services include assistance with personal care ac-tivities, housekeeping tasks, meal preparation, and escort services. The CDS option is available for Family Care.

Home-Delivered Meals. Provides nutritious meals delivered by community-based provider agencies to an individual’s home.

Residential Care. Provides services for individuals who require access to services on a 24-hour ba-sis, but who do not need daily nursing interven-tion. Care is provided in DADS-licensed assisted living facilities. The individual pays the provider for room and board and may also have co-payment liability.

Special Services for Persons with Disabilities. Contracts with public or private agencies to pro-vide services to help individuals with disabilities achieve habilitative or rehabilitative goals that en-courage maximum independence.

31

Str

ate

gy

1.4

.1 N

on

-Me

dic

aid

Ser

vic

es

F

Y 2

00

8

FY

20

09

F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1

4

1

OP

4

N

um

be

r o

f Co

ngre

gat

e M

eal

s S

erve

d (

AA

A)

59

,688

5

5,5

80

55

,489

1

4

1

OP

6

N

um

be

r o

f Ho

me-

de

live

red

Mea

ls S

erv

ed

(A

AA

) 1

6,8

50

17

,256

1

6,6

05

1

4

1

OP

7

#

of

Pe

rson

s R

ece

ivin

g H

om

em

ake

r S

erv

ice

s (A

AA

) 2

,49

2

2,2

30

2

,36

7

1

4

1

OP

1

0

Nu

mb

er

of O

ne-

wa

y T

rips

(AA

A)

81

0,00

3

77

6,74

8

71

6,37

4

1

4

1

EF

1

A

vera

ge

Mon

thly

Co

st P

er In

div

idua

l Se

rve

d:

Non

-Med

ica

id C

om

-m

un

ity S

erv

ice

s an

d S

uppo

rts

(XX

) $

186

.65

$

200

.07

$

209

.81

1

4

1

EF

3

S

tate

wid

e A

vera

ge C

ost

pe

r C

ong

reg

ate

Mea

l (A

AA

) $

4.7

1

$4

.94

$

5.1

1

1

4

1

EF

4

S

tate

wid

e A

vg C

ost

Per

Ho

me-

deliv

ere

d M

eal (

AA

A)

$4

.64

$

4.8

3

$4

.91

1

4

1

EF

5

S

tate

wid

e A

vera

ge C

ost

Per

Pe

rson

Re

ceiv

ing

Ho

mem

ake

r S

er-

vice

s (A

AA

) $

604

.77

$

623

.14

$

613

.61

1

4

1

EX

2

A

vera

ge

Nu

mbe

r o

f in

div

idua

ls R

ece

ivin

g N

on-

Med

ica

id C

om

mu

-n

ity S

erv

ice

s an

d S

up

port

s (X

X)

36

,420

3

8,1

84

36

,745

T

ota

l $

141

,572

,09

9

$1

52,2

93,5

08

$

155

,987

,81

5

S

tate

$

12,

376

,550

$

18,

227

,156

$

16,

236

,797

F

ed

era

l $

128

,927

,61

8

$9

1,50

4,9

89

$9

2,51

4,7

13

O

the

r $

267

,931

2

67,

931

0

F

TE

Po

sit

ion

s

0

0

0

32

Strategy 1.4.2 Mental Retardation Community Services

Mental Retardation (MR) Community Services include services and supports provided to persons in the DADS mental retardation priority population who reside in the community. These services do not include services provided through an ICF/MR or Medicaid waiver programs. MR Community Services assist individuals to par-ticipate in age-appropriate community activities and services. These services include: Community Supports. Individualized activities provided in an individual’s home or at community locations to facilitate an individual’s ability to per-form functional living skills and other daily living activities. Day Habilitation Services. Services provided away from an individual’s home to help the individ-ual develop and refine skills necessary to live and work in the community. Eligibility Determination. An assessment or endorsement conducted by the Mental Retarda-tion Authority (MRA) to determine if an individual has mental retardation or is a member of the DADS mental retardation priority population. Employment Services. Support services to as-sist individuals in securing and maintaining com-munity employment. Respite. Services that can be provided in or out of the individual’s home to temporarily relieve an individual’s family members or other unpaid pri-mary caregivers of their responsibilities for provid-ing care to the individual. Service Coordination. Assistance in accessing medical, social, educational, and other appropriate services and supports that will help an individual achieve a quality of life and community participa-tion acceptable to the individual. Therapies. Support services provided by li-censed or certified professionals including psy-chology, nursing, social work, occupational ther-apy, speech therapy, physical therapy, dietary services, and certain behavioral health services.

33

Str

ateg

y 1.

4.2

Men

tal

Ret

ard

atio

n C

om

mu

nit

y S

ervi

ces

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 4

2 O

P

2 A

vera

ge M

onth

ly N

umbe

r of

Indi

vidu

als

with

MR

Rec

eivi

ng

Com

mun

ity S

erv

ices

12

,860

12

,998

12

,927

1 4

2 E

F

2 A

vera

ge M

onth

ly C

ost P

er in

divi

dual

with

MR

Rec

eivi

ng C

om-

mun

ity S

ervi

ces

$571

.73

$574

.45

$661

.10

T

ota

l $9

3,44

4,55

3 $9

7,44

0,31

4 $1

02,1

98,2

23

S

tate

$9

2,77

9,38

3 $9

6,79

1,69

4 $1

02,1

93,2

23

G

R D

edi

cate

d $4

,620

$4

,620

$5

,000

F

eder

al

$0

$0

$0

O

ther

$6

60,5

50

$644

,000

$0

F

TE

Po

siti

on

s 0

0

0

34

Strategy 1.4.3 Promoting Independence through Outreach, Awareness, and Relocation

The Texas Promoting Independence Plan was developed in response to the US Supreme Court ruling in Olmstead v. L.C. and two Executive Or-ders, GWB99-2 and RP13. Two activities under the larger Promoting Independence Plan include community outreach and awareness, and reloca-tion services. Community outreach and aware-ness is a systematic program of public information developed to target groups who are most likely to be involved in decisions regarding long-term ser-vices and supports. Relocation services involve assessment and case management to assist indi-viduals in nursing facilities who choose to relocate to community-based services and supports. It includes funding for Transition to Living in the Community (TLC) services to cover establishing and moving to a community residence.

Adults and children residing in nursing facilities who relocate to the most integrated community setting of their choice require a thorough assess-ment, intensive case management, housing assis-tance, and funds to set up a community residence. Intensive case management may be needed to help build and implement the service and support systems for adults and children so they can return to the community. With limited income and re-sources, Medicaid recipients in facilities may re-quire help to set up community households, such as security deposits, and assistance to purchase household goods and groceries. Relocation as-sistance and relocation funding, in combination or separately, allow more individuals to return to the community. Community outreach activities raise awareness and improve processes for informing decision makers about long-term services and support options. .

35

Str

ateg

y 1.

4.3

Pro

mo

tin

g In

de

pen

den

ce t

hro

ug

h O

utr

each

, A

war

enes

s, a

nd

R

elo

cati

on

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

The

re a

re n

o m

eas

ures

for

this

str

ateg

y.

T

ota

l 21

7090

3 20

0835

0 39

8978

0

S

tate

12

4815

9 42

992

3383

036

F

eder

al

2660

00

9216

14

$953

,372

O

ther

65

6744

65

6744

60

6744

F

TE

Po

siti

on

s 0

0

0

36

Strategy 1.4.4 In-Home and Family Support—

Regional and Local Services (IHFS-RLS)

The IHFS-RLS program provides individuals with physical disabilities (without diagnosis of mental disability) with a means to purchase the support they need in order to remain in the community. Direct grant benefits are provided to eligible indi-viduals with physical disabilities to purchase ser-vices that enable them to live in the community. The services include: attendant care, home health services, home health aide services, homemaker services and chore services; medical, surgical, therapeutic, diagnostic and other health services related to a person’s disability; pre-approved trans-portation and room and board cost incurred by person with physical disability or his family during evaluation or treatment; purchase or lease of spe-cial equipment or architectural modifications of a home to facilitate the care, treatment therapy, or general living conditions of a person with a disabil-ity; respite care; and transportation services. IHFS-RLS provides up to $1,200 per certification year in capital expenditure funds, subsidy funds, or a combination of both, including co-payment for the purchase of ongoing services, or the purchase of equipment or architectural modifications. There is a lifetime limit of $3,600 in capital expenditure funds. After this limit is reached, additional funds cannot be issued for any one-time purchases cost-ing over $250. Eligibility Requirements. To be eligible for ser-vices, an applicant must:

be age 4 or older,

have a permanent physical disability that results in a substantial functional limitation in one or more major life areas that limits the individual’s ability to function independently, and

meet income eligibility criteria based on the State Median Income (SMI). Co-payments begin when an individual’s income iis at/above 105% of the SMI.

There are no resource eligibility requirements.

37

Str

ateg

y 1.

4.4

In

-Ho

me

an

d F

am

ily

Su

pp

ort

(IH

FS

) F

Y 2

008

FY

200

9 F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 4

4 O

P

1 A

vera

ge N

umbe

r of

Indi

vidu

als

Per

Mon

th R

ecei

ving

In-h

ome

Fam

ily S

uppo

rt S

ervi

ces

4,56

2 5,

410

6,41

5

1 4

4 E

F

1 A

vera

ge M

onth

ly C

ost o

f In-

hom

e F

amily

Sup

port

Ser

vice

s P

er

indi

vidu

al

70.4

4 69

.23

68.0

4

T

ota

l $4

,286

,526

$4

,647

,920

$4

,818

,914

S

tate

$4

,286

,526

$4

,647

,920

$4

,818

,914

F

eder

al

$0

$0

$0

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0

0

38

Strategy 1.4.5 In-Home and Family Support—Mental Retardation (IHFS-

MR)

IHFS-MR provides financial assistance to eligible persons and families for the purpose of purchasing items that meet a need that exists solely because of the person’s mental disability or co-occurring physical disability. The pro-gram directly supports the person to live in his or her natural home, inte-grates the person into the community, or promotes the person’s self-sufficiency.

Funds may be used for the following: services such as respite care, spe-

cialized therapies, home care, counseling, and training, such as in-home parent training;

special equipment, such as ther-apy equipment and assistive tech-nology;

home modifications; transportation; and other items that meet the pro-

gram’s criteria.

There is a limit of $2,500 per year, with the amount granted depending on the individual’s needs, income and applica-tion of a sliding co-pay scale. This is a resource of last resort, meaning that all other available resources must be ac-cessed before using these funds. Eligibility Requirements. Individuals with a mental disability or their families must meet four eligibility criteria – diag-nosis, residency, financial, and need.

39

Str

ateg

y 1.

4.5

Men

tal

Ret

ard

atio

n In

-Ho

me

Ser

vice

s

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 4

5 O

P

1 N

umbe

r of

indi

vidu

als

with

MR

Rec

eivi

ng In

-hom

e an

d F

amily

S

uppo

rt P

er Y

ear

3,08

5 3,

073

3,07

3

1 4

5 E

F

1 A

vera

ge A

nnua

l Gra

nt P

er in

divi

dual

with

MR

Rec

eivi

ng In

-ho

me

and

Fam

ily S

uppo

rt

$1,7

37.7

2 $1

,861

.94

$1,8

61.9

4

T

ota

l $5

,360

,870

$5

,721

,740

$5

,721

,740

S

tate

$5

,360

,870

$5

,721

,740

$5

,721

,740

F

eder

al

$0

$0

$0

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0

0

40

Strategy 1.5.1 Program of All-Inclusive Care for the Elderly (PACE)

PACE uses a comprehensive care approach, providing an array of services for a capitated monthly fee. PACE provides all health-related services for an individual, including in-patient and out-patient medical care, and specialty services (dentistry, podiatry, social services, in-home care, meals, transportation, day ac-tivities, and housing assistance).


be 55 years of age or older,

meet the medical necessity for nursing facility admission (see appendices for a description of the medical necessity deter-mination process),

live in a PACE service area (Amarillo or El Paso),

be determined by the PACE Interdiscipli-nary Team as able to be safely served in the community,

have a monthly income that is within 300% of the Supplemental Security In-come (SSI) monthly income limit ($2,022*), and

have countable resources of no more than $2,000**.


** A couple must have a monthly income of no more than $3,618 with countable resources of no more than $3,000.

41

Str

ateg

y 1.

5.1

Pro

gra

m o

f A

ll-I

ncl

usi

ve C

are

for

the

Eld

erly

(P

AC

E)

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 5

1 O

P

1 A

vera

ge N

umbe

r of

Rec

ipie

nts

Per

Mon

th: P

rogr

am

for

All

Incl

usiv

e C

are

(PA

CE

) 90

5 89

6 1,

026

1 5

1 E

F

1 A

vera

ge M

onth

ly C

ost P

er R

ecip

ient

: Pro

gram

for

All

Incl

usiv

e C

are

(PA

CE

) $2

,752

.22

$2,7

64.7

1 $2

,895

.21

T

ota

l $2

9,89

1,81

3 $2

9,72

8,93

1 $3

5,64

5,82

6

S

tate

$1

1,78

3,35

3 $9

,435

,279

$1

0,46

2,76

3

F

eder

al

$18,

108,

460

$20,

293,

652

$25,

183,

063

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0

0

42

Strategy 1.6.1 Nursing Facility Payments Nursing Facility Care. Provides institutional nurs-ing care for individuals whose medical condition requires the skills of a licensed nurse on a regular basis. The nursing facility must provide for the medical, nursing, and psychosocial needs of each individual, to include room and board, social ser-vices, over-the-counter drugs (prescription drugs are covered through the Medicaid Vendor Drug program or Medicare Part D), medical supplies and equipment, personal needs items, and rehabilitative therapies. Daily Medicare skilled nursing facility co-insurance payments are also paid for individuals who are eligible for both Medicare and Medicaid. Medicaid Swing Bed Program. Permits partici-pating rural hospitals to use their beds inter-changeably to provide acute hospital and long-term nursing facility care for individuals eligible for Medicaid when Medicaid beds are not available in skilled nursing facilities in the same geographic area. Services that are also available to eligible Medi-caid residents in a Medicaid nursing facility in-clude: Augmented Communication Device Systems. Provides reimbursement to the nursing facility for a communication device, also referred to as a speech-generating device system, for the individ-ual to be able to communicate with others. The request must be documented to be medically nec-essary by the resident’s physician and receive prior authorization from DADS for reimbursement. Customized Power Wheelchairs. Provides reim-bursement to the nursing facility for a customized power wheelchair that is designed, adapted, and fabricated to meet the physical and medical needs of an individual; the individual must be able to oper-ate the wheelchair. A Customized Power Wheel-chair must be documented by the resident’s physi-cian to be medically necessary and for the exclusive use of the resident for which it is designed. The nursing facility must receive prior authorization through Texas Medicaid and Healthcare Partner-ship (TMHP) to ensure reimbursement before pur-chasing a customized power wheelchair. Emergency Dental Services. Provides reim-bursement for emergency dental services for indi-viduals residing in nursing facilities who are eligi-ble for Medicaid. Specialized and Rehabilitative Services. Pro-vides reimbursement for physical, occupational, and speech therapy when ordered by the resi-dent’s physician for an initial evaluation. The phy-sician may request approval for additional evalua-tions and services with documentation of a new illness, an acute onset of illness, an injury, or a substantive change in a pre-existing condition.

43

Str

ateg

y 1.

6.1

Nu

rsin

g F

acili

ty P

aym

ents

F

Y 2

006

FY

200

7 F

Y 2

008

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 6

1 O

P

1 A

vera

ge N

umbe

r of

indi

vidu

als

Rec

eivi

ng M

edic

aid-

fund

ed

Nur

sing

Fac

ility

Ser

vice

s P

er M

onth

55

,953

54

,943

54

,828

1 6

1 E

F

3 N

et N

ursi

ng F

acili

ty C

ost P

er M

edic

aid

Res

iden

t Per

Mon

th

$2,6

74.7

1 $2

,981

.42

$3,1

42.6

5

T

ota

l $1

,809

,179

,726

$1

,989

,051

,971

$2

,082

,620

,806

S

tate

$7

05,1

11,9

15

$624

,935

,80

0 $6

17,9

87,2

45

F

eder

al

$1,1

02,7

37,7

03

$1

,362

,78

6,06

3

$1,4

64,6

39,5

61

O

ther

$1

,330

,108

$1

,330

,108

$0

F

TE

Po

siti

on

s 0

0 0

44

Strategy 1.6.2 Medicare Skilled Nurs-ing Facility

Medicaid pays the Medicare Skilled Nurs-ing Facility (SNF) co-insurance for Medi-caid recipients in Medicare (XVIII) facili-ties. Medicaid also pays the co-payment for Medicaid Qualified Medicare Benefici-ary (QMB) recipients, and for “Pure” (i.e., Medicare-only) QMB recipients. For re-cipients in dually certified facilities (certified for both Medicaid and Medi-care), Medicaid pays the coinsurance less the applied income amount for both Medicaid only and Medicaid QMB recipi-ents. For “Pure” QMB recipients, the en-tire coinsurance amount is paid. The amount of Medicare co-insurance per day is set by the federal government at one-eighth of the hospital deductible.

Eligibility Requirements. To be eligible for Medicaid coverage in a nursing facil-ity, an individual must:

reside in a Medicaid-certified facility for 30 consecutive days,

be eligible for Supplemental Secu-rity Income (SSI) from the Social Security Administration or be deter-mined by the Texas Health and Hu-man Services Commission to be financially eligible for Medicaid, and

meet medical necessity require-ments*.

See the appendices for a description of the medical necessity determination process.

45

Str

ateg

y 1.

6.2

Med

icar

e S

kille

d N

urs

ing

Fac

ility

F

Y 2

008

FY

200

9 F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 6

2 O

P

1 A

vera

ge N

umbe

r of

Indi

vidu

als

Rec

eivi

ng C

opai

d M

edic

aid/

Med

icar

e N

ursi

ng F

acili

ty S

ervi

ces

Per

Mon

th

6,61

3 6,

861

7,21

5

1 6

2 E

F

1 N

et P

aym

ent

Per

Indi

vidu

al fo

r C

opai

d M

edic

aid/

Med

icar

e N

ursi

ng F

acili

ty S

ervi

ces

Per

mon

th

$1,8

01.8

1 $1

,919

.31

$2,0

01.3

7

T

ota

l $1

43,0

50,3

01

$158

,020

,19

6 $1

73,9

38,8

16

S

tate

$5

5,25

0,39

5 $4

9,44

9,27

9 $5

1,62

3,30

1

F

eder

al

$87,

799,

906

$108

,570

,91

7 $1

22,3

15,5

15

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0

0

46

Strategy 1.6.3 Hospice

Medicaid recipients, who no longer desire curative treatment and who have a physician’s prognosis of six months or less to live, are eligible for Medicaid Hospice services. Services include physician and nursing care; medical social ser-vices; counseling; home health aide; personal care, homemaker, and household services; physical, occupational, or speech language pathology services; bereavement counseling; medical appliances and supplies; drugs and biologi-cals; volunteer services; general inpatient care (short-term); and respite care.

Service settings can be in the home, in community settings, or in long-term facilities.

Medicaid rates for community-based Hospice are based on Medicare rates set by the Center for Medicare and Medicaid Services (CMS). For individuals residing in a nursing fa-cility and receiving hospice services, the nursing facility also receives a payment of 95% of the established nursing facility rate.

Eligibility Requirements. Hospice is for all age groups, including chil-dren, during their final stages of life.

47

Str

ateg

y 1.

6.3

Ho

spic

e F

Y 2

008

FY

200

9 F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 6

3 O

P

1 A

vera

ge N

umbe

r of

indi

vidu

als

Rec

eivi

ng H

ospi

ce S

ervi

ces

Per

Mon

th

5,95

9 6,

236

6,76

8

1 6

3 E

F

1 A

vera

ge P

aym

ent P

er in

divi

dual

Per

Mon

th fo

r H

ospi

ce

$2,5

13.0

4 $2

,760

.98

$2,8

80.5

4

T

ota

l $1

79,7

02,5

55

$206

,607

,04

3 $2

30,0

14,8

78

S

tate

$6

9,66

1,26

1 $6

3,99

9,89

0 $6

8,26

6,11

6

F

eder

al

$110

,041

,29

4 $1

42,6

07,1

53

$161

,849

,86

2

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0 0

48

Strategy 1.6.4 Promoting Independence by Providing Community-Based Client Services

Texas’ Promoting Independence Initiative supports allowing an individual who is aging or has a disabil-ity to make a choice in the residential setting where they want to receive their long-term services and supports, which is often the most integrated resi-dential setting available. Among the many goals of the Initiative the following continue to have a significant impact: providing opportunities for individuals residing

in state supported living centers to move to a community alternative within 180 days of an individual’s request and recommendation for movement to an alternative living arrangement,

providing opportunities for individuals living in Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) that serve four-teen or more individuals to move to an alterna-tive living arrangement within twelve months of the of the referral of their request to relocate into an alternative living arrangement,

providing opportunities for individuals residing in Medicaid-certified nursing facilities (NF) to move into the community to receive services without going on a waiver interest list (Money Follows the Person), and

providing intensive services for persons with three or more state mental hospital facility ad-missions within a 180-day period.

In 2000, the Community Living Options process was implemented for individuals who reside in a large ICF/MR. The Community Living Options process was designed to provide information on alternative settings, review an individual’s goals, and identify an individual who indicates a preference for an al-ternative living arrangement to the institutional set-ting. An individual who indicates a desire for alter-native services is referred to the local Mental Retar-dation Authority (MRA). Senate Bill 27 (80th Legislature, Regular Session, 2007) directed DADS to delegate to local MRAs the Community Living Options function for adult residents at state supported living centers. This process was renamed the Community Living Op-tions Information Process (CLOIP). This legisla-tion required the development of an effective CLOIP, creation of uniform procedures for the im-plementation of the CLOIP, and to minimize any potential conflict of interest regarding the CLOIP between a state supported living center and an adult resident, an adult resident’s legally author-ized representative, or a local MRA. The process was fully operational by January 2008.

49

Str

ateg

y 1.

6.4

Pro

mo

te In

dep

en

den

ce b

y P

rovi

din

g C

om

mu

nit

y-b

ase

d C

li-

ent

Ser

vice

s

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 6

4 O

P

1 A

vera

ge N

umbe

r of

Pro

mot

ing

Ind

epen

denc

e (R

ide

r 14

) In

di-

vidu

als

Ser

ved

Per

Mon

th

4,74

7 5,

333

6,22

4

1 6

4 E

F

1 A

vera

ge M

onth

ly C

ost P

er in

divi

dual

Ser

ved:

Pro

mot

ing

Inde

-pe

nden

ce (

Rid

er

14)

$1,3

94.1

5 $1

,477

.81

$1,5

67.3

5

T

ota

l $7

9,40

9,16

0 $9

5,30

0,42

7 $1

17,0

58,7

07

S

tate

$3

0,57

8,27

4 $3

0,62

2,84

4 $3

4,71

6,93

1

F

eder

al

$48,

830,

886

$64,

677,

483

$82,

341,

776

O

ther

$0

$0

$0

F

TE

Po

siti

on

s 0

0

0

50

Strategy 1.7.1 Intermediate Care Facilities—Mental Retardation (ICF/MR)

An Intermediate Care Facility for Persons with Mental Retardation or Related Conditions (ICF/MR) is a residential facility serving four or more individu-als with mental retardation or a related condition. Provision of active treatment is the core require-ment of certification as an ICF/MR. Active treat-ment is the aggressive, consistent implementation of a program of specialized and generic training, treatment and health services. Active treatment does not include services to maintain generally in-dependent individuals who are able to function with little supervision or in the absence of a continuous active treatment program. Section 1905(d) of the Social Security Act created this optional Medicaid benefit to certify and fund these facilities. Each facility must comply with fed-eral and state standards, applicable laws, and regulations. ICF/MR are operated by both private and public (community MHMR centers and a state agency) entities. These facilities provide diagnosis, treatment, rehabilitation, ongoing evaluation, plan-ning, 24-hour supervision, coordination, and inte-gration of health or rehabilitative services to help each individual function at their greatest ability. Eligibility Requirements. To be eligible for the ICF/MR Program, a person must: have a full scale intelligence quotient (IQ) score

of 69 or below, as determined by a standard-ized individual intelligence test and have an adaptive behavior level with mild to extreme deficits in adaptive behavior as determined by a standardized assessment of adaptive behav-ior; or

have a full scale IQ score of 75 or below and a primary diagnosis by a licensed physician of a related condition, and have an adaptive behav-ior level with mild to extreme deficits in adap-tive behavior as determined by a standardized assessment of adaptive behavior; or

have a primary diagnosis of a related condition diagnosed by a licensed physician regardless of IQ and have an adaptive behavior level with moderate to extreme deficits in adaptive be-havior as determined by a standardized as-sessment of adaptive behavior; and

be in need of and able to benefit from the ac-tive treatment provided in the 24-hour super-vised residential setting of an ICF/MR; and

be eligible for Supplemental Security Income (SSI) or be determined to be financially eligible for Medicaid by the Texas Health and Human Services Commission.

51

Str

ateg

y 1.

7.1

In

term

edia

te C

are

Fac

iliti

es -

Me

nta

l Ret

ard

atio

n (

ICF

/MR

) F

Y 2

008

FY

200

9 F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 7

1 O

P

1 A

vera

ge N

umbe

r of

Per

sons

In IC

F/M

R M

edic

aid

Bed

s P

er

Mon

th

6,39

5 6,

267

6,16

8

1 7

1 E

F

1 M

onth

ly C

ost P

er

ICF

/MR

Me

dica

id E

ligib

le In

divi

dual

$4

,497

.00

$4,4

64.0

0 $4

,535

.47

T

ota

l $3

45,0

64,3

68

$336

,742

,82

0 $3

27,6

96,2

93

S

tate

$1

06,4

61,5

32

$79,

637,

419

$69,

070,

210

G

R D

edi

cate

d $2

5,21

8,56

0 $2

3,47

8,91

7 $2

6,82

1,47

9

F

eder

al

$209

,287

,00

8 $2

29,6

95,2

40

$231

,285

,03

0

O

ther

$4

,097

,268

$3

,931

,244

$4

1,54

3

F

TE

Po

siti

on

s 28

.7

29.0

29

.0

52

Strategy 1.8.1 MR State Supported Living Center Services

This program provides direct services and supports for individuals with mental retardation admitted to the twelve state supported living centers and the Rio Grande State Center, which provides campus-based mental retardation residential services along with mental health services. State supported living centers are located in Abilene, Austin, Brenham, Corpus Christi, Denton, El Paso, Lubbock, Lufkin, Mexia, Richmond, San Angelo, and San Antonio. The Rio Grande State Center located in Harlingen, is operated by the Department of State Health Services (DSHS). The Department of Aging and Disability Services (DADS) has contracted with DSHS to provide services to persons with mental retardation at this location.

Each center is certified as an Intermediate Care Facility for Persons with Mental Retardation (ICF/MR), a Medicaid-funded federal/state service. Approximately 60% of the operating funds for the facilities are received from the federal government and 40% are provided through State General Revenue or third-party revenue sources.

State supported living centers and the Rio Grande State Center provide 24-hour residential services, comprehensive behavioral treatment services and health care services, including physician, nursing, and dental services. Other services include skills training; occupational, physical and speech therapies; vocational programs and employment; and services to maintain connections between residents and their families/natural support systems.

Eligibility Requirements. Residential services in a state supported living center serve individuals with severe or profound mental retardation and those individuals with mental retardation who are medically fragile or who have behavioral problems.

53

Str

ateg

y 1.

8.1

MR

Sta

te S

cho

ols

Ser

vice

s F

Y 2

008

FY

200

9 F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

1 8

1 O

P

1 A

vera

ge M

onth

ly N

umbe

r of

MR

Cam

pus

Res

iden

ts

4,83

2 4,

627

4,51

2

1 8

1 O

P

2 A

vera

ge M

onth

ly N

umbe

r of

Indi

vidu

als

with

MR

Wai

ting

for

Adm

issi

on to

Any

Sta

te S

upp

orte

d Li

ving

Cen

ter

Cam

pus

15

15

15

1 8

1 O

P

3 A

vera

ge M

onth

ly N

umbe

r of

Indi

vidu

als

with

MR

Wai

ting

for

Adm

issi

on T

o A

Spe

cific

Sta

te S

uppo

rted

Liv

ing

Cen

ter

Cam

-pu

s 4

4 4

1 8

1 E

F

1 A

vera

ge M

onth

ly C

ost P

er M

R C

am

pus

Res

iden

t $8

,965

.13

$10,

599.

82

$12,

440.

43

1 8

1 E

F

2 A

vera

ge N

umbe

r of

Da

ys in

divi

dual

s W

ith M

R W

ait F

or A

dmis

-si

on T

o A

ny

Sta

te S

uppo

rted

Liv

ing

Cen

ter

Cam

pus

15

15

15

1 8

1 E

F

3 A

vera

ge N

umbe

r of

Da

ys in

divi

dual

s W

ith M

R W

ait F

or A

dmis

-si

on T

o A

Spe

cific

Sta

te S

uppo

rte

d Li

ving

Cen

ter

Cam

pus

22

22

22

T

ota

l $5

19,8

34,1

28

$588

,544

,25

0 $6

73,5

74,8

00

S

tate

$1

77,1

90,9

19

$154

,071

,69

4 $1

87,3

68,9

88

G

R D

edi

cate

d $2

9,70

2,91

9 $2

9,80

4,70

0 $2

6,00

0,00

0

F

eder

al

$290

,079

,69

9 $3

70,1

70,3

97

$433

,357

,51

2

O

ther

$2

2,86

0,59

1 $5

88,5

44,2

50

$673

,574

,80

0

F

TE

Po

siti

on

s 11

,971

.0

12,7

96.1

14

,239

.1

1 8

1 O

C

2 N

umbe

r of

con

sum

ers

with

MR

wh

o m

oved

from

Ca

mpu

s to

C

omm

unity

20

6 25

2 35

0

1 8

1 O

C

1 A

vera

ge N

umbe

r of

Da

ys M

R C

am

pus

Res

iden

ts R

ecom

-m

ende

d fo

r C

omm

unity

Pla

cem

ent W

ait f

or P

lace

men

t 12

7 15

0 15

0

54

Strategy 1.9.1 Capital Repairs and

Renovations

For DADS, funding in this strategy is for the construction and renova-tion of facilities at the state sup-ported living centers (SSLC) and state-owned bond homes for per-sons with mental retardation. The vast majority of projects currently funded and underway are to bring existing facilities into compliance with the requirements in the Life Safety Code and/or other critical repairs and renovations, including fire sprinkler systems, fire alarm systems, emergency generators, fire/smoke walls, roofing, air con-ditioning, heating, electrical, plumbing, etc.

The large number of buildings on SSLC campuses and the age of many of these buildings necessi-tates ongoing capital investments to ensure that the buildings are functional, safe, and in compli-ance with all pertinent standards. Compliance with such standards is mandatory to avoid the loss of federal funding for the state facili-ties.

55

Str

ateg

y 1.

9.1

Cap

ita

l Rep

airs

an

d R

eno

vati

on

s F

Y 2

008

FY

200

9 F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

The

re a

re n

o m

eas

ures

for

this

str

ateg

y.

T

ota

l $8

,530

,200

$1

5,24

8,81

3 $5

6,99

5,09

4

S

tate

$1

42,0

28

$142

,028

$1

42,0

28

G

R D

edi

cate

d $2

89,8

02

$289

,803

$2

89,8

03

F

eder

al

$0

$0

$0

O

ther

$8

,098

,370

$1

4,81

6,98

2 $5

6,56

3,26

3

F

TE

Po

siti

on

s 0

0 0

56

Strategy 2.1.1 Facility and Community-Based Regulation

According to the Health and Safety Code, Chapters 142, 242, 247 and 252, and the Texas Human Resources Code, Chapter 103, all long-term care facilities/agencies that meet the definition of nursing facilities, assisted liv-ing facilities, adult day care facilities, privately owned ICFs/MR, and HCSSAs must be licensed and maintain compliance with all licensure rules in order to operate in Texas. Licensed facilities/agencies wishing to participate in the Medicare and/or Medicaid programs must be certified and maintain compliance with certification regulations according to Titles XVIII and/or XIX of the Social Security Act. Government-owned/operated ICFs/MR and hospi-tal-based skilled nursing facilities are also required to be certified in order to participate in Medicare and/or Medi-caid. The types of regulated programs include: Nursing Facility. DADS licenses nursing facilities and certifies nursing facilities that choose to serve individuals through Medicare and Medicaid. DADS is also responsi-ble for conducting an annual inspection, investigating complaints and provider self-reported incidents, as well as monitoring facilities that are out of compliance with state and federal regulations. ICFs/MR. All non-government owned/operated facilities must be licensed by DADS. Government-owned/operated facilities and other facilities serving Medicaid recipients must be certified. DADS conducts an annual inspection, investigates complaints and provider self-reported incidents, as well as monitors facilities that are out of compliance with regulations. Assisted Living Facility. DADS is responsible for li-censing these facilities, conducting an annual inspection, investigating complaints and self-reported incidents, and monitoring facilities that are out of compliance with regu-lations. Adult Day-Care Facility. DADS is responsible for licens-ing these facilities, conducting an annual inspection, in-vestigating complaints and provider self-reported inci-dents, and monitoring facilities that are out of compliance with regulations. HCSSAs. DADS is responsible for licensing home health agencies and hospice providers and for certifying their ongoing participation in the Medicare program. DADS also investigates complaints and provider self-reported incidents, and monitors facilities that are out of compliance with regulations. Waiver Programs. DADS conducts initial and annual certification reviews of the Home and Community-based Services (HCS) waiver contracts and the Texas Home Living (TxHmL) waiver contracts. DADS is responsible for investigating complaints and provider self-reported incidents related to HCS and TxHmL services. DADS also receives and follows up on Department of Family and Protective Services (DFPS) findings related to abuse, neglect, or exploitation investigations of persons who receive HCS or TxHmL services.

57

Str

ateg

y 2.

1.1

Fac

ility

an

d C

om

mu

nit

y-B

ase

d R

egu

lati

on

F

Y 2

008

FY

200

9 F

Y 2

010

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

2 1

O

C

1 P

erce

nt o

f Fac

ilitie

s C

ompl

ying

with

Sta

ndar

ds A

t Tim

e of

In

spec

tion

for

Lice

nsur

e an

d/o

r M

edic

are/

Med

icai

d C

ertif

icat

ion

63.4

7%

66.3

5%

64.1

2%

2 1

1 O

P

4 N

umbe

r of

Ins

pect

ions

Com

plet

ed P

er Y

ear

4,56

0 5,

368

4,96

4

2 1

1 O

P

9 T

otal

Dol

lar

Am

oun

t Col

lect

ed F

rom

Fin

es

$1,5

11,1

89.

$1,5

29,3

23

$1,5

20,2

56

2 1

1 O

P

11 N

umbe

r of

Hom

e a

nd C

omm

unity

Sup

port

Ser

vice

s A

genc

y Li

cens

es Is

sued

2,

314

2,22

5 2,

270

2 1

1 O

P

12 N

umbe

r of

Hom

e a

nd C

omm

unity

Sup

port

Ser

vice

s A

genc

y In

spec

tions

Con

duct

ed

1,25

6 1,

236

1,24

6

2 1

1 O

P

13 #

of C

ompl

aint

Inve

stig

atio

ns C

ondu

cted

On

-site

: Hom

e an

d C

omm

unity

Sup

por

t Ser

vice

s A

genc

ies

1,92

0 2,

016

1,96

8

T

ota

l $5

7,04

7,23

4 $6

4,43

6,70

5 $7

1,53

4,59

2

S

tate

$1

6,56

7,59

5 $2

3,11

9,51

0 $2

2,87

4,99

2

G

R D

edi

cate

d $1

,901

,037

$1

,936

,140

$1

9,48

3,47

3

F

eder

al

$38,

508,

572

$39,

381,

055

$46,

711,

257

O

ther

$7

0,03

0 $0

$0

F

TE

Po

siti

on

s 97

8.8

1,05

3.6

1,09

5.2

58

Strategy 2.1.2 Credentialing / Certification Under the authority of federal and state law, DADS licenses, certifies, permits, and monitors individuals for the purpose of employability in fa-cilities and agencies regulated by DADS. The four credentialing programs are:

Nursing Facility Administrator Licensing and Enforcement. Responsibilities include licensing and continuing education activities; investigating complaints or referrals; coordinating sanction rec-ommendations and other licensure activities with the governor-appointed Nursing Facility Adminis-trators Advisory Committee; imposing and moni-toring sanctions; providing due process considera-tions; and developing educational, training, and testing curricula.

Nurse Aide Registry and Nurse Aide Training and Competency Evaluation Program (NATCEP). Responsibilities include nurse aide certification and sanction activities; approving or renewing NATCEPs; withdrawing NATCEP ap-proval; and providing due process considerations and a determination of nurse aide employability in nursing facilities regulated by DADS via the Nurse Aide Registry. Employee Misconduct Registry (EMR). Re-sponsibilities include providing due process con-siderations and a determination of unlicensed staff employability in facilities and agencies regulated by DADS via the EMR. Medication Aide Program. Responsibilities in-clude continuing education activities; issuing and renewing medication aide permits; imposing and monitoring of sanctions; providing due process considerations; approving and monitoring medica-tion aide training programs in educational institu-tions; developing educational, training, and testing curricula; and coordinating and administering ex-aminations.

59

Str

ateg

y 2.

1.2

Cre

den

tial

ing

/ C

erti

fic

atio

n

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

2 1

O

C

8 P

erce

nt o

f Com

pla

ints

and

Ref

erra

ls R

esul

ting

in D

isci

plin

ary

Act

ion:

Nur

sing

Fac

ility

Adm

inis

trat

ors

36.6

%

38.7

4%

40.6

%

2 1

2 O

P

1 N

umbe

r of

Lic

ense

s Is

sued

or

Ren

ew

ed P

er Y

ear

: N

ursi

ng

Fac

ility

Ad

min

istr

ato

rs

1,10

7 1,

020

1,07

3

T

ota

l $9

73,6

14

$1,3

82,8

09

$1,2

78,2

26

S

tate

$4

28,6

12

$833

,561

$6

63,1

52

F

eder

al

$334

,163

$3

55,5

25

$417

,049

O

ther

$2

10,8

39

$193

,723

$1

98,0

25

F

TE

Po

siti

on

s 24

.5

26.0

26

.0

60

Strategy 2.1.3 Long-Term Services and Supports Quality Outreach

The Quality Assurance and Improvement (QA&I) section of the Center for Policy and Innovation per-forms a variety of functions designed to enhance the quality of services and supports. Major initia-tives are described below. The Quality Monitoring program represents an edu-cational rather than regulatory approach to quality improvement. Quality monitors, who are nurses, pharmacists, and dietitians, provide technical assis-tance to long-term facility staff. The quality moni-tors perform structured assessments to promote best practice in service delivery. In addition, quality monitors provide in-service education programs. The pharmacist quality monitors also conduct one-on-one physician education using a formal process called academic detailing through which best prac-tices in medication evaluation and management are discussed with facility medical directors. Quality Monitoring Team visits are also provided to facilities and may include more than one discipline during the same visit. The technical assistance visits focus on specific, statewide quality improve-ment priorities for which evidence-based best prac-tice can be identified from published clinical re-search. Topics included in the monitoring visits are: restraint reduction, continence promotion, use of indwelling bladder catheters, improving vaccina-tion rates, enhancing advance-care planning, im-proving fall-risk management, decreasing the inap-propriate use of artificial nutrition and hydration, improving routine hydration practices and prevent-ing unintended weight loss, improving pain assess-ment and management, improving the appropriate-ness of psychoactive drug use, preventing and treating pressure ulcers, and improving medication safety through the reduction of medications that have poor safety profiles for the elderly. DADS has expanded the Quality Monitoring Pro-gram model to state supported living centers, com-munity ICFs/MR, assisted living facilities, and home and community-based services providers. The pur-pose of the program is to increase positive out-comes and to improve the quality of services for individuals served in these settings. A related web-site, http://www.TexasQualityMatters.org, supports the program by providing online access to best-practice information and links to related research. QA&I staff conducts two annual large-scale sur-veys. The Nursing Facility Quality Review is a statewide survey process used to benchmark the quality of care and the quality of life for people in Texas nursing facilities through random sampling. The Long-Term Services and Supports Quality Re-view is an annual statewide survey of individuals receiving services and supports through home and community-based and institutional programs from DADS.

http://www.texasqualitymatters.org/�

61

Str

ateg

y 2.

1.3

Lo

ng

-Ter

m S

ervi

ces

and

Su

pp

ort

s Q

ual

ity

Ou

trea

ch

FY

200

8 F

Y 2

009

FY

201

0

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

2 1

3 O

P

1 #

of Q

ualit

y M

onito

ring

Vis

its to

Nur

sing

Fac

ilitie

s 3,

556

3,55

6 3,

556

2 1

3 E

F

1 A

vera

ge C

ost p

er

Qua

lity

Mon

itori

ng P

rogr

am V

isit

$915

.32

$1,0

06.8

5 $1

,032

.02

T

ota

l $4

,871

,589

$6

,421

,372

$5

,489

,028

S

tate

$2

58,8

04

$228

,054

$5

70,9

24

F

eder

al

$3,2

19,2

39

$3,2

97,8

56

$,35

88,1

04

O

ther

$1

,393

,546

$1

,330

,000

$1

,330

,000

F

TE

Po

siti

on

s 74

.7

72.5

78

.4

62

Strategy 3.1.1 Central Administration Central Administration supports administrative functions for all DADS programs including execu-tive direction and leadership, legal, civil rights, hearings of provider appeals, planning, budget management, fiscal accounting and reporting, as-set management, program statistics, public infor-mation, state and federal government relations, internal audit, and program support. Under the Older Americans Act, central administration sup-ports functions such as building system capacity to meet service needs; serving as a comprehensive resource on aging issues via research, policy analysis, public information, and marketing; and advocating for the needs of older Texans through the Long-Term Care Ombudsman Program and in partnership with public and private organizations.

Strategy 3.1.2 Information Technology (IT) Provides technology products, services, and sup-port to all DADS divisions to further their efforts in achieving the DADS mission. This responsibility extends to establishing, managing, and monitoring agreements for IT products, services, and/or sup-port supplied by external organizations, coordinat-ing all technology procurements including technical contractors, and technology policies and proce-dures published in the DADS IT Handbook. The application systems developed, deployed, and sup-ported under this strategy cover financial systems, including revenue systems; consumer information systems; facility management systems; and deci-sion support systems. Functions performed in-clude project management, software applications development, and documentation.

Strategy 3.1.3 Other Support Services

Includes statewide policy and oversight of support services including contract management policy, historically underutilized businesses, forms and handbook management, records management and storage, building maintenance, mailroom, and in-ventory. This strategy also includes direct support to staff in all programs in the state office. Although HHSC has assumed responsibility for procurement and facility acquisition and management, DADS continues to be responsible for implementing ap-propriate process and procedures within service level agreements.

63

FY

200

8 F

Y 2

009

FY

201

0

Str

ateg

y 3.

1.1

Cen

tral

Ad

min

istr

atio

n

Exp

end

ed

Exp

end

ed

Bu

dg

ete

d

T

ota

l $2

7,95

9,96

5 $2

9,57

2,09

1 $3

3,32

3,23

9

S

tate

$1

1,40

2,59

0 $1

2,97

6,85

4 $1

3,29

7,68

3

F

eder

al

$15,

329,

117

$15,

412,

528

$18,

779,

919

O

ther

$1

,228

,258

$1

,182

,709

$1

,245

,637

F

TE

Po

siti

on

s 34

0.1

374.

0 37

4.0

Str

ateg

y 3.

1.2

In

form

atio

n T

ech

no

log

y (I

T)

T

ota

l $2

6,34

9,80

4 $3

6,01

7,77

0 $3

8,26

2,34

7

S

tate

$9

,575

,441

$1

5,71

9,48

6 $1

6,79

5,56

7

F

eder

al

$15,

604,

744

$20,

064,

897

$20,

872,

506

O

ther

$1

,169

,619

$2

33,3

87

$594

,274

F

TE

Po

siti

on

s 12

8.1

99.3

10

1.7

Str

ateg

y 3.

1.3

Oth

er S

up

po

rt S

ervi

ces

T

ota

l $1

,615

,775

$2

,715

,131

$2

,089

,870

S

tate

$6

11,7

32

$961

,706

$8

02,3

51

F

eder

al

$915

,050

$1

067,

367

$1,1

97,7

92

O

ther

$8

8,99

3 $6

86,0

58

$89,

727

F

TE

Po

siti

on

s 35

.3

35.0

35

.0

64

Toll-Free Hotline Numbers

Description Hotline Number

AARP Elder Care Locator 1-800-677-1116

Abuse/Neglect Reports 1-800-252-5400

Alzheimer’s Association 1-800-272-3900

Area Agencies on Aging 1-800-252-9240

Consumer Rights and Ser-vices DADS

1-800-458-9858

Emergency Dental, Rehab/Specialized Services

1-800-792-1109

Food Stamps Complaints Inquiry

1-800-252-9330 1-800-448-3927

Governor’s Helpline 1-800-843-5789

Home Health Agency Abuse Reporting

1-800-228-1570

Legal Hotline for Elder Tex-ans

1-800-622-2520

Long-Term Care Facility Incident Reporting

1-800-458-9858

Long-Term Care Ombuds-man Program

1-800-252-2412

Long-Term Care Credential-ing

1-800-452-3934

Medicaid Eligibility General Medically Needy

1-800-834-7106 1-800-252-8263 1-800-335-8957

Medicare Customer Center 2nd Opinion Surgery

1-800-442-2620 1-800-633-4227

Regulatory Services 1-800-458-9858

Social Security 1-800-772-1213

Volunteer and Community Engagement

1-800-889-8595

Texas Attorney General Consumer Helpline

1-800-621-0508

Texas Attorney General (Fraud Against Seniors)

1-800-337-3928

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