CLASS Quarterly Webinar Aug. 2 2 , 2 0 1 7 CLASS Webinar Agenda - - PowerPoint PPT Presentation

CLASS Quarterly Webinar

• Aug. 2 2 , 2 0 1 7

CLASS Webinar Agenda

• Electronic Visit Verification (EVV) Reminders and

Updates

• CDS Overview
• Frequent Contract Monitoring Citations
• Requirement for DSAs to Provide All Services on

the IPC

• CMA Role as Advocate for Individual
• Habilitation Service Codes Deactivated
• Use of Habilitation Transportation
• Respond to Webinar Questions

EVV Reminders & Updates

Christi Tolbert HHSC EVV Operations

Introduction

This presentation is for providers w ho are required to use Health and Hum an Services Com m ission ( HHSC) Electronic Visit Verification ( EVV) and are contracted w ith:

• HHSC and enrolled with Texas Medicaid Healthcare

Partnership (TMHP)

• Managed Care Organizations (MCOs)

CLASS Services Required to Use EVV

Services provided in the hom e and in the com m unity by an attendant:

• In-home Respite Services
• Community First Choice (PAS/ HAB)
• Nurses are not required to use EVV at this time

EVV Updates

Pilots

• DataLogic GPS Pilot started May 22, 2017
• Providers were selected by volunteering
• No hard dates yet for expansion but will start

slowly adding more providers and attendants

• EVV visit maintenance reduction pilot started Feb.

1, 2017

• Average of 10% increase in auto-verified visits

EVV Updates

Upcom ing

• HHSC is currently working with EVV vendors and

MCOs on a process that will allow MCOs to submit authorizations to the EVV vendors

• EVV Provider Manual is still being developed

EVV Updates

Reason Code 3 0 5

• As of July 1, 2017,
• Please see HHSC alert posted on June 27, 2017 to

view revisions

EVV Updates

Most m isused Reason Code

• Reason Code 100 – Schedule Variation
• RC 100 is selected when the attendant or assigned

staff provides more or fewer hours of service than scheduled or provides services at a different time of day than scheduled, as requested by the individual/ member.

• All situations that require documentation must be

documented according to program policy.

EVV Updates

Most m isused Reason Code ( cont.)

• Reason Code 100 – Schedule Variation
• This reason code cannot be used when an attendant
• r assigned staff fails to clock in and/ or clock out,

unless the appropriate non-preferred reason code (RC 900, 905 or 910) is also saved to visit.

• Misuse of this preferred reason code may result in

contract action(s). This is a preferred reason code.

EVV Updates

Unlocking Visit Maintenance

• Providers must submit requests to the appropriate

payor the affected individual or member is associated with in a secure email

• Requests are reviewed on a case-by-case basis

and will be at the payor’s discretion to approve or deny the request

• All requests must include required information and

supporting documentation

EVV Updates

• Provider Name
• Payor’s Name
• EVV Vendor Name
• HHSC (DADS) Contract

Number

• Tax Identification

Number (TIN)

• National Provider

Identification Number (NPI)

• Individual/ member(s) Name
• Individual/ member(s)

Medicaid Identification Number

• Dates you need access to
• Explanation of why you need

to unlock visit maintenance past 60 days, with any supporting documentation Unlocking Visit Maintenance Required I nform ation:

EVV Reminders

Data Elem ents

• Provider agencies must ensure data elements

entered into the EVV system are accurate and complete

• Missing or incorrect data elements in the EVV

system may result in:

• Denied claims
• Recoupment during contract monitoring
• Contract actions
• Inaccurate or blank EVV reports

EVV Reminders

Data Elem ents The EVV Visit Log may not populate data which can be caused by the following:

• Missing HCPCS or Invalid HCPCS billing code combos
• Missing or Invalid Contract Number
• Missing or Invalid Tax Identification Number (TIN)

(invalid= incorrect number of characters)

• Missing or Invalid National Provider Identification

Number (NPI) (invalid= incorrect number of characters)

EVV Reminders

Data Elem ents ( cont.) The EVV Visit Log may not populate data which can be caused by the following:

• Missing or Invalid Texas Provider Identification

(TPI) (invalid= incorrect number of characters)

• Missing or Invalid Medicaid ID (invalid= incorrect

number of characters)

• Incorrect Payor assigned to the individual/ member

EVV Reminders

Data Elem ents

• EVV Vendors will lock visit maintenance until the

provider agency enters missing data elements into the system

• If the provider has not addressed the missing or

inaccurate data elements, the EVV vendor will notify each payor for further action.

EVV Reminders

Cell Phones

• Cell phones are not allowed to be used to call-in

and out of the EVV system

• Cell phones can ONLY be used to call in SAD

values

• Visits are subject to recoupment if found to be

confirmed using a cell phone

EVV Reminders

Hom e Landlines

• Please ensure the individual/ member’s home

landline phone number entered into the EVV system is truly their landline phone number

• EVV Vendors conduct random samples of the

phone numbers entered as landlines in the EVV system

• Each payor receives a report from the EVV vendor

with phone sample results

Thank You

HHSC EVV Em ail: electronic_ visit_ verification@hhsc.state.tx.us HHSC EVV W ebsite: w w w .hhs.texas.gov/ node/ 2 6 3 9

Consumer Directed Services Overview and Support Consultation Services

Heatherly Chenet and Victoria Washburn Consumer Directed Services Policy

Consumer Directed Services

• The Consum er Directed Services ( CDS) option:
• Is an alternative to traditionally delivered and

managed services, such as an agency delivery model.

• Allows participants, or their representatives if

applicable, to have the responsibility for managing all aspects of service delivery in a person-centered planning process.

• Promotes personal choice and control over the

delivery of services, including who provides the services and how services are provided.

The CDS Option

• Is available for services in programs for persons who

live in their own home or with family.

• Everyone is given the opportunity to select the CDS
• ption when available.
• Individuals may receive services from a provider

agency and self-direct other services at the same time.

• Individuals may have a direct service provider and a

case manager/ service coordinator.

Services Available Through the CDS Option

The CDS Option

• Individuals choosing the CDS option must select

their own Financial Management Services Agency (FMSA) from the FMSA choice list.

• The individual or their legally authorized

representative (LAR) becomes the CDS employer.

• Responsible for developing the budget with

the assistance of the FMSA.

• An individual or LAR may appoint a willing

adult to assist in performing employer responsibilities.

The CDS Employer is:

I NDI VI DUAL who is at least 18 years old and does NOT have a court-appointed guardian PARENT or LAR of a minor-aged individual Any COURT-APPOI NTED GUARDI AN regardless of the age of the individual receiving services.

The Financial Management Services Agency

• A Financial Management Services Agency (FMSA)

is:

• A contracted entity that provides financial

management services (FMS) and

• Provides employer support for the individual

participating in the CDS option

• FMSAs conduct payroll and pay employer federal

and state taxes on behalf of CDS employers

CDS in Action

• CDS employers hire their own service providers

and manage the daily operations ensuring services are delivered according to the individual’s authorized service plan.

• CDS employers are responsible for hiring, training,

scheduling, and approving time records for each of their service providers.

• FMSAs processes payroll, request reimbursement

from Health and Human Services, assist the employer in developing the budget, and provide

• n-going assistance to the employer.

Case Manager Responsibilities

• Offer the CDS option at program enrollment, at

the annual review, and at the individual’s request

• Use HHS forms 1581-1584, 1586 to educate the

individual on their rights, responsibilities, and resources in the CDS option

• Present a current HHS web-based list of available

FMSAs that serve the individual’s county per an individual’s specific program NOTE: The FMSA does not have to be located in the individual’s county

Case Manager Responsibilities (cont.)

• Assess the individual for services and level of care
• Develop the service plan and indicate services to

be delivered through the CDS option

• Send referrals and authorized service plans to the

FMSA

• Answer questions related to service plans and

authorizations

Case Manager Responsibilities (cont.)

• Indicates services that must have a back-up plan
• May request a Corrective Action Plan (CAP) as

needed

• Processes:
• Transfers
• Suspensions
• Terminations

Note: CDS is a service delivery option that allows more control over services. FMSAs and em ployers m ust follow individual program rules.

Consumer Directed Services Overview and Support Consultation Services

Support Consultation

Support Consultation

• An optional service
• Provides a level of training, assistance, and support
• Does not duplicate or replace financial management

services (FMS), case management services, or other available program or non-program service or resource

• Provides practical skills training and assistance to

successfully manage CDS employer responsibilities

• Must be budgeted

Support Consultation: Delivery

Support consultation is delivered to:

• An employer
• An employer's designated representative (DR)
• An individual receiving services through the CDS
• ption if that individual will be the employer within

six months of the initiation of support consultation services to the individual

Support Consultation: Basics

• Skills training and assistance can include:
• Recruiting, screening, and hiring workers
• Developing and documenting job descriptions
• Verifying employment eligibility and

qualifications

• Completing documents required to:
• Employ an individual
• Retain a contractor or vendor
• Manage service providers

Support Consultation: Basics (cont.)

• Skills training and assistance can include:
• Communicating effectively, solving problems,

and documenting employer responsibilities in the CDS option

• Developing, revising, and implementing service

back-up plans

• Performing employer responsibilities
• Complying with the individual's program and

CDS rules

• Developing ongoing decision making skills for

employer-related and employment-related situations.

Support Consultation: Availability

Available in the follow ing program s:

• Community Living Assistance and Support Services

(CLASS)

• Deaf Blind with Multiple Disabilities (DBMD)
• Home and Community-Based Services (HCS)
• Texas Home Living (TxHmL)
• Community Care for Aged and Disabled (CCAD)

Support Consultation: Budgeting

• An employer or DR may budget and initiate

support consultation services while the individual is participating in the CDS option.

• Before initiation of the service, the employer or DR

must:

• Identify the person or persons (the employer,

the DR, or the individual within six months after becoming the employer) to receive the service and establish goals specific to the service;

Support Consultation: Budgeting (cont.)

• Before initiation of the service, the employer or DR

must (cont.):

• Obtain approval of the goals established for the

service from the individual's service planning team;

• Develop a budget for support consultation; and
• Obtain approval of the budget from the FMSA.

Support Consultation: Budgeting (cont.)

• An employer or DR, a case manager or service

coordinator, an FMSA, or an HHSC representative may recommend that the individual's service planning team approve support consultation services for an individual if:

• The individual receiving services through the

CDS option will become the employer within six months after the service is initiated;

• The employer or DR demonstrate a need for the

service;

Support Consultation: Budgeting (cont.)

• An employer or DR, a case manager or service

coordinator, an FMSA, or an HHSC representative may recommend that the individual's service planning team approve support consultation services for an individual if:

• The individual's health and welfare may regress

without additional support for managing and directing service providers; or

• Other reasons that the service planning team

has determined justify the need for the service.

Support Consultation: Budgeting (cont.)

• If the individual's service planning team authorizes

support consultation, the team must:

• Approve the funds, the duration, and the

frequency of the service;

• Assist with development of goals and ensure

that the activities required to meet the goals through support consultation comply with this chapter;

• Approve the goals for support consultation and

the person or persons who will receive the service (the individual, employer, or DR); and

• Terminate the service when goals are met.

Employer Responsibilities

• An employer or DR must ensure that a support

advisor meets service provider requirements, including:

• Obtaining documentation required to verify the

applicant's qualifications and eligibility to provide support consultation services

• Submitting documentation to the FMSA for

review of the person's eligibility

• Obtaining approval from the FMSA of the

person's eligibility to provide support consultation services

• Maintaining documentation to verify continued

eligibility during service delivery

Resources

Texas Rules Governing CDS and FMSAs:

• Texas Administrative Code: Title 40, Part1, Chapter

49,effective September 1, 2014 relating to Contracting for Community Services

• Texas Administrative Code: Title 40, Part1, Chapter

41,effective March 20, 2016 relating to Consumer Directed Services CDS Option Employer Manual:

• https: / / www.dads.state.tx.us/ services/ cds/ employer/

CDS Forms and Handbook:

• https: / / hhs.texas.gov/ doing-business-hhs/ provider-

portals/ long-term-care-providers/ consumer-directed- services-cds/ cds-forms-handbooks

Questions?

CDS@hhsc.state.tx.us

44

Thank you

Frequent Contract Monitoring Citations

Contract Compliance & Performance Management

Sarah Schmidt August 22, 2017

CLASS Contract Management & Monitoring

Update on Contract Compliance and Frequent Citations

48

Contract Compliance

Points to Remember: TAC §49.302: (c)- ensure that an employee, subcontractor, or volunteer can effectively communicate with an individual/ LAR concerning service planning and the provision of services, which may require the contractor to provide an interpreter for the individual (d)- must not allow an individual to perform services under the contract or perform other work that benefits the contractor

49

Contract Compliance (cont.)

Points to Remember: TAC §49.302: (e)- comply with the terms of the contract, which requires compliance with federal and state laws, rules, and regulations, including TAC Chapter 49, rules governing services provided under the contract, and applicable reimbursement rules in TAC Chapter 355 (g)(1)- subscribe to receive HHSC e-mail updates, using the link provided at the HHSC website https: / / service.govdelivery.com/ accounts/ TXHHSC/ s ubscriber/ new

50

Contract Compliance (cont.)

Points to Remember: TAC §49.302: (h)- notify HHSC of a change of ownership or change in legal entity in accordance with § 49.210(a)(1) (i)(1-2)- notify HHSC of a change to contract’s contact information (mailing, physical, e-mail address, phone, fax numbers, etc) At least 30 days before the change Within 3 days after the change if a natural disaster

• r unforeseen disaster prevents compliance with

above

51

Contract Compliance and Performance Management

Monitoring Review Schedule and Timelines

• If a contract is serving individuals, it will be

scheduled for a formal monitoring review every 21-24 months.

• If a contract scores below a 90% on a formal

monitoring review, an additional intermittent review will be conducted within 11-13 months from the most recent formal monitoring review.

• A contract could potentially be reviewed three
• times within a 2 year period based on overall
• compliance scores.

CLASS Contract Monitoring Frequent Citations- Case Management Agency

Please see CLASS CMA Monitoring Workbook for reference information https://hhs.texas.gov/Doing-Business-HHS/Provider- Portals/Resources/Contract-Fiscal-Compliance- Monitoring-Tools

53

Contract Compliance and Performance Management

Standard I I I .5 . Renew al SPT

• The CMA must explain to the individual/ LAR or

person actively involved with the individual, orally and in writing the mandatory participation requirements of an individual as described in §45.302.

• The SPT meeting must be convened at least

annually, between 30 and 90 calendar days before the end of the IPC period.

Contract Compliance and Performance Management

Standard I I I .6 . Renew al SPT

• Within 10 business days of HHSC notification of

approval, the case manager must provide copies

• f the HHSC authorized IPC, IPPs, habilitation

plan/ habilitation training plan, SPT notes and ID/ RC to all members of the SPT and to any additional CLASS service providers (FMSA, Continued Family Services [ CFS] , and Support Family Services [ SFS] ), as necessary.

Contract Compliance and Performance Management

Additional Docum ents

• Therapy Justifications (8606As) and Request for

Adaptive Aids, Medical Supplies, or Minor Home Modifications (3660) must also be provided with the HHSC authorized IPC, IPPs, habilitation plan/ habilitation training plan, SPT notes and ID/ RC, if applicable.

Contract Compliance and Performance Management

Standard I I I .8 . Revision SPT

• The CMA must submit revision documentation to

HHSC at least 30 calendar days before the proposed effective date.

• Within five business days of HHSC transmission of

the authorized IPC, the case manager must provide copies to the individual/ LAR and any additional CLASS service providers (DSA, FMSA, CFS, and SFS), as necessary.

Contract Compliance and Performance Management

Standard I I I .9 . I PP Service Review s

• The CMA must in accordance with the CLASS

Provider Manual meet with the individual/ LAR to complete Form 3595, IPP Service Review, reviewing the individual’s progress toward achieving the goals and objectives as described on the IPP .

Contract Compliance and Performance Management

Standard I I I .9 . I PP Service Review s ( cont.)

• That includes the following documentation for all

services on the IPC:

• Documentation of progress or lack of progress

toward goals/ objectives as identified on the IPPs / IPC;

• Assess the individual’s satisfaction with the

provision of CLASS program services;

• Identify any changes to the individual’s needs, if

applicable; and

• If applicable, FMS option.

Contract Compliance and Performance Management

Standard I I I .9 . I PP Service Review s ( cont.)

• That includes the following documentation for all

services on the IPC:

• Refer to Appendix X: Quarterly Due Dates Chart
• The CMA must provide a copy of the IPP

Quarterly/ 90-Day Service Review to the individual/ LAR, DSA, and FMSA (if applicable) within 5 business days of the review date.

Contract Compliance and Performance Management

Standard I I I .1 0 . Medicaid Eligibility

• The CMA must verify the individual’s Medicaid

eligibility monthly. Standard I V.7 Billing

• The CMA must complete Form 3625 supported by

written documentation or case note.

• Timekeeper must sign Form 3625.

CLASS Contract Monitoring Frequent Citations- Direct Service Agency

Please see CLASS DSA Monitoring Workbook for reference information https://hhs.texas.gov/Doing-Business-HHS/Provider- Portals/Resources/Contract-Fiscal-Compliance- Monitoring-Tools

62

Contract Compliance and Performance Management

Standard I I .2 : Staff Qualifications / Training

• Habilitation/ CFC Habilitation staff must receive
• rientation before the first date of service delivery.

Standard I I .3 : Staff Qualifications / Training

• All DSA staff must receive annual training every

12 months on A/ N/ E, Rights and Responsibilities, and review of the CLASS rules in TAC Chapter 45.

Contract Compliance and Performance Management

Standard VI .2 : Renew al

• Annually, the DSA must explain orally and in

writing to the individual and LAR or person actively involved with the individual:

• Rights and responsibilities including complaint

procedures

• How to report an allegation of abuse,

neglect, or exploitation

• How to make a complaint

Contract Compliance and Performance Management

I PP Service Sum m aries Section 3 3 5 0 IPP Service Summaries required for the following:

• Auditory enhancement training
• Behavioral support
• Dietary services (nutritional services)
• Habilitation training
• Occupational therapy
• Physical therapy
• Prevocational services

Contract Compliance and Performance Management

I PP Service Sum m aries Section 3 3 5 0 IPP Service Summaries required for the following (cont.):

• Specialized therapies
• Speech therapy
• Supported employment services

Copies of the completed IPP Service Summaries must be provided to the CMA within five business days of completing the IPP Service Summary.

Contract Compliance and Performance Management

I PP Service Sum m ary

• The DSA quarterly review/ 90-Day Service

Summary must include the following elements:

• Current observable/ measurable goals and
• bjectives
• Frequency and duration of sessions attended
• Rationale for missed sessions

Refer to Appendix X: Quarterly Due Dates Chart

Contract Compliance and Performance Management

I PP Service Sum m ary

• The DSA quarterly review/ 90-Day Service

Summary must include the following elements:

• Progress or lack of progress
• Actions taken, as applicable (e.g., in-servicing,

counseling, etc.)

• Revisions of goals and objectives, as applicable

Refer to Appendix X: Quarterly Due Dates Chart

Contract Compliance and Performance Management

Transfers

• Copies of the identified records must be delivered

to the receiving DSA within five calendar days of notification by the case manager of the individual's decision to transfer to a different DSA.

• The transferring DSA is required to maintain

documentation of the specific records that were delivered to the receiving DSA, as well as the date

• f the delivery.

Contract Compliance and Performance Management

Corrective Action Plans ( CAP)

• There is no HHSC form for Corrective Action Plans

(CAP).

• Each contract must decide what format works

best for their business practices.

• CMAs and DSAs must continue to adhere to any

CAP approved by HHSC .

Who To Contact?

• Contract Enrollment and Administration
• Fax Number

(512) 438-5528

• Email: communityservicescontracts@dads.state.tx.us
• Unit Voicemail Box

(512) 438-3550

• Contract Compliance and Performance Management
• Sarah Schmidt, Manager

(512) 438-5370

• Tinia Collins, Contract Specialist

(512) 438-2232

• Angie Campos, Contract Specialist

(512) 438-2544

• Joseph Cantu, Contract Specialist

(512) 438-4300

• Max Pachl, Contract Specialist

(512) 438-4784

• Fax Number

(512) 438-3639

71

IDD Operations Portal Update

IDD Program Eligibility & Support (IDD PES)

Fabian Aguirre, Unit Manager

Presentation Topics

• IDD Operations Portal Update
• Coordination of smooth transition from

STAR+ PLUS Waiver (SPW) & MDCP STAR Kids (SK) into CLASS

IDD Operations Portal

W hat is the I DD Operations Portal?

• An efficient online submission system where long

term care providers and Local Intellectual/ Developmental Authorities (LIDDA) can electronically submit and receive documents to and from IDD PES and IDD UR.

• The IDD Operations Portal is scheduled for release

this fall.

IDD Operations Portal

W hy is this better?

• Improves secure document transmission.
• Reduces need for follow-up calls, emails, and faxes.
• Ability for CMAs and DSAs to check submission

status at any time.

• Receive status updates on submissions.

IDD Operations Portal

W ho w ill use the portal? HHS contractors that provide IDD services in the following programs:

• Community Living Assistance and Support Services
• Case Management Agencies
• Direct Services Agencies
• Deaf Blind with Multiple Disabilities Providers
• Home and Community-based Services Providers

IDD Operations Portal

W ho w ill use the portal ( cont.) ? HHS contractors that provide IDD services in the following programs:

• Texas Home Living Providers
• Intermediate Care Facility for Individuals with Intellectual

Disabilities Providers

• Community First Choice Non-Waiver

IDD Operations Portal

W here do I register?

• HHSC will be providing more information about how to

register for and use the online portal prior to implementation this fall.

• This information will come in the form of email alerts,

information letters, training webinars, computer-based training and in-person communications via existing stakeholder meeting events.

• HHSC will also make available a dedicated

troubleshooting email address, and is in development

• f a user guide for this new resource.

Coordination of Smooth Transition from STAR+PLUS Waiver (SPW) & MDCP STAR Kids (SK) into CLASS

SPW & MDCP SK closures

Coordination of sm ooth transition from STAR+ PLUS W aiver ( SPW ) & MDCP STAR Kids ( SK) into CLASS:

• Inform the individual/ LAR they have the option of

selecting CLASS or remaining in SPW/ MDCP SK.

• The CMA must ensure…
• There are no gaps in needed services or overlaps in

enrollment

• All relevant parties are aware of the transition.
• Enrollment IPC includes a projected CLASS state

date in the future.

• If the previous program is SPW/ MDCP SK, IPC start

date must be for the 1 st of the m onth.

Message Lines Table

CLASS DBMD

I DD PES: Eligibility (ID/ RCs and Programmatic) 512-438-2 4 8 4 N/ A I DD PES: Enrollments (Enrollment IPCs, Pre-Enrollment Assessments) 512-438-2 4 8 4 N/ A I DD PES: Transfers, Suspensions, Terminations 512-438-2 4 8 4 N/ A I DD UR: IPCs (Revisions, Renewals) 512-438-4 8 9 6 512-438-4 8 9 6 I DD UR: DBMD (Eligibility, Enrollments, Transfers, Suspensions, Terminations) N/ A 512-438-4 8 9 6

Thank you

Requirement for DSAs to Deliver All Services on the IPC

DSA Provide Services on IPC

CLASS rules in 40 TAC §45.805 specify the DSA must ensure CLASS services are provided in accordance with the individual's IPC and the individual's IPP .

DSA Provide Services on IPC

• A DSA must ensure that a DSA staff person

participates as a member of an individual's service planning team (SPT).

• The SPT is minimally composed of the

individual/ LAR, the case manager, and the DSA.

• The IPC is signed as evidence of agreement by the

individual/ LAR, the case manager, and the DSA.

DSA Provide Services on IPC

• An individual wanted to transfer to another DSA.
• The DSA that the individual wanted to transfer to

explained that the agency only provided CFC PAS/ HAB and skilled nursing care.

• Can a DSA only provide certain services under the

CLASS program (for example nursing or CFC PAS/ HAB)?

DSA Provide Services on IPC

Each DSA enters into a Provider Agreement with HHSC. The contract lists the CLASS services that must be

• provided. Here is the specific language:
• PAGE 1 Section 1 Service Codes- a list of CLASS service

codes is included here.

DSA Provide Services on IPC

• PAGE 2 Section 2: Health and Human Services

Commission (“System Agency”) and the legal entity (Contractor) named in Section I (Department and Contractor, collectively, the “parties,” each a “party) hereby enter into this contract (provider agreement) (“the contract”) for the provision of services under the contract type specified in Section I for the considerations set forth herein. The contract begin date specified in Section I is not valid until this contract is signed by both parties.

DSA Provide Services on IPC

• CLASS TAC allows a DSA to refuse an individual in

45.212(e) If DSAs serving the catchment area in which the individual resides are not willing to provide CLASS Program services or CFC services to an individual because they have determined that they cannot ensure the individual's health and safety, the CMA must provide to HHSC, in writing, the specific reasons the DSAs have determined that they cannot ensure the individual's health and safety.

CMA Role as Advocate for Individual

CMA Role as Advocate for Individual

Per 40 TAC 45.103 Case management is a service that assists an individual in the following:

• Assessing the individual's needs
• Enrolling into the CLASS Program
• Developing the individual's IPC
• Coordinating the provision of CLASS Program services and

CFC services

CMA Role as Advocate for Individual

Per 40 TAC 45.103 Case management is a service that assists an individual in the following (cont.):

• Monitoring the effectiveness of the CLASS and CFC

services and the individual's progress toward achieving the identified outcomes

• Accessing non-CLASS Program services and non-CFC

services

• Resolving a crisis that occurs regarding the individual
• Advocating for the individual's needs

CMA Role as Advocate for Individual

• A CMA must ensure that a case manager

participates as a member of an individual's service planning team.

• A CMA must ensure that during the service

planning team meeting the proposed IPC is reviewed, signed as evidence of agreement, and dated by:

• The individual or LAR;
• The case manager; and
• The DSA.

Habilitation Service Codes Deactivated

Habilitation Service Codes Deactivated

• Information Letter 17-15, titled “Removal of

Service Codes for Habilitation and Residential Habilitation” was issued 6/ 29/ 17.

• Announced service codes 10, 10A, and 10V for

CLASS were deactivated effective 7/ 10/ 17.

• CLASS DSA or FMSA will not be able to submit a

service claim that includes any of these service codes.

• CLASS DSA must use service code 10 CFC.
• FMSA must use service code 10 CFV.

Habilitation Service Codes Deactivated

• CLASS Form 3621, CLASS/ CFC — Individual Plan
• f Care, and CLASS Form 3621-T, CLASS/ CFC –

IPC Service Delivery Transfer Worksheet have been revised to remove service code 10, Habilitation, service code 10 A, Habilitation – Delegated and 10V, Habilitation.

• CLASS CMAs and CLASS DSAs must use the

applicable, revised IPC form for any IPC, including

• ne concerning a transfer, with an effective date of
• Nov. 1, 2017 or later.
• The revised forms are available on HHSC’s website

with a revision date of July 2017.

Providing Transportation in CLASS

Providing Transportation in CLASS

• Transportation is an activity included as CLASS

habilitation.

• Transportation may be provided by CFC PAS/ HAB

staff, if authorized on IPC.

• Funding for taxi services or public transportation is

available as an adaptive aid.

Providing Transportation in CLASS

• SPT must determine whether an individual

requires transportation as a service of habilitation;

• Case manager must include transportation on the

IPC;

• If transportation is included on the IPC, the SPT

must:

• Develop a transportation plan for an individual

who receives transportation from DSA or through CDS option; and

• Develop IPP for transportation with goals based
• n transportation plan.

Providing Transportation in CLASS

Form 3598, Individual Transportation Plan

• SPT must develop a transportation

plan

• describes how transportation will be

delivered

• identifies the appropriate number of

transportation hours

• CFC PAS/ HAB provider providing

transportation must meet requirements as described in 40 TAC §45.803(d)(20)

Providing Transportation in CLASS

CFC PAS/ HAB provider and Transportation Habilitation provider must bill for time spent providing each separate service.

Thank You For Your Attention.

Questions?

classpolicy@hhsc.state.tx.us

104

Wrap Up

• Next Webinar is scheduled for November 2017
• Announcement to go out by GovDelivery
• Please keep up-to-date with HHSC email alerts to

learn when this webinar is posted to the CLASS webpage.

Wrap Up

• Your feedback will assist HHSC in refining this

communication format to suit the needs of CLASS providers and other interested parties.

• If you have comments regarding this webinar,

please send them to the CLASS mailbox at classpolicy@hhsc.state.tx.us

Thank You For Joining Us!