DADS’ BLUE BOOK

February 2010

DADS’ Blue Book is published by the Texas Department 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 comprehensive array of aging and disability services, supports, and opportunities that are easily accessed 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] 2

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

3

64

4

DADS’

PROGRAMS AND SERVICES

5

Strategy 1.1.1 Intake, Access and Eligibility to Services and Supports The Department of Aging and Disability Services (DADS) provides functional eligibility determination, development of individual service plans that are based on consumer needs and preferences, assistance in obtaining information, and authorizing 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 Retardation Authorities (MRAs). DADS RLS staff determine functional eligibility for Title XIX, and functional and financial eligibility for Title XX community services and supports programs to enable individuals to remain in the most integrated community settings, and delay or prevent institutionalization. MRAs determine eligibility for General Revenue (GR) funded services and assist consumers in accessing appropriate services 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 Insurance Assistance Program (SHIP) in Texas, a national program funded by the Centers for Medicare and Medicaid Services. Through Legal Assistance services, AAAs provide information, counseling, and assistance to Medicare beneficiaries of any age and/or their representatives regarding Medicare, Medicaid, public benefits, entitlements, and other types of health insurance. To determine the location and phone number for a DADS office, visit DADS website at: http://www.dads.state.tx.us/contact/index.html

6

7 4

1 1 1 EF

6

1 1 1 OP 3

5

1 1 1 OP

1 1 1 EF

4

OC

1 1

$174.20

Average Monthly Cost per individuals with MR Receiving Assessment and Service Coordination

$52,757,640 $5,117,653 1,831.0

$51,641,713 $84,824,504 $2,176,375 1,637.0

State Federal Other FTE Positions

$89,951,316

$147,826,609

$138,642,592

Total

$29.75

$174.20

170,805

8,846

73.52%

$29.70

Average Monthly Cost per Case: Community Services and Supports

165,281

8,721

Average Monthly Number of Individuals with MR Receiving Assessment and Service Coordination Average Number of Persons Eligible per Month: Community Services and Supports

72.73%

FY 2009 Expended

FY 2008 Expended

Percent of Long-term Care Persons Served in Community Settings

Strategy 1.1.1 Intake, Access and Eligibility to Services and Supports

FY 2010

1,857.4

$3,775,363

$101,814,356

$76,497,614

$182,087,333

$29.79

$174.20

173,487

8,823

73.70%

Budgeted

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 include, 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 individuals referred to the program by the Texas Department 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 guardian. DADS staff who provide guardianship services are required to be certified by the Texas Guardianship Certification Board.

8

9

$0 108.0

$5,009,689 $0 102.9

Federal Other FTE Positions

$7,093,384

$1,589,478

$6,149,588 $1,139,899

$7,093,384

387

State

198

Average Number of APS DADS Consumers Receiving Guardi2 anship Services through Contracts with Private Guardianship Programs

1 1 2 OP

741

Total

871

Expended

Expended

1 1 2 OP

FY2009

FY 2008

Average Number of individuals Receiving Guardianship Ser1 vices from DADS staff

Strategy 1.1.2 Guardianship

300

856

108.0

$0

$6,995,223

$3,609,340

$6,995,223

Budgeted

FY 2010

Strategy 1.2.1 Primary Home Care (PHC) PHC provides non-skilled, personal care services for individuals whose chronic health problems impair their ability to perform activities of daily living (ADL). Personal attendants assist individuals in performing ADLs, such as arranging or accompanying individuals on trips to receive medical treatment, bathing, dressing, grooming, preparing meals, housekeeping, and shopping. On average, individuals are authorized to receive approximately 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 Supplemental 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 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.

10

11 1

1

1 2 1 OP

1 2 1 EF

1

OC

1 2

$479,096,185

$0 0

$422,507,194 $130,680,916 $201,388,447 $0 0

Total State Federal Other FTE Positions

$249,375,387

$113,763,482

$757.55

52,660

$682.15

Average Monthly Cost Per individual Served: Primary Home Care

51,574

Average Number of individuals Served Per Month: Primary Home Care

111,738

Expended

Expended 110,318

FY 2009

FY 2008

Average Number of Individuals Served Per Month: Medicaid Non-waiver Community Services and Supports

Strategy 1.2.1 Primary Home Care (PHC)

0

$0

$269,819,458

$135,942,628

$543,912,613

$834.01

54,347

114,573

Budgeted

FY 2010

Strategy 1.2.2 Community Attendant Services (CAS) CAS provides non-skilled personal care services for individuals whose chronic health problems impair 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 individual on trips to receive medical treatment, bathing, dressing, grooming, preparing meals, housekeeping, 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 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 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.

12

13

1 1

1 2 2 OP

1 2 2 EF

$0 0

$201,388,447 $0 0

Federal Other FTE Positions

$249,375,387

$113,763,482

$332,069,363 $130,680,916

$363,138,869

$719.42

42,938

State

$654.70

42,141

FY 2009 Expended

FY 2008 Expended

Total

Average Monthly Cost Per individuals Served: Community Attendant Services

Average Number of individuals Served Per Month: Community Attendant Services

Strategy 1.2.2 Community Attendant Services (CAS)

FY 2010

0

$0

$269,819,458

$135,942,628

$405,762,086

$795.18

42,523

Budgeted

Strategy 1.2.3 Day Activity and Health Services (DAHS) Licensed adult day-care facilities provide daytime services five days a week (Monday-Friday). Services are designed to address the physical, mental, medical, and social needs of individuals, and must be provided or supervised by a licensed nurse. Services include nursing and personal care; noontime meal; snacks; transportation; and social, educational, and recreational activities. Individuals receive services based on half-day (three to six hours) units of service; an individual may receive a maximum 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 supervision 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 personal 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.

14

15

1 1

1 2 3 OP

1 2 3 EF

$4,151,101 0

$60,010,875 $3,466,231 0

Federal Other FTE Positions

$71,672,576

$28,738,766

$35,520,359

State

$104,562,443

$508.38

$98,997,465

$496.88

Average Monthly Cost Per individual Served: Day Activity and Health Services

17,140

Total

16,603

FY 2009 Expended

FY 2008 Expended

Average Number of individuals Served Per Month: Day Activity and Health Services

Strategy 1.2.3 Day Activity and Health Services (DAHS)

FY 2010

0

0

$78,681,710

$32,689,751

$111,371,461

$524.25

17,703

Budgeted

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, assisted living/residential care, emergency response, nursing, minor home modifications, occupational therapy, personal assistance, home delivered meals, physical therapy, respite care, speech pathology, and transition assistance services. Consumer Directed Services (CDS) option is available for this program. Eligibility Requirements. An individual must: be 21 years of age or older, meet the medical necessity 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 countable 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 services in a nursing facility, and choose waiver services instead of nursing facility care based on an informed choice. * SSI levels are adjusted at the federal level each year based upon the annual increase in the Consumer Price Index.

Integrated Care Management (ICM) program. Beginning February 1, 2008 individuals began receiving services in the Dallas and Tarrant service areas through the ICM program, a Medicaid managed care program for people who are 65 years of age and older or who have disabilities. 16

OP

EF

1 3 1

1 3 1

1

1

$618,590 0

$162,912,737 $251,956,112 $1,267,139 0

State Federal Other FTE Positions

$313,039,671

$141,918,881

$4555,77,142

$416,135,988

Total

25,995

$1,456.42

25,049

FY 2009 Expended

FY 2008 Expended

$1,379.85

Average Monthly Cost Per individual Served: Medicaid Community Based Alternatives (CBA) Waiver

Average Number of individuals Served Per Month: Medicaid Community Based Alternatives (CBA) Waiver

Strategy 1.3.1 Community Based Alternatives (CBA)

17

FY 2010

0

0

$342,580,652

$142,315,708

$483,896,360

$1,550.92

25,927

Budgeted

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 individual’s needs, residential assistance, supported employment, day habilitation, respite, dental treatment, 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 annualized per capita cost for ICF/MR services, whichever is greater. * SSI levels are adjusted at the federal level each year based upon the annual increase in the Consumer Price Index. 18

19

1 3 2 EF

1 3 2 OP

1

1

$2,987,600 0

$333,206,028 $2,990,735 0

Federal Other FTE Positions

$425,870,411

$195,278,729

State

$624,137,740

$549,623,259 $213,441,496

Total

$3,442.93

$3,421.63

Average Monthly Cost Per Individual Served: Home and Community-Based Services (HCS) Waiver

15,107

13,386

FY 2009 Expended

FY 2008 Expended

Average Number of Individuals Served Per Month: Home and Community-Based Services (HCS) Waiver

Strategy 1.3.2 Home and Community-Based Services (HCS)

FY 2010

0

0

$517,119,721

$214,724,912

$731,844,633

$3,449.71

17,255

Budgeted

Strategy 1.3.3 Community Living Assistance and Support Services (CLASS) The CLASS Program provides services and supports 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, habilitation, minor home modifications, nursing services, occupational and physical therapy, behavioral support services, respite, specialized therapies, speech pathology, pre-vocational services, supported employment, support family services, and transition assistance services. The CDS option is available for habilitation, respite, nursing, physical therapy, occupation therapy and speech/ hearing therapy. 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 countable resources of no more than $2,000,



have an Individual Service Plan (ISP) that does not exceed 200% of the estimated annualized per capita cost of providing services in an ICF/MR to an individual qualifying for an ICF/MR Level of Care VIII.

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

20

21

1 3 3 EF

1 3 3 OP

1

1

$160,275,189

$0 0

$$140,694,488 $54,897,416 $85,662,043 $0 0

Total State Federal Other FTE Positions

$110,297,202

$49,977,987

$3,427.25

3,897

Expended

Expended 3,781

FY 2009

FY 2008

$3,101.32

Average Monthly Cost Per Individual Served: Community Living Assistance & Support (CLASS) Waiver

Average Number of Individuals Served Per Month: Community Living Assistance & Support (CLASS) Waiver

Strategy 1.3.3 Community Living Assistance and Support Services (CLASS)

0

$0

$135,708,205

$56,382,449

$192,090,654

$3,650.47

4,385

Budgeted

FY 2010

Strategy 1.3.4 Deaf-Blind Multiple Disabilities (DBMD) The DBMD Program provides services and supports for individuals with deaf-blindness and one or more other disabilities as an alternative to residing in an ICF/MR. Individuals may reside in their own or family home or in small group homes. Services include adaptive aids and medical supplies, dental services, assisted living, behavioral support services, case management, chore services, minor home modifications, residential habilitation, day habilitation, intervener, nursing services, occupational therapy, physical therapy, orientation and mobility, respite, speech, hearing and language therapy, supported employment, employment assistance, dietary services, financial management services for the consumer directed services option, and transition assistance. The CDS option is available for day habilitation, respite, 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 functioning, 

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,



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

* SSI levels are adjusted at the federal level each year based upon the annual increase in the Consumer Price Index. 22

23

1 1

1 3 4 OP

1 3 4 EF

$7,184,808

$0 0

$7,052,639 $2,780,150 $4,272,489 $0 0

Total State Federal Other FTE Positions

$4,907,569

$2,277,239

$3,873.25

$3,941.24

Average Monthly Cost Per IndividualServed: Medicaid Deafblind with Multiple Disabilities Waiver

152

147

FY 2009 Expended

FY 2008 Expended

Average Number of Individuals Served Per Month: Medicaid Deaf-blind with Multiple Disabilities Waiver

Strategy 1.3.4 Deaf-Blind Multiple Disabilities (DBMD)

FY 2010

150

0

$0

$5,191,072

$2,156,726

$7,347,798

$4,082.78

Budgeted

Strategy 1.3.5 Medically Dependent Children Program (MDCP) The MDCP provides a variety of services and supports for families caring for children who are medically dependent as an alternative to residing in a nursing facility. Specific services include adaptive aids, adjunct support services, minor home modifications, respite, and transition assistance services. The CDS option is available for respite and adjunct support services provided by an attendant or by a nurse.

Eligibility Requirements. An individual must: 

be under 21 years of age,



meet the medical necessity requirements* for nursing facility admission,



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 individual to receive services in a nursing facility.

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

24

25

1 1

1 3 5 OP

1 3 5 EF

$0 0

$23,761,183 $6,244 0

Other FTE Positions

$33,180,761

$14,564,876

$15,455,391

State

Total

Federal

$1,449.25

2,745

$47,745,637

$1,323.93

2,469

FY 2009 Expended

FY 2008 Expended

$39,222,818

Average Monthly Cost Per Individual Served: Medically Dependent Children Program

Average Number of Individuals Served Per Month: Medically Dependent Children Program

Strategy 1.3.5 Medically Dependent Children Program (MDCP)

FY 2010

0

$0

$34,730,449

$14,429,399

$49,159,848

$1,517.96

2,699

Budgeted

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), Community Living Assistance and Support Services (CLASS), Deaf Blind Multiple Disabilities (DBMD), State of Texas Access Reform (STAR+PLUS), and Medically Dependent Children Program (MDCP). CWP provides an alternative 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, intervener, minor home modifications, nursing, orientation and mobility, personal assistance, transportation, respite, social work, employment assistance, supported employment, 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 income limit for SSI ($2,022/month*), have countable resources 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 services 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. * SSI levels are adjusted at the federal level each year based upon the annual increase in the Consumer Price Index.

26

27

1

1 3 6

EF

1

1 3 6 OP

$0 0

$2,384,878 $0 0

Federal Other FTE Positions

$2,705,111

$1,229,741

$3,923,317 $1,538,439

$3,934,852

$1,913.84

171

State

$1,824.80

179

FY 2009 Expended

FY 2008 Expended

Total

Average Monthly Cost Per Individual Served: Medicaid Consolidated Waiver Program

Average Number of Individuals Served Per Month: Medicaid Consolidated Waiver Program

Strategy 1.3.6 Consolidated Waiver Program (CWP)

FY 2010

159

0

$0

$2,566,587

$1,066,336

$3,632,923

$1,904.05

Budgeted

Strategy 1.3.7 Texas Home Living Waiver (TxHmL) The TxHmL Program provides essential services and supports for individuals with mental retardation or a related condition as an alternative to residing in an ICF/MR. Individuals must live in their own or family homes. Service components are comprised of the Community Living Service category and the Technical and Professional Supports Services category. The Community Living Service category includes community support, day habilitation, employment assistance, supported employment, 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. 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;



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.

28

29

1 1

1 3 7 OP

1 3 7 EF

$7,581,877

$0 0

$8,750,476 $3,442,166 $5,308,310 $0 0

Total State Federal Other FTE Positions

$5,188,940

$2,392,937

$600.64

$586.89

Average Monthly Cost Per Individual Served: Texas Home Living Waiver

1,052

Expended

Expended 1,243

FY 2009

FY 2008

Average Number of Individuals Served Per Month: Texas Home Living Waiver

Strategy 1.3.7 Texas Home Living Waiver (TxHmL)

994

0

$0

$7,733,236

$3,212,915

$10,946,151

$917.69

Budgeted

FY 2010

Strategy 1.4.1 Non-Medicaid Services Adult Foster Care. Provides a 24-hour living arrangement with supervision in an adult foster home for individuals who, because of physical, mental, or emotional limitations are unable to continue independent 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 arrangement for transportation. The individual pays the provider for room and board. Consumer-Managed Personal Attendant Services.

Provides services for individuals with physical disabilities 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 nursing, nutrition, and supportive services in adult day care facilities that are licensed by DADS. Emergency Response Services. Provides a 24hour electronic emergency call system for functionally impaired elderly or disabled individuals who live alone or are physically isolated from the community. Family Care. Assists individuals who are functionally limited in performing activities of daily living. Services include assistance with personal care activities, 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 basis, but who do not need daily nursing intervention. 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 provide services to help individuals with disabilities achieve habilitative or rehabilitative goals that encourage maximum independence. 30

31

6 Number of Home-delivered Meals Served (AAA) 7 # of Persons Receiving Homemaker Services (AAA)

1 4 1 OP

1 4 1 OP

EF EF EF

1 4 1

1 4 1

1 4 1

1 4 1 EX

EF

1 4 1

Average Monthly Cost Per Individual Served: Non-Medicaid Community Services and Supports (XX)

5

55,580

267,931 0

$12,376,550 $128,927,618 $267,931 0

State Federal Other FTE Positions

$91,504,989

$18,227,156

$152,293,508

$141,572,099

Total

$623.14

$4.83

$4.94

$200.07

776,748

2,230

17,256

38,184

$604.77

$4.64

$4.71

$186.65

810,003

2,492

16,850

59,688

FY 2009

Expended

FY 2008

Expended

36,420

Statewide Average Cost Per Person Receiving Homemaker Services (AAA) Average Number of individuals Receiving Non-Medicaid Commu2 nity Services and Supports (XX)

4 Statewide Avg Cost Per Home-delivered Meal (AAA)

3 Statewide Average Cost per Congregate Meal (AAA)

1

1 4 1 OP 10 Number of One-way Trips (AAA)

4 Number of Congregate Meals Served (AAA)

1 4 1 OP

Strategy 1.4.1 Non-Medicaid Services

0

0

$92,514,713

$16,236,797

$155,987,815

36,745

$613.61

$4.91

$5.11

$209.81

716,374

2,367

16,605

55,489

FY 2010 Budgeted

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 participate 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 perform functional living skills and other daily living activities. Day Habilitation Services. Services provided away from an individual’s home to help the individual develop and refine skills necessary to live and work in the community. Eligibility Determination. An assessment or endorsement conducted by the Mental Retardation 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 assist individuals in securing and maintaining community 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 primary caregivers of their responsibilities for providing 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 participation acceptable to the individual. Therapies. Support services provided by licensed or certified professionals including psychology, nursing, social work, occupational therapy, speech therapy, physical therapy, dietary services, and certain behavioral health services. 32

33

2 2

1 4 2 OP

1 4 2 EF

$644,000 0

$4,620 $0 $660,550 0

GR Dedicated Federal Other FTE Positions

$0

$4,620

$96,791,694

$93,444,553 $92,779,383

$97,440,314

$574.45

State

$571.73

12,998

Expended

Expended 12,860

FY 2009

FY 2008

Total

Average Monthly Cost Per individual with MR Receiving Community Services

Average Monthly Number of Individuals with MR Receiving Community Services

Strategy 1.4.2 Mental Retardation Community Services

0

$0

$0

$5,000

$102,193,223

$102,198,223

$661.10

12,927

Budgeted

FY 2010

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 Orders, GWB99-2 and RP13. Two activities under the larger Promoting Independence Plan include community outreach and awareness, and relocation services. Community outreach and awareness is a systematic program of public information developed to target groups who are most likely to be involved in decisions regarding long-term services and supports. Relocation services involve assessment and case management to assist individuals 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 assessment, intensive case management, housing assistance, 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 resources, Medicaid recipients in facilities may require help to set up community households, such as security deposits, and assistance to purchase household goods and groceries. Relocation assistance 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. . 34

35

There are no measures for this strategy.

656744 0

266000 656744 0

Federal Other FTE Positions

921614

1248159

42992

2008350

Expended

Expended

2170903

FY 2009

FY 2008

State

Total

Strategy 1.4.3 Promoting Independence through Outreach, Awareness, and Relocation

0

606744

$953,372

3383036

3989780

Budgeted

FY 2010

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 individuals with physical disabilities to purchase services 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 transportation and room and board cost incurred by person with physical disability or his family during evaluation or treatment; purchase or lease of special equipment or architectural modifications of a home to facilitate the care, treatment therapy, or general living conditions of a person with a disability; 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 costing over $250. Eligibility Requirements. To be eligible for services, 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. 36

37

1 1

1 4 4 OP

1 4 4 EF

$0 0

$0 $0 0

Federal Other FTE Positions

$0

$4,647,920

$4,286,526 $4,286,526

$4,647,920

69.23

State

70.44

Average Monthly Cost of In-home Family Support Services Per individual

5,410

Total

4,562

FY 2009 Expended

FY 2008 Expended

Average Number of Individuals Per Month Receiving In-home Family Support Services

Strategy 1.4.4 In-Home and Family Support (IHFS)

FY 2010

0

$0

$0

$4,818,914

$4,818,914

68.04

6,415

Budgeted

Strategy 1.4.5 In-Home and Family Support—Mental Retardation (IHFSMR) 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 cooccurring physical disability. The program directly supports the person to live in his or her natural home, integrates the person into the community, or promotes the person’s selfsufficiency. Funds may be used for the following:  services such as respite care, specialized therapies, home care, counseling, and training, such as in-home parent training;  special equipment, such as therapy equipment and assistive technology;  home modifications;  transportation; and  other items that meet the program’s criteria. There is a limit of $2,500 per year, with the amount granted depending on the individual’s needs, income and application of a sliding co-pay scale. This is a resource of last resort, meaning that all other available resources must be accessed before using these funds. Eligibility Requirements. Individuals with a mental disability or their families must meet four eligibility criteria – diagnosis, residency, financial, and need. 38

39

1 1

1 4 5 OP

1 4 5 EF

$5,721,740

$0 0

$5,360,870 $0 $0 0

State Federal Other FTE Positions

$0

$5,721,740

Total

$5,360,870

3,073 $1,861.94

3,085

FY 2009 Expended

FY 2008 Expended

$1,737.72

Average Annual Grant Per individual with MR Receiving Inhome and Family Support

Number of individuals with MR Receiving In-home and Family Support Per Year

Strategy 1.4.5 Mental Retardation In-Home Services

FY 2010

0

$0

$0

$5,721,740

$5,721,740

$1,861.94

3,073

Budgeted

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 activities, and housing assistance). Eligibility Requirements. An individual must: 

be 55 years of age or older,



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



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



be determined by the PACE Interdisciplinary Team as able to be safely served in the community,



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



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

* SSI levels are adjusted at the federal level each year based upon the annual increase in the Consumer Price Index. ** A couple must have a monthly income of no more than $3,618 with countable resources of no more than $3,000. 40

41

1

1

1 5 1 OP

1 5 1 EF

$29,728,931

$0 0

$29,891,813 $11,783,353 $18,108,460 $0 0

Total State Federal Other FTE Positions

$20,293,652

$9,435,279

$2,764.71

896

$2,752.22

905

FY 2009 Expended

FY 2008 Expended

Average Monthly Cost Per Recipient: Program for All Inclusive Care (PACE)

Average Number of Recipients Per Month: Program for All Inclusive Care (PACE)

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

FY 2010

0

$0

$25,183,063

$10,462,763

$35,645,826

$2,895.21

1,026

Budgeted

Strategy 1.6.1 Nursing Facility Payments Nursing Facility Care. Provides institutional nursing 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 services, 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 coinsurance payments are also paid for individuals who are eligible for both Medicare and Medicaid. Medicaid Swing Bed Program. Permits participating rural hospitals to use their beds interchangeably to provide acute hospital and longterm 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 Medicaid residents in a Medicaid nursing facility include: 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 individual to be able to communicate with others. The request must be documented to be medically necessary by the resident’s physician and receive prior authorization from DADS for reimbursement. Customized Power Wheelchairs. Provides reimbursement 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 operate the wheelchair. A Customized Power Wheelchair must be documented by the resident’s physician 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 Partnership (TMHP) to ensure reimbursement before purchasing a customized power wheelchair. Emergency Dental Services. Provides reimbursement for emergency dental services for individuals residing in nursing facilities who are eligible for Medicaid. Specialized and Rehabilitative Services. Provides reimbursement for physical, occupational, and speech therapy when ordered by the resident’s physician for an initial evaluation. The physician may request approval for additional evaluations and services with documentation of a new illness, an acute onset of illness, an injury, or a substantive change in a pre-existing condition. 42

43

3 Net Nursing Facility Cost Per Medicaid Resident Per Month

1 6 1 EF

$1,330,108 0

$1,330,108 0

Other FTE Positions

$624,935,800 $1,362,786,063

$705,111,915 $1,102,737,703

$1,989,051,971

$1,809,179,726

State

$2,981.42

54,943

$2,674.71

55,953

FY 2007 Expended

FY 2006 Expended

Federal

Total

1

1 6 1 OP

Average Number of individuals Receiving Medicaid-funded Nursing Facility Services Per Month

Strategy 1.6.1 Nursing Facility Payments

FY 2008

0

$0

$1,464,639,561

$617,987,245

$2,082,620,806

$3,142.65

54,828

Budgeted

Strategy 1.6.2 Medicare Skilled Nursing Facility Medicaid pays the Medicare Skilled Nursing Facility (SNF) co-insurance for Medicaid recipients in Medicare (XVIII) facilities. Medicaid also pays the co-payment for Medicaid Qualified Medicare Beneficiary (QMB) recipients, and for “Pure” (i.e., Medicare-only) QMB recipients. For recipients in dually certified facilities (certified for both Medicaid and Medicare), Medicaid pays the coinsurance less the applied income amount for both Medicaid only and Medicaid QMB recipients. For “Pure” QMB recipients, the entire coinsurance amount is paid. The amount of Medicare co-insurance per day is set by the federal government at oneeighth of the hospital deductible. Eligibility Requirements. To be eligible for Medicaid coverage in a nursing facility, an individual must: 

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



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



meet medical necessity requirements*.

See the appendices for a description of the medical necessity determination process. 44

45

1 6 2 EF

1 6 2 OP

1

1

$49,449,279 $0 0

$55,250,395 $87,799,906 $0 0

State Federal Other FTE Positions

$108,570,917

$158,020,196

Total

$143,050,301

6,861

$1,919.31

6,613

FY 2009 Expended

FY 2008 Expended

$1,801.81

Net Payment Per Individual for Copaid Medicaid/Medicare Nursing Facility Services Per month

Average Number of Individuals Receiving Copaid Medicaid/ Medicare Nursing Facility Services Per Month

Strategy 1.6.2 Medicare Skilled Nursing Facility

FY 2010

0

$0

$122,315,515

$51,623,301

$173,938,816

$2,001.37

7,215

Budgeted

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 services; 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 biologicals; volunteer services; general inpatient care (short-term); and respite care. Service settings can be in the home, in community settings, or in longterm 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 facility 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 children, during their final stages of life.

46

47 $0 0

$110,041,294 $0 0

Federal Other FTE Positions

$142,607,153

$63,999,890

$69,661,261

$206,607,043

$2,760.98

$179,702,555

$2,513.04

6,236

State

1 Average Payment Per individual Per Month for Hospice

1 6 3 EF

5,959

FY 2009 Expended

FY 2008 Expended

Total

1

1 6 3 OP

Average Number of individuals Receiving Hospice Services Per Month

Strategy 1.6.3 Hospice

FY 2010

0

$0

$161,849,862

$68,266,116

$230,014,878

$2,880.54

6,768

Budgeted

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 disability 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 residential 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 fourteen or more individuals to move to an alternative 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 admissions 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 alternative living arrangement to the institutional setting. An individual who indicates a desire for alternative services is referred to the local Mental Retardation 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 Options Information Process (CLOIP). This legislation required the development of an effective CLOIP, creation of uniform procedures for the implementation 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 authorized representative, or a local MRA. The process was fully operational by January 2008. 48

49

1 1

1 6 4 OP

1 6 4 EF

$0 0

$48,830,886 $0 0

Federal Other FTE Positions

$64,677,483

$30,622,844

$30,578,274

State

$95,300,427

$1,477.81

$79,409,160

$1,394.15

Average Monthly Cost Per individual Served: Promoting Independence (Rider 14)

5,333

Total

4,747

FY 2009 Expended

FY 2008 Expended

Average Number of Promoting Independence (Rider 14) Individuals Served Per Month

Strategy 1.6.4 Promote Independence by Providing Community-based Client Services

FY 2010

0

$0

$82,341,776

$34,716,931

$117,058,707

$1,567.35

6,224

Budgeted

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 individuals with mental retardation or a related condition. Provision of active treatment is the core requirement of certification as an ICF/MR. Active treatment 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 independent 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 federal 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, planning, 24-hour supervision, coordination, and integration 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 standardized 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 behavior; 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 behavior level with mild to extreme deficits in adaptive 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 behavior as determined by a standardized assessment of adaptive behavior; and  be in need of and able to benefit from the active treatment provided in the 24-hour supervised 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. 50

51

$3,931,244 29.0

$25,218,560 $209,287,008 $4,097,268 28.7

Federal Other FTE Positions

$229,695,240

$23,478,917

$79,637,419

$106,461,532

State

$4,464.00

GR Dedicated

Total

$4,497.00

$336,742,820

1 Monthly Cost Per ICF/MR Medicaid Eligible Individual

1 7 1 EF

6,267

Expended

Expended 6,395

FY 2009

FY 2008

$345,064,368

1

1 7 1 OP

Average Number of Persons In ICF/MR Medicaid Beds Per Month

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

29.0

$41,543

$231,285,030

$26,821,479

$69,070,210

$327,696,293

$4,535.47

6,168

Budgeted

FY 2010

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. 52

53

Average Number of Days MR Campus Residents Recommended for Community Placement Wait for Placement Number of consumers with MR who moved from Campus to 2 Community

22 $588,544,250

$588,544,250 12,796.1

22 $519,834,128 $177,190,919 $29,702,919 $290,079,699 $22,860,591 11,971.0

Average Number of Days individuals With MR Wait For Admission To A Specific State Supported Living Center Campus Total State GR Dedicated Federal Other FTE Positions

3

1 8 1 EF

$370,170,397

$29,804,700

$154,071,694

15

15

1 8 1 EF

$10,599.82

4

15

4,627

252

150

Average Number of Days individuals With MR Wait For Admis2 sion To Any State Supported Living Center Campus

$8,965.13

4

15

4,832

206

127

FY 2009 Expended

1 Average Monthly Cost Per MR Campus Resident

2

Average Monthly Number of Individuals with MR Waiting for Admission to Any State Supported Living Center Campus Average Monthly Number of Individuals with MR Waiting for 3 Admission To A Specific State Supported Living Center Campus

1 Average Monthly Number of MR Campus Residents

1

FY 2008 Expended

1 8 1 EF

1 8 1 OP

1 8 1 OP

1 8 1 OP

1 8 1 OC

1 8 1 OC

Strategy 1.8.1 MR State Schools Services

350

150

14,239.1

$673,574,800

$433,357,512

$26,000,000

$187,368,988

$673,574,800

22

15

$12,440.43

4

15

4,512

FY 2010 Budgeted

Strategy 1.9.1 Capital Repairs and Renovations For DADS, funding in this strategy is for the construction and renovation of facilities at the state supported living centers (SSLC) and state-owned bond homes for persons 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 conditioning, heating, electrical, plumbing, etc. The large number of buildings on SSLC campuses and the age of many of these buildings necessitates ongoing capital investments to ensure that the buildings are functional, safe, and in compliance with all pertinent standards. Compliance with such standards is mandatory to avoid the loss of federal funding for the state facilities.

54

55

There are no measures for this strategy.

Strategy 1.9.1 Capital Repairs and Renovations

Expended

Expended

$14,816,982 0

$142,028 $289,802 $0 $8,098,370 0

State GR Dedicated Federal Other FTE Positions

$0

$289,803

$142,028

$8,530,200

Total

$15,248,813

FY 2009

FY 2008

0

$56,563,263

$0

$289,803

$142,028

$56,995,094

Budgeted

FY 2010

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 living 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 hospital-based skilled nursing facilities are also required to be certified in order to participate in Medicare and/or Medicaid. 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 responsible 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 selfreported incidents, as well as monitors facilities that are out of compliance with regulations. Assisted Living Facility. DADS is responsible for licensing these facilities, conducting an annual inspection, investigating complaints and self-reported incidents, and monitoring facilities that are out of compliance with regulations. Adult Day-Care Facility. DADS is responsible for licensing these facilities, conducting an annual inspection, investigating complaints and provider self-reported incidents, 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 selfreported 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.

56

57

$0 1,053.6

$70,030 978.8

Other FTE Positions

$1,936,140 $39,381,055

$1,901,037 $38,508,572

Federal

$23,119,510

GR Dedicated

State

$64,436,705

$57,047,234 $16,567,595

Total

2,016

1,920

# of Complaint Investigations Conducted On-site: Home and Community Support Services Agencies

2 1 1 OP 13

1,236

2,225

1,256

2,314

$1,529,323

5,368

66.35%

FY 2009 Expended

Number of Home and Community Support Services Agency Inspections Conducted

Number of Home and Community Support Services Agency Licenses Issued

$1,511,189.

4,560

63.47%

FY 2008 Expended

2 1 1 OP 12

2 1 1 OP 11

9 Total Dollar Amount Collected From Fines

Percent of Facilities Complying with Standards At Time of Inspection for Licensure and/or Medicare/Medicaid Certification

2 1 1 OP

1 4 Number of Inspections Completed Per Year

OC

2 1 1 OP

2 1

Strategy 2.1.1 Facility and Community-Based Regulation

1,095.2

$0

$46,711,257

$19,483,473

$22,874,992

$71,534,592

1,968

1,246

2,270

$1,520,256

4,964

64.12%

FY 2010 Budgeted

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 facilities 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 recommendations and other licensure activities with the governor-appointed Nursing Facility Administrators Advisory Committee; imposing and monitoring sanctions; providing due process considerations; 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 approval; 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). Responsibilities include providing due process considerations and a determination of unlicensed staff employability in facilities and agencies regulated by DADS via the EMR. Medication Aide Program. Responsibilities include continuing education activities; issuing and renewing medication aide permits; imposing and monitoring of sanctions; providing due process considerations; approving and monitoring medication aide training programs in educational institutions; developing educational, training, and testing curricula; and coordinating and administering examinations. 58

59

8 1

OC

2 1 2 OP

2 1

FTE Positions

Other

Federal

State

Total

24.5

$210,839

$428,612 $334,163

$973,614

1,107

Number of Licenses Issued or Renewed Per Year: Nursing Facility Administrators

26.0

$193,723

$833,561 $355,525

$1,382,809

1,020

38.74%

Expended

Expended 36.6%

FY 2009

FY 2008

Percent of Complaints and Referrals Resulting in Disciplinary Action: Nursing Facility Administrators

Strategy 2.1.2 Credentialing / Certification

26.0

$198,025

$663,152 $417,049

$1,278,226

1,073

40.6%

Budgeted

FY 2010

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 performs a variety of functions designed to enhance the quality of services and supports. Major initiatives are described below. The Quality Monitoring program represents an educational rather than regulatory approach to quality improvement. Quality monitors, who are nurses, pharmacists, and dietitians, provide technical assistance to long-term facility staff. The quality monitors 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 oneon-one physician education using a formal process called academic detailing through which best practices 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 improvement priorities for which evidence-based best practice can be identified from published clinical research. Topics included in the monitoring visits are: restraint reduction, continence promotion, use of indwelling bladder catheters, improving vaccination rates, enhancing advance-care planning, improving fall-risk management, decreasing the inappropriate use of artificial nutrition and hydration, improving routine hydration practices and preventing unintended weight loss, improving pain assessment and management, improving the appropriateness 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 Program model to state supported living centers, community ICFs/MR, assisted living facilities, and home and community-based services providers. The purpose of the program is to increase positive outcomes and to improve the quality of services for individuals served in these settings. A related website, http://www.TexasQualityMatters.org, supports the program by providing online access to bestpractice information and links to related research. QA&I staff conducts two annual large-scale surveys. 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 Review is an annual statewide survey of individuals receiving services and supports through home and 60 community-based and institutional programs from DADS.

61

$1,330,000 72.5

$3,219,239 $1,393,546 74.7

Federal Other FTE Positions

$3,297,856

$228,054

$258,804

$6,421,372

$1,006.85

State

$915.32 $4,871,589

1 Average Cost per Quality Monitoring Program Visit

2 1 3 EF

3,556

Expended

Expended 3,556

FY 2009

FY 2008

Total

1 # of Quality Monitoring Visits to Nursing Facilities

2 1 3 OP

Strategy 2.1.3 Long-Term Services and Supports Quality Outreach

78.4

$1,330,000

$,3588,104

$570,924

$5,489,028

$1,032.02

3,556

Budgeted

FY 2010

Strategy 3.1.1 Central Administration Central Administration supports administrative functions for all DADS programs including executive direction and leadership, legal, civil rights, hearings of provider appeals, planning, budget management, fiscal accounting and reporting, asset management, program statistics, public information, state and federal government relations, internal audit, and program support. Under the Older Americans Act, central administration supports 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 support 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 support supplied by external organizations, coordinating all technology procurements including technical contractors, and technology policies and procedures published in the DADS IT Handbook. The application systems developed, deployed, and supported under this strategy cover financial systems, including revenue systems; consumer information systems; facility management systems; and decision support systems. Functions performed include 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 inventory. 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 appropriate process and procedures within service level agreements. 62

63

Strategy 3.1.3 Other Support Services

Strategy 3.1.2 Information Technology (IT)

Strategy 3.1.1 Central Administration

$1,182,709 374.0

$1,228,258 340.1

Federal Other FTE Positions

99.3

$1,169,619 128.1

Other FTE Positions

$686,058 35.0

$611,732 $915,050 $88,993 35.3

State Federal Other FTE Positions

$1067,367

$961,706

$1,615,775 Total

$2,715,131

$233,387

$26,349,804 $9,575,441 $15,604,744

Total State Federal

$36,017,770 $15,719,486 $20,064,897

$15,412,528

$15,329,117

Total State

FY 2009 Expended $29,572,091 $12,976,854

FY 2008 Expended $27,959,965 $11,402,590

35.0

$89,727

$1,197,792

$802,351

$2,089,870

101.7

$594,274

$38,262,347 $16,795,567 $20,872,506

374.0

$1,245,637

$18,779,919

FY 2010 Budgeted $33,323,239 $13,297,683

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 Services DADS Emergency Dental, Rehab/ Specialized Services 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 Texans

1-800-622-2520

Long-Term Care Facility Incident Reporting

1-800-458-9858

Long-Term Care Ombudsman Program

1-800-252-2412

Long-Term Care Credentialing

1-800-452-3934

1-800-458-9858 1-800-792-1109

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

Texas Attorney General (Fraud Against Seniors)

1-800-337-3928

Texas Attorney General Consumer Helpline

1-800-621-0508

Volunteer and Community 64 Engagement

1-800-889-8595