Transcript WELCOME TO THE HCS ENROLLMENT FAMILY MEETING

HCS Enrollment
The Gulf Coast Center
1
Home and Community Based
Services - HCS
Home and Community Based Services (HCS) is a
Medicaid waiver program. Its purpose is to . . .

Support individuals in their chosen living environment

Meet the individual’s specific needs

Maximize natural community supports

Provide services that assist the individual with living
in the community
2
Daily Living Services and Supports
Adaptive Aids
Devices, controls or appliances which enable a person
to retain or increase their abilities to perform daily
living activities or control their environment
($10,000 per service plan year)
3
Daily Living Services and Supports
Case Management to assist with . . .
 Eligibility
 Coordinating and developing the service plan
 Monitoring the quality and deliver of services
 Advocating for the individual
 Identifying resources
 Making community referrals
 Providing crisis intervention
 Safe guarding individual’s rights
4
Daily Living Services and Supports
Counseling and Therapies
Audiology
 Assessment
 Intervention
 Training
 Consultation with individual, family & provider
Dietary
 Assessment
 Consultation
 Staff training related to basic or special nutritional
needs
5
Daily Living Services and Supports
Counseling and Therapies, continued
Occupational Therapy – Assists with achievement of
independent functioning skills plus . . .
 Assessment
 Development of treatment plans
 Training
 Consultation
 Assistance with adaptive aids
6
Daily Living Services and Supports
Counseling and Therapies, continued
Physical Therapy – assist with . . .
 Increasing range of motion
 Improving physical functioning
 Retaining physical conditioning
Speech Therapy – assist with . . .
 Assessing
 Developing treatment plans
 Training
 Consulting
 Providing adaptive aids
7
Daily Living Services and Supports
Day Habilitation
Day program designed to assist in learning, retaining
and improving self-help, socialization and adaptive
skills necessary to successfully and safely reside in the
community
Dental
$1,000 per plan year for . . .
 Emergency, preventive, and therapeutic dental
treatment
 Regular exams
8
Daily Living Services and Supports
Nursing
Licensed nurse to . . .
 Monitor health conditions
 Monitor medication administration
 Refer for medical services
 Training of families and staff
Prescription Drugs
 Unlimited prescriptions for individuals with Medicaid only
 Individuals eligible for both Medicaid and Medicare must
obtain prescription medications through Medicare Part D Plan
9
Daily Living Services and Supports
Respite

In-home or out-of-home temporary relief

Limited to 30 days per plan year
Supported Employment
Assistance to sustain paid employment for those who
require intensive on-going supports to perform in a
work setting
10
Daily Living Services and Supports
Minor Home Modifications
Modifications to living quarters which ensure safety, security,
and accessibility in order to live in the community
(Lifetime maximum = $10,000)

Determining what is needed

Arranging for someone to do the work

Paying for the work
Social Work

Assessing needs

Directing the meeting of the needs

Training/consultation with individual, family or provider
11
Residential Services and Supports
Supported Home Living
For those who chose to live in their
own or family home
Includes support in learning, retaining, or improving
skills related to activities of daily living
Supervised Living
For those who chose to live in
a group home setting; assistance available during
normal sleeping hours if needed
Includes habilitation, supervision and availability of
staff
12
Residential Services and Supports
Residential Support
For those who chose to live in
a group home setting and need assistance during
normal sleeping hours
Awake staff provides . . .

Supervision

Supports for needs such as
 Special
medical conditions
 Maladaptive
 Assistance
behaviors
with daily living activities
13
Residential Services and Supports
Foster/Companion Care Services
For those who chose to live in a home-like setting
(family’s or other’s)
Provides . . .

Habilitation

Supervision

Supports
14
HCS Eligibility Requirements





Mental retardation or a related condition
Deficits in adaptive behavior and a Full Scale IQ of
75 or below
Eligible for Medicaid
No age limit for enrollment
Have a service plan costing no more than
 $86,313.38 for Level of Need (LON) 1, 5, or 8,
 $98,773.56 for LON 6
 $173,876.88 for LON 9
15
Medicaid Eligibility
Supplemental Security Income (SSI)
Contact your local Social Security Administration
office

Medicaid Assistance Only (MAO)
Complete Form 1200 which is available at
http://www.dhs.state.tx.us/Forms/Form1200.html

Contact Texas Department of Health and Human
Services Medicaid office
713-696-7155
Your Service Coordinator needs to assist in this process

16
Documentation Required
for Enrollment

Determination of eligibility

Medicaid approval

ICAP (Inventory for Client & Agency Planning)
Used to determine a Level of Need (LON)
17
Documentation Required
for Enrollment
Completed During Enrollment






Verification of freedom of choice
Medicaid estate recovery program
MR/RC assessment form
Documentation of provider choice
Person directed plan (PDP)
Individual HCS plan of care (IPC
18
HCS Providers (Companies)
Texas Department of Aging and Disability Services
(DADS) authorizes 148 companies to provide HCS in
Brazoria & Galveston Counties.
Each company is required to offer* the full array of
services and supports.
* May contract services from others
19
HCS Providers (Companies)
Who Are They?
How Can They Be Contacted?

You will be given a current list of providers

This list includes names, phone and fax numbers,
addresses and number of people served by county

The Gulf Coast Center also has available provider
brochures
20
HCS Providers (Companies)
Selecting an HCS Provider

Decide what is important to you and develop a list of
questions to ask.
Gulf Coast Center will provide a list of typical questions.

Review provider brochures and other materials
21
HCS Providers (Companies)
Selecting an HCS Provider

Attend Provider Fairs.

Ask Providers for References.

Visit Provider Facilities, Day Habilitation Sites and
Homes

Talk With Individuals and Families Who Are Already
Participating in HCS
22
Important Resources

The Arc of the Gulf Coast, 281-388-1161

Gulf Coast Center, 888-839-3229
Leigh Saunders
Donna Dean

Medicaid Eligibility
713-696-7155

Provider List
23