Transcript Yes Waiver - Texas System of Care

YES WAIVER
PREPARING FOR STATEWIDE ROLL OUT
DEPARTMENT OF STATE HEALTH SERVICES
IN COLLABORATION WITH UT-TEXAS INSTITUTE FOR EXCELLENCE IN MENTAL HEALTH
INTRODUCTION
CARMEN BLISS, LMSW
JENNIFER MARTINEZ
Youth Empowerment Services (YES)
Waiver
CARMEN BLISS, LMSW
JENNIFER MARTINEZ
STATEWIDE BY FY2016
• Rider 80 of the 83R legislative session directed the Health and Human Services Commission
(HHSC) and Department of State Health Services (DSHS) to initiate the statewide expansion
of the Youth Empowerment Services waiver. The specific language of the Rider states:
•
1915(c) Youth Empowerment Services Waiver Expansion. The Health and Human Services
Commission, in conjunction with the Department of State Health Services, shall initiate the
expansion of the 1915(c) Youth Empowerment Services (YES) waiver statewide during the 2014-15
biennium. Expansion into new service areas is contingent upon approval by the Centers for
Medicare and Medicaid Services (CMS).
• While awaiting approval of expansion of YES Waiver as a Medicaid program by Centers for
Medicare and Medicaid Services (CMS), DSHS will expand as a general revenue funded
program.
• Meeting the needs of Texas
OVERVIEW OF 1915(C) WAIVER
• Legislative direction to the Health and Human Services Commission (HHSC) – prevent custody
relinquishment of children with Severe Emotional Disturbance (SED)
• HHSC authorized DSHS to develop and operate a 1915(c) waiver for children with SED
• YES Waiver provides home and community-based services to children who otherwise need
institutional care (e.g., psychiatric inpatient care) or whose parents would turn to state custody
for care
• Must be cost neutral to Medicaid (average Medicaid service cost with waiver less than or equal to
average Medicaid service cost w/o waiver)
• Currently implemented in Bexar, Travis, Fort Bend, Harris, Brazoria, Galveston, Cameron, Hidalgo,
Willacy and Tarrant Counties
• Submitting waiver amendments to CMS for expansion into Burnet, Williamson, and McClennan
counties
• Will continue to submit waiver amendments until all expansion into all Texas counties is complete
YES WAIVER GOALS
1.
Provide a more complete continuum of flexible community-based services
and supports for children and adolescents with SED and their families
2.
Ensure access to other flexible non-traditional support services, including the
parent partners
3.
Develop individualized plans of care (IPC) through a family-centered planning
process
4.
Prevent or reduce inpatient psychiatric admissions for children and
adolescents with SED
5.
Reduce and prevent out-of-home placements by all child-serving agencies
6.
Improve the clinical and functional outcomes of children and adolescents
YES WAIVER SERVICE ARRAY
• Respite (In-Home and Out-OfHome);
• Adaptive Aids and Supports;
• Community Living Supports;
• Specialized Therapies (Animal
Assisted Therapy, Art Therapy,
Music Therapy, Recreational
Therapy, Nutritional
Counseling);
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Employment Assistance;
Family Supports;
Minor Home Modifications;
Non-Medical Transportation;
Paraprofessional Services;
Supportive Employment;
Transitional Services
Supportive Family-based
Alternative;
TIMELINE & ROLE OF UT: TEXAS INSTITUTE FOR
EXCELLENCE IN MENTAL HEALTH (TIEMH)
ERIN ESPINOSA, PH.D.
UT-TIEMH
2015
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
Cohort One Targeted Support
Cohort Two Targeted Support
Cohort Three Targeted Support
Cohort Four Targeted
Suppporet Training
JAN
FEB
MAR
APR
2015
MAY
JUN
JUL
AUG
ACTIVITIES
• Receive S-Kit and Implementation Workbook
• Turn in completed Implementation Workbook to TIEMH
• TIEMH reviews Implementation Workbook and submits Process and
Organizational questions for review and consideration
• Regional In-Person Planning and Strategy meeting
• Process and organizational support calls with TIEMH
TIEMH TOOLS
BONNIE EVANS, MPSYCH
UT-TIEMH
Texas Institute of Excellence in Mental Health (TIEMH) /
University of Texas at Austin
IMPLEMENTATION TOOLS
Implementation Workbook
 Organizational overview /
readiness for YES Waiver
- Leadership
- Community Engagement
- Wraparound Teams
- YES Provider Network
- Plan for Targets
- Quality Indicators
- Next Steps
YES Starter-Kit (S-KIT)
The ‘How to’ of YES Waiver
- Roles & Definitions
- Identifying & Developing a Provider
Network
- Inquiry Line
- High Quality Wraparound
- Marketing & Community
- YES Eligibility Criteria
- Medicaid
- Resources (Data Scan, Safety/Crisis
Plans)
- Statewide Expansion Timeline
TIEMH TEAM
REBECCA MARQUEZ, M.ED.
UT-TIEMH
TEXAS INSTITUTE FOR EXCELLENCE IN MENTAL HEALTH
•
•
Erin Espinosa, Ph.D.
Research Associate
[email protected]
512-232-0606
Bonnie Evans, MPsych
• Rebecca Marquez, M.Ed.
Implementation Specialist: YES Waiver
Implementation Specialist: Wraparound
[email protected]
[email protected]
512-232-8327
512-232-8309 (main line)
Texas System of Care Website: http://www.txsystemofcare.org/
PROVIDER NETWORKS
JENNIFER MARTINEZ, DSHS
KIM GARRETT, DSHS
YES WAIVER PROVIDER NETWORK
• YES Service Array
• Provider Qualifications
• Building a provider Network
• IDD providers
• Existing staff members
• Relatives and trusted friends of waiver participants
• Graduate Students
• Employees with known flexible schedules
• Professional Associations
YES SERVICE ARRAY
• Respite (In-Home & Out-Of-Home)
• Adaptive Aids and Supports
• Community Living Supports
• Family Supports
• Minor Home Modifications
• Non-Medical Transportation
• Paraprofessional Services
• Specialized Therapies
• Animal Assisted Therapy
• Art Therapy
• Music Therapy
• Recreational Therapy
• Nutritional Counseling
• Supportive Family-based Alternative
• Transitional Services
RESPITE
Respite is furnished on a short-term basis because of the absence or need for relief of those persons who
normally provide care for the Waiver participant.
In-Home Respite:
• May be provided in the individual’s home or place of residence
• May be provided in the private residence of a respite care provider if that provider is a relative of the
participant
• Is an excellent resource that has long-lasting potential benefits
Out-of-Home Respite:
• May be provided in:
• Foster homes licensed by DFPS
• General Residential Operations licensed by DFPS
• Day or overnight camps accredited by the ACA
• Child care centers/homes licensed by DFPS
• Are more available in some areas than others
ADAPTIVE AIDS AND SUPPORTS
Devices and supports recommended by the treatment team that contribute to the
improved functioning of the Waiver participant in the community as a service under the
approved Service Authorization.
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Therapeutic Peer Support
Provides fees to facilitate the participant’s involvement in peer support activities
such as specialized groups (i.e., dance class, scouts)
•
Therapeutic Equipment/Supplies
Provides fees for items necessary to execute and/or maintain the participant’s
treatment plan and to help the participant achieve therapy goals (i.e., art supplies,
basketball)
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Note: Minor Home Modifications and Adaptive Aids and Supports have a collective
limit of $5,000 annually
COMMUNITY LIVING SUPPORTS
•
May be provided in the participant’s home or community
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CLS training may be provided to participant and/or LAR
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CLS may train in skills related to care of the waiver participant for family members (i.e., parenting
skills)
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CLS may train in skills related to ADLs, IADLs, communication, relationship-building, and integration
into community activities (i.e., anger control, anxiety reduction)
•
All CLS supports should be targeted at enabling the participant to attain or maintain maximum
potential
•
All CLS training is presented by staff who have a solid understanding of participant’s goals and have
the education and knowledge to assist in their attainment. May include evidence-based practices,
a structured curriculum, and best practices
•
Documentation must justify the necessity of the high level of support provided by Community
Living Supports
Qualified Mental Health Professional - Community Services
FAMILY SUPPORTS
Family Supports provides peer mentoring and support to the primary
caregivers by:
• Modeling self-advocacy skills
• Modeling advocacy for Waiver participant
• Providing information
• Providing referrals
• Providing non-clinical skills training and role modeling
• a high school diploma, or a high school equivalency certificate
• at least one cumulative year of receiving or navigating mental health
community services
• be under the direct clinical supervision of a master's level therapist
MINOR HOME MODIFICATIONS
These services include Home Accessibility / Safety Adaptations - Physical
adaptations to the Waiver participant's residence that are necessary to
ensure the health, welfare and safety of the participant.
• Minor Home Modifications must be age appropriate and related to
specific therapeutic goals
• The Waiver Provider is required to maintain written documentation of
reasonable cost for services
• Examples are door chimes, room dividers, and doorway gates
• Note: Minor Home Modifications and Adaptive Aids and Supports have
a collective limit of $5,000 annually
NON-MEDICAL TRANSPORTATION
Non-Medical transportation enables Waiver participants to gain access to
Yes Waiver and other community services, activities and resources.
• Transportation providers must have a valid Texas driver's license and
insurance appropriate to the vehicle used to provide transportation
• Transportation may be provided to YES Waiver activities identified on
the Service Authorization
• Transportation is best provided with natural resources
• Transportation does not include any other medical transportation under
the State plan
PARAPROFESSIONAL SERVICES
Paraprofessional Services are essential to promote community inclusion in typical
child/youth activities and exceed what would normally be available for children and
adolescents in the community.
Services include skilled mentoring and coaching as well as preventing and managing
behaviors stemming from a serious emotional disturbance.
• a high school diploma, or a high school equivalency certificate
• minimum of one year of full-time experience in the provision of activities to a
population similar to those served under this waiver
• demonstrate competency in the provision and documentation of the specified or
comparable service
SPECIALIZED THERAPIES
Animal Assisted Therapy ~ Art Therapy ~ Music Therapy ~
Recreational Therapy ~ Nutritional Counseling
The intent of these services is to maintain or improve health, welfare, and/or
effective functioning in the community.
• Licensed professionals, with documented training and experience relative to
the specialized therapies identified above, or
• Individuals who meet the appropriate certification standards listed below:
• Art Therapy Credentials Board (AT-BC)
• Certification Board for Music Therapists (MT-BC)
• Pet Partners program, Equine Assisted Growth and Learning
Association (EAGALA), and the North American Riding for the
Handicapped Association (NARHA)
• National Council of Therapeutic Recreation Certification (CTRS). Texas
Certified Therapeutic Recreation Specialist (TRS/TXC)
• Texas Board of Examiners of Dietitians
SUPPORTIVE FAMILY-BASED ALTERNATIVE
• SFA are designed to provide therapeutic support to the Waiver participant,
often when the family is at its wit’s end. They are designed to model
appropriate behaviors for the Waiver participant and the family with the
objective of enabling the Waiver participant to successfully return to their
family and live in the community with their family.
• Facilitated by a DFPS licensed Child-Placing Agency
• Provide therapeutic support to the child and caregiver to model
appropriate behaviors
• May be authorized up to 90 consecutive days or cumulative days per
individual service plan per year
• Note: Although the participant is with a Child-Placing Agency, the child is
NOT being placed in any form of foster care
TRANSITIONAL SERVICES
• A one time non–recurring allowable expense when a Waiver participant
transitions from the family home, an YES Waiver approved institution, or a
provider-operated setting to their own private community residence
• Services Provided must meet the requirements of the approved service
authorization and are of reasonable cost
• Assistance may include:
• Utility and security deposits for the home/apartment; rent is not included
• Needed household items such as linens and cooking utensils
• Essential furnishings
• Moving Expenses
• Services Necessary to ensure health and safety in the apartment/home (e.g.,
pest eradication, allergen control, one-time cleaning)
• Transitional assistance is limited to $2500 per waiver participant and a transition
plan must be in place
YES WAIVER
•
A strong Provider Network enables the YES Waiver to provide
intensive community-based services for children and
adolescents with SED.
•
A strong Provider Network allows more flexibility for families
and prevents or reduces the institutionalization of children and
adolescents with SED.
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The input of the entire Wraparound Team in carefully selecting
services maximizes the opportunity for the YES Waiver
participant and family to be successful.
LMHA RESPONSIBILITIES
CANDIS GUIDRY, DSHS
CHRISTINE MEDEIROS, DSHS
LMHA RESPONSIBILITIES
WEBINAR
JANUARY 27, 2015
LMHA ADMINISTRATIVE ACTIVITIES
• Recruit Waiver Providers & Potential Waiver
Recipients
• Maintain Local Inquiry List
• Determine Clinical Eligibility and Recommend a
Level of Care
• Coordinate with DSHS to obtain Medicaid eligibility
• Present Choice Options to Client
•
Waiver Services
•
Institutional Services
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Other Non-Waiver Services
• Complete Service Authorizations for each participant
• Provide Intensive Case Management using the National
Wraparound model
• Transition Planning
• Conduct Utilization Management, Quality Assurance &
Improvement Activities
• Direct enter into CMBHS (CED, POC, & Service Notes if
provider)
Additional responsibilities if LMHA is the Comprehensive
Waiver Provider for YES Waiver Services
REFERRALS AND INQUIRY LIST
•
Individuals requesting services under the YES Waiver may or may not be current clients of the LMHA.
The LMHA should provide information about the YES Waiver to any client that may be eligible for the
YES Waiver.
•
The LMHA may receive referrals of individuals requesting the YES Waiver from outside agencies,
organizations, or providers; however, the Legally Authorized Representative (LAR) or individual
must make the telephone call to be placed on the Inquiry List.
•
Individuals may present to the LMHA requesting the YES Waiver without a referral.
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Register each individual on the Inquiry List that contacts the LMHA based on the date and time the
phone call was received.
•
The LMHA must submit a current and up-to-date Inquiry List to DSHS on the last business day of
each month.
ENROLLMENT
1. Must enroll and serve in the YES Waiver a minimum average of clients (based on
5% of Children Services Targets). All YES Waiver participants served will count
toward overall Children’s Services targets except where clients over the age of 18
are authorized into an Adult Level of Care.
2. An enrolled and served client is defined as a client with a submitted and
approved Initial Service Authorization.
3. Must submit Service Authorizations in accordance with the YES Waiver Policy and
Procedure Manual.
4. Must continue to assess and, if found to be eligible, enroll clients in excess of
their minimum enrollment requirement in accordance with Inquiry List
Management policies.
5. Must not maintain a wait list for YES Waiver enrollment.
KEY TO SUCCESS: WRAPAROUND
Intensive Case Management to client ratio of 1:10
The Wraparound Facilitator leads the comprehensive Child and Family Team Meeting with the
identified team members to develop, but is not limited to, the identification of goals and
objectives, Crisis/Safety Planning, and the development of the Service Authorization, and its
ongoing monitoring.
Service Authorization development includes:
1. The identification of types of YES Waiver services;
2. The identification annual quantity of YES Waiver services;
3. Calculations of annual cost for proposed services;
4. State Plan Services;
5. Non-Waiver services (i.e., DSHS general revenue flexible funds);
6. Sustainability through natural supports and community resources for transition
planning.
Texas Department of State Health Services (DSHS)
QUALITY MANAGEMENT PLAN
• Each LMHA must have a
Quality Management Plan
that includes compliance
and improvement
activities for the YES
Waiver.
• DSHS YES Waiver Program
approves each LMHA’s QM
Plan for the YES Waiver.
QM & UM ACTIVITIES
• Inquiry List
• Clinical Eligibility
• Critical Incident Reporting
• Termination Reasons
• Service Authorization
• Provider Credentialing &
Training
• Waiver Service Provision
• Utilization Patterns
• Wraparound Plan
• Treatment outcomes
• Crisis/Safety Plan
• Service claims
• Engagement
EXPERIENCE FROM AN LMHA
MONICA RODRIGUEZ, TROPICAL TEXAS BEHAVIORAL HEALTH
QUESTION & ANSWER
CARMEN BLISS, DSHS
THANK YOU FOR JOINING US TODAY!!