Revision 19-0; Effective July 7, 2019

Referring Entity References and Online Training Resources

Training designed to give PASRR referring entities the information, tools and resources needed to successfully complete the PASRR Level 1 Screening (PL1) may be accessed via the Texas Health and Human Services Learning Portal and enrolling in the course titled “PASRR Referring Entity (Online).”

Training designed to give a comprehensive knowledge for the PL1 may be accessed via the Texas Health and Human Services Learning Portal and enrolling in the course titled “PASRR PL1 (Online).”

Written step-by-step instructional guides regarding how to complete the PL1 form may be found by navigating to the PASRR Forms and Instructions page and clicking on one of the following hyperlinks:

• Detailed Item by Item Guide for completing the PL1 Screening Form (Referring Entities) [PDF] — This document provides complete step-by-step instructions for referring entities on when and how to complete the PL1.
• Detailed Item by Item Guide for completing the PL1 Screening Form and IDT Form (Local IDD Authorities and Nursing Facilities) [PDF] — This document contains complete step-by-step instructions for local authorities and nursing facilities on when and how to complete the PL1 and confirm IDT meetings.

LIDDA/LMHA/LBHA Training Materials

The LTC online portal can be accessed here. A log-on identification number is required to access the LTC online portal for alerts, PASRR Level II Evaluation (PE) submissions and corrections. Access details can be found in the Long-Term Care (LTC) User Guide for Preadmission Screening and Resident Review (PASRR)[PDF], which also provides information for LIDDAs and LMHAs/LBHAs for using the LTC online portal to submit all PASRR screenings and evaluations.

Written step-by-step instructional guides regarding how to complete the PE form may be found by navigating to the PASRR Forms and Instructions page or by clicking on of the following hyperlink:

• Detailed Item by Item Guide for Completing the PASRR Evaluation (PDF) — This document provides step-by-step instructions on when and how to submit the PE.

Revision 19-0; Effective July 7, 2019

Relocation Referrals

The following chart contains the email address for each STAR+PLUS managed care organization (MCO). A local intellectual and developmental disability authority (LIDDA) uses the appropriate email address to send a completed Form 1579, Referral for Relocation Services, as an attachment.

MCO Name	Relocation referrals should be sent to:
Amerigroup STAR+PLUS	starplusservicecoordination@amerigroup.com
Cigna-Health Spring	Transition_MFP_Team@healthspring.com
Molina Healthcare of Texas	Molina.STARPLUS@Molinahealthcare.com
Superior Health Plan	nursing.facility@superiorhealthplan.com
United Healthcare Community Plan	etxcilfax@uhc.com

MCO Service Coordination Contact Information

If the LIDDA has already made a referral for relocation services and needs assistance from the MCO, the LIDDA should contact the MCO service coordinator (SC).

If the LIDDA is unable to locate or contact the MCO SC directly, then the LIDDA should contact the MCO service coordination hotline using the chart below.

MCO Name	STAR+PLUS Service Coordination Hotline
Amerigroup STAR+PLUS	1-800-315-5385, Ext. 35765
Amerigroup STAR+PLUS IDD	1-866-696-0710, Ext. 36171
Cigna-Health Spring	1-877-725-2688
Molina Healthcare of Texas	1-866-409-0039
Superior Health Plan	1-877-277-9772
United Healthcare Community Plan	1-800-349-0550

Revision 19-0; Effective July 7, 2019

Below is a general description of the types of legal authority available to make decisions on behalf of another person or to support a person to make his or her own decisions. More information about some of these options and guardianship is available at: https://hhs.texas.gov/laws-regulations/legal-information/guardianship.

Option	Definition	Enabling Statute
Supported Decision Making	A process of supporting and accommodating an adult with a disability to enable the adult to make life decisions, including decisions related to where the adult wants to live; the services, supports and medical care the adult wants to receive; whom the adult wants to live with and where the adult wants to work, without impeding the self-determination of the adult. A supported decision maker does not have the authority to make a decision on behalf of the person.	Texas Estates Code §1357.002(3)
Surrogate Decision Maker	"Surrogate decision-maker" means a person with decision-making capacity who is identified as the person who has authority to consent to medical treatment on behalf of an incapacitated patient in certain facilities (hospital, nursing facility) who needs medical treatment. A surrogate decision maker is authorized to consent to only medical treatment on behalf of the person.	Texas Health and Safety Code §313.002 (10)
Guardianship of Person	A guardian of the person is appointed by a court to act on behalf of an incapacitated person and, considering the preferences of the person, decides: Where the person will live. Whether to limit contact with family and friends. What medical or psychological treatment the person will receive. Where the person can go. What personal rights the person will have (e.g., drive a car, have a cell phone, date) within the limitations of the court order.	Texas Estates Code Chapter 1151. Rights, Powers, and Duties Under Guardianship
Guardianship of Estate	A guardian of the estate is appointed by a court to act on behalf of an incapacitated person and decides (with court approval): What should be done with the person’s property. Which bills to pay and when. How to invest the person’s money. Whether to enter into a contract to buy or sell property.	Texas Estates Code Title 3. Guardianship and Related Procedures
Medical Power of Attorney	A competent adult person may execute a medical power of attorney for someone to make any or all health care decisions on behalf of the person in accordance with the person’s wishes, including religious and moral beliefs, when the person is no longer capable of making them for himself or herself. Someone with medical power of attorney is authorized to make only health care decisions on behalf of a person in the event the person becomes incapacitated.	Texas Health and Safety Code §166.164
Durable Power of Attorney	A competent adult person may execute a durable power of attorney, which will continue in the event of future incapacity of the person in designating an agent who is empowered to take certain actions regarding the person’s property. Someone with durable power of attorney is not authorized to make medical and other health care decisions for the person.	Texas Probate Code §481
Advanced Medical Directives	A competent adult person may execute an advanced medical directive, which is “an instruction...to administer, withhold, or withdraw life-sustaining treatment in the event of a terminal or irreversible condition.”	Health and Safety Code Chapter 166

Revision 19-0; Effective July 7, 2019

Identifying and managing risks are part of providing services and supports to people with intellectual and developmental disabilities. Depending on their individual circumstances, people who receive institutional and community services can be at risk of adverse outcomes. Identifying risks is an important part of mitigating future risks and adverse outcomes to the individual.

Identifying and Planning to Mitigate Risk at the Individual Level

Effective risk management begins with assessment and service planning centered around the individual’s needs and preferences. Potential risks are identified and documented, and individualized mitigation strategies are mapped out. Ongoing documentation of services targeted to address risk and negotiations around risk provide evidence of risk management.

Risk Management Begins with the Individual Assessment Process

Just as service planning begins with a needs assessment, risk management should begin with an effort to identify potential and perceived risks to the individual. In many cases, these risks are directly linked to the disability-specific needs identified during the assessment process. However, the presence and projected consequences of such risks may not always be documented in an individual’s record. Risk identification is more than a conversation between an individual, their family members, service providers, case managers and others. It also involves a comprehensive documentation of that conversation. Such documentation provides the context and rationale for elements in the service plan and provides evidence that a risk management process is in place.

Behavioral Risks

Some people with disabilities may place themselves and others at greater risk through their behavior. Behavioral risks include:

• poor decision-making about safety and health issues, as a result of a brain injury or cognitive limitation;
• violent or criminal behavior;
• substance abuse; and
• suicide.

Risks to Personal Safety

Many people who are elderly or who have severe disabilities are vulnerable to abuse and exploitation. They are often dependent on others for assistance with everyday activities, such as eating or bathing, as well as with participation in the community. Thus, they face the additional risks of neglect, abuse and financial exploitation. In addition, personal safety, including safe evacuation, can be compromised by mobility and cognitive impairments. Other personal safety risks can include unsanitary or unsafe housing and social isolation.

Additional information is available here (PDF).

For information about medical and health related risks, see the Common Risk Factors and Basic Clinical Guidelines to Gauge Level of Risk (PDF) chart.