Why was the decision made to do a State Plan Amendment 1915(i) rather than a 1915(c) Medicaid waiver?
The decision to seek a State Plan Amendment rather than a waiver was made because HCBS waivers generally require the person qualify medically for a nursing home or ICF/IID. This would exclude the target population of the program (people who no longer require an institutional level of care). The 1915(i) State Plan Amendment allows the state to develop its own needs-based criteria, appropriate to the population served. 1915(c) waivers require the person meet a level of care for a Medicaid-qualified institutional setting; Institutions of Mental Disease for people between 21 and 65 are not a qualified institutional setting under Medicaid. A 1915(c) waiver would exclude a majority of the target population for the program who are between 21 and 65.
Does HCBS-AMH Adaptive Aids service cover applications for a person's phones to assist with medication reminders and other prompts to assist in independent living?
Yes, applications for a person's phone will be covered in Adaptive Aids.
What work has been done to ensure there is housing availability? Are housing vouchers available?
HHSC has been working closely with Texas Department of Housing and Community Affairs to ensure the HCBS-AMH target population will be eligible to participate in Section 811 and Project Access. Additionally, HHSC is working with community providers to expand housing opportunities.
Are HCBS-AMH services billed as fee for service?
Yes, HCBS-AMH enrollees are served through a fee-for-service delivery system where providers are paid for each service. Rates are posted on the Rate Analysis website.
What is the maximum income level for participants to be eligible for the HCBS-AMH program?
People receiving HCBS-AMH services must have income that does not exceed 150 percent of the Federal Poverty Line.
How can I bill my claims?
The provider agency and recovery manager can use Clinical Management for Behavioral Health Services to submit service encounters, Individual Recovery Plans and Medicaid claims, when CMBHS is made available. Until such time that CMBHS has the capacity to support these functions, submission of this information will be submitted as otherwise outlined below:
- The HCBS-AMH provider will email the HCBS-AMH invoicing template to HHSC via encrypted mail. The invoicing template shall be submitted no later than 5 p.m. (Central Standard Time) 15 calendar days after the last day of the following month.
- The time period for services is as follows: The first day of the month through the last day of the month.
How were billing rates set?
HHSC held a rate hearing on March 3, 2014, to gain input from potential providers to ensure the rates were set appropriately and correspond to the intensity of the provision services required to meet the needs of the individual. Payment rates for HCBS-AMH services were developed based on payment rates determined for other programs that provide similar services.
Will there be an overall cap for HCBS-AMH services?
There will not be a cap for billing HCBS-AMH services. Cost neutrality doesn't have to be demonstrated in this program. HHSC will have final approval of the Individual Recovery Plan and all billing invoices.
What does the * on the billing rates mean?
Tied to the Acute Care code in the applicable Texas Medicaid Fee Schedule located on the Texas Medicaid & Healthcare Partnership website (see Fee Schedules).
What is the current rate based on? Can peer support be billed for a group? Why is the rate lower than rehabilitation?
The current rate for peer support is based on a rates hearing HHSC held on March 3, 2014, to gain input from potential providers to ensure the rates were set appropriately and correspond to the intensity of the provision services required to meet the needs of each person. Peer support can't be billed for a group.
The peer support services in the HCBS-AMH program are designed to provide advocacy and foster recovery-oriented skills to help a person enhance their recovery. In the HCBS-AMH program, peer support is considered different than psychosocial rehabilitation in the HCBS-AMH program. Because of this, the educational requirements for HCBS-AMH peer supports differ than those for HCBS-AMH providers of psychosocial rehabilitation. Instead, the educational requirements for peer support are in line with those requirements for paraprofessionals and the service rates were based off the ones for a paraprofessional.
Will the recovery managers be the people responsible for finding and matching the person to housing and housing vouchers? Are there special trainings for them to understand the work that has been done with the 811 waivers and other work on housing capacity?
The recovery manager is responsible for coordinating and monitoring services, including housing services for the person enrolled in HCBS-AMH. HHSC is working on accessing special trainings on housing for the recovery manager and will notify them when these trainings become available. Also, it is the expectation that the recovery manager has knowledge of housing resources available in the areas they serve.
When a person is still enrolled in a facility and trying to transition to the community, how should the recovery manager bill for services? Should the provider bill under "Transition Services" or "Recovery Management Services?"
The Recovery Management Transitional Fee is a one-time fee paid to the recovery manager for the first three months of the provision of recovery management transitional services. The amount of this one- time Recovery Management Transitional Fee is not dependent on the person's length of stay during these three months of recovery management transitional services. The Recovery Management Transitional fee is $1,842.87.
Are HCBS-AMH service providers and recovery managers guaranteed a certain number of enrolled participants?
HCBS-AMH providers and recovery managers are selected by the individual receiving services, therefore, HHSC is unable to guarantee a certain number of participants.
Are the HCBS-AMH service providers and recovery managers required to go through any special training?
The training requirements can be viewed in our HCBS-AMH provider manual, which is also available on our website.
Can the same agency apply for both the Recovery Management and Service Provider Open Enrollments?
Yes, the same agency can apply for both open enrollments. However, that agency can't provide both service components (recovery management and services) to the same person. Claims Management Services mandates the recovery manager must be a separate entity from the HCBS-AMH service provider. HCBS-AMH Recovery Management Entities must not be a provider of other HCBS-AMH services listed on the person's Individual Recovery Plan, unless the HCBS-AMH Recovery Management Entity is the only willing and qualified entity in a geographic area where the person chooses to receive the services. This procedure is subject to change upon the Centers for Medicare & Medicaid Services (CMS's) final approval of the State Plan Amendment.
Will the provider offer all services, including recovery management?
HCBS-AMH has two separate providers, the service provider and recovery manager. The service provider provides all services offered within the program, except recovery management. Recovery Management is a separate independent provider.
That being said, the same agency can apply for both open enrollments. However, that agency can't provide both service components (recovery management and services) to the same person. CMS mandates the recovery manager must be a separate entity from the HCBS-AMH service provider. HCBS-AMH Recovery Management Entities can't be a provider of other HCBS-AMH services listed on the person's IRP, unless the HCBS-AMH Recovery Management Entity is the only willing and qualified one in a geographic area where the person chooses to receive the services. This procedure is subject to change upon CMS's final approval of the State Plan Amendment.
What kind of Qualified Medicare surveys will be involved in being a provider or recovery management organization?
Please review Section 15000 of the provider manual, which is also available on the webpage.
Have the IRP forms been developed or will each provider and recovery manager create their own?
The IRP template has been developed with input from Via Hope. The IRP template is included in the provider manual which is accessible online at the HCBS-AMH website.
In the unlikely event that a provider is unable to provide the necessary/authorized services or goes out of business unexpectedly, who is responsible for filling that gap and providing the necessary services?
The recovery manager will work closely with the person to help them select a new provider of services.
What is the frequency and expectation of interactions with the MCO?
It is expected that the MCO service coordinator will participate in weekly phone calls with the recovery manager and HCBS-AMH providers.
What if I have questions about the open enrollments?
All procurement-related questions should be referred to Procurement and Contract Services. Questions concerning requirements relating to the dates of submission and the completion of required forms should be forwarded to PCS at firstname.lastname@example.org.
How often is IRP approved?
It is anticipated the recovery manager and participant will update the IRP every 90 days to ensure it is a reflection of the participant's current needs and desires.
If the provider has a current contract with DSHS, is this opportunity a conflict?
No, this isn't a conflict.
What is the recovery manager to individual ratio?
Caseload sizes for the individual recovery manager are preferably 10 people or less and shall be no more than 15.
Can a service agency provide services from a home-based office?
Home-based offices are allowed as long as they meet HCBS setting requirements.
Can interns provide Community Psychiatric Supports and Treatment?
Licensure candidates can provide services as part of a graduate program under the direct supervision of an appropriately licensed professional.
Referral and Enrollment
Will each person be eligible to participate in the program if they are on parole or probation?
As long as the person is not an inmate of the criminal justice system, they are able to participate in the HCBS-AMH program.
Who can refer a person for the HCBS-AMH program?
A person can be referred by an LMHA or by a state hospital.
How is a person determined eligible for the HCBS-AMH program?
People must meet the following initial criteria to be eligible for HCBS-AMH:
- Diagnosis of serious mental illness.
- Extended tenure (three or more cumulative years) in an inpatient psychiatric hospital during the five years prior to enrollment.
- Person is not accessing these services by any other means, including enrollment in:
- Long-term Services and Supports
- Community Living Assistance and Support Services
- Deaf Blind with Multiple Disabilities
- Home and Community-based Services Waiver
- Texas Home Living Waiver
- State of Texas Access Reform plus Managed Care HCBS Waiver
In addition to meeting initial eligibility criteria, HCBS-AMH eligibility is determined using demographic, clinical, functional and financial criteria. People are assessed using the HCBS-AMH Uniform Assessment.
Are Qualified Medicare Beneficiary and Community-based Alternatives Home and Community-based Services programs that people can't be dually enrolled in?
People enrolled in QMB would not qualify for the traditional Medicaid-funded HCBS - AMH program, because they are not Medicaid eligible. However, they could qualify for HCBS-AMH as a non-Medicaid participant using general revenue if funding permits. If this person is enrolled as a non-Medicaid participant, their enrollment in QMB can impact providers when claiming for some services.
CBA has been replaced by the STAR+PLUS Home and Community-based Services waiver. The STAR+PLUS Home and Community-based Services waiver is a HCBS program and the person couldn't be dually enrolled.
If a person enrolled in HCBS-AMH required a Certified Nursing Assistant, what service is that billed under?
CNA services fall under Personal Assistance Services. These services fall under Acute Care Services which will be provided thru the Managed Care Organization .
Is STAR+PLUS statewide? Why is the HCBS-AMH target population mostly eligible to receive services from a STAR+PLUS MCO?
Yes, as of Sept. 1, 2014, STAR + PLUS is available statewide. The HCBS-AMH target population will mostly be enrolled in STAR + PLUS MCO because they meet one of the following criteria:
- Have a disability and qualify for supplemental security
- Income or Medicaid because of low income
- Qualify for Medicaid because they receive STAR+PLUS Home and Community-based Services
- Are not dually eligible and are receiving services through one of the five programs for people with intellectual and developmental disabilities
State hospitals can refer to the HCBS program? What is the process if the referring LMHA to the state hospital is not a provider of HCBS?
State hospitals will be responsible for referring any person residing in that state hospital who meets the initial criteria. This referral is submitted to the HCBS-AMH program. The LMHA linked with that state hospital doesn't need to be a provider of services in order for the referral process to take place. If the person is enrolled, they will have a choice of which provider (of those available in their chosen community) they want to have provide HCBS-AMH services.