Note: All webinars and resources on this page are solely for agencies that contract with HHS to provide financial management services to people who use the Consumer Directed Services (CDS) option and those people who use the CDS option.

FMSA Quarterly Technical Assistance Webinar, May 25, 2017

FMSA Quarterly Technical Assistance Webinar, Feb. 16, 2017

FMSA Quarterly Technical Assistance Webinar, Jan. 8, 2016

Topics on this webinar include updates on Community First Choice, Abuse, Neglect and Exploitation Investigations, Department of Labor Home Care Rule, and updates from the National Center for Participant Directed Services National Conference.

Presentation in HTML

Topics

  • Community First Choice — What's New and What Will be Changing?
  • Abuse, Neglect and Exploitation Investigations
  • Department of Labor Home Care Rule
  • Important Updates for the National Center for Participant Directed Services National Conference
  • Tips, Reminders and Updates

Community First Choice

  • March 2015: The Centers for Medicare and Medicaid Services (CMS) approved the states 1915 (b) (4) waiver, allowing STP providers to be the sole provider of individuals enrolled in a DADS IDD waiver.
  • April 2, 2015: CMS approved a state plan amendment to implement CFC.
  • April 27, 2015: DADS released ILs to implement CFC until rules were adopted.
  • June 1, 2015: HHSC rules governing CFC became effective.
  • June 1, 2015: HHCS and DADS implemented CFC.
  • August & September 2015: MCAC and DADS Council recommended Texas Register publication of the DADS proposed CFC rules.
  • November 1, 2015: Transportation related to "habilitation services" to be billed to the respective waiver rather than CFC.
  • March/April 2016: Anticipated HHSC adoption of DADS CFC rules.

 

Eligibility Criteria

To be eligible for CFC services an individual must:

  • Be a child or an adult who is eligible for Medicaid
  • Require an institutional level of care, e.g.:
    • A nursing facility
    • An institution of mental disease
    • An intermediate care facility for individuals with an intellectual disability or related condition

Who Can Receive CFC?

Individuals:

  • enrolled in a DADS 1915(c) IDD waiver are eligible to receive CFC Services;
  • on a 1915(c) Medicaid waiver interest list may also be eligible for CFC and would receive services through a managed care organization;
  • enrolled in fee-for-service managed care through STAR+PLUS or STAR Health who meet an institutional level of care.

Due to a federal limitation, STAR+PLUS HCBS waiver members whose financial eligibility is established as Medical Assistance Only are excluded from CFC.

Managed Care CFC VS. DADS 1915 (C) Waiver CFC

The information included in this presentation applies to individuals receiving CFC services from a provider or FMSA through a contract with DADS to provide the HCS, TxHmL, CLASS or DBMD 1915 (c) waiver programs.

Implementation in DADS 1915(C) Waiver Programs

Individuals currently receiving services through one of the following 1915(c) waiver programs will access their CFC benefits through their DADS comprehensive waiver provider:

  • Home and Community-based Services (HCS);
  • Texas Home Living (TxHmL);
  • Community Living Assistance and Support Services (CLASS); or
  • Deaf Blind with Multiple Disabilities (DBMD).

Individuals can also choose to self direct their CFC PAS/HAB using the Consumer Directed Services (CDS) option.

CFC for the CDS option was implemented through two information letters:

  • Information Letter No. 2015-29, Implementation of Community First Choice through the Consumer Directed Services Option in the Home and Community-based Services and Texas Home Living Programs; and
  • Information Letter No. 15-31, Implementation of Community First Choice Through the Consumer Directed Services Option for Individuals in the Community Living Assistance and Support Services or Deaf Blind with Multiple Disabilities Programs

Until the DADS CFC rules are adopted, FMSAs and CDS employers are expected to meet the requirements set forth in the ILs.

Ensure that your FMSA staff and CFS employers understand these ILs.

CFC services in DADS waiver programs include:

  • Personal Assistance Services (PAS)/Habilitation (HAB) (CDS Option)
  • Emergency Response Services (ERS)
  • Support Management

CFC Personal Assistance Services/Habilitation

Personal Assistance Services — Assistance with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and health-related tasks through hands-on assistance, supervision or cueing.

Habilitation — Acquisition, maintenance, and enhancement of skills necessary for the individual to accomplish ADLs, IADLs, and health-related tasks.

CFC Support Management

If an individual who is receiving CFC PAS/HAB would like training on how to select, manage and dismiss service providers, the provider or the financial management services agency (FMSA) must provide CFC support management to the individual by providing written information developed by DADS and HHSC and available on the DADS website.

The individual's desire to receive support management will be indicated in a check box in the service plan.

If the individual is self-directing CFC PAS/HSAB, the FMSA is responsible for providing the written Support Management information.

The individual may also receive Support Consultation, if desired or recommended.

There will not be any DADS CFC contracts.

Qualified entities that decide to enter into one of the following contracts will be providing FMS for CFC:

  • CDS Home and Community-based Services (HCS);
  • CDS Texas Home Living (TxHmL);
  • CDS Community Living Assistance and Support Services (CLASS); or
  • CDS Deaf Blind with Multiple Disabilities (DBMD).
  • For HCS, TxHmL, CLASS and DBMD, the CFC services PAS and HAB are combined into one CFC service, CFC PAS/HAB.
  • All of the tasks and activities, except transportation, delivered through SHL, CS, CLASS habilitation or DBMD residential habilitation will be delivered through CFC PAS/HAB.
  • For HCS and TxHmL, CDS SHL and CDS CS were automatically converted to CFC PAS/HAB on June 1, 2015; for CLASS and DBMD. CDS Habilitation and CDS residential habilitation are being converted to CFC PAS as IPCs are being renewed or if the HAB service is being revised.
  • The reimbursement rate for CFC CDS PAS/HAB will be the same as the current CDS HCS SHL, CDS TxHmL CS, DBMD residential habilitation and CLASS habilitation reimbursement rates.
  • The CFC FMS rate will be the same as FMS rate in HCS, TxHmL, CLASS and DBMD.
  • Individuals receiving HCS host home/companion care, supervised living, or residential support will not receive CFC PAS/HAB or CFC ERS.
  • The authorization amount for CDS CFC PAS/HAB will appear in a separate section of the IPC from the calculation of the individual's waiver individual plan of care (IPC) cost.
  • Criminal history checks for employees hired to provide CFC CDS PAS/HAB will be paid for by the FMSA FMS fee. The cost will not be paid for from the CDS employer budget.
  • FMSAs were to have shared with CDS employers the CDS employer attached to IL 15-29 or IL 15- 31.
  • To maintain eligibility for the waiver, an individual must receive at least one waiver service monthly or monthly monitoring.
  • For those enrolled in HCS and TxHmL, who are MAO, monthly service coordination does not count as a monthly service.

Requirement to Pay at Least $8.00 per Hour

  • Amendments to Title 40 Texas Administrative Code (TAC), Chapter 49, require FMSAs to ensure CDS employers or designated representatives pay service providers who provide the services listed above at or above $8.00 per hour.
  • Amendments to Title 40, TAC, Chapter 41 require a CDS Employer to pay at least $8.00 per hour to employees who provide certain services.
  • APPLIES to HCS, CLASS, TxHmL and DBMD Community First Choice personal assistance services/habilitation (CFC PAS/HAB)

Transportation

  • Beginning November 1, 2015, for HCS and TxHmL participants, transportation activities related to habilitation will be charged to the waiver program rather than CFC.
  • IL 15-52: Providing Transportation in the Home and Community-based Services and Texas Home Living Waiver Programs Note: (Updates IL 15-28 & IL 15-29)
  • Beginning December 1, 2015, for HCS and TxHmL participants, transportation activities related to habilitation will be charged to the waiver program rather than CFC.
  • IL 15-53 Providing Transportation in the Community Living Assistance and Support Services and Deaf Blind with Multiple Disabilities Waiver Programs Note: (Updates IL 15-30 & IL 15-31)
  • CLASS & DBMD: Although transportation is included as an activity under habilitation and residential habilitation, CDS transportation is identified separately on the IPC under the new service code 48V and corresponding bill codes.
  • HCS and TxHmL: Although transportation is included as an activity under SHL and CS, CDS transportation is identified separately on the IPC under the new service code TRV and corresponding bill codes.

CLASS and DBMD Transportation Plan

For CLASS and DBMD, if transportation is included on the IPC, the SPT must:

  • develop a transportation plan for an individual who receives transportation from a program provider or through the Consumer Directed Services (CDS) option.
  • If an individual receives transportation through the CDS option, the CMA and DBMD program provider must send a copy of the transportation plan to the FMSA.
  • The service provider qualifications must meet those associated with habilitation and residential habilitation.
  • Any billing to transportation must reflect an activity listed on the transportation plan.

HCS and TxHmL Transportation

If transportation is included on the PDP:

  • the SPT must develop a transportation plan for an individual who receives transportation through the CDS option;
  • if the individual is receiving all HCS or TxHmL program services through the CDS option, the service coordinator must include transportation on the IPC based on the individual transportation plan; and
  • the service coordinator must send a copy of the transportation plan to the FMSA.

CDS employer must ensure transportation is provided in accordance with the transportation plan.

The transportation provider must meet the SHL or CS service provider qualifications.

Documenting the Delivery of Transportation Activities

The employer may create a transportation log including most of the same information listed on the Individual Transportation Plan.

To document each trip:

  • The CDS employer completes:
    • Date of transportation
    • Goal or Trip Purpose
    • Destination
  • The CDS transportation provider completes:
    • Begin time
    • End time
    • Total time
  • Both the employer and employee sign the form.

Determining Whether to Include CFC FMS or FMS on the IPC

  • The service coordinator must include CFC FMS, rather than FMS, on the IPC if CFC CDS PAS/HAB is the only service the individual is receiving through the CDS option.
  • The service coordinator must include FMS, rather than CFC FMS, on the IPC if the individual is using the CDS option for CFC PAS/HAS and is receiving at least one other TxHmL or HCS service using the CDS option.
  • FMS and CFC FMS must not be included on the IPC at the same time.
  • Information Letter No. 2015-29 April 24, 2015

CFC for Individuals Enrolled in a DADS ICF/IID Waiver Program and Who is Also Receiving PCS

  • CFC PAS/HAB will replace the PCS service for individuals enrolled in both PCS and one of the following DADS waivers:
    • HCS
    • TxHmL
    • CLASS
    • DBMD
  • Transition will occur throughout 2016.
  • Once a new IPC is authorized, Individuals will need to complete a revised budget workbook to include CFC PAS/HAB.
  • CDS employers must not submit time sheets for PCS service hours after the termination of PCS and the authorization of the individual's CFC PAS/HAB hours.
  • There will be only ONE FMS fee.
  • Information Letter No. 15-71: http://www.dads.state.tx.us/providers/communications/2015/letters/IL2015-71.pdf

CFC for Individuals Enrolled in TxHmL Program and Receiving PHC

  • CFC PAS/HAB will replace the PHC services for individuals enrolled in both PHC and the TxHmL Program.
  • Transition will occur throughout 2016.
  • Once a new IPC is authorized, Individuals will need to complete a revised budget workbook to include CFC CDS PAS/HAB instead of CDS PHC services.
  • CDS employers must not submit time sheets for PHC service hours after the termination of PHC and the authorization of CFC PAS/HAB.
  • There will be only ONE FMS fee.
  • Information Letter No. 15-35: http://www.dads.state.tx.us/providers/communications/2015/letters/IL2015-35.pdf

DADS CFC Rules

  • Expected to be adopted March/April 2016.
  • Includes amendments to the following rule Chapters:
    • Chapter 49 Contracting
    • Chapter 41, CDS
    • Chapter 9, HCS and TxHmL
    • Chapter 45 CLASS
    • Chapter 42 DBMD

Stay Tuned…More Change to Come!!

HHSC and DADS will be making some changes to ensure consistency in service planning for CFC PAS/HAB in the TxHmL and HCS waiver programs.

Draft information will be posted next week for stakeholder input.

In the very near future, DADS will be launching a computer-based CFC training for HCS and TxHmL service coordinators. The training includes a reminder that service provider qualifications for CFC PAS/HAB follow both CFC guidance AND CDS rules.

Online Information

For more information, please visit: hhs.texas.gov/doing-business-hhs/provider-portals/resources/community-first-choice-cfc/cfc-waiver-programs/webinars-training-cfc

Please email ALL policy questions regarding CFC to MCD_CFC@hhsc.state.tx.us (The DADS CFC Policy mailbox has been discontinued and all questions are forwarded to the HHSC mailbox.)

HHSC CFC website: hhs.texas.gov/doing-business-hhs/provider-portals/resources/community-first-choice-cfc/cfc-waiver-programs/webinars-training-cfc

Abuse, Neglect and Exploitation Policy Updates

How is APS Organized in Texas?

  • Department of Family & Protective Services
    • Adult Protective Services
      • In-Home Investigations
      • Provider Investigations

Senate Bill 1880 and CDS

Effective 9/1/15, allegations of ANE committed against individuals using the CDS option will be investigated by the APS Provider Investigations program.

Before 9/1/15, these allegations were investigated by the APS In-Home program.

What Does this Mean?

Staying the Same

Changing

  • Notification will be given to the employer and the FMSA
  • Investigation report will be given to the employer and the FMSA

Why Does APS Notify?

  • Protection of the alleged victim
  • Preservation of evidence

Who is Investigated?

The APS Provider Program investigates an allegation if one of the following persons is the alleged perpetrator of ANE involving an individual receiving service through the CDS option:

  • a CDS employee;
  • a legally authorized representative (LAR);
  • a designated representative (DR);
  • a case manager;
  • a service coordinator; or
  • a representative of an FMSA.

What Happens After ANE is Reported to DFPS?

  1. The allegation of ANE is assigned to an APS Provider investigator. If the FMSA representative is the alleged perpetrator, the FMSA must immediately assign a different representative to the CDS employee during the investigation.
  2. The investigator notifies the CDS employer and the FMSA.
  3. The FMSA sends a copy of the notification to the appropriate person, based on the consumers program (has one business day after receipt):
    • HCS or TxHmL: the Client Rights Officer (CRO) of the LIDDA employing the individual's service coordinator;
    • CLASS or DBMD: the program director of the entity employing the individual's case manager; and
    • PHC or MDCP: the individual's DADS regional office. CMPAS: The CMPAS Provider also serves as the FMSA.
      • The CRO, program director, DADS regional office representative, or CMPAS provider representative will inform the individuals case manager or service coordinator of the notification.
  4. The investigator conducts the investigation.
  5. The investigator provides an investigation report to the CDS employer and the FMSA.
    • The FMSA sends a copy of the investigation report to the appropriate person, based on the consumers program (has one business day after receipt):
      • HCS or TxHmL: the Client Rights Officer (CRO) of the LIDDA employing the individual's service coordinator;
      • CLASS or DBMD: the program director of the entity employing the individual's case manager; and
      • PHC or MDCP: the individual's DADS regional office.
      • CMPAS: The CMPAS Provider also serves as the FMSA.
        • The CRO, program director, DADS regional office representative, or CMPAS provider representative will inform the individuals case manager or service coordinator of the notification.
  6. The FMSA completes Form 1719: Notification of Investigatory Findings and sends to the alleged perpetrator (has 5 business days from receipt of report).

The Case Manager/Service Coordinator Responsibilities

Intake Report

  • Holds service planning team meeting with CDS employer (within 4 business days after receipt of report).
    • The SPT discusses what actions an employer has or will take to protect the individual during the investigation.

Final Investigation Report

  • If there is a confirmed or inconclusive finding of ANE or if concerns and recommendations are included in the report: hold another SPT meeting in person or by phone (within 4 business days after receipt of report).
    • the SPT discusses the findings or concerns and recommendations; and
    • the case manager/service coordinator documents, in writing, any actions that have been or will be taken by the CDS employer as a result of the findings or concerns and recommendations.
      • DADS Form 1741, Corrective Action Plan, may be used for this purpose.

What Happens in an Investigation?

  • The investigator collects documentary evidence such as service plans, timesheets and training records.
  • The investigator collects testimonial evidence through interviews resulting in written statements.
  • The investigator observes the environment where the alleged incident took place.
  • The investigator analyzes evidence to reach a finding of whether the ANE occurred.
  • The investigator issues an investigation report.

What is Included in an Investigation Report?

  • Summary of Evidence
  • Findings
  • Concerns & Recommendations

CDS Employer Responsibilities

It is the employers responsibility to:

  1. ensure protection of the individual receiving services in the event of a DFPS investigation of ANE against a CDS employee or FMSA;
  2. preserve evidence; train each of their service providers on abuse, neglect, and exploitation (ANE);
  3. inform each service provider of the Employee Misconduct Registry (EMR);
  4. document ANE training on Form 1732; and
  5. document EMR notification on Form 1732-EMR.

ANE Forms

  • Form 1732 has been amended to more fully document that CDS service providers understand ANE.
    • The revised form will only be required for new employees, not current.
  • Form 1735 has been amended to document the responsibility CDS employers have for ensuring the protection of individuals receiving services in the event of a DFPS investigation.
    • CDS employers must resign the revised form at the time of service plan renewal.
  • Form 1582 has been amended to document the responsibility CDS employers have for ensuring the protection of individuals receiving services in the event of a DFPS investigation.
  • Form 1719: Notification of Investigatory Findings: FMSAs must complete using information from the final investigatory report received from APS and send to the alleged perpetrator.

Information Letters and Employer Letter

  • IL 2015-83 (MDCP and PHC): http://www.dads.state.tx.us/providers/communications/2015/letters/IL2015-83.pdf
  • IL 2015-82 (CLASS, DBMD, HCS, TxHmL): http://www.dads.state.tx.us/providers/communications/2015/letters/IL2015-82.pdf
  • IL 2015-80 (CMPAS): http://www.dads.state.tx.us/providers/communications/2015/letters/IL2015-80.pdf
  • Information on, "how to recognize ANE and how to protect oneself" can be found in the CDS Employer Manual http://www.dads.state.tx.us/services/cds/employer/chapter5.html#recognize

Department of Labor Home Care Rule

Dates

  • Oct. 31, 2014: DOL issued the final home care rule to become effective January 1, 2015.
  • December 2014 and January 2015: U.S. District Court Judge Richard Leon issued opinions and orders vacating the Final Rule's revised third party regulation and revised definition of companionship services.
  • DOL filed an appeal.

Appeal Decision

On August 21, 2015, the Court of Appeals issued a unanimous opinion affirming the validity of the Final Rule and reversing the district court's orders.

On October 6, 2015, Chief Justice of the United States John Roberts denied an application to stay a decision by the U.S. Court of Appeals for the District of Columbia upholding the U.S. Department of Labor's Home Care Final Rule. Therefore, the court's decision on August 21, 2015 took effect on October 13, 2015.

What it Addresses

The Home Care ruling addresses minimum wage and overtime protection policies in the following programs or services, including the Consumer Directed Services (CDS) Option:

  • Medically Dependent Children Program;
  • Primary Home Care, Community Attendant Services, and Family Care;
  • Consumer Managed Personal Attendant Services;
  • Community Living Assistance and Support Services;
  • Deaf Blind with Multiple Disabilities;
  • Home and Community-based Services; and
  • Texas Home Living.

Enforcement

Enforcement of the final rule began November 12, 2015.

November 12, 2015 through December 31, 2015, DOL exercised prosecutorial discretion in determining whether to bring enforcement actions, giving strong consideration to the extent to which states and other entities have made good faith efforts to bring their home care programs into compliance.

CDS Employers

DADS revised and posted Information Letter 2014-66.

Employers need to check DOL website to see if they can still use the exemption.

In accordance with CDS rules section, 41.241, employers must pay employees overtime in accordance with current state and federal laws.

DADS is considering allowing pooling of funds across services to fund overtime.

Resources

For more information on the ruling, see DOL's webpage: http://www.dol.gov/whd/homecare/litigation.htm.

For further information, see the following DOL website at http://www.dol.gov/whd/homecare/; call DOL's toll-free information and helpline, 1-866-4USWAGE (1-866-487-9243), available 8am to 5pm in your time zone; or consult your legal counsel.

For CDS employers, DADS has reissued http://www.dads.state.tx.us/providers/communications/2015/letters/IL2014-66.pdf, originally published on October 17, 2014.

Important Information from the National Resource Center for Participant Directed Services

Example IRS Tax Forms

NRCPDS provided copies of tax forms to be completed by FMSAs as Vendor Fiscal/Employer Agents. Effective February 1, 2016, Those forms can be found under Appendix III of the Consumer Directed Services Handbook.

Samples will include:

  • SS-4
  • Form 2678
  • Form 940 and Schedule R
  • Form 941 and Schedule R
  • W-2

Conference Material

To be posted on the CDS webpage on DADS website under Training and Webinars, training materials. It will include:

  • FAQ about the DOL Home Care Rule
  • Suggested Steps to Refund Over-Collected FICA for Participant Employers Using a Fiscal/Employer Agent
  • About Revenue Procedure 2013-39 & Its Impact on Fiscal/Employer Agent Services

Note: If you call an IRS agent who informs you that an individual IRS 941 or 940, please send the name of the agent and the office location to the CDS mailbox. DADS will forward to the IRS contact who will be reaching out to that agent.

Tips, Reminders and Updates

Tips and Reminders

  • Don't forget to review and use TAC, Ch. 49 in addition to Ch. 41
  • Sign up for both HHSC and DADS Gov Delivery to know about trainings, IL's, etc. — Quarterly webinars and the annual quality improvement training are required per TAC §41.301(a) (4).
  • Managed Care expansion activities and updates are provided on the HHSC website at: http://www.hhsc.state.tx.us/medicaid/managed-care/mmc.shtml
  • Health Plan Management Complaints: HPM_Complaints@hhsc.state.tx.us
  • General Questions: Managed_Care_Initiatives@hhsc.state.tx.us

Care Billing

Training material related to CARE billing for HCS and TxHmL services will be added to the DADS website under Training and Webinars Training Presentations.

When billing in CARE, after you have entered the dollar amounts to be billed for each day (from the time sheet for that service), the next screen asks for the number of units. The number of units represents the number of hours of service delivered that particular day (again from the timesheet). Remember that the CARE system rounds anything less than a quarter unit up to the next quarter unit which will falsely decreases the amount of funds remaining for that particular service. Be sure to pay close attention at the end of the plan year for those who use all of the funds in their IPC. You may be required to "back out several units" so that the amount of funds remaining is accurate.

Federal and State Audits

Expenditures of Medicaid funds are routinely audited by various state and federal entities, including Office of Investigator General and The Centers for Medicare and Medicaid Services.

In some cases fines are levied against a state with billing errors and in other cases funds from an FMSA may be recouped.

It is a good practice to implement some quality monitoring strategies to ensure that billing is correct and in accordance with CDS rules.

Updated Forms Since September 2015

Form Description of Changes
Form 1725 Instructions Amended to state that only the FMSAs conducts background checks
Form 1725 Remove EMR phone number and add website
Form 1735-MDCP Remove CPR/choking under "training requirements for all service providers" because it is not a requirement for providers of employment assistance or supported employment
Form 1735-PCS New Form
Form 1726 Removed requirements stating the power of attorney (POA) must be the designated representative
Form 1724 Black-out FMSA check box for 1732-EMR
Form 1732 Add ANE training requirements
Form 1719 Create new form – Notification of Investigatory Findings
Form 1582 Add ANE protection responsibility
Form 1735 Add ANE protection responsibility
Form 1589 New Form: Consumer Directed Services Revision Worksheet (Alert will be posted soon)

Abuse, Neglect and Exploitation, Sept. 25, 2015

This webinar provides information about what constitutes abuse, neglect and exploitation (ANE), the process the Texas Department of Family and Protective Services (DFPS) uses to investigate reports of ANE, and recent DFPS changes.

Presentation in HTML

Speakers

  • Michael Roberts, Department of Family and Protective Services, Adult Protective Services
  • Elizabeth Jones, Department of Aging and Disability Services, Center for Policy and Innovation

What Does APS Do?

Mission:

To protect older adults and people with disabilities from abuse, neglect and exploitation (ANE)

Vision:

Protecting with purpose, passion and persistence

Core Values:

  • We champion the SAFETY and DIGNITY of vulnerable adults
  • We conduct ourselves with INTEGRITY
  • We demonstrate RESPECT for all persons
  • We COLLABORATE to improve outcomes

How Is APS Organized in Texas?

Department of Family and Protective Services Adult Protective Services has two divisions:

  • In-Home Investigations
  • Provider Investigations

Senate Bill 1880 and CDS

Effective 9/1/15, allegations of ANE committed against individuals using the CDS option will be investigated by the APS Provider Investigations program.

Before 9/1/15, these allegations were investigated by the APS In-Home program.

What Does This Mean?

Staying the same:

  • How to report ANE
  • APS investigates

Changing:

  • Notification of allegations made to DFPS
  • APS will request employer records
  • Written statements
  • Investigation timeframe
  • Investigation report provided at case conclusion

What is Abuse?

Physical abuse

  • act or failure to act performed knowingly, recklessly, or intentionally, including incitement to act;
  • act of inappropriate or excessive force or corporal punishment; or
  • use of chemical or bodily restraints not in compliance with federal and state laws and regulations

Sexual abuse

  • unwanted hugging, kissing, stroking, fondling, indecent exposure, etc. with sexual intent

Sexual exploitation

  • a pattern of sexual abuse
  • Verbal/emotional abuse
  • curse, vilify, or degrade; or
  • threaten with physical or emotional harm

What is Neglect?

  • a negligent act or omission by any individual responsible for providing, which caused or may have caused physical or emotional injury or death or which placed a person at risk of physical or emotional injury or death

 

What is Exploitation?

the illegal or improper act or process of using a person or the resources of a person for monetary or personal benefit, profit, or gain

Preventing Abuse, Neglect, and Exploitation

You can protect yourself by—

  • Checking references
  • Paying attention to background checks
  • Keeping track of money, valuables, and medications
  • Being careful with checks and credit cards
  • Being careful with the use of your car
  • Being careful with house and car keys
  • Not loaning money to service providers
  • Not giving benefits to service providers that are not budgeted

This information can also be found in your CDS Employer Manual http://www.dads.state.tx.us/services/cds/employer/chapter5.html#recognize

How to Recognize ANE

Physical Signs

  • Injury that has not been cared for properly
  • Injury that is inconsistent with explanation for its cause
  • Pain from touching
  • Cuts, puncture wounds, burns, bruises, welts
  • Dehydration or malnutrition without illness-related cause
  • Poor coloration
  • Sunken eyes or cheeks
  • Inappropriate administration of medication
  • Soiled clothing or bedding
  • Frequent use of hospital or health care/doctor-shopping
  • Lack of necessities such as food, water, or utilities
  • Lack of personal effects, pleasant living environment, personal items
  • Forced isolation

How to Recognize ANE

Behavioral Signs

  • Fear
  • Anxiety, agitation
  • Anger
  • Isolation, withdrawal
  • Depression
  • Non-responsiveness, resignation, ambivalence
  • Contradictory statements, implausible stories
  • Hesitation to talk openly
  • Confusion or disorientation

Signs by Caregiver

  • Prevents contact with friends or family
  • Anger, indifference, aggressive behavior
  • History of substance abuse, mental illness, criminal behavior, or family violence
  • Lack of affection
  • Flirtation or coyness as possible indicator of inappropriate sexual relationship
  • Conflicting accounts of incidents
  • Withholds affection
  • Talks of caregiving as a burden

Signs of Financial Abuse

  • Frequent expensive gifts from individual to caregiver
  • Missing personal belongings, papers, credit cards
  • Numerous unpaid bills
  • A recent will when individual seems incapable of writing will
  • Caregiver's name added to bank account
  • Individual unaware of own monthly income
  • Individual signs on loan
  • Frequent checks made out to "cash"
  • Unusual activity in bank account
  • Irregularities on tax return
  • Individual unaware of reason for appointment with banker or attorney
  • Caregiver's refusal to spend money on individual
  • Signatures on checks or legal documents that do not resemble individual's

This information can also be found in your CDS Employer Manual http://www.dads.state.tx.us/services/cds/employer/chapter5.html#recognize

How to Report ANE

Two options:

How to Report Complaints

Two options:

What Happens After ANE is reported to DFPS?

  • The allegation of ANE is assigned to an APS Provider investigator.
  • The investigator notifies the CDS employer and service coordinator/case manager of the allegation.
  • The investigator conducts the investigation.
  • The investigator provides an investigation report to the CDS employer and service coordinator/case manager.

Why Does APS Notify?

  • Protection of the alleged victim
  • Preservation of evidence

What Happens in an Investigation?

  • The investigator collects documentary evidence such as service plans, timesheets and training records.
  • The investigator collects testimonial evidence through interviews resulting in written statements.
  • The investigator observes the environment where the alleged incident took place.
  • The investigator analyzes evidence to reach a finding of whether the ANE occurred.§
  • The investigator issues an investigation report.

What is Included in an Investigation Report?

  • Summary of Evidence
  • Findings
  • Concerns & Recommendations

What does the Case Manager/Service Coordinator do with the Report?

  • Notifies FMSA of the allegation
  • FMSA included if requested by employer and if FMSA agrees
  • Holds service planning team meeting with CDS employer
  • If requested by employer, second SPT is held after investigation is complete

CDS Employer Responsibilities

As a CDS Employer it is your responsibility to:

  • ensure protection of the individual receiving services in the event of a DFPS investigation of ANE against a CDS employee, CM/SC or FMSA representative
  • implement backup plan
  • preserve evidence
  • timesheets

Training documentation

  • train each of your service providers on abuse, neglect, and exploitation (ANE);
  • inform each service provider of the Employee Misconduct Registry (EMR);
  • document ANE training on Form 1732; and
  • document EMR notification on Form 1732-EMR.

Form 1732

  • Form 1732 will be amended soon to more fully document that CDS service providers understand ANE
  • DADS will release alert when the form is ready for use along with a date that CDS employers must start using the form
  • The revised form will only be required for new employees, not current

Form 1735

  • Form 1735 will be amended soon to document the responsibility CDS employers have for ensuring the protection of individuals receiving services in the event of a DFPS investigation
  • CDS employers must resign the revised form at the time of service plan renewal.

Notification of Investigatory Findings

  • CDS employers must use the final investigation report received from APS to complete the Notification of Investigatory Findings and send to the FMSA for release to the alleged perpetrator.
  • The CDS employee must provide the Notification of Investigatory Findings to the FMSA within three business days of receipt of the final investigation report.
  • The form will be available online.

Employer Letter

  • Draft CDS Employer letter has been posted for external comment: http://www.dads.state.tx.us/providers/communications/alerts/alerts.cfm?alertid=2012

Thank you!

Questions?