Informed Consent

Texas assures that all individuals participating in the demonstration or their Legally Authorized Representative (LAR) -- i.e., parent, guardian, or managing conservator of a minor individual, or a guardian of an adult -- will be informed of all their rights and options for long-term services and supports. Texas assures that all participants will know of all of their options and be aware that participation is voluntary. This includes acceptance of services and the consent to participate in the evaluation component of the grant. The service provision consent will be obtained prior to delivering services during the care planning phase. Relocation contractors, long-term care ombudsmen, nursing facility social workers, DADS waiver case managers, local MRAs and MHAs, and third-party not-for-profits will provide the education and information about community services and participation in the demonstration. DADS case managers and MRA staff will secure the appropriate forms that an individual or their LAR will sign indicating they have been informed and are voluntarily choosing to participate in the demonstration without coercion.

Choice in Selecting a Service

DADS case managers and MRAs will discuss the full array of long-term services and supports options with each individual or their LAR who voluntarily choose to participate in the demonstration. Individuals or their LAR will be informed of all their options for selecting an alternative living arrangement including community and residential settings.   Individuals or their LAR will sign a service agreement indicating their choice of where they will receive services.


DADS assures that direct consumers, advocates, and providers will play a critical role in the implementation of this grant as they have in the creation and implementation of the current MFP and Promoting Independence initiatives. These groups played a critical role in the development of this application. The DADS unit for Stakeholder Relations will ensure stakeholder input, participation and involvement and serve as a central point for scheduled, ongoing communication and input. This unit assists staff throughout the agency to engage stakeholders and consider their input in policies, rules and decisions. As described in Appendix H, Texas engages in formal scheduled meetings with stakeholders to ensure their participation in budget and planning processes. The Promoting Independence Advisory Committee meets four times per year to provide direction for the current MFP and Promoting Independence initiatives.

As part of the development of this application, DADS distributed the CMS application to stakeholders the second week in August and convened on August 18, 2006, a stakeholder meeting to outline CMS’ objectives, discuss consumer needs, and identify relocation barriers that the MFP grant could address. The last week of August, DADS sent a survey to stakeholders to identify gaps, needs and additional services to provide additional direction and ideas. One-on-one interviews were conducted with 25 individuals and/or family members of individuals who have relocated from nursing facilities or ICFs-MR as well. DADS convened a second stakeholder meeting on October 4, 2006, to receive additional advice on the grant application.

The Stakeholder Relations Unit will develop a plan to use the Promoting Independence Advisory Committee and a newly-established MFP Grant Implementation Task Force. This plan will ensure involvement of direct consumers, their families, advocates, and providers. Representation will reflect aging and disability (physical, cognitive, sensory and mental disability communities) organizations, rural and urban providers, institutional and community providers.

The task force members’ primary role will be to participate in the design of the operational protocol and implementation of the demonstration and assist in the policy decision-making in these areas. Consumer members of committee will be reimbursed for travel expenses and receive stipends for time spent in task force activities. Any accommodations needed for committee members’ participation will be secured in advance.

Maintenance of Effort

Texas estimates that it expended $1,939,881,431 on state Medicaid home and community-based long term care services in FY 2005. This exceeds the amount spent in previous state fiscal years. Texas assures that it will continue to provide at least this amount during the demonstration project, unless the legislature reduces the appropriation for these services. DADS and HHSC have requested funding above this level for the first two years of the project.

Information Technology

Texas assures that it will work with CMS and/or its national evaluation contractor so that the reports collected during the grant will permit reliable comparisons of grant projects across states and an effective evaluation of the demonstration project will be submitted timely and according to specifications established by CMS.



Updated: May 1, 2015