Provide a description of the service delivery system(s) used for each population that the State will serve through the Money Follows the Person Rebalancing Demonstration.§ Include both the delivery mechanism (fee-for-service, managed care, self-directed, etc.) and the Medicaid mechanism through which qualified HCBS will be provided at the termination of the demonstration period (waiver, 1115 demonstration, Medicaid State Plan, etc.).§ For all HCBS demonstration services and supplemental demonstration services, there is no Medicaid mechanism understanding that the services terminate with the 365 day demonstration period; however, the State must detail the providers or network used to deliver services.
Texas uses both a fee-for-service and managed care service delivery system.§ The Texas MFP Demonstration will transition individuals into the existing 1915(c) home and community based waivers.§ A separate demonstration 1915(c) waiver will not be created for the MFP Demonstration. After the 12-month demonstration period, individuals will continue in the same 1915(c) waiver program as long as they meet the eligibility requirements of the program.
DADS operates two nursing facility 1915(c) waivers and four ICFs/MR 1915(c) waivers while HHSC operates one nursing facility waiver.§ Two additional 1915(c) waivers, the Consolidated Waiver Program, operate in Bexar County (San Antonio Area) and are administered as one program.§ All 1915(c) waivers are fee for service, with the exception of the Star+PLUS 1915 (b) and (c) waiver, which delivers managed care services and is operated by HHSC.
Texas assures CMS that all Demonstration participants will be eligible under the waiver cost limits approved by the State when transitioning from the Demonstration to the population at-large as long as they meet all the other eligibility criteria.§ Additionally, case management is reimbursed as an administrative service, not as targeted case management.
Provider manuals for all home and community based 1915(c) waivers can be accessed at the following website: http://www.dads.state.tx.us/news_info/publications/handbooks/index.html#handbooks
All aspects of the home and community based 1915(c) waiver programs are under continuous quality review.§ Accordingly, the websites have the most up to date program information.
Updated: May 1, 2015