Revision 19-0; Effective July 7, 2019

 

3100 Diversion Coordinator Duties

Revision 19-0; Effective July 7, 2019

 

A LIDDA designates a qualified staff as the diversion coordinator pursuant to the performance contract. A LIDDA must ensure that the diversion coordinator performs the following duties:

  • identify available community living options, services and supports to assist individuals to successfully live in the community;
  • provide information and assistance to service coordinators (SCs), habilitation coordinators (HCs), and other LIDDA staff who are facilitating diversion for individuals at risk of admission to an NF and for individuals transitioning to the community from an NF;
  • coordinate educational activities for SCs, HCs and other LIDDA staff about available community services and about strategies to avoid NF admission;
  • coordinate educational activities for referring entities about available community resources, services and strategies to avoid NF admission;
  • within 45 to 75 calendar days after an individual is admitted into an NF, review the individual’s admission to ensure that community living options, services and supports that could provide an alternative to NF services have been explored and if not, refer the individual to his or her HC for that purpose;
  • identify, arrange and coordinate access to community services as a diversion to NF admission for an individual who has chosen community living during the PE process; and
  • request a targeted NF Home and Community-based Services (HCS) diversion slot for an individual as described in Section 3220, Requesting a Targeted NF HCS Diversion Slot, or transition slot as described in Section 6500, Transitioning to the HCS Program.

 

3200 Diverting from NF Admission

Revision 19-0; Effective July 7, 2019

 

HHSC may make available a targeted NF HCS diversion slot to an individual with ID or DD who is determined to be at imminent risk of a long term stay in an NF. After a positive PL1 for preadmission is completed and entered in the LTC online portal, a LIDDA must conduct a PE on the individual to determine if the individual:

  • has ID or DD; and
  • meets medical necessity.

 

3210 Criteria for Diverting from NF Admission

Revision 19-0; Effective July 7, 2019

 

To be eligible for a targeted NF HCS diversion slot, a diversion coordinator must document the following:

  • The individual is at imminent risk of a long term stay in an NF;
  • The individual has a PE, conducted within the past 21 days, that indicates the individual has ID or DD, meets NF medical necessity and is appropriate for community placement;
  • The individual has a diagnosis that will meet HCS diagnostic eligibility criteria, meaning the individual has an ICF Level of Care (LOC) I or VIII*; and
  • Other adequate and appropriate community resources, excluding state supported living centers, are unavailable to meet the individual’s needs as evidenced by attempts to obtain community-based services and supports, such as:
    • For an individual 21 or older:
      • Medicaid State Plan services;
      • community ICF/IID services in a facility with six beds or fewer; and
      • general revenue-funded services; or
    • For an individual 20 or younger:
      • Medicaid State Plan services;
      • supports through the local school district;
      • general revenue-funded services; and
      • community ICF/IID services in a facility with six beds or fewer unless out-of-home placement is not desired.

*If a LIDDA determines that the individual meets the criteria for both ICF LOC I and VIII, then the LIDDA documents “ICF LOC I.” If the individual only meets the criteria for ICF LOC VIII, then the LIDDA documents “ICF LOC VIII.”

 

3220 Requesting a Targeted NF HCS Diversion Slot

Revision 19-0; Effective July 7, 2019

 

If a LIDDA determines that an individual meets the criteria for a targeted NF HCS diversion slot, the diversion coordinator requests a targeted NF HCS diversion slot for the individual by completing and submitting Form 1047, Request for HCS Targeted NF Diversion Slot, in accordance with the form’s instructions.

Upon receipt, HHSC staff reviews the completed Form 1047. HHSC staff may request additional information or documentation. Within three working days after receipt of Form 1047 and any necessary additional documentation, HHSC determines whether the individual meets the criteria for a targeted NF HCS diversion slot.

  • If it is determined the individual does not meet the criteria, HHSC will, within one business day, notify the LIDDA and the individual or LAR in writing of the denial of an offer of a targeted NF HCS diversion slot and provide the individual or LAR with an opportunity for a fair hearing.
  • If it is determined the individual meets the criteria and a targeted NF HCS diversion slot is immediately available, HHSC will send a letter authorizing the LIDDA to offer the individual the opportunity to enroll in HCS.

 

3230 Enrolling in HCS as a Diversion to NF Admission

Revision 19-0; Effective July 7, 2019

 

A LIDDA enrolls an individual in the HCS program as an alternative to NF admission, in accordance with the requirements in the HCS rules, LIDDA Handbook and this section. A LIDDA ensures an assigned SC or enhanced community coordinator (ECC) completes the following:

  • develops and revises as necessary a diversion plan, using Form 1050, Nursing Facility or Crisis Diversion Plan, with the individual and LAR;
  • develops Form 8665, Person-Directed Plan, in accordance with the HCS program rules, using all available assessments and to include the individual’s:
    • strengths and preferences; and
    • medical, nursing, nutritional management, clinical and support needs; and
  • conducts a pre-move site review using Form 1042, Pre-Move Site Review, to determine whether supports are in place and any areas of concern have been addressed before the individual enrolls in HCS.

 

3230.1 Enhanced Community Coordination Funds

Revision 19-0; Effective July 7, 2019

 

Enhanced community coordination funds are available to LIDDAs through the HHSC/LIDDA performance contract for an individual who is enrolling in HCS as a diversion to NF admission. The purpose of the funds is to enhance an individual’s natural supports and promote successful community living. Funds are intended to pay for:

  • one-time emergency assistance, such as:
    • rental or utility assistance;
    • nutritional supplements;
    • clothing; and
    • medication;
  • items to address an individual’s special needs, including minor home modifications not funded by other sources;
  • transportation to and from trial visits with community providers; and
  • educational tuition assistance, such as for vocational programs through community colleges so an individual can develop job skills.

A LIDDA should contact its HHSC contract manager to discuss how to access funds.

 

3240 Post Enrollment in HCS as a Diversion to NF Admission

Revision 19-0; Effective July 7, 2019

 

For one year after an individual has enrolled in the HCS program as a diversion to NF admission, an SC or ECC must:

  • conduct HCS SPT meetings quarterly, or more frequently if there is a change in the individual’s needs or if requested by the individual or LAR;
  • revise the HCS person-directed plan (PDP), as necessary, and coordinate the individual’s services and supports;
  • conduct monthly face-to-face visits with the individual, or more frequently if determined by the HCS SPT based on risk factors, and monitor the delivery of all services and supports;
  • conduct at least three onsite visits of community service delivery sites at the intervals described below to determine whether supports continue to be in place and any areas of concern are being addressed using Form 1043, Post-Move Monitoring. (Note: More frequent onsite visits may be required to determine whether supports continue to be in place and any areas of concern are being addressed during the first 90 days after enrolling in HCS):
    • within the first seven days after enrollment in the HCS program;
    • between eight and 45 days; and
    • between 46 and 90 days;
  • inquire about any recent hospitalizations, emergency department contacts, increased physician visits or other crises, including medical crises, and if the individual experiences such, convene the HCS SPT to identify all necessary revisions to the individual's HCS PDP to address additional need for services;
  • ensure the individual receives timely assessments of behavioral, medical, nursing, specialized therapies and nutritional management needs, as necessary, and as indicated on the HCS PDP;
  • record health care status sufficient to readily identify when changes in the individual's status occurs;
  • conduct service planning, ensure the program provider’s implementation of services and monitor all services identified on the HCS PDP, including:
    • reviewing the HCS program provider’s implementation plans and provider records;
    • visiting service delivery sites as needed to determine the individual’s needs are being met; and
    • monitoring critical incidents involving the individual and convening the HCS SPT to develop a plan for needed prevention or intervention services for the individual; and
  • monitor the individual while on suspension from the HCS program at least monthly, maintain communication with the program provider and provide reports to HHSC upon request.