Revision 19-0; Effective July 7, 2019

 

4100 Eligibility for Habilitation Coordination Funded by Medicaid

Revision 19-0; Effective July 7, 2019

 

An individual is eligible for habilitation coordination funded by Medicaid if the individual:

  • has an active PE that is positive for ID or DD;
  • is a Medicaid recipient;
  • is 21 or older; and
  • is residing in an NF.

 

4200 Assignment of Habilitation Coordinator

Revision 19-0; Effective July 7, 2019

 

A LIDDA must assign a habilitation coordinator (HC) to an eligible individual within two business days after the PE is entered in the LTC online portal. The HC must attend the individual’s initial IDT meeting along with the LIDDA representative who is a required member of the IDT (see Section 2500, PASRR Initial IDT/SPT Meeting, and Section 4300, Initial IDT/SPT Meeting). If the assigned HC functions in another LIDDA capacity, the HC will indicate all represented functions on the sign-in sheet.

The HC must review the individual’s PE, Form 1054, Community Living Options, completed by the PE evaluator, and any other available supporting documentation (e.g., diagnostic information in CARE, previous LIDDA services, previous service plans) before the initial IDT meeting.

 

4300 Initial IDT/SPT Meeting

Revision 19-0; Effective July 7, 2019

 

The HC must attend the individual’s initial IDT meeting. The PE evaluator shares the results of the CLO presented during the PE (i.e., completed Form 1054, Community Living Options. If barriers are identified in Sections 6, 7 or 8 of Form 1054, then the HC and IDT members should determine whether provision of any specialized service could help eliminate barriers. If so, the specialized service is considered recommended and must be identified as such on the PASRR Comprehensive Service Plan (PCSP) form.

 

4310 Attendance at Initial IDT/SPT Meeting

Revision 19-0; Effective July 7, 2019

 

At the initial IDT/SPT meeting for an individual, the following LIDDA staff are in attendance:

  • the LIDDA staff representative who is a required member of the IDT (HHSC strongly encourages this LIDDA staff representative be the LIDDA staff who conducted the PE)*; and
  • the assigned HC**.

The assigned HC can be designated as the LIDDA required member of the initial IDT if the HC completed the PE.

*Attendance at the initial IDT/SPT meeting as a required IDT member is an activity that is included in the PE reimbursement rate.

**An HC’s attendance at the initial IDT/SPT meeting is reimbursed through the habilitation coordination reimbursement rate if the HC and individual are face-to-face.

Note: Following an initial IDT/SPT meeting, a LIDDA must comply with Section 2520, Confirmation of IDT/SPT Meeting Information.

 

4400 Requesting Authorization for Habilitation Coordination

Revision 19-0; Effective July 7, 2019

 

 

 

4410 IDT Agrees to Habilitation Coordination

Revision 19-0; Effective July 7, 2019

 

If the IDT agrees to the provision of habilitation coordination for an eligible individual, the HC requests authorization for habilitation coordination in accordance with the Habilitation Coordination Billing Guidelines.

 

4420 Refusal of Habilitation Coordination

Revision 19-0; Effective July 7, 2019

 

If an eligible individual/LAR does not want habilitation coordination, the HC:

  • requests authorization for habilitation coordination in accordance with the Habilitation Coordination Billing Guidelines to fund the HC’s attendance at the IDT; and
  • uses Form 1044, Refusal of Habilitation Coordination, to document the refusal of habilitation coordination, obtains necessary signatures, provides the individual/LAR a copy of the completed form and maintains the original completed form in the individual’s record.

 

4500 Developing Individual Profile and Habilitation Service Plan at First SPT Meeting

Revision 19-0; Effective July 7, 2019

 

If the IDT agrees to the provision of habilitation coordination for an individual, the HC convenes the first SPT meeting immediately after the initial IDT meeting.

At the first SPT meeting, the HC continues the discovery process and develops and uses Form 1063, Individual Profile – Nursing Facility, and Form 1057, Habilitation Service Plan (HSP). This section describes developing an individual profile and an HSP at the first SPT meeting. Although Section 5400, Develop and Revise Habilitation Service Plan and Individual Profile, describes the process for developing and revising an HSP and individual profile, a fully robust HSP and individual profile are not expected by the end of the first SPT meeting.

Information from the following sources is discussed with the SPT and included in the HSP and individual profile where appropriate:

  • the PE or resident review;
  • the CLO that was conducted during the PE;
  • CARE (e.g., diagnostic data, previous LIDDA services);
  • previous service plans (e.g., ISPs and HSPs); and
  • other available supporting documentation, including previous assessments such as those listed in Section 5210, Reviewing Assessments.

Also included in the HSP are all specialized services (including habilitation coordination) agreed upon during the IDT meeting. At a minimum, for each specialized service agreed upon during the IDT meeting, the HSP must indicate either:

  • an assessment will be conducted; or
  • the amount, frequency and duration of the specialized service to be provided.

 

4510 Specialized Services Requiring an Assessment

Revision 19-0; Effective July 7, 2019

 

An assessment is required for:

  • all NF specialized services; and
  • the following IDD habilitative specialized services:
    • behavioral support;
    • employment assistance; and
    • supported employment.

The HSP must state an outcome that supports initiating an assessment.

 

4520 Specialized Services that Do Not Require an Assessment

Revision 19-0; Effective July 7, 2019

 

For independent living skills training and day habilitation, the SPT identifies for inclusion in Section 5 of Form 1057, Habilitation Service Plan (HSP):

  • the outcome(s); and
  • the amount, frequency and duration based on the individual’s identified needs, interests and desired outcomes.

 

4530 Frequency and Duration of Habilitation Coordination

Revision 19-0; Effective July 7, 2019

 

The duration of habilitation coordination is “while the individual is residing in the nursing facility,” which is pre-printed on Form 1057, Habilitation Service Plan (HSP). The frequency of habilitation coordination is determined by the SPT in accordance with the requirements in rule and Section 5100, Required Face-to-Face Visits.

 

4600 Initiating IDD Habilitative Specialized Services after First SPT Meeting

Revision 19-0; Effective July 7, 2019

 

The LIDDA is responsible for initiating IDD habilitative specialized services within 20 business days after the date of the IDT meeting. “Initiating” means to take necessary action that will result in an individual receiving an assessment or the specialized service in a timely manner.

 

4700 Providing Habilitation Coordination

Revision 19-0; Effective July 7, 2019

 

The HC provides ongoing habilitation coordination in accordance with Section 5000, Habilitation Coordination, continuing the discovery process and revising Form 1057, Habilitation Service Plan (HSP), with the SPT as assessments become available and as the individual’s needs change or are more fully realized.