Revision 14-1; Effective September 1, 2014

 

 

This section provides additional detail on services available under special circumstances or to certain targeted populations.

 

7100 Program Services

Revision 14-1; September 1, 2014

 

Program service descriptions are provided in the manual as a convenience to readers. Full program information is contained in the MDCP waiver.

 

7110 Respite Services Description

Revision 14-1; September 1, 2014

 

Rules:

40 Texas Administrative Code (TAC) Chapter 51, §51.103(40), Definitions
40 TAC Chapter 51, Division 3, Service Delivery Requirements for Respite and Flexible Family Support Services
40 TAC Chapter 51, Subchapter E, Claims Payment and Documentation

Respite services occur in two forms:

  • in-home; and
  • out-of-home.

 

7111 In-Home Respite

Revision 14-1; September 1, 2014

 

In-home respite is a service which provides temporary relief for the primary caregiver from caregiving activities when the primary caregiver would usually perform such activities. Respite is typically provided in the residence of the individual, but may be provided in other community settings except for limitations documented in 40 TAC Chapter 51, §51.231, Service Limitations.

Other community settings may include a:

  • park;
  • provider’s home; or
  • relative’s home.

All respite settings must be located within the state of Texas.

 

7112 Out-of-Home Respite

Revision 14-1; September 1, 2014

 

Respite provided in in-home settings should not be confused with out-of-home respite, which is provided in the following contracted settings:

  • special care facilities;
  • licensed day care facilities;
  • hospitals;
  • nursing facilities;
  • camps accredited by the American Camping Association; and
  • foster family homes approved by a Department of Family and Protective Services (DFPS) child placement agency.

 

7120 Flexible Family Support Services

Revision 14-1; September 1, 2014

 

Flexible family support services provide temporary relief for the primary caregiver from caregiving activities during the time when the primary caregiver is working, attending job training or attending school.

 

7130 Adaptive Aids

Revision 14-1; September 1, 2014

 

Rules:

40 TAC Chapter 51, Subchapter B, Division 3, §51.231(c), Service Limitations
40 TAC Chapter 51, Subchapter C, Division 1, Adaptive Aids
40 TAC Chapter 51, Subchapter D, Division 7, Service Delivery Requirements for Adaptive Aids
40 TAC Chapter 51, Subchapter E, Claims Payment and Documentation

Adaptive aids (AAs) are devices necessary to treat, rehabilitate, prevent or compensate for conditions resulting in disability or loss of function. AAs enable an individual to perform activities of daily living or control the environment in which the individual lives.

AAs are approved on a case-by-case basis. Examples of AAs that DADS may approve are:

  • van lifts;
  • van modifications;
  • jump seats;
  • tumble forms;
  • feeder seats;
  • medically appropriate strollers;
  • barrier-free lifts;
  • environmental control units;
  • alarm systems;
  • support rails;
  • electrical work related to use of AAs;
  • installation costs for AAs; and
  • repairs to AAs.

 

7140 Minor Home Modifications

Revision 14-1; September 1, 2014

 

Rule: 40 TAC Chapter 51, §51.323, List of Minor Home Modifications

A minor home modification (MHM) must be a modification to the individual’s home that is necessary to ensure the health, welfare and safety of the individual, or to enable the individual to function with greater independence in the individual’s home.

 

7141 AA and MHM Bid Forms

Revision 14-1; September 1, 2014

 

MDCP requires specific information from providers during the bidding process for adaptive aids (AAs) and minor home modifications (MHMs). To help providers with these bids, DADS provides forms that contain all of the necessary information. The use of these forms is optional; however, the required information is not optional and must be submitted before a bid will be reviewed.

DADS will return all bids which do not include the required information to the provider. Incomplete bids that need to be returned and resubmitted may lead to a delay in an MDCP participant getting an AA or MHM completed. Once the forms are re-submitted with all required information, the forms will be reviewed by DADS staff.

 

7150 Transition Assistance Services

Revision 14-1; September 1, 2014

 

40 TAC Chapter 62, Contracting To Provide Transition Assistance Services

The Transition Assistance Services (TAS) benefit makes a one-time only payment for non-recurring, set-up expenses for individuals transitioning to the community.

Providers may find additional information on the TAS website.

 

7160 Employment Services

Revision 14-1; September 1, 2014

Employment services are intended to assist individuals to find employment and maintain employment in the community. Senate Bill 45, passed by the 83rd Legislature, required that all Medicaid waivers offer Employment Assistance (EA) and Supported Employment (SE). Both EA and SE are offered under the Consumer Directed Services option.

 

7161 Employment Assistance (EA)

Revision 14-1; September 1, 2014

 

The Home and Community Support Services Agency (HCSSA) will provide EA to an individual to help the individual locate paid competitive employment or self-employment in an integrated setting in the community.

Competitive employment is work:

  • in the competitive labor market, in which anyone may compete for employment, that is performed on a full-time or part-time basis in an integrated setting; and
  • for which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. Note: This definition is consistent with 34 Code of Federal Regulations (CFR) 361.5 (b) (11).

An integrated setting is a setting typically found in the community in which applicants or eligible individuals interact with people without disabilities, other than service providers, to the same extent that people without disabilities in comparable positions interact with other people without disabilities. An integrated setting does not include a setting in which:

  • groups of people with disabilities work in an area that is not part of the general workplace where people without disabilities work; or
  • a mobile crew of people with disabilities work in the community. Note: This definition is consistent with 34 CFR 361.5 (b) (33).

Self-employment is work in which the individual:

  • solely owns, manages and operates a business;
  • is not an employee of another person, entity or business; and
  • actively markets a service or product to potential customers. Note: This definition is consistent with the Department of Assistive and Rehabilitative Services (DARS) Community Rehabilitation Program Standards for Providers at www.dars.state.tx.us/drs/providermanual/.

EA services include, but are not limited to, the following:

  • identifying an individual's employment preferences, job skills, and requirements for a work setting and work conditions;
  • locating prospective employers offering employment compatible with an individual's identified preferences, skills and requirements; and
  • contacting a prospective employer on behalf of an individual and negotiating the individual's employment.

EA may be provided through the waiver if documentation is maintained in the individual’s record that the service is not available to the individual under a program funded under §110 of the Rehabilitation Act of 1973, or for individuals under age 22, under a program funded under the Individuals with Disabilities Education Act (IDEA). (20 United States Code (U.S.C.) §1401 et seq.)

The provider must ensure provision of EA, as identified through use of Form 2429, Job Interest Assessment, to individuals if the services are not available through DARS, or for individuals under age 22, the local school district for individuals.

 

7162 EA Services

Revision 14-1; September 1, 2014

 

Employment Assistance (EA) services consist of developing and implementing strategies for achieving the individual’s desired employment outcome, including more suitable employment for individuals who are employed. Services are individualized, person-directed and may include:

  • exploring options related to wages and employment outcomes (including self-employment outcomes);
  • exploring the individual’s interests, capabilities, preferences and ongoing support needs;
  • exploring the extended services and supports required at and away from the job site that will be necessary for employment success;
  • observing the individual's work skills and behaviors at home and in the community;
  • touring current or potential work environments with the individual;
  • assisting the individual to understand the impact of work activity on his services and financial supports;
  • assisting the individual to utilize work incentives to maintain needed benefits;
  • collecting personal and professional reference information;
  • assessing the individual's learning style and needs for adaptive technology, accommodations and on-site supports;
  • assessing the individual's strengths, challenges and transferable skills from previous job placements;
  • identifying the individual's assets, strengths and abilities;
  • identifying negotiable and non-negotiable employment conditions;
  • identifying targeted job tasks the individual can perform or potentially perform;
  • identifying potential employers or self-employment options;
  • training related to an individual’s assessed needs specific to his employment preferences, job skills and requirements for a work setting and work conditions;
  • writing resumes and proposals to assist in placement;
  • contacting employers and developing individual jobs;
  • performing a job analysis to determine if a potential job meets the individual’s interests, capabilities, preferences, and ongoing support needs;
  • assisting the individual with job applications, pre-employment forms, practice interviews, and pre-employment testing or physicals;
  • accompanying the individual to interviews;
  • negotiating aspects of the individual’s employment with prospective employers;
  • educating the employer about the Work Opportunity Tax Credit and other employer benefits;
  • assisting the individual with transportation needs which include:
    • developing the individual's transportation plan;
    • training the individual on how to travel to and from a job;
    • securing transportation for, or transporting an individual, as necessary, to assist the individual to obtain a job; and
  • participating in service planning meetings, including those with the Department of Assistive and Rehabilitative Services (DARS), or for individuals under age 22, the individual’s school district.

For self-employment, services may additionally include:

  • supporting the individual in work-related tasks or behaviors such as advertising, marketing, sales, accounting, and obtaining licenses and registrations;
  • training or consulting with paid or natural supports (accountants, employees, etc.) who will be supporting the individual either short-term or long-term in managing the business; and
  • setting up services to address long-term supports that will be necessary to sustain the business.

EA does not include using Medicaid funds paid by DADS to the provider for incentive payments, subsidies or unrelated vocational training expenses, such as:

  • paying the employer to hire an individual;
  • paying the employer for supervision, training, support and adaptations for an individual that the employer typically makes available to other workers without disabilities filling similar positions in the business; or
  • paying the individual as an incentive to participate in EA activities, or for expenses associated with the start-up costs or operating expenses of an individual’s business.

The case manager will notify the provider of the inclusion of employment assistance services on the individual’s Individual Plan of Care (IPC) by sending Form 2411, Interim Plan of Care, or Form 2412, Budget Revision, along with Form 2430, Employment Assistance and Supported Employment Service Authorization, to the provider or, for Consumer Directed Services delivered services, to the financial management services agency. The provider must begin providing or subcontracting for the EA services described and approved in the individual’s IPC.

 

7163 Documentation Requirements for EA

Revision 14-1; September 1, 2014

 

For the period of time employment assistance (EA) is included in the individual’s Individual Plan of Care (IPC), the service provider must develop and update quarterly a plan for delivering EA, including documentation of the following information:

  • Name of the individual;
  • Individual’s employment goal;
  • Strategies for achieving the individual’s employment goal, including those addressing the individual’s anticipated employment support needs;
  • Names of the people, in addition to the individual, whose support is or will be needed to ensure successful employment placement, and the corresponding level of support those persons are providing or have committed to providing;
  • Any concerns about the effect of earnings on benefits and a plan to address those concerns;
  • Progress toward the individual’s employment goal; and
  • If progress is slower than anticipated, an explanation of why the documented strategies have not been effective, and a plan to improve the effectiveness of the individual’s employment search.

 

7164 Supported Employment (SE)

Revision 14-1; September 1, 2014

 

Supported Employment (SE) services help an individual sustain competitive employment or self-employment.

Competitive employment is work:

  • in the competitive labor market, in which anyone may compete for employment, that is performed on a full-time or part-time basis in an integrated setting; and
  • for which an individual is compensated at or above the minimum wage, if the individual is not self-employed but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. Note: This definition is consistent with 34 CFR 361.5 (b) (11).

An integrated setting is a setting typically found in the community in which applicants or eligible individuals interact with people without disabilities, other than service providers, to the same extent that people without disabilities in comparable positions interact with other people without disabilities. An integrated setting does not include a setting in which:

  • groups of people with disabilities work in an area that is not part of the general workplace where people without disabilities work; or
  • a mobile crew of people with disabilities work in the community. Note: This definition is consistent with 34 CFR 361.5 (b) (33).

Self-employment is work in which the individual:

  • solely owns, manages and operates a business;
  • is not an employee of another person, entity or business; and
  • actively markets a service or product to potential customers. Note: This definition is consistent with the Department of Assistive and Rehabilitative Services (DARS) Community Rehabilitation Program Standards for Providers at www.dars.state.tx.us/drs/providermanual/.

SE services include:

  • assistance provided as an individual, in order to sustain competitive employment, to an individual who, because of a disability, requires intensive, ongoing support to be self-employed, work from home, or perform in a work setting at which individuals without disabilities are employed;
  • employment adaptations, supervision and training related to an individual’s assessed need; and
  • individuals earning at least minimum wage, if not self-employed.

SE may be provided through the waiver if documentation is maintained in the individual’s record, for an individual under age 22, that the service is not available to the individual under a program funded under the Individuals with Disabilities Education Act (IDEA). (20 U.S.C. §1401 et seq.)

The provider must ensure provision of SE, as needed, for an individual to sustain competitive employment or self-employment, if the services are not available through the local school district for an individual under age 22.

 

7165 Supported Employment Activities

Revision 14-1; September 1, 2014

 

Supported Employment (SE) services consist of developing and implementing strategies for helping the individual sustain competitive employment or self-employment. Services are individualized, person-directed and include:

  • orienting and training the individual in work-related tasks;
  • training or consulting with employers, co-workers or advocates to maximize natural supports;
  • monitoring job performance;
  • communicating with managers and supervisors to gather input and plan training;
  • communicating with company personnel or support systems to ensure job retention;
  • training in work-related tasks or behaviors to ensure job retention (for example, grooming or behavior management);
  • setting up compensatory strategies;
  • assisting the individual to report earned income to the Social Security Administration and the Texas Health and Human Services Commission;
  • assisting the individual to develop a method for ongoing income reporting and for staying informed about the impact of the individual’s earnings on cash, Medicaid and other benefits;
  • assisting the individual with transportation needs which include:
    • developing the individual's transportation plan;
    • training the individual on how to travel to and from the job; and
    • securing transportation for, or transporting an individual, as necessary, to assist the person to sustain the job;
  • assisting the individual to utilize work incentives to maintain needed benefits and continue to access needed supports and services;
  • assisting the individual with career advancement; and
  • assisting the individual to develop assets and obtain self-sufficiency through work.

For self-employment, services may additionally include:

  • training or consulting in work-related tasks or behaviors such as support for advertising, marketing and sales;
  • training or consulting with paid or natural supports (accountants, employees, etc.) who are supporting the individual either short-term or long-term in managing the business;
  • problem-solving related to company personnel or support systems necessary to run the business effectively and efficiently; and
  • assistance with bookkeeping, marketing and managing data or inventories.

SE does not include sheltered work or other similar types of vocational services furnished in specialized facilities, or using Medicaid funds paid by DADS to the provider for incentive payments, subsidies or unrelated vocational training expenses, such as:

  • paying an employer:
    • as encouragement to hire an individual; or
    • for supervision, training, support and adaptations for an individual that the employer typically makes available to other workers without disabilities filling similar positions in the business; and
  • paying the individual:
    • as an incentive to participate in SE activities; or
    • for expenses associated with the start-up costs or operating expenses of an individual’s business.

The case manager will notify the provider of the inclusion of SE services on the individual’s Individual Plan of Care prior to the Department of Assistive and Rehabilitative Services (DARS) closing out the individual's services, if applicable, or for initial SE services by sending Form 2411, Interim Plan of Care, or Form 2412, Budget Revision, along with Form 2430, Employment Assistance and Supported Employment Service Authorization, to the provider, or for Consumer Directed Services delivered services to the financial management services agency. The provider must begin providing or subcontracting for the SE services described and approved in the individual’s service plan without a gap between the provision of DARS services and the waiver services.

 

7166 Documentation Requirements for SE

Revision 14-1; September 1, 2014

For the period of time supported employment (SE) is included in the individual’s Individual Plan of Care (IPC), the service provider must develop and update quarterly a plan for delivering SE, including documentation of the following information:

  • Name of the individual;
  • Information about the individual’s employment, including:
    • Name of the employer;
    • Estimated hours worked (e.g., range in a month, average per week);
    • Estimated earnings (e.g., hourly wage, average monthly earnings);
  • Any concerns about the effect of earnings on benefits, and a plan to address those concerns;
  • A plan for decreasing (i.e., fading) the amount of SE an individual receives;
  • Progress toward fading SE; and
  • If fading progress is slower than anticipated, an explanation of why the documented strategies have not been effective, and a plan to improve the effectiveness.

 

7170 Role of the Case Manager

Revision 14-1; September 1, 2014

 

The DADS case manager coordinates with other agencies, including the Texas Health and Human Services Commission, regarding an individual’s continued Medicaid eligibility once he or she begins working. The DADS case manager also coordinates with the Department of Assistive and Rehabilitative Services (DARS) and the local school districts, seeking third party resources before using employment assistance and supported employment (in the case of school districts).

Activity includes:

  • Devoting time during an individual’s initial service planning meeting to discuss employment with the individual and family, and the process to obtain employment services and supports;
  • Making the referral to DARS, assisting with completing the application form, and documenting the referral and outcome of the referral in the individual’s case record;
  • Continuing to explore the possibility of employment at subsequent service planning meetings for an individual who is not employed in the community;
  • Affirming or explaining how an individual can work and still maintain current medical benefits (e.g., through the Medicaid Buy-In program), and in most cases will have an increase in income;
  • Explaining rights to appeal if services are denied, reduced or terminated; and
  • Monitoring whether the individual and family are satisfied with the employment supports.

 

7180 Department of Assistive and Rehabilitative Services (DARS)

Revision 14-1; September 1, 2014

 

Before using employment assistance, the individual must first seek services from DARS. Also known as the Vocational Rehabilitation (VR) agency, DARS is the state agency whose primary focus is assisting individuals with disabilities to obtain integrated, competitive employment.

Note: The individual does not have to, and should not be referred to, DARS for supported employment.

 

7181 Role of DARS in Employment Assistance

Revision 14-1; September 1, 2014

 

The individual and any other support persons, as desired, should meet with the Department of Assistive and Rehabilitative Services (DARS) Vocational Rehabilitation (VR) counselor to apply for DARS services as soon as possible after the individual identifies an employment goal. To locate the nearest DARS office, visit the Office Locator Web page. In addition to the information listed on Page 2 of the DARS Applicant Guide, the individual should bring or submit to the DARS office before his initial appointment:

  • a copy of the individual’s court-ordered guardianship documents, if a court-ordered guardian has been appointed;
  • a copy of the individual’s most recent service plan;
  • current vocational assessments or person-directed plans that focus on employment opportunities;
  • other available records pertaining to the individual’s disabilities (including, but not limited to, medical, psychological and psychiatric reports); and
  • contact information for the individual’s case manager.

 

7182 Coordination of DADS and DARS Services

Revision 14-1; September 1, 2014

 

If the Vocational Rehabilitation (VR) counselor determines that the Department of Assistive and Rehabilitative Services (DARS) is not the appropriate resource to meet the individual's needs and does not take an application for services, documentation of this decision in the individual's record serves as sufficient evidence that DARS services are not available and the individual is eligible to receive employment assistance (EA).

An individual who has applied for services from DARS is eligible to receive EA until DARS has developed the individual’s plan for employment (IPE). The individual’s service planning team must ensure that communication is maintained with the DARS VR counselor regarding waiver-funded services provided between the DARS VR application and the "start date" of services from DARS, as defined in the individual's DARS VR IPE.

Note: If an individual refuses to contact DARS, he or she may not receive EA.

With permission of the individual, the service planning team members supporting an individual determined eligible for DARS services, along with the individual, must:

  • if possible, attend any DARS planning meetings related to the individual's employment;
  • if possible, take an active role in providing input to the DARS IPE;
  • review the long-term services and supports listed on the DARS IPE, and, if any of those services and supports are available through the waiver, incorporate them in a revision to the MDCP Individual Plan of Care (IPC) for DADS consideration; and
  • begin providing those services and supports described in the approved section in the MDCP IPC prior to DARS closure of the individual's case.

DADS and DARS have a memorandum of agreement in place that further describes the coordination policies and processes for individuals seeking employment.

 

7190 Roles of the HCSSA or CDS Employer

Revision 14-1; September 1, 2014

 

The Home and Community Support Services Agency (HCSSA) and Consumer Directed Services (CDS) employer have two main roles in supporting the employment services.

  1. Help to Locate Services

The HCSSA and financial management services agency (FMSA) assist individuals in locating employment related services, such as transportation. They encourage individuals and their families to choose an employment services provider as early in the service planning process as possible. They also provide the individual with a list of employment services providers from which to choose.

  • The individual may want to select a provider, or choose a new provider, to provide employment services. An individual can search for providers by area of the state on the Long Term Care Quality Reporting System website.
  • The individual may receive employment services from a Community Rehabilitation Program (CRP) through Department of Assistive and Rehabilitative Services (DARS) funding. If the individual is not eligible for DARS services, DADS funding can be used via the CDS option or by the provider subcontracting with the CRP. A list of CRPs can be found on the DARS website.

A Supplemental Security Income (SSI) or Social Security Disability Income (SSDI) eligible individual has the option to receive employment services from an Employment Network (EN) through the Ticket to Work program. A list of ENs in Texas can be found on the DARS Ticket to Work website.

  1. Ensure Provision of Services

The HCSSA and FMSA identify individuals who are interested in pursuing employment and assist them in identifying and obtaining their desired employment outcome. They provide or contract for Employment Assistance Services when DARS funding is not available. They provide or contract for Supported Employment Services. They also engage with qualified staff to greatly enhance the effectiveness of employment services.

There are many training opportunities available, including those through the:

 

7200 Consumer Directed Services (CDS) Option

Revision 14-1; September 1, 2014

 

40 TAC Chapter 41, Consumer Directed Services Option

The CDS option is available for respite, flexible family support services, employment assistance and supported employment provided by an attendant or by a nurse.

The CDS option allows individuals or their legally authorized representatives the opportunity to hire, train, supervise and fire, if necessary, their service providers. CDS employers are required to select a financial management services agency (FMSA), formerly called Consumer Directed Services Agency, to pay the employees and file employer taxes on behalf of the CDS employer. The FMSA also provides an in-person CDS employer orientation when an individual starts the CDS option.

CDS employers can find additional information about the CDS option in the:

In addition to following the CDS option rules for employer responsibilities, the CDS rules point out which MDCP rules apply to CDS employers, including:

  • service definitions;
  • provider qualifications;
  • training requirements; and
  • service delivery documentation.

The CDS rules require FMSAs at the initial CDS employer orientation to explain the specific program rule requirements that CDS employers must follow. Each employer must sign Form 1735, Employer and Financial Management Services Agency Service Agreement, Form 1735-MDCP.pdf, to acknowledge understanding of MDCP rules.

 

7300 Personal Care Services (PCS)

Revision 14-1; September 1, 2014

 

The PCS program is available to Medicaid recipients under the age of 21 who are eligible for Texas Health Steps (THSteps).

PCS provides assistance with activities of daily living (ADL), instrumental ADL and health-related functions due to a physical, cognitive, or behavioral limitation related to a disability or chronic health condition. The PCS program is administered by the Texas Health and Human Services Commission; however, the Texas Department of State Health Services determines eligibility for services.

An individual receiving MDCP services may apply to receive services through the PCS program, in addition to receiving services from MDCP. Since PCS addresses different needs than those met by MDCP services, the individual's decision to access PCS does not affect the MDCP services authorized by DADS case managers.

For individuals receiving services from both PCS and MDCP, close coordination between DADS and PCS case managers is necessary to ensure the MDCP Individual Plan of Care accurately reflects all services being delivered.

 

7310 MDCP Applicant Who Receives PCS

Revision 14-1; September 1, 2014

 

If an individual receives services from Personal Care Services (PCS) and wants to apply for MDCP services, the DADS case manager informs the individual about the coordination of services that must occur between the DADS and PCS case managers.

 

7320 CDS Option and Personal Care Services

Revision 14-1; September 1, 2014

 

If the individual is using the Consumer Directed Services (CDS) option for MDCP services and Personal Care Services, the CDS employer must use the same financial management services agency (FMSA) for both programs. Using a single FMSA reduces any tax risk to the employer by avoiding duplication of employer tax identification numbers and fiscal/employer agents.

 

7400 Targeted Case Management (TCM)

Revision 14-1; September 1, 2014

 

Local Authorities (LAs) provide service coordination to individuals with intellectual and developmental disabilities (IDD) in the DADS LA priority population. This service is called Targeted Case Management.

DADS waiver services, including MDCP and TCM, are mutually exclusive. An individual receiving MDCP services cannot receive TCM at the same time.