9-2017

 

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Purpose

The relocation function is a component of service coordination. The primary purpose of the relocation function is to support the transition of members and future members who desire to move from an institution to the community. A relocation specialist (RS) works for an entity contracted with a managed care organization (MCO) to perform the relocation function.

 

Overview of Relocation Function

  • Conduct outreach and education to nursing facilities and residents on options for receiving long-term services and supports (LTSS) in the community;
  • Identify members interested in relocating;
  • Respond to referrals for relocation and conduct relocation assessments;
  • Develop and implement person-centered relocation plans;
  • Coordinate housing and non-covered community services, as mutually agreed;
  • Provide support on day of relocation and conduct follow-up; and
  • Collect data on relocations as specified by the Texas Health and Human Services Commission and/or MCOs.

 

Relocation Tasks

MCO RS Both Conduct Outreach and Education
    X Conduct regular visits to nursing facilities to educate individuals in the facility, family members and potential referral sources about community-based services, including STAR+PLUS Home and Community Based Services (HCBS), and the availability of assistance with relocation. Educate potential referral sources regarding the availability of STAR+PLUS HCBS.
    X Provide group and individual training to nursing facility staff on relocation services.
  X   Encourage a referral to a Local Contact Agency for residents interested in relocating.
MCO RS Both Identify and Refer Individuals Interested in Relocating (non-Minimum Data Set Referrals)
    X If an RS learns of a member’s desire to move to the community, the RS must notify the member’s MCO. If an MCO learns of a member’s desire to move to the community, the MCO must notify the RS. Either party has three business days to notify the other party.
  X   Upon receipt of referral, the RS must make an initial contact face-to-face or by telephone within five business days to schedule a relocation assessment. Initial contact must be with the member or the member’s authorized representative (AR). An AR such as a family member or friend who is knowledgeable of the member’s situation and services may be engaged to support information provided by the member. 
X     The MCO service coordinator must contact the member to schedule an assessment for STAR+PLUS HCBS within 14 business days of notification by the RS. The MCO has 45 days to complete all assessment activities related to STAR+PLUS HCBS eligibility.
  X   Provide the appropriate Local Intellectual and Developmental Disability Authority (LIDDA) with contact information for members interested in relocating who have an Intellectual or Developmental Disability (IDD). Provide notification to the appropriate MCO that a referral was made to the LIDDA.
MCO RS Both Respond to Referrals for Relocation and Conduct Relocation Assessment
  X   When contacted by the MCO via Form 1579, Referral for Relocation Services, or after referral is received from another source, conduct a face-to-face relocation assessment with the member or AR within 14 business days. An AR such as a family member or friend who is knowledgeable of the member’s situation and services may be engaged to support information provided by the member.  The assessment includes, but is not limited to:
  • goals of the member with regard to community living;
  • preferences for post-relocation housing;
  • information regarding informal support;
  • information regarding finances and need for support;
  • need for post-relocation non-waiver supports;
  • history of unsuccessful relocation attempts and reasons attempts were not successful; and
  • barriers to relocation.
  X   Share results from assessment with the MCO.
    X Develop a person-centered relocation plan with the member or AR and others whom he/she chooses to have involved.
    X Advocate with nursing facility staff, RS and service coordinator(s) to support the member’s needs, preferences and goals.
    X Through their respective assessments, the MCO service coordinator and RS identify and include in the MCO service plan and/or RS’ transition plan non-covered community services, including, but not limited to:
  • help setting up a utility or telephone account;
  • non-medical transportation, including mainline, special transit and local transportation providers;
  • start-up groceries, as needed; or
  • banking, bill payment and direct deposit.
    X Maintain regular, open communication with all parties who are involved in the relocation process.
MCO RS Both Coordinate Housing, Non-Medicaid Community Supports and Discharge
    X If the member is in need of housing, the RS is primarily responsible to help secure affordable, accessible and integrated housing consistent with the resident’s preferences. The RS assists the member in applying for:
  • Project Access, as indicated;
  • Section 811 Project Rental Assistance, as available; and
  • other affordable housing options, as necessary.
X     If the member is interested in assisted living, personal care homes or adult foster care, the MCO service coordinator will review options available among contracted providers.
    X Assist the member in accessing community supports, such as food banks, utility assistance, emergency rental assistance and emergency SNAP.
    X Participate in the discharge planning process with the member or AR, service coordinator(s), RS and others important to the member.
X     MCOs will negotiate and set the discharge date in coordination with the RS and other community and social supports, as necessary.
    X If an MCO or RS becomes aware of a change to the discharge date, the MCO or RS must notify the other party immediately.
MCO RS Both Provide Support on Relocation Day and Follow-up
    X Coordinate with all parties to ensure everything is in place at the time of discharge.
    X Help facilitate the member’s notification to Social Security of the member’s new address as soon as possible after relocating to the community.
X     The MCO service coordinator will remind nursing facility staff to transfer Medicaid benefits from the facility to the community.
    X Be present at new address on relocation day to ensure all services are in place.  Assist in setting up household, as needed.
    X

Notify the other party if the member does not have all necessary Medicaid and non-Medicaid supports in place on the day of relocation.

    X Provide follow up, which may include:
  • determining if there are unresolved issues related to transfer of benefits, health, emotional well-being, etc.;
  • communicating all unresolved medical issues to the MCO service coordinator; and
  • assisting the member in addressing unmet needs.
  X   Contact the member at least seven times over the course of 90 days post-relocation to ensure a successful transition to the community. Notify the MCO if the member has an unmet need.

 

Minimum Qualifications

An MCO must offer a contract to provide the relocation function to an entity with at least five years contracting with the state to provide relocation functions as of Sept. 1, 2016, to members transitioning from institutions to Medicaid community-based LTSS.

An MCO may offer a contract to a new entity to provide the relocation function. The new entity must meet all of the following qualifications:

  • Adherence to Health Insurance Portability and Accountability Act (HIPAA) compliant data management requirements and other stipulations of the MCO;
  • Experience identifying barriers to relocation for members who express an interest in moving from nursing facilities in Texas to a home and community-based setting;
  • Knowledge of community resources for members with disabilities of all ages and how to access those resources;
  • Knowledge of community and federal housing resources and how to access those resources, as appropriate;
  • Knowledge of Medicaid, including, but not limited to, Medicaid managed care, long term services and supports, eligibility requirements and how to apply and qualify for Medicaid;
  • Ability to hire, train, supervise and direct RS staff that ensures the successful transition of members from nursing facilities. The entity is responsible for ensuring any RS is not listed in the HHSC employee misconduct registry, Inspector General (IG) list of excluded entities and individuals, and HHSC do not hire registries. The entity must conduct a fingerprint background check and share the results with the MCO prior to hiring an RS;
  • Two years of experience developing transition plans for members; and
  • Three years of experience working directly with people with disabilities of all ages or the entity must have at least three years of experience subcontracting with an entity described above to provide the relocation function.

 

Shared Appendix 61

This appendix appears in the following handbooks:

STAR+PLUS Handbook (SPH): Appendix XXX
STAR+PLUS Program Support Unit Operational Procedures Handbook (SPOPH): Appendix XXX