consumer directed services

Consumer Directed Services (CDS) Implementation Training for the Home and

Community-based Services (HCS) and the Texas Home Living (TxHmL) Programs

Consumer Directed Consumer Directed

ServicesServicesHCS & TxHmLHCS & TxHmL

Enrollment ScreensEnrollment Screens&&

Individual Plan of CareIndividual Plan of Care

CHANGESCHANGES

Presentation AgendaPresentation Agenda

TopicTopic Target AudienceTarget Audience

EnrollmentsEnrollments MRA StaffMRA Staff

Revisions/Annual Revisions/Annual Provider and MRA StaffProvider and MRA StaffRenewalsRenewals

Transfers (Adding/ Transfers (Adding/ Provider and MRA StaffProvider and MRA StaffChanging providers Changing providers

- PE Staff)- PE Staff)

MRA ENROLLMENT STEPSMRA ENROLLMENT STEPS(L01) - Enrollment (HCS &TxHmL) – Change(L01) - Enrollment (HCS &TxHmL) – Change

(L23)(L23) - MR/RC – No Change- MR/RC – No Change

(L02) - IPC (HCS &TxHmL) – Change(L02) - IPC (HCS &TxHmL) – Change

(L03) -(L03) - Enrollment Checklist - No ChangeEnrollment Checklist - No Change

(L09) - Register Client Update - No Change (L09) - Register Client Update - No Change

(L05) - Provider Choice - Change(L05) - Provider Choice - Change

ConsumerConsumer Demographic Update Demographic Update

ScreensScreens……NO CHANGES!NO CHANGES! (L11)(L11) Client Name Update Client Name Update (L12)(L12) Client Address Update Client Address Update (L10)(L10) Client Correspondent Client Correspondent

UpdateUpdate (L20)(L20) Guardian Information Guardian Information

UpdateUpdate

Permanency Planning Review Permanency Planning Review (339)(339)

““MRA Only” Screen (If MRA Only” Screen (If Applicable)Applicable)

No ChangesNo Changes

L01 - CONSUMER L01 - CONSUMER ENROLLMENTENROLLMENT

01-08-08 01-08-08 L01:CONSUMER ENROLLMENT: ADD/CHANGE/DELETEL01:CONSUMER ENROLLMENT: ADD/CHANGE/DELETE VC060220 VC060220

PLEASE ENTER ONE OF THE FOLLOWING:PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: __________CLIENT ID: __________ COMPONENT CODE/LOCAL CASE NUMBER: ___ / __________COMPONENT CODE/LOCAL CASE NUMBER: ___ / __________ PLEASE ENTER THE FOLLOWING:PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: _ (A/ADD,C/CHANGE,D/DELETE)TYPE OF ENTRY: _ (A/ADD,C/CHANGE,D/DELETE) *** PRESS ENTER ****** PRESS ENTER *** ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

01-08-08 01-08-08 L01:CONSUMER ENROLLMENT: ADDL01:CONSUMER ENROLLMENT: ADD VC060225 VC060225 NAME: CAKE, PATTY CLIENT ID: 29653 NAME: CAKE, PATTY CLIENT ID: 29653 MEDICAID NUMBER: 010119400 LOCAL CASE NUMBER: 0001011940 MEDICAID NUMBER: 010119400 LOCAL CASE NUMBER: 0001011940 (Contract Number-REMOVED)(Contract Number-REMOVED) COMPONENT: 030 COMPONENT: 030 ENROLLMENT REQUEST DATE: 03012002 (MMDDYYYY) ENROLLMENT REQUEST DATE: 03012002 (MMDDYYYY) WAIVER TYPE: 1 (1-HCS,4-TXHML) WAIVER TYPE: 1 (1-HCS,4-TXHML) PRIOR DISCHARGE FROM A MEDICAID CERTIFIED NF OR ICF-MR?: N (Y/N) PRIOR DISCHARGE FROM A MEDICAID CERTIFIED NF OR ICF-MR?: N (Y/N) ADMIT FROM:1(1=COMM,2=ICF-MR,3=STATE SCH,4=REFINANCE,5=STATE HOSP) ADMIT FROM:1(1=COMM,2=ICF-MR,3=STATE SCH,4=REFINANCE,5=STATE HOSP) ENTER ONE OF THE FOLLOWING: ENTER ONE OF THE FOLLOWING:

SLOT TYPE :SLOT TYPE :3030_ (5-OBRA, 7-MDU, 9-ICF-MR, 12-PI, 13-PI4, 16-LA/REF,_ (5-OBRA, 7-MDU, 9-ICF-MR, 12-PI, 13-PI4, 16-LA/REF,18-TXHML/WL, 20-ICFMR#2, 25-PI#3, 26-CPS-HCS, 27-SM-MED ICFMR, 29-HOPE, 30-IL 18-TXHML/WL, 20-ICFMR#2, 25-PI#3, 26-CPS-HCS, 27-SM-MED ICFMR, 29-HOPE, 30-IL REDUCTION, 31-PI-08, 32-PI5, 33-SMICF2, 34-CPS-08, 35-NF-08)REDUCTION, 31-PI-08, 32-PI5, 33-SMICF2, 34-CPS-08, 35-NF-08)

SLOT TRACKING NUMBER: SLOT TRACKING NUMBER: 649999999 649999999 MFP DEMO? MFP DEMO? NN (Y/N) (Y/N)

COUNTY OF SERVICE: COUNTY OF SERVICE: 227227 GUARDIAN: GUARDIAN: LAST NAME : *SELF*__________ SUFFIX : ____ LAST NAME : *SELF*__________ SUFFIX : ____ FIRST NAME: ____________ MIDDLE INITIAL: _ FIRST NAME: ____________ MIDDLE INITIAL: _ C/O : _____________________________ PHONE: ( ___ ) ___ - ____ C/O : _____________________________ PHONE: ( ___ ) ___ - ____ STREET : STREET : 12345 MUDPIE12345 MUDPIE__________________ __________________

CITY : CITY : AUSTINAUSTIN_______________ STATE: TX ZIP CODE: _______________ STATE: TX ZIP CODE: 7870178701 ____ ____ READY TO ADD?: READY TO ADD?: YY (Y/N) (Y/N)

ACT:_ (L00/AUTH DATA ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNACT:_ (L00/AUTH DATA ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRN

L05 - PROVIDER CHOICEL05 - PROVIDER CHOICE

01-08-08 01-08-08 L05:PROVIDER CHOICE: ADD/DELL05:PROVIDER CHOICE: ADD/DEL VC060227 VC060227 PLEASE ENTER ONE OF THE FOLLOWING: PLEASE ENTER ONE OF THE FOLLOWING:

CLIENT ID: __________ CLIENT ID: __________ COMPONENT CODE/LOCAL CASE NUMBER: 030 / __________ COMPONENT CODE/LOCAL CASE NUMBER: 030 / __________

MEDICAID NUMBER: _________ MEDICAID NUMBER: _________

PLEASE ENTER THE FOLLOWING: PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: _ (A/ADD,D/DELETE) TYPE OF ENTRY: _ (A/ADD,D/DELETE) *** PRESS ENTER *** *** PRESS ENTER ***

ACT: ___ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)ACT: ___ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

01-08-08 01-08-08 L05:PROVIDER CHOICE: ADDL05:PROVIDER CHOICE: ADD VC060228 VC060228

NAME : CLIENT ID : NAME : CLIENT ID : MEDICAID NUMBER: LOCAL CASE NUMBER: MEDICAID NUMBER: LOCAL CASE NUMBER: COMPONENT : COMPONENT : SLOT TYPE : SLOT TRACK NO: SLOT TYPE : SLOT TRACK NO:

PROGRAM PROVIDER (PRGP): PROGRAM PROVIDER (PRGP):

COMPONENT: ___ COMPONENT: ___ LOCAL CASE NUMBER: __________ CONTRACT NUMBER: _________ LOCAL CASE NUMBER: __________ CONTRACT NUMBER: _________ LOCATION CODE: ____ LOCATION CODE: ____

CONSUMER DIRECTED SERVICE AGENCY (CDSA): CONSUMER DIRECTED SERVICE AGENCY (CDSA):

COMPONENT: ___ COMPONENT: ___ LOCAL CASE NUMBER: __________ CONTRACT NUMBER: _________LOCAL CASE NUMBER: __________ CONTRACT NUMBER: _________

SERVICE BEGIN DATE: SERVICE BEGIN DATE: 0108200801082008 (MMDDYYYY) SERVICE COUNTY: (MMDDYYYY) SERVICE COUNTY: 227 TRAVIS227 TRAVIS

READY TO READY TO ADD? _ (Y/N) ADD? _ (Y/N)

ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

L02 - INDIVIDUAL PLAN OF L02 - INDIVIDUAL PLAN OF CARE CARE

(HCS)(HCS)

01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CAREL02:INDIVIDUAL PLAN OF CARE VC060230 VC060230 PLEASE ENTER ONE OF THE FOLLOWING: PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: CLIENT ID: 3761337613 COMPONENT CODE/LOCAL CASE NUMBER: COMPONENT CODE/LOCAL CASE NUMBER: 030030 / __________ / __________ MEDICAID NUMBER: _________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: TYPE OF ENTRY: I I I=INITIAL N=RENEWAL I=INITIAL N=RENEWAL E=ERROR CORRECTION T=TRANSFER E=ERROR CORRECTION T=TRANSFER R=REVISION D=DELETE R=REVISION D=DELETE

PLEASE ENTER FOR INITIAL PLANS ONLY: PLEASE ENTER FOR INITIAL PLANS ONLY: BEGIN DATE: BEGIN DATE: 0108200801082008 (MMDDYYYY) (MMDDYYYY)

PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT TYPES: PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT TYPES: 16=LA/REF, 17=TXHML/REF, 18=TXHML/WL 16=LA/REF, 17=TXHML/REF, 18=TXHML/WL _ 365 DAYS _ 270 DAYS _ 180 DAYS _ 365 DAYS _ 270 DAYS _ 180 DAYS *** PRESS ENTER *** *** PRESS ENTER ***


HCSHCS01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY:INITIALL02:INDIVIDUAL PLAN OF CARE ENTRY:INITIAL VC060232A VC060232A NAME: RANGERS, POWER A. CLCN: 020 0000222996 CLIENT ID: 37613 NAME: RANGERS, POWER A. CLCN: 020 0000222996 CLIENT ID: 37613 BEG DT: 01082008 REV DT: (MMDDYYYY) END DT: 01062009BEG DT: 01082008 REV DT: (MMDDYYYY) END DT: 01062009 SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS CMM CASE MANAGEMENT CMM CASE MANAGEMENT 12 12 MONS SP SPEECH/LANGUAGE MONS SP SPEECH/LANGUAGE ___ ___ HRS HRS SHL SUPPORTED HOME LIV SHL SUPPORTED HOME LIV 900 900 HRS OT OCCUPATIONAL THERA HRS OT OCCUPATIONAL THERA HRS HRS FC HCS FOSTER CARE FC HCS FOSTER CARE DAYS PT PHYSICAL THERAPY DAYS PT PHYSICAL THERAPY HRS HRS SL SUPERVISED LIVING SL SUPERVISED LIVING DAYS DI DIETARY DAYS DI DIETARY HRS HRS RSS RES SUPPORT SVC RSS RES SUPPORT SVC DAYS PS PSYCHOLOGY DAYS PS PSYCHOLOGY HRS HRS NU NURSING NU NURSING 20 20 HRS AU AUDIOLOGY HRS AU AUDIOLOGY HRS HRS REH RESPITE HR REH RESPITE HR 300 300 HRS SW SOCIAL WORK HRS SW SOCIAL WORK HRS HRS RE RESPITE RE RESPITE DAYS DE DENTAL DAYS DE DENTAL DOLDOL DH DAY HABILITATION DH DAY HABILITATION 240 240 DAYS AA ADAPTIVE AIDS DAYS AA ADAPTIVE AIDS 100 100 DOL DOL SE SUPPORTED EMP SE SUPPORTED EMP HRS MHM MINOR HOME MODS HRS MHM MINOR HOME MODS 1009 1009 DOL DOL SCV SUPPORT CONSULTAT SCV SUPPORT CONSULTAT 20 20 HRS FMSV FMS MONTHLY FEEHRS FMSV FMS MONTHLY FEE 12 MO12 MO

WILL ANY SERVICES BE SELF DIRECTED? WILL ANY SERVICES BE SELF DIRECTED? YY (Y/N) (Y/N)RESIDENTIAL TYPE: RESIDENTIAL TYPE: 33 (2-5) LOCATION: OHFH (OHFH) (2-5) LOCATION: OHFH (OHFH) READY TO ADD? READY TO ADD? YY (Y/N) (Y/N)

ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: INITIALL02:INDIVIDUAL PLAN OF CARE ENTRY: INITIAL VC060234A VC060234A NAME: RANGERS, POWER A. CLCN: 020 0000222996 CLIENT ID: 37613 NAME: RANGERS, POWER A. CLCN: 020 0000222996 CLIENT ID: 37613 IPC BEGIN DATE:01-08-2008 REVISE DATE: END DATE:01-06-2009 IPC BEGIN DATE:01-08-2008 REVISE DATE: END DATE:01-06-2009

SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS CMMB CASE MANAGEMENT CMMB CASE MANAGEMENT 12 12 HRS SHLV SUPP HOME LIV HRS SHLV SUPP HOME LIV 900 900 HRS HRS REHV RESPITE (HOURS) REHV RESPITE (HOURS) 300300HRS SCV SUPPORT CONSULT HRS SCV SUPPORT CONSULT 20 20 HRS FMSV HRS FMSV MONTHLY FEE MONTHLY FEE 12 12 MO MO

WILL ANY SERVICES BE SELF DIRECTED? WILL ANY SERVICES BE SELF DIRECTED? YY (Y/N) (Y/N) CALCULATE?: CALCULATE?: NN(Y/N) CDS ESTIMATED ANNUAL TOTAL: 20,121.00* (Y/N) CDS ESTIMATED ANNUAL TOTAL: 20,121.00* READY TO ADD? READY TO ADD? YY (Y/N) (Y/N) ANNUAL COST: 36,436.60 COST CEILING: 78,967.75* ANNUAL COST: 36,436.60 COST CEILING: 78,967.75*

ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

HCSHCS01-01-08 01-01-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: INITIALL02:INDIVIDUAL PLAN OF CARE ENTRY: INITIAL VC060237A VC060237A

NAME: RANGERS, POWER A. CLCN:020 0000222996 CLIENT ID:37613 NAME: RANGERS, POWER A. CLCN:020 0000222996 CLIENT ID:37613 IPC BEGIN DATE:01-08-2008 REVISE DATE: END DATE:01-06-2009 IPC BEGIN DATE:01-08-2008 REVISE DATE: END DATE:01-06-2009

SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS CMMA CASE MANAGEMENT CMMA CASE MANAGEMENT 12 12 MO NU NURSING MO NU NURSING 20 20 HRS HRS

DH DAY HABILITATION DH DAY HABILITATION 240 240 DAYS AA ADAPTIVE AIDS DAYS AA ADAPTIVE AIDS 100 100 DOL DOL MHM MINOR HOME MODS MHM MINOR HOME MODS 1009 1009 DOLDOL

PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: 16,315.60*PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: 16,315.60*READY TO CONTINUE? Y(Y/N)READY TO CONTINUE? Y(Y/N) ANNUAL COST: 36,436.60 COST CEILING: 78,967.75* ANNUAL COST: 36,436.60 COST CEILING: 78,967.75*

ACT:____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) ACT:____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

HCSHCS01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: INITIALL02:INDIVIDUAL PLAN OF CARE ENTRY: INITIAL VC060238A VC060238A

NAME: RANGERS, POWER A. CLCN: 020 0000222996 CLIENT ID: 37613 NAME: RANGERS, POWER A. CLCN: 020 0000222996 CLIENT ID: 37613 PRGP:CONTRACT: COMPONENT: LOCAL CASE NUMBER:PRGP:CONTRACT: COMPONENT: LOCAL CASE NUMBER:CDSA:CONTRACT: COMPONENT: LOCAL CASE NUMBER: CDSA:CONTRACT: COMPONENT: LOCAL CASE NUMBER:

IPC BEGIN DATE: 01/08/2008 REVISE DATE: 01/08/2008 END DATE: 01/06/2009 IPC BEGIN DATE: 01/08/2008 REVISE DATE: 01/08/2008 END DATE: 01/06/2009

TOTAL ANNUAL COST : 36,436.60 TOTAL ANNUAL COST : 36,436.60 COST CEILING: 78,967.75 COST CEILING: 78,967.75

ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN? N (Y/N) ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN? N (Y/N)

CONTRACTED PROVIDER NAME: CONTRACTED PROVIDER NAME: ______________ ______________ DATE DATE

(MMDDYYYY): ____________(MMDDYYYY): ____________

IDT CERTIFICATION STATEMENTIDT CERTIFICATION STATEMENT

NAME DATE(MMDDYYYY) NAME DATE(MMDDYYYY) CASE MANAGER: CASE MANAGER: FOREST SERVICEFOREST SERVICE__________________ 12292007 __________________ 12292007 NURSE: NURSE: NURSE JOANNE_____________ _______NURSE JOANNE_____________ _______ 12292007 12292007 CONSUMER/LEGAL REPRESENTATIVE: CONSUMER/LEGAL REPRESENTATIVE: QUACK, DUCKIEQUACK, DUCKIE 12292007 12292007

L02 - INDIVIDUAL PLAN OF L02 - INDIVIDUAL PLAN OF CARE CARE

(TxHmL)(TxHmL)

01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CAREL02:INDIVIDUAL PLAN OF CARE VC060230 VC060230 PLEASE ENTER ONE OF THE FOLLOWING: PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: CLIENT ID: 4001140011 COMPONENT CODE/LOCAL CASE NUMBER: COMPONENT CODE/LOCAL CASE NUMBER: 010010 / __________ / __________ MEDICAID NUMBER: _________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: TYPE OF ENTRY: I I I=INITIAL N=RENEWAL I=INITIAL N=RENEWAL E=ERROR CORRECTION T=TRANSFER E=ERROR CORRECTION T=TRANSFER R=REVISION D=DELETE R=REVISION D=DELETE

PLEASE ENTER FOR INITIAL PLANS ONLY: PLEASE ENTER FOR INITIAL PLANS ONLY: BEGIN DATE: BEGIN DATE: 0108200801082008 (MMDDYYYY) (MMDDYYYY)

PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT TYPES: PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT TYPES: 16=LA/REF, 17=TXHML/REF, 18=TXHML/WL 16=LA/REF, 17=TXHML/REF, 18=TXHML/WL _ 365 DAYS _ 270 DAYS _ 180 DAYS _ 365 DAYS _ 270 DAYS _ 180 DAYS *** PRESS ENTER *** *** PRESS ENTER ***


TxHmLTxHmL01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY - INITIALL02:INDIVIDUAL PLAN OF CARE ENTRY - INITIAL VC060233A VC060233A NAME: TURTLE,NINJA CLCN: 010 0000002217 CLIENT ID: 40011 NAME: TURTLE,NINJA CLCN: 010 0000002217 CLIENT ID: 40011 BEG DT: 01082008 REV DT: ________ (MMDDYYYY) END DT: 01062009 BEG DT: 01082008 REV DT: ________ (MMDDYYYY) END DT: 01062009

SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS AU AUDIOLOGY ___DOL OT OCCUPATIONAL THERAPY ___HRS AU AUDIOLOGY ___DOL OT OCCUPATIONAL THERAPY ___HRS BES BEHAVIOR SUPPORT BES BEHAVIOR SUPPORT 12 12 HRS PT PHYSICAL THERAPY ___HRS HRS PT PHYSICAL THERAPY ___HRS CS COMMUNITY SUPPORT CS COMMUNITY SUPPORT 100100HRS RE RESPITE HRS RE RESPITE 10 10 DAYS DAYS DH DAY HABILITATION DH DAY HABILITATION 120120DAYS REH RESPITE HR DAYS REH RESPITE HR 10 10 HRS HRS DI DIETARY ___HRS SP SPEECH/LANGUAGE ___HRS DI DIETARY ___HRS SP SPEECH/LANGUAGE ___HRS EA EMP ASSISTANCE ___HRS SE SUPPORTED EMP ___HRS EA EMP ASSISTANCE ___HRS SE SUPPORTED EMP ___HRS NU NURSING NU NURSING 20 20 HRS DE DENTAL 500DOL HRS DE DENTAL 500DOL MHM MINOR HOME MOD MHM MINOR HOME MOD ________DOL AA ADAPTIVE AIDS ___DOL DOL AA ADAPTIVE AIDS ___DOL MHMR MINOR HOME MOD RE MHMR MINOR HOME MOD RE ______DOL AAR ADAPTIVE AIDS REQ. ___DOL DOL AAR ADAPTIVE AIDS REQ. ___DOL SCV SUPPORT CONSULTAT SCV SUPPORT CONSULTAT 10 10HRS FMSV FMS MONTHLY FEE HRS FMSV FMS MONTHLY FEE 12 12 MONS MONS

WILL ANY SERVICES BE SELF DIRECTED? WILL ANY SERVICES BE SELF DIRECTED? YY (Y/N) (Y/N) RESIDENTIAL TYPE: RESIDENTIAL TYPE: 33 (2-5) LOCATION: (2-5) LOCATION: OHFHOHFH (OHFH) (OHFH) READY TO CONTINUE?: _ (Y/N) READY TO CONTINUE?: _ (Y/N) ACT: ____ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)ACT: ____ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

TxHmLTxHmL01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY - INITIALL02:INDIVIDUAL PLAN OF CARE ENTRY - INITIAL VC060234A VC060234A NAME: TURTLE,NINJA CLCN: 010 00002217 CLIENT ID: 40011 NAME: TURTLE,NINJA CLCN: 010 00002217 CLIENT ID: 40011

IPC BEGIN DATE:01-08-2008 REVISE DATE: END DATE:01-06-2009 IPC BEGIN DATE:01-08-2008 REVISE DATE: END DATE:01-06-2009

SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS BESV BEHAVIOR SUPPORT BESV BEHAVIOR SUPPORT 12 12 HRSHRS REV RESPITE REV RESPITE 10 10 DAYS DAYS

CSV COMMUNITY SUPPORT CSV COMMUNITY SUPPORT 100100HRS REHV RESPITE HR HRS REHV RESPITE HR 10 10 HRS HRS DHV DAY HABILITATION DHV DAY HABILITATION 120120DAYSDAYS DEV DENTAL DEV DENTAL 500500 DOL DOL NUV NURSING NUV NURSING 20 20 HRS FMSV FMS MONTHLY FEE HRS FMSV FMS MONTHLY FEE 12 12 MONS MONS SCV SUPPORT CONSULTAT SCV SUPPORT CONSULTAT 10 10HRSHRS

WILL ANY SERVICES BE SELF DIRECTED? WILL ANY SERVICES BE SELF DIRECTED? YY (Y/N) (Y/N) CALCULATE?: CALCULATE?: N N (Y/N) CDS ESTIMATED ANNUAL TOTAL: 7,624.00* (Y/N) CDS ESTIMATED ANNUAL TOTAL: 7,624.00*

READY TO ADD? READY TO ADD? YY (Y/N) ANNUAL COST: 11,961.36 COST CEILING: 13,000.00 (Y/N) ANNUAL COST: 11,961.36 COST CEILING: 13,000.00 ACT:___ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)ACT:___ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

TxHmLTxHmL01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY - INITIALL02:INDIVIDUAL PLAN OF CARE ENTRY - INITIAL VC060234A VC060234A NAME: TURTLE,NINJA CLCN: 010 00002217 CLIENT ID: 40011 NAME: TURTLE,NINJA CLCN: 010 00002217 CLIENT ID: 40011

IPC BEGIN DATE:01-08-2008 REVISE DATE: END DATE:01-06-2009 IPC BEGIN DATE:01-08-2008 REVISE DATE: END DATE:01-06-2009

SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS BESV BEHAVIOR SUPPORT BESV BEHAVIOR SUPPORT 00 HRSHRS REV RESPITE REV RESPITE 10 10 DAYS DAYS

CSV COMMUNITY SUPPORT CSV COMMUNITY SUPPORT 100100HRS REHV RESPITE HR HRS REHV RESPITE HR 10 10 HRS HRS DHV DAY HABILITATION DHV DAY HABILITATION 0 0 DAYSDAYS DEV DENTAL DEV DENTAL 00 DOLDOL NUV NURSING NUV NURSING 20 20 HRS FMSV FMS MONTHLY FEE HRS FMSV FMS MONTHLY FEE 12 12 MONS MONS SCV SUPPORT CONSULTAT SCV SUPPORT CONSULTAT 10 10HRSHRS



TxHmLTxHmL01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY INITIALL02:INDIVIDUAL PLAN OF CARE ENTRY INITIAL VC060237A VC060237ANAME: TURTLE,NINJA CLCN: 010 0000222996 CLIENT ID: 37613 NAME: TURTLE,NINJA CLCN: 010 0000222996 CLIENT ID: 37613 IPC BEGIN DATE: 01-08-2008 REVISE DATE: END DATE: 01-06-2009 IPC BEGIN DATE: 01-08-2008 REVISE DATE: END DATE: 01-06-2009

SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS

BES BEHAVIOR SUPPORT BES BEHAVIOR SUPPORT 1212 HRS HRS DH DAY HABILTATION DH DAY HABILTATION 120120 DAYS DAYS

DE DENTAL DE DENTAL 500500 DOL DOL

PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: 4,337.36PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: 4,337.36

READY TO CONTINUE? READY TO CONTINUE? YY(Y/N) ANNUAL COST: 11,961.36 COST CEILING: 13,000.00(Y/N) ANNUAL COST: 11,961.36 COST CEILING: 13,000.00 ACT: ___ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)ACT: ___ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

TxHmLTxHmL01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: INITIALL02:INDIVIDUAL PLAN OF CARE ENTRY: INITIAL VC060238A VC060238A

NAME: TURTLE,NINJA CLCN: 010 0000002217 CLIENT ID: 40011 NAME: TURTLE,NINJA CLCN: 010 0000002217 CLIENT ID: 40011 PRGP:CONTRACT: COMPONENT: LOCAL CASE NUMBER: PRGP:CONTRACT: COMPONENT: LOCAL CASE NUMBER: CDSA:CONTRACT: COMPONENT: LOCAL CASE NUMBER:CDSA:CONTRACT: COMPONENT: LOCAL CASE NUMBER:

IPC BEGIN DATE: 01/08/2008 REVISE DATE: END DATE: 01-06-2009 IPC BEGIN DATE: 01/08/2008 REVISE DATE: END DATE: 01-06-2009 TOTAL ANNUAL COST : 11,961.36 COST CEILING: 13,000.00 TOTAL ANNUAL COST : 11,961.36 COST CEILING: 13,000.00 ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN? N (Y/N) ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN? N (Y/N) CONTRACTED PROVIDER NAME: ___________________________ CONTRACTED PROVIDER NAME: ___________________________

DATE (MMDDYYYY): _________ DATE (MMDDYYYY): _________


NAME DATE(MMDDYYYY) NAME DATE(MMDDYYYY) CASE MANAGER: CASE MANAGER: FORREST SERVICEFORREST SERVICE_________________ 12272007 _________________ 12272007 NURSE: NURSE: NURSE JOANNE_____________ _______NURSE JOANNE_____________ _______ 12272007 12272007 CONSUMER/LEGAL REPRESENTATIVE: CONSUMER/LEGAL REPRESENTATIVE: SPLINTER SPLINTER 12272007 12272007

HCS & TxHmLHCS & TxHmL

IPC HARD COPYIPC HARD COPY

HCS IPC HARD COPYHCS IPC HARD COPY

HCS: CDS SERVICES THAT CAN BE SELF-HCS: CDS SERVICES THAT CAN BE SELF-DIRECTEDDIRECTED

• Supported Home LivingSupported Home Living• Respite HourlyRespite Hourly• Respite DailyRespite Daily

Entering the information from Entering the information from

the hard copy IPC into CAREthe hard copy IPC into CARE

TxHmL HARD COPY IPCTxHmL HARD COPY IPC

TxHmL: CDS SERVICES THAT CAN BE SELF-TxHmL: CDS SERVICES THAT CAN BE SELF-DIRECTEDDIRECTED

• AudiologyAudiology RespiteRespite• Behavior SupportBehavior Support Respite HourlyRespite Hourly• Community SupportCommunity Support Speech/LanguageSpeech/Language• Day HabilitationDay Habilitation Supported Supported

EmploymentEmployment• DietaryDietary DentalDental• Employee AssistanceEmployee Assistance Minor Home ModMinor Home Mod• NursingNursing Adaptive AidsAdaptive Aids• Occupational TherapyOccupational Therapy• Physical TherapyPhysical Therapy

Entering the information from Entering the information from

the hard copy IPC into CAREthe hard copy IPC into CARE

TxHmL & HCSTxHmL & HCS

RENEWALS & RENEWALS & REVISIONSREVISIONS

TxHmLTxHmL01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: RENEWALL02:INDIVIDUAL PLAN OF CARE ENTRY: RENEWAL VC060233A VC060233A NAME: HAMMER, M C JR CLCN: 070 0000004321 CLIENT ID: 11007 NAME: HAMMER, M C JR CLCN: 070 0000004321 CLIENT ID: 11007 BEG DT: 03022008 REV DT: 03022008 (MMDDYYYY) END DT: 03012009 BEG DT: 03022008 REV DT: 03022008 (MMDDYYYY) END DT: 03012009

SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS AUAU AUDIOLOGY AUDIOLOGY HRS OTHRS OT OCCUPATIONAL THERAPY OCCUPATIONAL THERAPY 2 2 HRS HRS BES BEHAVIOR SUPPORT BES BEHAVIOR SUPPORT 1010 HRS PT PHYSICAL THERAPY HRS PT PHYSICAL THERAPY HRS HRS CSCSVV COMMUNITY SUPPORT COMMUNITY SUPPORT 80 80 HRS REHRS REVV RESPITE RESPITE 30 30 DAYS DAYS DH DAY HABILITATION DH DAY HABILITATION 104104DAYS REH RESPITE HR DAYS REH RESPITE HR HRS HRS DIDI DIETARY DIETARY HRS SPHRS SP SPEECH/LANGUAGE SPEECH/LANGUAGE DOL DOL EAEAVV EMP ASSISTANCE EMP ASSISTANCE 10 10 HRS SE SUPPORTED EMP HRS SE SUPPORTED EMP _HRS _HRS NUNU NURSING NURSING 8_8_ HRS DE HRS DE DENTAL DENTAL DOL DOL MHMMHM MINOR HOME MOD MINOR HOME MOD DOL AA DOL AA ADAPTIVE AIDS ADAPTIVE AIDS DOL DOL MHMR MINOR HOME MOD RE MHMR MINOR HOME MOD RE DOL AAR ADAPTIVE AIDS REQ. DOL AAR ADAPTIVE AIDS REQ. DOL DOL SCV SUPPORT CONSULTAT SCV SUPPORT CONSULTAT 1_1_ HRS FMSV FMS MONTHLY FEE HRS FMSV FMS MONTHLY FEE 12 12 MONSMONS

WILL ANY SERVICES BE SELF DIRECTED? WILL ANY SERVICES BE SELF DIRECTED? YY (Y/N) (Y/N) RESIDENTIAL TYPE: RESIDENTIAL TYPE: 33 (2-5) LOCATION: (2-5) LOCATION: OHFHOHFH (OFH) (OFH) READY TO CONTINUE?: READY TO CONTINUE?: YY (Y/N) (Y/N) ACT: ____ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)ACT: ____ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

TxHmLTxHmL01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY – RENEWALL02:INDIVIDUAL PLAN OF CARE ENTRY – RENEWAL VC060234A VC060234A NAME: HAMMER, M C JR CLCN: 070 00004321 CLIENT ID: 11007 NAME: HAMMER, M C JR CLCN: 070 00004321 CLIENT ID: 11007

IPC BEGIN DATE:03022008 REVISE DATE: 03022008 END DATE:03012008 IPC BEGIN DATE:03022008 REVISE DATE: 03022008 END DATE:03012008

SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS CSV COMMUNITY SUPPORT CSV COMMUNITY SUPPORT 80 80 HRS REV RESPITE HRS REV RESPITE 30 30 DAY DAY EAV EMP ASSISTANCE EAV EMP ASSISTANCE 10 10 HRS SCV SUPPORT CONSULTAT HRS SCV SUPPORT CONSULTAT 1 1 HRSHRS FMSV MONTHLY FEE FMSV MONTHLY FEE 12 12 MON MON



TxHmLTxHmL01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY – RENEWALL02:INDIVIDUAL PLAN OF CARE ENTRY – RENEWAL VC060237A VC060237ANAME: HAMMER, M C JR CLCN: 070 00004321 CLIENT ID: 11007 NAME: HAMMER, M C JR CLCN: 070 00004321 CLIENT ID: 11007 IPC BEGIN DATE: 03022008 REVISE DATE: 03022008 END DATE: 03012009 IPC BEGIN DATE: 03022008 REVISE DATE: 03022008 END DATE: 03012009

SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS

BES BEHAVIOR SUPPORT BES BEHAVIOR SUPPORT 1010 HRS HRS DH DAY HABILTATION DH DAY HABILTATION 104104 DAYS DAYS

NU NURSING NU NURSING 8 8 HRS HRS OT OCCUPATIONAL THERAPY OT OCCUPATIONAL THERAPY 22 HRS HRS

PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: 3,912.44PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: 3,912.44

READY TO CONTINUE? READY TO CONTINUE? YY(Y/N) ANNUAL COST: 12,923.74 COST CEILING: 13,000.00(Y/N) ANNUAL COST: 12,923.74 COST CEILING: 13,000.00 ACT: ___ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)ACT: ___ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

TxHmLTxHmL01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: RENEWALL02:INDIVIDUAL PLAN OF CARE ENTRY: RENEWAL VC060238A VC060238A

NAME: HAMMER, M C JR CLCN: 070 00004321 CLIENT ID: 11007 NAME: HAMMER, M C JR CLCN: 070 00004321 CLIENT ID: 11007 PRGP:CONTRACT: 001007000 COMPONENT: 9DS LOCAL CASE NUMBER: 000911 PRGP:CONTRACT: 001007000 COMPONENT: 9DS LOCAL CASE NUMBER: 000911 CDSA:CONTRACT: 009777777 COMPONENT: OMY LOCAL CASE NUMBER: 009311CDSA:CONTRACT: 009777777 COMPONENT: OMY LOCAL CASE NUMBER: 009311

IPC BEGIN DATE: 03022008 REVISE DATE: 03022008 END DATE: 03012009 IPC BEGIN DATE: 03022008 REVISE DATE: 03022008 END DATE: 03012009 TOTAL ANNUAL COST : 12,923.74 COST CEILING: 13,000.00 TOTAL ANNUAL COST : 12,923.74 COST CEILING: 13,000.00 ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN? N (Y/N) ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN? N (Y/N) CONTRACTED PROVIDER NAME: _CONTRACTED PROVIDER NAME: _ICAN DUITICAN DUIT__________________ __________________

DATE (MMDDYYYY): DATE (MMDDYYYY): 01292008 01292008_________ _________


NAME DATE(MMDDYYYY) NAME DATE(MMDDYYYY) CASE MANAGER: CASE MANAGER: DON KING JR DON KING JR _________________ 01272008 _________________ 01272008 NURSE: NURSE: NURSE MIMI_____________ _______ NURSE MIMI_____________ _______ 01272008 01272008 CONSUMER/LEGAL REPRESENTATIVE: CONSUMER/LEGAL REPRESENTATIVE: MIKE TYSON JR MIKE TYSON JR 01272008 01272008

TxHmLTxHmL01-08-08 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: REVISE/RENEWALL02:INDIVIDUAL PLAN OF CARE ENTRY: REVISE/RENEWAL VC060233A VC060233A NAME: HAMMER, M C JR CLCN: 070 0000004321 CLIENT ID: 11007 NAME: HAMMER, M C JR CLCN: 070 0000004321 CLIENT ID: 11007 BEG DT: 03022008 REV DT: 03022008 (MMDDYYYY) END DT: 03012009 BEG DT: 03022008 REV DT: 03022008 (MMDDYYYY) END DT: 03012009

SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS AUAU AUDIOLOGY AUDIOLOGY HRS OTHRS OT OCCUPATIONAL THERAPY OCCUPATIONAL THERAPY 2 2 HRS HRS BES BEHAVIOR SUPPORT BES BEHAVIOR SUPPORT 1010 HRS PT PHYSICAL THERAPY HRS PT PHYSICAL THERAPY HRS HRS CSCSVV COMMUNITY SUPPORT COMMUNITY SUPPORT 80 80 HRS REHRS REVV RESPITE RESPITE 30 30 DAYS DAYS DH DAY HABILITATION DH DAY HABILITATION 104104DAYS REH RESPITE HR DAYS REH RESPITE HR HRS HRS DIDI DIETARY DIETARY HRS SPHRS SP SPEECH/LANGUAGE SPEECH/LANGUAGE DOL DOL EAEAVV EMP ASSISTANCE EMP ASSISTANCE 10 10 HRS SE SUPPORTED EMP HRS SE SUPPORTED EMP _HRS _HRS NUNU NURSING NURSING 8_8_ HRS DE HRS DE DENTAL DENTAL DOL DOL MHMMHM MINOR HOME MOD MINOR HOME MOD DOL AA DOL AA ADAPTIVE AIDS ADAPTIVE AIDS DOL DOL MHMR MINOR HOME MOD RE MHMR MINOR HOME MOD RE DOL AAR ADAPTIVE AIDS REQ. DOL AAR ADAPTIVE AIDS REQ. DOL DOL SCV SUPPORT CONSULTAT SCV SUPPORT CONSULTAT 11_ HRS FMSV FMS MONTHLY FEE _ HRS FMSV FMS MONTHLY FEE 12 12 MONSMONS

WILL ANY SERVICES BE SELF DIRECTED? WILL ANY SERVICES BE SELF DIRECTED? YY (Y/N) (Y/N) RESIDENTIAL TYPE: RESIDENTIAL TYPE: 33 (2-5) LOCATION: (2-5) LOCATION: OHFHOHFH (OFH) (OFH) READY TO CONTINUE?: READY TO CONTINUE?: YY (Y/N) (Y/N) ACT: ____ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)ACT: ____ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

CHANGING SERVICE DELIVERY CHANGING SERVICE DELIVERY OPTION(SDO) FOR A SPECIFIC SERVICEOPTION(SDO) FOR A SPECIFIC SERVICE

REVISION & RENEWALREVISION & RENEWAL(currently TxHmL Only)(currently TxHmL Only)

PrgP SDOPrgP SDO CDS SDOCDS SDO

Behavior SupportBehavior Support Community Community SupportSupport

Day HabilitationDay Habilitation Employment Employment AssistanceAssistance

NursingNursing Respite Respite

Occupational TherapyOccupational Therapy

CONTACT INFOCONTACT INFO

PATRICK MARTINPATRICK MARTIN

[email protected]@dads.state.tx.us

(512) 438-4916(512) 438-4916

GEOFF SHUTEGEOFF SHUTE

[email protected]@dads.state.tx.us

(512) 438-5020(512) 438-5020

BREAKBREAK

Questions and AnswersQuestions and Answers

Transfers: adding, Transfers: adding, changing, and changing, and

discontinuing an discontinuing an individual’s individual’s

participation in the participation in the CDS optionCDS option

A transfer occurs whenever a A transfer occurs whenever a contract number (vendor number) contract number (vendor number) associated with an individual is associated with an individual is added, ended, or changed.added, ended, or changed.

A transfer in CARE occurs when a A transfer in CARE occurs when a individual moves from aindividual moves from a

1. Program Provider (PrgP) to 1. Program Provider (PrgP) to PrgP,PrgP,2. PrgP to Consumer Directed 2. PrgP to Consumer Directed Services Agency (CDSA),Services Agency (CDSA),3. CDSA to CDSA, or3. CDSA to CDSA, or4. CDSA to PrgP.4. CDSA to PrgP.

When the individual has When the individual has selected a PrgP and/or a CDSA, selected a PrgP and/or a CDSA, the transfer effective date the transfer effective date must be agreed upon by the all must be agreed upon by the all of the appropriate entities of the appropriate entities involved: involved:

the transferring program the transferring program provider, provider, the receiving program the receiving program provider, provider, the current program provider, the current program provider, the CDS Agency (ies), and the CDS Agency (ies), and the individual/LAR.the individual/LAR.

The receiving/current PrgP The receiving/current PrgP or the MRA’s service or the MRA’s service coordinator must mail or coordinator must mail or fax a copy of the Request fax a copy of the Request for Transfer Form and a for Transfer Form and a copy of the transfer IPC to copy of the transfer IPC to the appropriate Program the appropriate Program Enrollment (PE) staff Enrollment (PE) staff person after the data entry person after the data entry has been completed.has been completed.

Subchapter D §41.403Subchapter D §41.403Transfer ProcessTransfer Process

(a) An individual's CDSA must (a) An individual's CDSA must process a request by the individual or process a request by the individual or LAR to transfer from one CDSA to LAR to transfer from one CDSA to another CDSA in accordance with another CDSA in accordance with transfer procedures and transfer procedures and requirements of the individual's requirements of the individual's program. program.

(b), (d), and (e) apply to the (b), (d), and (e) apply to the transferring CDSA, employer or transferring CDSA, employer or Designated Representative (DR), and Designated Representative (DR), and the receiving CDSA, respectively. the receiving CDSA, respectively.

(c) Within five working days after the receipt (c) Within five working days after the receipt of a request to transfer, the case manager of a request to transfer, the case manager (HCS) or service coordinator must (HCS) or service coordinator must (TxHmL): (TxHmL):

(1) process the individual's request to (1) process the individual's request to transfer from one CDSA to another CDSA in transfer from one CDSA to another CDSA in accordance with the requirements of the accordance with the requirements of the individual's program and this chapter; individual's program and this chapter;

(2) calculate the number of units or amount (2) calculate the number of units or amount of funds needed to complete the service of funds needed to complete the service plan (IPC) period based on the individual's plan (IPC) period based on the individual's current service plan (use CDSA Transfer current service plan (use CDSA Transfer Information Form 1742/1743); Information Form 1742/1743);

(3) revise the service plan to indicate the (3) revise the service plan to indicate the number of units or amount of funds number of units or amount of funds calculated in this subsection effective the calculated in this subsection effective the date of transfer; and date of transfer; and

(A) approve only the units and funds (A) approve only the units and funds calculated as needed if units and funds calculated as needed if units and funds remaining in the budget meet or exceed the remaining in the budget meet or exceed the needed number or units or amount of funds needed number or units or amount of funds to complete the service period, or approve to complete the service period, or approve only the amount remaining in the budget only the amount remaining in the budget for the period remaining in the individual's for the period remaining in the individual's service plan; and service plan; and

(B) provide a copy of the transferring (B) provide a copy of the transferring service plan to the receiving CDSA and service plan to the receiving CDSA and employer before the effective date of the employer before the effective date of the transfer; and transfer; and

(4) provide a copy of the individual's revised (4) provide a copy of the individual's revised service plan to the transferring CDSA, the service plan to the transferring CDSA, the receiving CDSA, and the employer or DR. receiving CDSA, and the employer or DR.

HCS CARE Screen HCS CARE Screen SequenceSequence 1. C06: Transferring Provider1. C06: Transferring Provider

2. C09: Receiving Provider2. C09: Receiving Provider3. C06: Receiving Provider 3. C06: Receiving Provider 4. C02: Receiving Provider 4. C02: Receiving Provider 5. C06: Receiving Provider5. C06: Receiving Provider

TxHmL CARE Screen TxHmL CARE Screen SequenceSequence1. L09: Transferring MRA1. L09: Transferring MRA2. L06: Transferring MRA 2. L06: Transferring MRA 3. L02: Transferring MRA 3. L02: Transferring MRA 4. L06: Transferring MRA4. L06: Transferring MRA

HCS Transfer ExampleHCS Transfer Example

In this transfer example, In this transfer example, the individual will transfer the individual will transfer from the current Program from the current Program Provider to a new Program Provider to a new Program Provider and initiate the Provider and initiate the CDS option (adding a CDS option (adding a CDSA).CDSA).

07-01-08 C06: TRANSFER: CONTRACT/SERVICES: A/C/D VC060311 07-01-08 C06: TRANSFER: CONTRACT/SERVICES: A/C/D VC060311 PLEASE ENTER ONE OF THE FOLLOWING: PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: CLIENT ID: 12341234___________ ___ COMPONENT CODE/LOCAL CASE NUMBER: COMPONENT CODE/LOCAL CASE NUMBER: 8XX8XX / __________ / __________

MEDICAID NUMBER: _________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: PLEASE ENTER THE FOLLOWING: CONTRACT NUMBER: CONTRACT NUMBER: 001001500001001500

TRANSFER EFFECTIVE DATE: TRANSFER EFFECTIVE DATE: 0701200807012008 (MMDDYYYY)(MMDDYYYY)

FOR ADD ONLY:FOR ADD ONLY:1. CHANGING PrgP OR CDS AGENCY? 1. CHANGING PrgP OR CDS AGENCY? YY (Y/N) (Y/N)2. ADDING A PrgP OR CDS AGENCY? 2. ADDING A PrgP OR CDS AGENCY? YY (Y/N) (Y/N)3. CHANGING SERVICE DELIVERY OPTIONS? 3. CHANGING SERVICE DELIVERY OPTIONS? YY (Y/N) (Y/N)

TYPE OF ENTRY:TYPE OF ENTRY:AA (A/ADD,C/CHANGE,D/DELETE) (A/ADD,C/CHANGE,D/DELETE)

*** PRESS ENTER *** *** PRESS ENTER *** ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN

DOC)DOC)

Matrix for CARE Screen C06Matrix for CARE Screen C06

Questions Questions Answer Answer CombinationsCombinations

Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid Valid InValid Valid InValid

1. ARE YOU CHANGING YOUR1. ARE YOU CHANGING YOUR Y N N Y Y N Y N N Y Y N Y N Y N

PROGRAM PROVIDER OR CDS PROGRAM PROVIDER OR CDS

AGENCY?AGENCY?

2. ARE YOU ADDING A PROGRAM N N Y Y N 2. ARE YOU ADDING A PROGRAM N N Y Y N Y Y N Y Y N

PROVIDER OR CDS AGENCY?PROVIDER OR CDS AGENCY?

3. ARE YOU CHANGING SERVICE N Y N N Y 3. ARE YOU CHANGING SERVICE N Y N N Y Y Y NY Y N

DELIVERY OPTIONS?DELIVERY OPTIONS?

Service Delivery Option (SDO) means having Service Delivery Option (SDO) means having waiver services delivered by a PrgP and/or by waiver services delivered by a PrgP and/or by the Individual self-directing the services (with the Individual self-directing the services (with support from the CDSA).support from the CDSA).

Explanations of the questions on CARE Explanations of the questions on CARE Header Screen C06/L06Header Screen C06/L06

1. Changing a PrgP or CDSA occurs when the SDO 1. Changing a PrgP or CDSA occurs when the SDO currently exists.currently exists.

2. Adding a PrgP or CDSA occurs when a SDO will 2. Adding a PrgP or CDSA occurs when a SDO will be added where it does not exist.be added where it does not exist.

3. Changing SDO occurs when an existing service 3. Changing SDO occurs when an existing service (s) is moved from one SDO to the other SDO (s) is moved from one SDO to the other SDO (contract/vendor numbers do not change). (contract/vendor numbers do not change).

07-01-08 C06: TRANSFER CONTRACT/SERVICES: ADD VC060311 07-01-08 C06: TRANSFER CONTRACT/SERVICES: ADD VC060311

NAME : TYE,BEAU NAME : TYE,BEAU CLIENT ID: 1234 CLIENT ID: 1234 EFFECTIVE DATE: 07012008 EFFECTIVE DATE: 07012008 (MMDDYYYY)(MMDDYYYY)

SERVICESERVICE SDO CLAIM - PD/UNPD = REMAIN TO USE SDO CLAIM - PD/UNPD = REMAIN TO USE UNITS UNITS ADAPTIVE AIDSADAPTIVE AIDS PRGPPRGP 100.00100.00 30.00 70.00 30.00 70.00 00__________ CASE MANAGEMENT PRGP CASE MANAGEMENT PRGP 1212 6.00 6.00 6.00 6.00 00_____ _____ DAY HABILITATION PRGPDAY HABILITATION PRGP 240240 110.00 110.00 130.00 130.00 44_____ _____ MINOR HOME MODS PRGPMINOR HOME MODS PRGP 1009.00 1009.001009.00 1009.00 00.00 00.00 00_____ _____ NURSING NURSING PRGPPRGP 2020 7.00 7.00 13.00 13.00 00_____ _____ RESPITE HOURLYRESPITE HOURLY PRGP 30 16.00 14.00 PRGP 30 16.00 14.00 00_____ _____ SUPPORTED HOME LIVINGSUPPORTED HOME LIVING PRGPPRGP 900900 430.00 430.00 470.00 470.00 00_____ _____ READY TO ADD? READY TO ADD? YY (Y/N) (Y/N)

07-01-08 C06: TRANSFER CONTRACT/SERVICES: ADD VC060316 NAME : TYE,BEAU CLIENT ID: 1234

TRANSFER EFFECTIVE DATE: 07-01-2008 TRANSFERRING:

SERVICE COUNTY: 006 LOCATION CODE: OHFH PRGP: COMP/LCN: 8XX / 0110111946 CONTRACT NUMBER: 001001500CDSA: COMP/LCN: ___ / __________ CONTRACT NUMBER: ________

RECEIVING: Enter only if changing/adding provider(s)

SERVICE COUNTY: ____ LOCATION CODE: ____ RESDENTIAL TYPE: ___ PRGP: COMP/LCN: 8YY / __________ CONTRACT NUMBER: 001001510CDSA: COMP/LCN: 8ZZ / __________ CONTRACT NUMBER: 001001600

DOLLAR AMTS: AA MHM DENTAL OTHER SVCSTO BE PROV NOW TO TRANS DT: 0.00 0.00 0.00 73.88

TRANSFER ACCEPTED? _ (Y/N) BY: _________________________ DATE: ________ (MMDDYYYY)

C.O. AUTHORIZE TRANSFER? _ (Y/N) BY: __________________ DATE: ________ (MMDDYYYY)

READY TO ADD? Y (Y/N) ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN

DOC

07-01-08 C09:REGISTER CLIENT UPDATE VC060420 07-01-08 C09:REGISTER CLIENT UPDATE VC060420 PLEASE ENTER AT LEAST ONE OF THE FOLLOWING: PLEASE ENTER AT LEAST ONE OF THE FOLLOWING: CLIENT ID:CLIENT ID: 12341234 __________ __________

COMPONENT CODE/LOCAL CASE NUMBER: 8YY / __________ COMPONENT CODE/LOCAL CASE NUMBER: 8YY / __________ NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW

ENROLLMENTS ENROLLMENTS USE THE PROVIDERS COMPONENT CODE IN THE ABOVE FIELD. USE THE PROVIDERS COMPONENT CODE IN THE ABOVE FIELD. *** PRESS ENTER *** *** PRESS ENTER *** ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN

DOC) DOC)

07-01-08 07-01-08 C09:REGISTER CLIENT UPDATE C09:REGISTER CLIENT UPDATE VC060425 VC060425

CLIENT LAST NAME/SUF: CLIENT LAST NAME/SUF: TYETYE CLIENT ID CLIENT ID : :

1234 1234 CLIENT FIRST NAME : CLIENT FIRST NAME : BEAUBEAU COMPONENT : 8YY COMPONENT : 8YY

CLIENT MIDDLE NAME : CLIENT MIDDLE NAME :

LOCAL CASE NUMBER LOCAL CASE NUMBER : : Y420Y420__________ __________ SEX SEX : M_ : M_

ETHNICITY ETHNICITY : W_ : W_ CLIENT BIRTHDATE (MMDDYYYY): 10231955 CLIENT BIRTHDATE (MMDDYYYY): 10231955 SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER : 66677999: 66677999 (N=NONE, U=UNKNOWN) (N=NONE, U=UNKNOWN) MEDICAID NUMBER MEDICAID NUMBER : 123456789 : 123456789 MEDICARE NUMBER: MEDICARE NUMBER: ____________ ____________

PRESENTING PROBLEM PRESENTING PROBLEM : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC) : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC)

REGISTRATION EFFECTIVE DATEREGISTRATION EFFECTIVE DATE : 072398 (MMDDYY) TIME (HHMM A/P): _____ : 072398 (MMDDYY) TIME (HHMM A/P): _____ LEGAL GUARDIANSHIP LEGAL GUARDIANSHIP : 1 : 1

MARITAL STATUS: 2 MARITAL STATUS: 2 ESTIMATED ANNUAL GROSS FAMILY INCOME: 7258 ESTIMATED ANNUAL GROSS FAMILY INCOME: 7258 FAMILY SIZE : 1 FAMILY SIZE : 1 SERVICE PARTICIPANT GROUP SERVICE PARTICIPANT GROUP : TS (CB, SB, PD, HC, TS, EC, UC) : TS (CB, SB, PD, HC, TS, EC, UC) READY TO UPDATE? READY TO UPDATE? YY (Y/N) (Y/N)

ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC) DOC)

07-01-08 C09:REGISTER CLIENT UPDATE VC060420 07-01-08 C09:REGISTER CLIENT UPDATE VC060420 PLEASE ENTER AT LEAST ONE OF THE FOLLOWING: PLEASE ENTER AT LEAST ONE OF THE FOLLOWING:

CLIENT ID: CLIENT ID: 12341234__________ __________

COMPONENT CODE/LOCAL CASE NUMBER: 8ZZ / __________ COMPONENT CODE/LOCAL CASE NUMBER: 8ZZ / __________

NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW

ENROLLMENTS USE THE PROVIDERS COMPONENT CODE IN THE ENROLLMENTS USE THE PROVIDERS COMPONENT CODE IN THE ABOVE FIELD. ABOVE FIELD.

*** PRESS ENTER *** *** PRESS ENTER *** ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU, ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU,

HLP(PF1)/SCRN DOC) HLP(PF1)/SCRN DOC)

07-01-08 07-01-08 C09:REGISTER CLIENT UPDATE C09:REGISTER CLIENT UPDATE VC060425 VC060425

CLIENT LAST NAME/SUF: CLIENT LAST NAME/SUF: TYE TYE CLIENT ID : 1234 CLIENT ID : 1234 CLIENT FIRST NAME : CLIENT FIRST NAME : BEAU BEAU COMPONENT : 8ZZ COMPONENT : 8ZZ

CLIENT MIDDLE NAME : CLIENT MIDDLE NAME :

LOCAL CASE NUMBER LOCAL CASE NUMBER :: Z420 Z420__________ __________ SEX SEX : M_ : M_

ETHNICITY ETHNICITY : W_ : W_ CLIENT BIRTHDATE (MMDDYYYY): 10231955 CLIENT BIRTHDATE (MMDDYYYY): 10231955 SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER : 66677999: 66677999 (N=NONE, (N=NONE, U=UNKNOWN) U=UNKNOWN) MEDICAID NUMBER MEDICAID NUMBER : 123456789 : 123456789 MEDICARE NUMBER: MEDICARE NUMBER: ____________ ____________

PRESENTING PROBLEM PRESENTING PROBLEM : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC) : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC)

REGISTRATION EFFECTIVE DATEREGISTRATION EFFECTIVE DATE : 072398 (MMDDYY) TIME (HHMM A/P): _____ : 072398 (MMDDYY) TIME (HHMM A/P): _____ LEGAL GUARDIANSHIP LEGAL GUARDIANSHIP : 1 : 1

MARITAL STATUS: 2MARITAL STATUS: 2 ESTIMATED ANNUAL GROSS FAMILY INCOME: 7258 ESTIMATED ANNUAL GROSS FAMILY INCOME: 7258 FAMILY SIZE : 1 FAMILY SIZE : 1 SERVICE PARTICIPANT GROUP SERVICE PARTICIPANT GROUP : TS (CB, SB, PD, HC, TS, EC, UC) : TS (CB, SB, PD, HC, TS, EC, UC) READY TO UPDATE? READY TO UPDATE? YY (Y/N) (Y/N)

ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC) DOC)

07-01-08 C06: TRANSFER: CONTRACT/SERVICES: A/C/D VC060311 07-01-08 C06: TRANSFER: CONTRACT/SERVICES: A/C/D VC060311

PLEASE ENTER ONE OF THE FOLLOWING: PLEASE ENTER ONE OF THE FOLLOWING:

CLIENT ID: CLIENT ID: 12341234______ ____ OMPONENT CODE/LOCAL CASE NUMBER: 8YY / __________ OMPONENT CODE/LOCAL CASE NUMBER: 8YY / __________


PLEASE ENTER THE FOLLOWING: PLEASE ENTER THE FOLLOWING:

CONTRACT NUMBER: CONTRACT NUMBER: 001001510001001510TRANSFER EFFECTIVE DATE: TRANSFER EFFECTIVE DATE: 0701200807012008

FOR ADD ONLY:FOR ADD ONLY:CHANGING PrgP OR CDS AGENCY? _ (Y/N)CHANGING PrgP OR CDS AGENCY? _ (Y/N)ADDING A PrgP OR CDS AGENCY? _ (Y/N)ADDING A PrgP OR CDS AGENCY? _ (Y/N)

CHANGING SERVICE DELIVERY OPTIONS? _ (Y/N)CHANGING SERVICE DELIVERY OPTIONS? _ (Y/N)

TYPE OF ENTRY: TYPE OF ENTRY: CC (A/ADD,C/CHANGE,D/DELETE) (A/ADD,C/CHANGE,D/DELETE)

*** PRESS ENTER *** *** PRESS ENTER ***

ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC)HLP(PF1)/SCRN DOC)

07-01-08 07-01-08 C06: TRANSFER CONTRACT/SERVICES: ADD VC060311 C06: TRANSFER CONTRACT/SERVICES: ADD VC060311

NAME : TYE,BEAU NAME : TYE,BEAU CLIENT ID: 1234 CLIENT ID: 1234 EFFECTIVE DATE: 07012008 EFFECTIVE DATE: 07012008 (MMDDYYYY)(MMDDYYYY)

SERVICE SERVICE SDO SDO CLAIM - PD/UNPD - TO USE = REMAIN NEWCLAIM - PD/UNPD - TO USE = REMAIN NEWUNITSUNITS SDO SDO

ADAPTIVE AIDS ADAPTIVE AIDS PRGP PRGP 100.00100.00 30.0030.00 0.00 0.00 70.00 70.00 PP________ CASE MANAGEMENT PRGP CASE MANAGEMENT PRGP 1212 6.006.00 0.00 0.00 6.00 6.00 PP________ DAY HABILITATION DAY HABILITATION PRGP PRGP 240240 110.00110.00 4.00 4.00 126.00 126.00 PP________ MINOR HOME MODS MINOR HOME MODS PRGP PRGP 1009.001009.00 1009.001009.00 0.00 0.00 0.00 0.00 PP________ NURSING PRGP NURSING PRGP2020 7.007.00 0.00 0.00 13.00 13.00 PP________ RESPITE HOURLY RESPITE HOURLY PRGP 30 16.00 0.00 14.00 PRGP 30 16.00 0.00 14.00 CC________ SUPPORTED HOME LIVING PRGP SUPPORTED HOME LIVING PRGP 900900 430.00430.00 0.00 0.00 470.00 470.00 CC________ READY TO CHANGE? READY TO CHANGE? YY (Y/N) (Y/N)

07-01-08 C06: TRANSFER CONTRACT/SERVICES: ADD VC060311 07-01-08 C06: TRANSFER CONTRACT/SERVICES: ADD VC060311

NAME : TYE,BEAU NAME : TYE,BEAU CLIENT ID: 1234 CLIENT ID: 1234 EFFECTIVE DATE: EFFECTIVE DATE: 0701200807012008 (MMDDYYYY)(MMDDYYYY)

SERVICESERVICE SDO SDO CLAIM -PD/UNPD - TO USE CLAIM -PD/UNPD - TO USE REMAIN NEWREMAIN NEW

UNITS UNITS SDO SDOADAPTIVE AIDSADAPTIVE AIDS PRGP 100.00 PRGP 100.00 30.00 30.00 0.000.00 70.00 P____70.00 P____CASE MANAGEMENT PRGP 12.00CASE MANAGEMENT PRGP 12.00 6.00 0.00 6.00 0.00 6.00 6.00 P____ P____DAY HABILITATION PRGP 240.00 110.00DAY HABILITATION PRGP 240.00 110.00 4.00 4.00 126.00 P____ 126.00 P____MINOR HOME MODS PRGP 1009.00 1009.00MINOR HOME MODS PRGP 1009.00 1009.00 0.00 0.00 0.00 P____ 0.00 P____NURSING PRGP 20.00NURSING PRGP 20.00 7.00 7.00 0.00 0.00 13.00 P____13.00 P____RESPITE HR CDSARESPITE HR CDSA 30.00 30.00 16.00 16.00 0.00 0.00 14.00 C____14.00 C____SUPPORTED HOME LIVING CDSA 900.00 430.00 0.00 SUPPORTED HOME LIVING CDSA 900.00 430.00 0.00 470.00 470.00 C____C____ CONFIRM NEW SDO? CONFIRM NEW SDO? YY (Y/N) (Y/N)

07-01-08 C06: CONSUMER TRANSFER CONTRACT/SERVICES: CHANGE 07-01-08 C06: CONSUMER TRANSFER CONTRACT/SERVICES: CHANGE VC060316VC060316

NAME : TYE,BEAUNAME : TYE,BEAU CLIENT ID: 1234 CLIENT ID: 1234 TRANSFER EFFECTIVE DATE: 07-01-2008 TRANSFER EFFECTIVE DATE: 07-01-2008 TRANSFERRING: TRANSFERRING:

SERVICE COUNTY: 006 LOCATION CODE: OHFH SERVICE COUNTY: 006 LOCATION CODE: OHFH PRGP: COMP/LCN: 8XX / 0110111946 CONTRACT NUMBER: 001001500PRGP: COMP/LCN: 8XX / 0110111946 CONTRACT NUMBER: 001001500CDSA: COMP/LCN: ___ / __________ CONTRACT NUMBER: _________ CDSA: COMP/LCN: ___ / __________ CONTRACT NUMBER: _________

RECEIVING: Enter only if changing/adding provider(s) RECEIVING: Enter only if changing/adding provider(s) SERVICE COUNTY: SERVICE COUNTY: 006006 LOCATION CODE: LOCATION CODE: OHFHOHFH RESIDENTIAL TYPE: RESIDENTIAL TYPE: 33 PRGP: COMP/LCN: 8YY / PRGP: COMP/LCN: 8YY / Y444Y444_____ CONTRACT NUMBER: 001001510_____ CONTRACT NUMBER: 001001510 CDSA: COMP/LCN: 8ZZ/ CDSA: COMP/LCN: 8ZZ/ Z420Z420 _____ CONTRACT NUMBER: 001001600 _____ CONTRACT NUMBER: 001001600

DOLLAR AMTS: AA MHM DENTAL OTHER SVCSDOLLAR AMTS: AA MHM DENTAL OTHER SVCS

TO BE PROV NOW TO TRANS DT: 0.00 0.00 0.00 TO BE PROV NOW TO TRANS DT: 0.00 0.00 0.00 73.88 73.88

TRANSFER ACCEPTED? _ (Y/N) BY: _________TRANSFER ACCEPTED? _ (Y/N) BY: ____________________________ DATE:_________________________ DATE:____________C.O. AUTHORIZE TRANSFER? _ (Y/N) BY: _______ DATE: ________ (MMDDYYYY) C.O. AUTHORIZE TRANSFER? _ (Y/N) BY: _______ DATE: ________ (MMDDYYYY)

READY TO CHANGE? READY TO CHANGE? YY (Y/N) (Y/N) ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN

DOC DOC

07-01-08 C02:INDIVIDUAL PLAN OF CARE VC060230 07-01-08 C02:INDIVIDUAL PLAN OF CARE VC060230 PLEASE ENTER ONE OF THE FOLLOWING: PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: CLIENT ID: 12341234__________ __________ COMPONENT CODE/LOCAL CASE NUMBER: 8YY / __________ COMPONENT CODE/LOCAL CASE NUMBER: 8YY / __________ MEDICAID NUMBER: _________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: TYPE OF ENTRY: TT I=INITIAL I=INITIAL N=RENEWAL N=RENEWAL

E=ERROR CORRECTION E=ERROR CORRECTION T=TRANSFER T=TRANSFER

R=REVISION R=REVISION D=DELETE D=DELETE

PLEASE ENTER FOR INITIAL PLANS ONLY: PLEASE ENTER FOR INITIAL PLANS ONLY: BEGIN DATE: ________ (MMDDYYYY)BEGIN DATE: ________ (MMDDYYYY)

PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT TYPES: PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT TYPES: 16=LA/REF, 17=TXHML/REF, 18=TXHML/WL 16=LA/REF, 17=TXHML/REF, 18=TXHML/WL _ 365 DAYS _ 270 DAYS _ 180 DAYS _ 365 DAYS _ 270 DAYS _ 180 DAYS *** PRESS ENTER *** *** PRESS ENTER *** ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN

DOC) DOC)

07-01-08 C02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060232A 07-01-08 C02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060232A NAME: TYE,BEAUNAME: TYE,BEAU CLCN: 8YY 000000Y420 CLIENT ID: 1234 CLCN: 8YY 000000Y420 CLIENT ID: 1234

BEG DT: 01012008 REV DT: 07012008 (MMDDYYYY) END DT: 12312008 BEG DT: 01012008 REV DT: 07012008 (MMDDYYYY) END DT: 12312008 SERVICE CATEGORY SERVICE CATEGORY UNITS UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS CMM CASE MANAGEMENT CMM CASE MANAGEMENT 1212___ MONS ___ MONS SHLV SUPPORTED HOME LIVING SHLV SUPPORTED HOME LIVING

900 HRS 900 HRS SP SPEECH/LANGUAGE _____ HRS SP SPEECH/LANGUAGE _____ HRS FC HCS FOSTER CARE __ DAYS FC HCS FOSTER CARE __ DAYS OT OCCUPATIONAL THERA _____ HRS OT OCCUPATIONAL THERA _____ HRS SL SUPERVISED LIVING __ DAYS SL SUPERVISED LIVING __ DAYS PT PHYSICAL THERAPY _____ HRS PT PHYSICAL THERAPY _____ HRS RSS RES SUPPORT SVC __ DAYS RSS RES SUPPORT SVC __ DAYS DI DIETARY DI DIETARY _____ HRS _____ HRS NU NURSING 20 NU NURSING 20

HRS HRS PS PSYCHOLOGY PS PSYCHOLOGY _____ HRS _____ HRS REHV RESPITE HR REHV RESPITE HR

30 HRS 30 HRS AU AUDIOLOGY AU AUDIOLOGY _____ HRS _____ HRS RE RESPITE __ DAYS RE RESPITE __ DAYS

SW SOCIAL WORK SW SOCIAL WORK _____ HRS _____ HRS DH DAY HAB DH DAY HAB

240 DAYS 240 DAYS SE SUPPORTED EMP _____ HRS SE SUPPORTED EMP _____ HRS FMSV FMS MONTHLY FEE FMSV FMS MONTHLY FEE 66 MONSMONS SCV SUPPORT CONSULTAT __SCV SUPPORT CONSULTAT ______ HRS __ HRS DE DENTAL DE DENTAL ___ DOL_ DOL AA ADAPTIVE AIDS AA ADAPTIVE AIDS 100__ DOL 100__ DOL MHM MINOR HOME MODS 1009 DOLMHM MINOR HOME MODS 1009 DOL

RESIDENTIAL TYPE: RESIDENTIAL TYPE: 33 (2-5) LOCATION: OHFH (OHFH) (2-5) LOCATION: OHFH (OHFH) READY TO CONTINUE? READY TO CONTINUE? YY (Y/N) (Y/N) ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1 ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1

07-01-08 C02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER 07-01-08 C02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060233AVC060233A

NAME: TYE,BEAUNAME: TYE,BEAU CLCN: 8ZZ 000000Z444 CLIENT ID: 1234 CLCN: 8ZZ 000000Z444 CLIENT ID: 1234 IPC BEGIN DATE: 01-01-2008 REVISE DATE: 07-01-2008 END DATE: 12-IPC BEGIN DATE: 01-01-2008 REVISE DATE: 07-01-2008 END DATE: 12-

31-2008 31-2008 SERVICE CATEGORY UNITS SERVICE CATEGORY SERVICE CATEGORY UNITS SERVICE CATEGORY

UNITS UNITS REHVREHV RESPITE HR 14.00 HRS SHLV SUPPORTED HOME LIVING RESPITE HR 14.00 HRS SHLV SUPPORTED HOME LIVING

470 HRS470 HRSFMSV FMS MONTHLY FEE 6.00 MONSFMSV FMS MONTHLY FEE 6.00 MONS

CDS ESTIMATED ANNUAL TOTAL: $9,206.86 CDS ESTIMATED ANNUAL TOTAL: $9,206.86

READY TO COMTINUE? READY TO COMTINUE? YY (Y/N) ANNUAL COST: $36,768.78 COST CEILING: (Y/N) ANNUAL COST: $36,768.78 COST CEILING: 78,967.7578,967.75

ACT: ____ (F/FWD,B/BK,L00MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) ACT: ____ (F/FWD,B/BK,L00MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

07-01-08 C02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060237A 07-01-08 C02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060237A NAME: TYE,BEAU CLCN: 8YY 000000Y420 CLIENT ID: 1234 NAME: TYE,BEAU CLCN: 8YY 000000Y420 CLIENT ID: 1234 IPC BEGIN DATE: 01-01-2008 REVISE DATE: 07-01-2008 END DATE: 12-31-IPC BEGIN DATE: 01-01-2008 REVISE DATE: 07-01-2008 END DATE: 12-31-

2008 2008 SERVICE CATEGORY SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS UNITS SERVICE CATEGORY UNITS CMMB CMMB CASE MGMT SELF DIR CASE MGMT SELF DIR 12.00 MONS NU NURSING12.00 MONS NU NURSING

20.00 HRS 20.00 HRS DHDH DAY HABILITATION DAY HABILITATION 240 DAYS REH RESPITE HR 16.00 240 DAYS REH RESPITE HR 16.00

HRS HRS SHL SUPPORTED HOME LVG 460 HRSSHL SUPPORTED HOME LVG 460 HRS AA ADAPTIVE AIDS AA ADAPTIVE AIDS

100.00 DOL100.00 DOLMHM MINOR HOME MODS MHM MINOR HOME MODS 1009.00 DOL1009.00 DOL

PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: $27,561.92 $27,561.92

READY TO CONTINUE? READY TO CONTINUE? YY (Y/N) (Y/N) ANNUAL COST: $36,768.78 ANNUAL COST: $36,768.78 COST CEILING: COST CEILING: $78,967.75$78,967.75

ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

07-01-08 C02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060238A 07-01-08 C02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060238A NAME: TYE,BEAUNAME: TYE,BEAU CLCN: 0000000001 CLIENT ID: 1234 CLCN: 0000000001 CLIENT ID: 1234 PRGP: CONTRACT:001001510 COMPONENT: 8YY LOCAL CASE NUMBER : PRGP: CONTRACT:001001510 COMPONENT: 8YY LOCAL CASE NUMBER :

000000Y420 000000Y420 CDSA: CONTRACT:001011600 COMPONENT: 8ZZ LOCAL CASE NUMBER : CDSA: CONTRACT:001011600 COMPONENT: 8ZZ LOCAL CASE NUMBER :

000000Z444 000000Z444 IPC BEGIN DATE: 01-01-2008 REVISE DATE: 07-01-2008 END DATE: 12-31-2008 IPC BEGIN DATE: 01-01-2008 REVISE DATE: 07-01-2008 END DATE: 12-31-2008 TOTAL ANNUAL COST: $36,078.88TOTAL ANNUAL COST: $36,078.88 COST CEILING: $78,967.75COST CEILING: $78,967.75

ARE ANY DIRECT SERVICES PROVIDED BY A RELATIVE/GUARDIAN? ARE ANY DIRECT SERVICES PROVIDED BY A RELATIVE/GUARDIAN? YY (Y/N)(Y/N)CONTRACTED PROVIDER NAME: CONTRACTED PROVIDER NAME: APRIL MAYAPRIL MAY____________________ ____________________ DATE (MMDDYYYY): DATE (MMDDYYYY): 0701200807012008 IDT CERTIFICATION STATEMENT IDT CERTIFICATION STATEMENT

DATE DATE NAME NAME

(MMDDYYYY) (MMDDYYYY) CASE MANAGER CASE MANAGER : : MAC TRUCKMAC TRUCK __________________________________________ 0701200807012008 NURSE NURSE : : N. RATCHET RNN. RATCHET RN__________________ __________________ 0701200807012008 CONSUMER/LEGAL REPRESENTATIVE : TYE,BEAUCONSUMER/LEGAL REPRESENTATIVE : TYE,BEAU 07012008 07012008

READY TO ADD? READY TO ADD? YY (Y/N) (Y/N) ACT: ____ (C00/PROV ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC) ACT: ____ (C00/PROV ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

07-01-08 C06:TRANSFER: CONTRACT/SERVICES: A/C/D VC060311 07-01-08 C06:TRANSFER: CONTRACT/SERVICES: A/C/D VC060311


CLIENT ID: CLIENT ID: 12341234______ ____ COMPONENT CODE/LOCAL CASE NUMBER: COMPONENT CODE/LOCAL CASE NUMBER: 8YY8YY / __________ / __________



CONTRACT NUMBER: CONTRACT NUMBER: 001001510001001510

TRANSFER EFFECTIVE DATE: TRANSFER EFFECTIVE DATE: 0701200807012008 FOR ADD ONLY:FOR ADD ONLY:

CHANGING PrgP OR CDS AGENCY? _ (Y/N)CHANGING PrgP OR CDS AGENCY? _ (Y/N)ADDING A PrgP OR CDS AGENCY? _ (Y/N)ADDING A PrgP OR CDS AGENCY? _ (Y/N)

CHANGING SERVICE DELIVERY OPTIONS? _ (Y/N)CHANGING SERVICE DELIVERY OPTIONS? _ (Y/N)

TYPE OF ENTRY: TYPE OF ENTRY: CC (A/ADD,C/CHANGE,D/DELETE) (A/ADD,C/CHANGE,D/DELETE)


ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC)HLP(PF1)/SCRN DOC)

07-12-08 C06: TRANSFER CONTRACT/SERVICES: CHANGE VC06031607-12-08 C06: TRANSFER CONTRACT/SERVICES: CHANGE VC060316 NAME : TYE,BEAUNAME : TYE,BEAU CLIENT ID: 1234 CLIENT ID: 1234 TRANSFER EFFECTIVE DATE: 07-01-2008 TRANSFER EFFECTIVE DATE: 07-01-2008 TRANSFERRING: TRANSFERRING:

SERVICE COUNTY: 006 LOCATION CODE: OHFH SERVICE COUNTY: 006 LOCATION CODE: OHFH PRGP: COMP/LCN: 8XX / 00101500 CONTRACT NUMBER: 001001500PRGP: COMP/LCN: 8XX / 00101500 CONTRACT NUMBER: 001001500CDSA: COMP/LCN: ___ / ________ CONTRACT NUMBER: _________ CDSA: COMP/LCN: ___ / ________ CONTRACT NUMBER: _________

RECEIVING: Enter only if changing/adding provider(s) RECEIVING: Enter only if changing/adding provider(s)

SERVICE COUNTY: 8YY LOCATION CODE: OHFH_ RESIDENTIAL TYPE: 3SERVICE COUNTY: 8YY LOCATION CODE: OHFH_ RESIDENTIAL TYPE: 3PRGP: COMP/LCN: 8YY / Y420 ____ CONTRACT NUMBER: 001001510PRGP: COMP/LCN: 8YY / Y420 ____ CONTRACT NUMBER: 001001510CDSA: COMP/LCN: 8ZZ / Z444_____ CONTRACT NUMBER: 001011600 CDSA: COMP/LCN: 8ZZ / Z444_____ CONTRACT NUMBER: 001011600

DOLLAR AMTS: AA MHM DENTAL OTHER SVCS DOLLAR AMTS: AA MHM DENTAL OTHER SVCS TO BE PROV NOW TO TRANS DT: 0.00 0.00 0.00 73.88 TO BE PROV NOW TO TRANS DT: 0.00 0.00 0.00 73.88

TRANSFER ACCEPTEDTRANSFER ACCEPTED? ? YY (Y/N) BY(Y/N) BY: : ART WORKART WORK______________________________ DATE: DATE: 0701200807012008C.O. AUTHORIZE TRANSFER? _ (Y/N) BY: _______ DATE: ________ (MMDDYYYY) C.O. AUTHORIZE TRANSFER? _ (Y/N) BY: _______ DATE: ________ (MMDDYYYY)

READY TO TRANSFER? READY TO TRANSFER? YY (Y/N) (Y/N) ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC

TxHmL Transfer TxHmL Transfer ExampleExample

In this transfer example, the In this transfer example, the individual will transfer from individual will transfer from

the current Program Provider the current Program Provider to a new Program Provider and to a new Program Provider and initiate the CDS option (adding initiate the CDS option (adding

a CDSA).a CDSA).

10-15-08 10-15-08 L09:REGISTER CLIENT UPDATE L09:REGISTER CLIENT UPDATE VC060420VC060420

PLEASE ENTER AT LEAST ONE OF THE FOLLOWING: PLEASE ENTER AT LEAST ONE OF THE FOLLOWING:

CLIENT ID: CLIENT ID: 98769876______ ______ COMPONENT CODE/LOCAL CASE NUMBER: COMPONENT CODE/LOCAL CASE NUMBER: 8SS8SS / __________ / __________

NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW ENROLLMENTS USE THE PROVIDERS COMPONENT CODE IN THE ENROLLMENTS USE THE PROVIDERS COMPONENT CODE IN THE

ABOVE FIELD. ABOVE FIELD.


ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC) HLP(PF1)/SCRN DOC)

10-15-08 L09:REGISTER CLIENT UPDATE VC06042510-15-08 L09:REGISTER CLIENT UPDATE VC060425 CLIENT LAST NAME/SUF: ABSENT CLIENT ID : 9876 CLIENT LAST NAME/SUF: ABSENT CLIENT ID : 9876 CLIENT FIRST NAME : MARCUS COMPONENT : 8SS CLIENT FIRST NAME : MARCUS COMPONENT : 8SS CLIENT MIDDLE NAME : CLIENT MIDDLE NAME : LOCAL CASE NUMBER : LOCAL CASE NUMBER : S777S777 SEX SEX : M : M ETHNICITY : W ETHNICITY : W CLIENT BIRTHDATE (MMDDYYYY): 02181974CLIENT BIRTHDATE (MMDDYYYY): 02181974 SOCIAL SECURITY NUMBER : 987654321 (N=NONE, U=UNKNOWN) SOCIAL SECURITY NUMBER : 987654321 (N=NONE, U=UNKNOWN)

MEDICAID NUMBER : 123456789 MEDICARE NUMBER: ____________ MEDICAID NUMBER : 123456789 MEDICARE NUMBER: ____________

PRESENTING PROBLEM : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC) PRESENTING PROBLEM : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC)

REGISTRATION EFFECTIVE DATE: 022391 (MMDDYY) TIME (HHMM A/P): 10:05A REGISTRATION EFFECTIVE DATE: 022391 (MMDDYY) TIME (HHMM A/P): 10:05A

LEGAL GUARDIANSHIP : 2 LEGAL GUARDIANSHIP : 2 MARITAL STATUS: 2 ESTIMATED ANNUAL GROSS FAMILY INCOME: 7252 MARITAL STATUS: 2 ESTIMATED ANNUAL GROSS FAMILY INCOME: 7252 FAMILY SIZE : 1 FAMILY SIZE : 1 SERVICE PARTICIPANT GROUP : __ (CB, SB, PD, HC, TS, EC, UC) SERVICE PARTICIPANT GROUP : __ (CB, SB, PD, HC, TS, EC, UC) READY TO UPDATE? READY TO UPDATE? YY (Y/N) (Y/N) ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN

DOC) DOC)

10-15-08 10-15-08 L09:REGISTER CLIENT UPDATE L09:REGISTER CLIENT UPDATE VC060420VC060420

PLEASE ENTER AT LEAST ONE OF THE FOLLOWING: PLEASE ENTER AT LEAST ONE OF THE FOLLOWING:

CLIENT ID: CLIENT ID: 98769876______ ______ COMPONENT CODE/LOCAL CASE NUMBER: COMPONENT CODE/LOCAL CASE NUMBER: 8TT8TT / __________ / __________

NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW ENROLLMENTS ENROLLMENTS

USE THE PROVIDERS COMPONENT CODE IN THE ABOVE FIELD. USE THE PROVIDERS COMPONENT CODE IN THE ABOVE FIELD.


ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC) HLP(PF1)/SCRN DOC)

10-15-08 L09:REGISTER CLIENT UPDATE VC06042510-15-08 L09:REGISTER CLIENT UPDATE VC060425 CLIENT LAST NAME/SUF: ABSENT CLIENT ID : 9876 CLIENT LAST NAME/SUF: ABSENT CLIENT ID : 9876 CLIENT FIRST NAME : MARCUS COMPONENT : 8TT CLIENT FIRST NAME : MARCUS COMPONENT : 8TT CLIENT MIDDLE NAME : CLIENT MIDDLE NAME : LOCAL CASE NUMBER : LOCAL CASE NUMBER : T10T10 SEX : M SEX : M ETHNICITY : W ETHNICITY : W CLIENT BIRTHDATE (MMDDYYYY): 02181974 CLIENT BIRTHDATE (MMDDYYYY): 02181974 SOCIAL SECURITY NUMBER : 987654321 (N=NONE, U=UNKNOWN) SOCIAL SECURITY NUMBER : 987654321 (N=NONE, U=UNKNOWN)

MEDICAID NUMBER : 123456789 MEDICARE NUMBER: MEDICAID NUMBER : 123456789 MEDICARE NUMBER:

____________ ____________ PRESENTING PROBLEM : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC) PRESENTING PROBLEM : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC)

REGISTRATION EFFECTIVE DATE: 022391 (MMDDYY) TIME (HHMM A/P): REGISTRATION EFFECTIVE DATE: 022391 (MMDDYY) TIME (HHMM A/P):

10:07A 10:07A LEGAL GUARDIANSHIP : 2 LEGAL GUARDIANSHIP : 2 MARITAL STATUS: 2 ESTIMATED ANNUAL GROSS FAMILY INCOME: 7252 MARITAL STATUS: 2 ESTIMATED ANNUAL GROSS FAMILY INCOME: 7252 FAMILY SIZE : 1 FAMILY SIZE : 1 SERVICE PARTICIPANT GROUP : __ (CB, SB, PD, HC, TS, EC, UC) SERVICE PARTICIPANT GROUP : __ (CB, SB, PD, HC, TS, EC, UC) READY TO UPDATE? READY TO UPDATE? YY (Y/N) (Y/N) ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN

DOC) DOC)

10-15-08 L06: CONSUMER TRANSFER: CONTRACT/SERVICES: A/C/D 10-15-08 L06: CONSUMER TRANSFER: CONTRACT/SERVICES: A/C/D VC060311 VC060311


CLIENT ID: CLIENT ID: 98769876

COMPONENT CODE/LOCAL CASE NUMBER: COMPONENT CODE/LOCAL CASE NUMBER: 8WW8WW / __________ / __________ MEDICAID NUMBER: _________ MEDICAID NUMBER: _________


CONTRACT NUMBER: CONTRACT NUMBER: 001010888001010888

TRANSFER EFFECTIVE DATE: TRANSFER EFFECTIVE DATE: 1015200810152008 (MMDDYYYY) (MMDDYYYY)

FOR ADD ONLY:FOR ADD ONLY: 1. CHANGING PROGRAM PROVIDER OR CDS AGENCY? 1. CHANGING PROGRAM PROVIDER OR CDS AGENCY? YY

(Y/N) (Y/N) 2. ADDING A PROGRAM PROVIDER OR 2. ADDING A PROGRAM PROVIDER OR CDS AGENCY? CDS AGENCY? YY (Y/N) (Y/N)

3. CHANGING SERVICE DELIVERY OPTIONS?3. CHANGING SERVICE DELIVERY OPTIONS? YY (Y/N) (Y/N)

TYPE OF ENTRY:TYPE OF ENTRY: AA (A/ADD,C/CHANGE,D/DELETE) (A/ADD,C/CHANGE,D/DELETE)


ACT: ____ (L00/TXHML DATA ENTRY MENU, A/HCS MAIN MENU, ACT: ____ (L00/TXHML DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC) HLP(PF1)/SCRN DOC)

10-15-08 L06: TRANSFER CONTRACT/SERVICES: ADD VC060311 10-15-08 L06: TRANSFER CONTRACT/SERVICES: ADD VC060311 NAME : ABSENT, MARCUS CLIENT ID: 9876 NAME : ABSENT, MARCUS CLIENT ID: 9876 EFFECTIVE DATE: 10152008 EFFECTIVE DATE: 10152008 (MMDDYYYY)(MMDDYYYY)

SERVICESERVICE SDO CLAIM - PD/UNPD = REMAIN TO USE SDO CLAIM - PD/UNPD = REMAIN TO USE NEW SDO NEW SDO UNITS UNITS

ADAPTIVE AIDSADAPTIVE AIDS PRGP 275.00 PRGP 275.00 150.00 125.00 150.00 125.00 00_____ _____ PPDAY HABILITATION PRGP 150.00DAY HABILITATION PRGP 150.00 95.00 95.00 55.00 55.00 1010_____ _____ PP MINOR HOME MODS PRGPMINOR HOME MODS PRGP 750.00 400.00 750.00 400.00 350.00 350.00 00_____ _____ PP NURSING PRGP 20NURSING PRGP 20 7.00 7.00 13.00 13.00 00_____ _____ P P RESPITE HOURLYRESPITE HOURLY PRGP 30 13.00 17.00 PRGP 30 13.00 17.00 00_____ _____ CC COMMUNITY SUPPORT COMMUNITY SUPPORT PRGP 175 PRGP 175 85.00 85.00 90.00 90.00 00_____ _____ C C READY TO ADD? READY TO ADD? YY (Y/N) (Y/N)

10-15-08 L06: TRANSFER CONTRACT/SERVICES: ADD VC060311 10-15-08 L06: TRANSFER CONTRACT/SERVICES: ADD VC060311 NAME : ABSENT, MARCUS CLIENT ID: 9876 NAME : ABSENT, MARCUS CLIENT ID: 9876 EFFECTIVE DATE: 10152008 EFFECTIVE DATE: 10152008 (MMDDYYYY)(MMDDYYYY)

SERVICESERVICE SDO CLAIM - PD/UNPD TO USE = SDO CLAIM - PD/UNPD TO USE = REMAIN NEW SDO REMAIN NEW SDO UNITS UNITS

ADAPTIVE AIDSADAPTIVE AIDS PRGP 275.00 PRGP 275.00 150.00 0.00 125.00_____ 150.00 0.00 125.00_____ P P DAY HABILITATION PRGP 150.00DAY HABILITATION PRGP 150.00 95.00 10.00 95.00 10.00 45.00_____ P 45.00_____ P MINOR HOME MODS PRGPMINOR HOME MODS PRGP 750.00 400.00 0.00 750.00 400.00 0.00 350.00_____ 350.00_____ PP NURSING PRGPNURSING PRGP 20 20 7.00 7.00 0.00 0.00 13.00_____ 13.00_____ P P RESPITE HOURLYRESPITE HOURLY PRGP PRGP 30 13.00 0.00 30 13.00 0.00 17.00_____ C 17.00_____ C COMMUNITY SUPPORTCOMMUNITY SUPPORT PRGP 175 PRGP 175 85.00 85.00 0.00 0.00 90.00_____ C 90.00_____ C READY TO CONFIRM? READY TO CONFIRM? YY (Y/N) (Y/N)

10-15-08 L06:CONSUMER TRANSFER CONTRACT/SERVICES: ADD VC06023810-15-08 L06:CONSUMER TRANSFER CONTRACT/SERVICES: ADD VC060238

NAME : ABSENT,MARCUS CLIENT ID: 9876 NAME : ABSENT,MARCUS CLIENT ID: 9876 TRANSFER EFFECTIVE DATE: 10152008 TRANSFER EFFECTIVE DATE: 10152008 TRANSFERRING: TRANSFERRING: SERVICE COUNTY: 006 LOCATION CODE: OHFH SERVICE COUNTY: 006 LOCATION CODE: OHFH PRGP: COMP/LCN: 8WW / 0110111946 CONTRACT NUMBER: 001008006PRGP: COMP/LCN: 8WW / 0110111946 CONTRACT NUMBER: 001008006CDSA: COMP/LCN: ___ / __________ CONTRACT NUMBER: _________CDSA: COMP/LCN: ___ / __________ CONTRACT NUMBER: _________RECEIVING: Enter only if changing/adding provider (s) RECEIVING: Enter only if changing/adding provider (s) SERVICE COUNTY: SERVICE COUNTY: 006006 LOCATION CODE: LOCATION CODE: OHFHOHFH RESIDENTIAL TYPE: RESIDENTIAL TYPE: 33PRGP: COMP/LCN: PRGP: COMP/LCN: 8SS8SS / / S777S777______ CONTRACT NUMBER: ______ CONTRACT NUMBER: 001010999001010999CDSA: COMP/LCN: CDSA: COMP/LCN: 8TT8TT / / T10T10____________ CONTRACT NUMBER: CONTRACT NUMBER: 001010777001010777 DOLLAR AMTS: AA MHM DENTAL DOLLAR AMTS: AA MHM DENTAL

OTHER SVCS OTHER SVCS TO BE PROV NOW TO TRANS DT: 0.00 0.00 0.00TO BE PROV NOW TO TRANS DT: 0.00 0.00 0.00

242.20 242.20 TRANSFER ACCEPTED?_ (Y/N) BY: ___________________ DATE:_________TRANSFER ACCEPTED?_ (Y/N) BY: ___________________ DATE:_________READY TO ADD? READY TO ADD? YY (Y/N) (Y/N) ACT: ____ (L00/AUTH DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC ACT: ____ (L00/AUTH DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC

10-15-08 L02:INDIVIDUAL PLAN OF CARE VC06023010-15-08 L02:INDIVIDUAL PLAN OF CARE VC060230 PLEASE ENTER ONE OF THE FOLLOWING:PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: CLIENT ID: 98769876____________ COMPONENT CODE/LOCAL CASE NUMBER: COMPONENT CODE/LOCAL CASE NUMBER: 8SS8SS / __________ / __________ MEDICAID NUMBER: _________MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING:PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: TYPE OF ENTRY: TT I=INITIAL N=RENEWAL I=INITIAL N=RENEWAL E=ERROR CORRECTION E=ERROR CORRECTION

T=TRANSFERT=TRANSFER R=REVISION R=REVISION

D=DELETED=DELETE PLEASE ENTER FOR INITIAL PLANS ONLY:PLEASE ENTER FOR INITIAL PLANS ONLY: BEGIN DATE: ________ (MMDDYYYY)BEGIN DATE: ________ (MMDDYYYY) PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT

TYPES:TYPES: 16=LA/REF, 17=TXHML/REF, 18=TXHML/WL16=LA/REF, 17=TXHML/REF, 18=TXHML/WL _ 365 DAYS _ 270 DAYS _ 180 DAYS_ 365 DAYS _ 270 DAYS _ 180 DAYS *** PRESS ENTER ****** PRESS ENTER *** ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU,

HLP(PF1)/SCRN DOC)HLP(PF1)/SCRN DOC)

10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY:TRANSFER VC060233A 10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY:TRANSFER VC060233A NAME: ABSENT,MARCUS CLCN: 8SS CLIENT ID: 9876 NAME: ABSENT,MARCUS CLCN: 8SS CLIENT ID: 9876 BEG DT: 04012008 REV DT: 10152008 (MMDDYYYY) END DT: 03312009 BEG DT: 04012008 REV DT: 10152008 (MMDDYYYY) END DT: 03312009 SERVICE CATEGORY SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS SERVICE CATEGORY

UNITS UNITS AUAU AUDIOLOGY AUDIOLOGY 0 DOL 0 DOL OT OCCUPATIONAL THERAPY 0.00 DOL OT OCCUPATIONAL THERAPY 0.00 DOL

BES BES BEHAVIOR SUPPORT BEHAVIOR SUPPORT 0 HRS 0 HRS PT PHYSICAL THERAPY 0 PT PHYSICAL THERAPY 0

HRS HRS CSV CSV COMMUNITY SUPPORT 175 HRS COMMUNITY SUPPORT 175 HRS RE RESPITE RE RESPITE

0 DAYS 0 DAYS DH DH DAY HABILITATION DAY HABILITATION 150 DAYS 150 DAYS REHV RESPITE HR REHV RESPITE HR

30 HRS 30 HRS DIDI DIETARY DIETARY 0 HRS 0 HRS SP SPEECH/LANGUAGE SP SPEECH/LANGUAGE

0 HRS 0 HRS EA EA EMP ASSISTANCE EMP ASSISTANCE 0 HRS 0 HRS SE SUPPORTED EMP SE SUPPORTED EMP

0 HRS 0 HRS NU NU NURSING NURSING 20 HRS 20 HRS DE DENTAL DE DENTAL

0 DOL 0 DOL MHM MHM MINOR HOME MOD MINOR HOME MOD 750 DOL 750 DOL AA ADAPTIVE AIDS AA ADAPTIVE AIDS

275 DOL 275 DOL MHMRMHMR MINOR HOME MOD RE MINOR HOME MOD RE 81 DOL 81 DOL AAR ADAPTIVE AIDS REQ. AAR ADAPTIVE AIDS REQ.

28 DOL 28 DOL SCV SCV SUPPORT CONSULTATION SUPPORT CONSULTATION 11 HRS HRS FMSV FMS MONTHLY FEE FMSV FMS MONTHLY FEE

6 6 MONS MONS

RESIDENTIAL TYPE: 3 (2-5) LOCATION: OHFH (OFH) RESIDENTIAL TYPE: 3 (2-5) LOCATION: OHFH (OFH) READY TO CONTINUE?:READY TO CONTINUE?: YY (Y/N) (Y/N) ACT: ___ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) ACT: ___ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER 10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060232B VC060232B

NAME: ABSENT,MARCUS CLCN: 8SS 000000S777 CLIENT ID: 9876 NAME: ABSENT,MARCUS CLCN: 8SS 000000S777 CLIENT ID: 9876

BEG DT: 04012008 REVISE DT: 10152008 (MMDDYYYY) END DATE: BEG DT: 04012008 REVISE DT: 10152008 (MMDDYYYY) END DATE: 03312009 03312009

SERVICE CATEGORY SERVICE CATEGORY UNITS UNITSCSVCSV COMMUNITY SUPPORTCOMMUNITY SUPPORT 90 HRS 90 HRSFMFM SVSV FMSFMS 6 MOS 6 MOSREHVREHV RESPITE HRRESPITE HR 17 HRS 17 HRS SCVSCV SUPPORT CONSULTATION 1 HRS SUPPORT CONSULTATION 1 HRS

CALCULATE?: CALCULATE?: YY (Y/N) (Y/N) CDS ESTIMATED ANNUAL TOTAL: CDS ESTIMATED ANNUAL TOTAL: $3,662.94$3,662.94

READY TO CONTINUE? READY TO CONTINUE? YY (Y/N) ANNUAL COST: $11,972.15 COST CEILING: (Y/N) ANNUAL COST: $11,972.15 COST CEILING: $13,000.00$13,000.00

ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) MENU,HLP(PF1)/SCRNDOC)

10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER 10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060232C VC060232C

NAME: ABSENT,MARCUSNAME: ABSENT,MARCUS CLCN: 8SS 000000S777 CLIENT ID: 9876 CLCN: 8SS 000000S777 CLIENT ID: 9876 BEG DT: 04012008 REVISE DT: 10152008 (MMDDYYYY) END DATE: BEG DT: 04012008 REVISE DT: 10152008 (MMDDYYYY) END DATE:

03312009 03312009

SERVICE CATEGORY SERVICE CATEGORY UNITS UNITSCSCS COMMUNITY SUPPORT 85HRSCOMMUNITY SUPPORT 85HRSDHDH DAY HABILITATION 150 DAYSDAY HABILITATION 150 DAYSNUNU NURSINGNURSING 20 HRS 20 HRSREHREH RESPITE HRRESPITE HR 13 HRS 13 HRSAAAA ADAPTIVE AIDSADAPTIVE AIDS 275 DOL275 DOLAARAAR ADAPTIVE AIDS READAPTIVE AIDS RE 28 DOL 28 DOLMHMMHM MINOR HOME MODSMINOR HOME MODS 750 DOL750 DOLMHMRMHMR MINOR HOME MODS RE 81 DOLMINOR HOME MODS RE 81 DOL

PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: $8,309.21PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: $8,309.21READY TO CONTINUE? READY TO CONTINUE? YY (Y/N) ANNUAL COST: $ 11,972.15 COST CEILING: (Y/N) ANNUAL COST: $ 11,972.15 COST CEILING:

$13,000.00$13,000.00

ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) MENU,HLP(PF1)/SCRNDOC)

10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060238A 10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060238A NAME: ABSENT,MARCUS CLCN: 8SS 000000S777 CLIENT ID: 9876 NAME: ABSENT,MARCUS CLCN: 8SS 000000S777 CLIENT ID: 9876 PRGP:CONTRACT: 001010888 COMPONENT: 8SS LOCAL CASE NUMBER: PRGP:CONTRACT: 001010888 COMPONENT: 8SS LOCAL CASE NUMBER: 000000S777 000000S777 CDSA:CONTRACT: 001010999 COMPONENT: 8TT LOCAL CASE NUMBER: CDSA:CONTRACT: 001010999 COMPONENT: 8TT LOCAL CASE NUMBER: 0000000T10 0000000T10

IPC BEGIN DATE: 04012008 REVISE DATE: 10152008 END DATE: 03312009 IPC BEGIN DATE: 04012008 REVISE DATE: 10152008 END DATE: 03312009 TOTAL ANNUAL COST : 3,925.82 COST CEILING: 13,000.00 TOTAL ANNUAL COST : 3,925.82 COST CEILING: 13,000.00 ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN?ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN? NN (Y/N) (Y/N) CONTRACTED PROVIDER NAME: CONTRACTED PROVIDER NAME: GENE POOLEGENE POOLE

DATE (MMDDYYYY):DATE (MMDDYYYY): 1015200810152008


NAME NAME DATE(MMDDYYYY) DATE(MMDDYYYY) CASE MANAGER: CASE MANAGER: JUNEJUNE MAYMAY ______________________________________________________________ 1014200810142008 NURSE: NURSE: NANA________________________________________________________________________________________________ 1014200810142008 CONSUMER/LEGAL REPRESENTATIVE: ABSENT,MARCUS_____ CONSUMER/LEGAL REPRESENTATIVE: ABSENT,MARCUS_____ 1014200810142008 READY TO ADD? : READY TO ADD? : YY (Y/N) (Y/N) ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC) DOC)

10-15-08 L06:CONSUMER TRANSFER CONTRACT/SERVICES: ADD 10-15-08 L06:CONSUMER TRANSFER CONTRACT/SERVICES: ADD VC060316VC060316

NAME : ABSENT,MARCUS CLIENT ID: 9876 NAME : ABSENT,MARCUS CLIENT ID: 9876 TRANSFER EFFECTIVE DATE: 10152008 TRANSFER EFFECTIVE DATE: 10152008 TRANSFERRING: TRANSFERRING: SERVICE COUNTY: 006 LOCATION CODE: OHFH SERVICE COUNTY: 006 LOCATION CODE: OHFH PRGP: COMP/LCN: 8WW / 0110111946 CONTRACT NUMBER: 001008006PRGP: COMP/LCN: 8WW / 0110111946 CONTRACT NUMBER: 001008006CDSA: COMP/LCN: ___ / __________ CONTRACT NUMBER: _________CDSA: COMP/LCN: ___ / __________ CONTRACT NUMBER: _________RECEIVING: Enter only if changing/adding provider (s) RECEIVING: Enter only if changing/adding provider (s) SERVICE COUNTY: 006 LOCATION CODE: OHFH RESIDENTIAL SERVICE COUNTY: 006 LOCATION CODE: OHFH RESIDENTIAL

TYPE:___TYPE:___PRGP: COMP/LCN: 8SS / S777______ CONTRACT NUMBER: 001010999PRGP: COMP/LCN: 8SS / S777______ CONTRACT NUMBER: 001010999CDSA: COMP/LCN: 8TT / T10______ CONTRACT NUMBER: 001010777CDSA: COMP/LCN: 8TT / T10______ CONTRACT NUMBER: 001010777 DOLLAR AMTS: AA MHM DENTAL DOLLAR AMTS: AA MHM DENTAL

OTHER SVCS OTHER SVCS TO BE PROV NOW TO TRANS DT: 0.00 0.00 0.00 TO BE PROV NOW TO TRANS DT: 0.00 0.00 0.00

242.20 242.20 TRANSFER ACCEPTED?TRANSFER ACCEPTED? YY (Y/N) BY: (Y/N) BY: PERCY VEERPERCY VEER________ DATE: ________ DATE:

1015200810152008READY TO TRANSFER? READY TO TRANSFER? YY (Y/N) (Y/N) ACT: ____ (L00/AUTH DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOCACT: ____ (L00/AUTH DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC

BREAKBREAK

Questions and AnswersQuestions and Answers

Abuse, Neglect and Abuse, Neglect and Exploitation (ANE)--Exploitation (ANE)--

What will change with the What will change with the implementation of CDS implementation of CDS and what will stay the and what will stay the

same? same?

Organization of The Texas Organization of The Texas Department of Family and Department of Family and

Protective Services (DFPS)Protective Services (DFPS)

Two branches:Two branches: Adult Protective Services Adult Protective Services

(APS)(APS)

Child Protective Services Child Protective Services (CPS)(CPS)

Organization of DFPS, cont.Organization of DFPS, cont.

APS breaks down into 2 APS breaks down into 2 divisions:divisions:

In-Home InvestigationsIn-Home Investigations Facility InvestigationsFacility Investigations

CPS is divided along lines of CPS is divided along lines of service delivery service delivery


APS only conducts investigations APS only conducts investigations into ANE allegations involving: into ANE allegations involving:

individuals over the age of 65, andindividuals over the age of 65, and

Individuals between the ages of 18 Individuals between the ages of 18 and 64 who have a disability.and 64 who have a disability.


One exception in APS is with regard to One exception in APS is with regard to facility facility investigationsinvestigations. If an minor individual with a . If an minor individual with a disability is receiving services in a facility, or by a disability is receiving services in a facility, or by a person employed by an HCS or TxHmL provider person employed by an HCS or TxHmL provider agency, allegations of ANE perpetrated by the agency, allegations of ANE perpetrated by the facility, or the provider agency’s employee will be facility, or the provider agency’s employee will be investigated by APS.investigated by APS.

CPS works on the supposition that for an CPS works on the supposition that for an individual under the age of 18, the parent is individual under the age of 18, the parent is ultimately responsible.ultimately responsible.

How it Works NowHow it Works Now Providers are still required to inform Providers are still required to inform

all individuals or their LARs, all individuals or their LARs, regardless of the service delivery regardless of the service delivery option they choose, how to report option they choose, how to report allegations of ANE to DFPSallegations of ANE to DFPS

Providers are still required to provide Providers are still required to provide all individuals or their LARs with the all individuals or their LARs with the toll-free number for reporting ANE, toll-free number for reporting ANE, regardless of the service delivery regardless of the service delivery option they chooseoption they choose

How it Works Now, cont.How it Works Now, cont.

DFPS DFPS Facility Facility Investigations Division of Investigations Division of APS investigates all allegations of ANE APS investigates all allegations of ANE involving individuals who receive services involving individuals who receive services in the HCS or TxHmL programs who are in the HCS or TxHmL programs who are being served through a provider agency.being served through a provider agency.

Providers are required to follow all Providers are required to follow all program rules regarding DFPS facility program rules regarding DFPS facility investigations.investigations.

What will change?What will change?

When an individual or his LAR chooses When an individual or his LAR chooses to self-direct his services and hires to self-direct his services and hires employees directly, allegations of employees directly, allegations of ANEANE involving employees of the involving employees of the individual or the LAR (employer) will individual or the LAR (employer) will be conducted by DFPS’ be conducted by DFPS’ In-Home In-Home Adult Protective Services division.Adult Protective Services division.

What will change, Cont.What will change, Cont.

The In-Home division of The In-Home division of APS does not conduct APS does not conduct ANE investigations ANE investigations involving individuals involving individuals under the age of 18. under the age of 18.

What will change, Cont.What will change, Cont.In the event a minor individual receiving HCSIn the event a minor individual receiving HCS

services under the CDS option is an allegedservices under the CDS option is an alleged

victim of ANE by an employee of the CDSvictim of ANE by an employee of the CDS

employer:employer:

Law enforcement should be notified, andLaw enforcement should be notified, and CPS may become involved only if there is CPS may become involved only if there is

suspicion the parent or legal guardian or the suspicion the parent or legal guardian or the minor is being negligent in the care or minor is being negligent in the care or supervision of the child.supervision of the child.

What will change, Cont.What will change, Cont. When DFPS In-Home division When DFPS In-Home division

conducts an ANE investigation conducts an ANE investigation involving a direct employee or involving a direct employee or contractor of the individual or LAR, contractor of the individual or LAR, the the provider or MRA provider or MRA is not is not responsible to follow program rules responsible to follow program rules related to APS related to APS facility facility investigations investigations involving the provider’s employees or involving the provider’s employees or contractors.contractors.

What will change, Cont.What will change, Cont. The individual or LAR who chooses The individual or LAR who chooses

CDS and hires employees or CDS and hires employees or contractors is responsible to train his contractors is responsible to train his employees and contractors regarding employees and contractors regarding the required time frame for reporting the required time frame for reporting ANE, and is responsible to provide ANE, and is responsible to provide his employees and contractors with his employees and contractors with the toll-free number for reporting.the toll-free number for reporting.

LUNCHLUNCH

The Role of the Case Manager or Service

Coordinator when Serving Individuals using the Consumer-

Directed Services Option

Winter, 2007

Case Management and Service Coordination

Includes:• Monitoring

• Facilitating Choice

• Identifying Additional Supports

• Coordinating Safeguards

Monitoring

Monitoring Activities

• Home visits to talk with individual

• Review of progress on service plan outcomes

• Review of documentation maintained by employer

• Review of CDSA reports

• Review of the effectiveness of service back-up plans, as necessary

• Review of any corrective action required

CDSA Reports

• The CDSA is required to provide a report quarterly, or monthly, if requested, to the CM/SC that addresses each service delivered through the CDS option, including the actual number of hours or units of service delivered

• The employer (individual or LAR) also receives this report

Communication with CDSA

• The CDSA is required to provide information about an individual’s participation in the CDS option w/in 3 working days of request by a CM/SC

• The CDSA must document and notify a CM/SC of issues or concerns related to an individual’s participation in CDS

Budget Revisions and Approval

• The employer or DR is required to make budget revisions when required by the CDSA, the CM/SC, the individual’s service team or a DADS representative

Choice

Enrollment in the CDS Option

• SC is required to present CDS option at time of enrollment

• CM or SC is required to present CDS option annually to individual or LAR

• If individual or LAR requests additional information or requests enrollment into CDS option, CM or SC must comply within 5 working days

• CM or SC must assist an individual or LAR to complete enrollment forms

Transfer to Another CDSA

• Transferring CDSA is required to notify employer and individual’s CM or SC in writing of units and dollars remaining in each budget as of scheduled transfer date

• Transferring CDSA is required to provide a final report to CM or SC within 5 days after transfer

• CM or SC has 5 working days to complete activities necessary for transfer to a different CDSA

Additional Supports

• Service planning team may recommend the employer appoint a Designated Representative (DR) to assist or perform employer responsibilities based on documentation provided by the CDSA.

Designated Representative

Support Consultation

• Service planning team must operate within existing budget to add support consultation funds

• Individual or DR must justify support consultation services, verify with CM or SC non-program resources are not available

• Support consultation must be approved by Service Planning Team

Support Consultation cont.

• Support Consultation services may be approved if:

(1) the individual receiving CDS will become employer

within 6 months;

(2) the employer or DR demonstrates need for Support

Consultation;

(3) the individual’s health and welfare may regress without additional supports for managing service providers:

(4) the service planning team has justified need for the service for other reasons.

Support Consultation cont.

• If service planning team approves Support Consultation, the service planning team is required to:

(1) approve the funds, the duration and frequency of service;

(2) assist with development of plan

(3) approve the outcomes for Support Consultation; and

(4) terminate Support Consultation when outcomes are met.

Support Advisor Responsibilities

• Support Advisor is required to notify CM or SC:

(1) when Support Consultation outcomes have

been met;

(2) if person receiving support consultation is

unable or unwilling to cooperate with service

delivery;

(3) of progress and status of the Support

Consultation service.

Safeguards

Service Back-up Plans

• The service planning team must describe:

(1) which CDS services are critical; and

(2) the length of time that constitutes a

service interruption or an emergency for the individual.

• The service planning team must approve all service back-up plans prior to implementation (CDS form 1740)

Corrective Action Plans• A CM or SC or service planning team may request a

corrective action plan (CAP) from an employer or DR. CAP to be provided in 10 days.

• A CAP can be requested if employer or DR:(1) hires ineligible service provider;(2) submits incomplete, inaccurate or late

documentation of service delivery;(3) does not follow budget;(4) does not comply with program requirements re: CDS

option; or(5) does not meet other employer responsibilities.

Corrective Action Plans cont.

• The employer or DR may request assistance from the CM or SC or others if the CAP is related to program rules or requirements

• A CAP (CDS form 1741) must include:

(1) the reason CAP is required;

(2) the action to be taken;

(3) the person responsible for each action;

(4) the date the action must be completed.

Termination of Participation in the CDS Option

• CM or SC is required to convene service planning team to address issues that may warrant immediate termination of participation in CDS

• Service planning team may recommend termination of CDS option if attempted interventions have not resulted in:(1) elimination of immediate jeopardy;(2) successful delivery of services;(3) employer responsibilities being met;(4) successful implementation of CAPs; or(5) accessing other supports to assist employer in

meeting employer responsibilities.

Termination of Participation in the CDS Option cont.

• CM or SC is required to complete following upon receipt of recommendation for involuntary termination from CDSA or other party:

(1) assist in development and implementation of CAP;

(2) document attempted interventions; and

(3) convene service planning team to:

(A) consider recommendation(s) made by CDSA

or other party;

(B) recommend additional interventions;

(C) make revisions to service plan.


• When an individual’s participation in CDS option is terminated, CM or SC is required to:

(1) ensure continuity of those services that were being delivered through CDS option; and

(2) document arrangements made to ensure continuity of services for services previously delivered

through CDS option.


• When service planning team recommends termination of CDS option, CM or SC is required to document:

(1) reason(s) for recommendation;(2) conditions and timeframes established by service

planning team for re-enrollment into CDS option;(3) justification for termination timeframes that

exceed 90 days; and(4) conditions and timeframes established by hearing officer, if applicable.


• For HCS and TxHmL, recommendations for termination must be submitted to DADS Access and Intake, Program Enrollments for review and processing.

Re-enrollment for Participation in the CDS Option

• Individual or LAR is required to notify CM or SC to request re-enrollment into CDS option

Re-enrollment for Participation in the CDS Option cont.

• Prior to re-enrollment into CDS option, CM or SC must:

(1) review reason for suspension or termination;(2) verify minimum 90-day period and any other conditions

have been met;(3) verify resolution of each issue that contributed to

suspension or termination; and(4) refer request for re-enrollment to service planning team to:

(A) revise service plan and re-enroll into CDS; OR(B) recommend denial to DADS Access and Intake, Program Enrollment for review and processing

• CDSA is required to notify CM or SC in writing within 2 working days of any repeat of prior noncompliance or additional noncompliance with requirements of individual’s program or CDS option

Re-enrollment for Participation in the CDS Option cont.

Due Process• CM or SC provides an oral explanation of an

“adverse” action recommended by a service planning team.

• Any recommendations for denial, reduction, suspension or termination of current or proposed CDS services must be submitted to DADS, Access and Intake, Program Enrollment for review. DADS will generate written notification of the right to a fair hearing as appropriate.

Questions and Answers

Monitoring and Oversight of HCS and TxHmL Providers who Serve Individuals using

the CDS Option

Winter, 2007

HCS Provider Certification Reviews

• Reviews will include individuals who receive CDS in review sample

• CDS responsibilities will be reviewed in conjunction with other program principles

• Review sequence will remain unchanged

TxHmL Provider Certification Reviews

• Reviews will monitor only provider services of individuals who receive CDS

• Compliance to §9.580(a)(21) will be reviewed in conjunction with other program principles

• Review sequence will remain unchanged

HCS Review Sample

• Individuals with CDS will be identified on pre-review report used by Waiver Survey and Certification (WS&C)

• One individual with CDS will always be included in the “comprehensive” review sample

• Additional individuals with CDS may be included in review sample depending on* # of individuals with CDS,* # of individuals served by contract,* findings re: CDS in “comprehensive” review.

CDS-Related Principles in HCS

• §9.175(b) - IDT may include CDSA representative

• §9.175(j)(1) - requires IDT to inform individual or LAR of right to transfer at least annually

• §9.175(j)(2) - requires IDT to document §9.175(j)(1)

CDS-Related Principles in HCS• §9.175(k) - for individuals receiving SHL or

Respite, requires IDT to at least annually:(1) inform individual or LAR of right to participate or discontinue CDS at any time(2) provide individual or LAR Forms 1581, 1582 and 1583 which contain information re: CDS(3) provide oral explanation of information re: CDS(4) provide individual or LAR opportunity to choose CDS and document choice on Form 1584

CDS-Related Principles in HCS• §9.175(l) - If individual or LAR chooses CDS,

requires IDT to:(1) provide names and contact info of all CDSAs in local service area(2) document individual’s or LAR’s choice of CDSA on Form 1584(3) document description of service component to be provided through CDS in ISP (4) document individual’s service back-up plan in ISP


• §9.175(m) - requires IDT to document:

- that individual/LAR was informed of right to participate or discontinue CDS at any time

and

- that list of CDSAs was given to individual or LAR who chose to participate in CDS in ISP


• §9.175(n) - requires IDT to recommend to DADS termination of FMS and support consultation for individuals in CDS if:(1) continued participation in CDS poses significant risk to individual’s health, safety, or welfare;(2) individual or LAR has not met Responsibilities of Employers and Designated Representatives section in Chapter 41, Subchapter B


• §9.175(o) - if IDT recommends termination of FMS and Support Consultation, IDT must:(1) submit IPC to DADS electronically(2) submit following documentation to DADS Access & Intake:

(A) description of service recommended for termination;

(B) reasons termination is recommended;(C) descriptions of attempts to resolve issues;(D) any other supporting documentation


• §9.177(b) - requires HCS providers adhere to each applicable rule or regulation

CDS Provider-Related Principles in TxHmL

• §9.580(a)(21) - requires program provider to notify and document notification of individual’s Service Coordinator of individual’s or LAR’s expressed interest in CDS option

HCS and TxHmL Provider Review Sequence Will Remain Unchanged

• Generally Prior Notification of Review

• Entrance Conference

• Home Visits

• Review of Documentation

• Periodic De-briefings

• Final De-briefing

• Exit Conference

CDS Implementation Training

TxHmL Authority Principles

DADS Contract Accountability and Oversight (CAO)

Monitoring and Oversight of

Mental Retardation Authorities

Overview • Identification of TxHmL Authority Principles Related to CDS

• Identification of MRA and SC Responsibilities

• Key changes to CAO Oversight Process and identification of acceptable evidence for annual TxHmL Authority review

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583 (u)

583 (s)

583 (v)

583 (b)

583 (t)

Oversight and Monitoring• Effective March 1, 2007, 40 TAC Chapter 9

includes new TxHmL authority principles specific to CDS

• Contract Accountability and Oversight Unit will continue to monitor MRA compliance with TxHmL Authority Principles through annual reviews.

• Review Process will include new principles beginning with implementation of CDS in 2008. Review sample will include, if applicable, CDS consumers.

Authority Principle Related to CDS

• 40 TAC §9.583 (b)Oversight Process Changes

Process for Enrollment The Service Coordinator (SC) must include the following in the PDP:

§9.567 (a) (6) – (8)

The MRA must:§9.567 (b) (1) – (5)

583 (b)

Process for Enrollment Related to 40 TAC §9.583

(b)Oversight Process ChangesThe SC must include in

the PDP: §9.567 (a) (6)(6) a statement that

the applicant was provided information regarding

CDS as required by subsection (b) of this section.

Acceptable Evidence:

PDP documents the applicant or LAR was provided the required information regarding the CDS option.


(b)Oversight Process ChangesThe SC must include in the PDP:

§9.567 (a) (7)(7) if the applicant

chooses to participate in CDS, a description of the service

components provided through CDS, as required by subsection (e) of this section.


All self-directed services must be included in the PDP.


(b)Oversight Process ChangesThe SC must include in the PDP:

§9.567 (a) (8)(8) if the applicant

chooses to participate in CDS, a description of the applicant’s service back- up plan, as required by subsection (e) of this

section.


The SC documents in the PDP a description of the applicant’s service back-up plan with required elements identified in subsection §41.217 (a) – (d).


(b)Oversight Process ChangesThe MRA must: §9.567 (b) (1)

(1) inform the applicant or LAR of the applicant’s right to participate in CDS and discontinue participation in CDS at any time, except as provided in 40 TAC §41.405 (a) of this title relating to Suspension of Participation in CDS;


Documentation that the applicant or LAR was provided the required information of the applicant’s right to participate or discontinue participation in CDS. (Form 1584)


(b)Oversight Process Changes §9.567 (b) (2) (A)

(2) inform the applicant or LAR that:A. except as provided in

subparagraph (B) of this paragraph, the applicant or LAR may choose to have one or more service components provided through CDS, the other service component must also be provided through CDS;


Documentation that the applicant or LAR was informed of the service components provided through CDS and exceptions to the service components.

Process for Enrollment Related to 40 TAC §9.583 (b)

Oversight Process Changes §9.567 (b) (2) (B)

(2) inform the applicant or LAR that:(B) if the applicant is receiving community support and respite and chooses to have one of these service components provided

through CDS, the other service component must also be provided through CDS;


Documentation that the applicant or LAR was informed of requirements related to choosing community support and respite service components provided through CDS.


(b)Oversight Process Changes §9.567 (b) (3)

(3) provide the applicant or LAR a copy of Forms 1581, 1582, and 1583 which are available at http://www.dads.state.tx.us/handbooks/form/default/asp?HB-CDS and which contain information about CDS, including a description of financial management services and support consultation;


Documentation that the applicant or LAR was given a copy of Forms 1581 (CDS Option overview), 1582 (CDS Responsibilities & Self Assessment), and 1583 (Employee Qualification Requirements).


(b)Oversight Process Changes §9.567 (b) (4)

(4) provide an oral explanation of the information contained in Forms 1581, 1582, and 1583 to the applicant or LAR; and


Documentation from the individual’s record that the applicant or LAR was given an oral explanation of the information contained in Forms 1581, 1582, 1583 and 1584.

Process for Enrollment Related to

40 TAC §9.583 (b)Oversight Process Changes §9.567 (b) (5)

(5) provide the applicant or LAR the opportunity to choose to participate in CDS and document the applicant’s or LAR’s choice on Form 1584, which is available at http://www.dads.state.tx.us/handbooks/form/default/asp?HB-CDS.


Individual or LAR choice documented on Form 1584


Oversight Process Changes §9.583 (h) (1)

An MRA must maintain for each individual:

(1) a current IPC


New IPC (Form 8582) for all individuals


Oversight Process Changes §9.583 (k) (1)

An MRA must ensure that a service coordinator:

(1) Initiates, coordinates and facilitates the PDP Planning process to meet the desires and needs as identified by an individual and LAR in the individual’s PDP.


PDP should address the individual’s desires and needs including evidence as to whether CDS option was desired or chosen.




(4) Coordinates and develops an individual’s IPC based on the individual’s PDP


New IPC (Form 8582)




(5) coordinates and monitors the delivery of TxHmL and non-TxHmL Program services.


If applicable, documentation concerning SC requesting either employer CAP per §41.221 (a)-(d) or CDSA transfer per requirements outlined in §41.403 (c) (1) – (4).


Oversight Process ChangesThe Service Coordinator must: §9.583 (m) (6)

(6) ensure that the individual or LAR is informed of decisions regarding denial or termination of services and the individual’s or LAR’s right to request a fair hearing as described in §9.571 of this subchapter (relating to Fair Hearings);


Documentation that the SC orally explained the requirements identified in §41.111 (b) and (c) concerning denials or terminations.


Oversight Process ChangesThe Service Coordinator must, at least annually §9.583 (r) (1) – (4)

(1) inform the individual or LAR of the individual’s right to participate in CDS and discontinue participation in CDS at any time, except as provided in 40 TAC §41.405 (a) of this title (relating to Suspension of Participation in CDS);


Documentation that the SC reviewed CDS participation rights at least annually.

583 (r)


Oversight Process Changes §9.583 (r) (2)

(2) provide the individual or LAR a copy of Forms 1581, 1582, and 1583 which are available at http://www.dads.state.tx.us/handbooks/form/default/asp?HB-CDSand which contain information about CDS, including a description of financial management services and support consultation


Documentation that a copy of Forms 1581, 1582, and 1583 were provided to individual or LAR .


Oversight Process Changes §9.583 (r) (3)

(3) provide an oral explanation of the information contained in Forms 1581, 1582, and 1583 to the individual or LAR; and


Documentation that Forms 1581, 1582 and 1583 were explained orally.


Oversight Process Changes §9.583(r) (4)

(4) provide the individual or LAR the opportunity to choose to participate in CDS and document the individual’s choice on Form 1584, which is available at http://www.dads.state.tx.us/handbooks/form/default/asp?HB-CDS.


Documentation of individual or LAR choice on Form 1584.


Oversight Process ChangesThe Service Coordinator must (if individual or LAR chooses CDS): §9.583 (s) (1) – (4)

(1) provide names and contact information to the individual or LAR regarding all CDSAs providing services in the MRA’s local service area;


Documentation that the SC provided names and contact information to the individual or LAR regarding all CDSAs providing services in the MRA’s local service area.

583 (s)


Oversight Process Changes §9.583 (s) (2)

(2) document the individual’s or LAR’s choice of CDSA on Form 1584;


Form 1584



(3) document, in the individual’s PDP, a description of the service components provided through CDS; and


Documentation in the Annual/Revised PDP describing the service components that will be provided through CDS.



(4)document, in the individual’s PDP, a description of the individual’s service back-up plan.


Documentation in the Annual/Revised PDP that describe the individual’s service back-up plan (Form 1740).

Elements of a service back-up plan are defined in the CDS rule: 40 TAC §41.103 (27) and §41.217 (a)-(d).


Oversight Process Changes §9.583 (t)

(t) document in the individuals PDP that the information described in subsections (r) and (s) (1) of this section was provided to the individual or LAR.


Documentation in the annual PDP that the SC shared CDS information detailed in (r) and (s)(1) with the individual or LAR.

583 (t)


Oversight Process Changes§9.583 (u) (1) (2)

For an individual participating in CDS, the MRA must recommend to DADS that financial management services and support consultation, if applicable, be terminated if the service coordinator determines that:

(1) the individual’s continued participation in CDS poses a significant risk to the individual’s health, safety or welfare; or


If applicable, documentation must demonstrate that the MRA recommended to DADS termination of these services if, SC determined that (u)(1) and/or (u)(2).

583 (u)


Oversight Process Changes §9.583 (u) (2)

(2) the individual or LAR has not complied with Chapter 41,

Subchapter B of this title (relating to Responsibilities of Employers and Designated Representatives).


If the MRA recommends termination of CDS services based on (u) (1) or (2), acceptable documentation may include the SC, DADS, or CDSA requesting a Corrective Action Plan per §41.221 (a)-(d) .


Oversight Process Changes §9.583 (v) (1) (2)

If an MRA makes a recommendation under subsection (u) of this section, the MRA must:

(1) submit the individual’s IPC to DADS electronically ; and


Documentation reflecting electronic submission of individual’s revised IPC to DADS

583 (v)


Oversight Process Changes §9.583 (v) (2) (A)-(D)

(2) submit the following, in writing, to the Department of Aging and Disability Services, Access and Intake, Program Enrollment, Utilization Review, P..O. Box 149030, Mail Code W-354, Austin, Texas 78714-9030.


Documentation describing (v) (2) (A)-(D) was submitted in writing to DADS


Oversight Process Changes §9.583 (v) (2) (A)-(D)

A. a description of the service recommendation for termination;

B. the reasons why termination is recommended;

C. a description of the attempts to resolve the issues before recommending termination; and

D. Other supporting documentation, as appropriate.


Documentation describing (v) (2) (A)-(D) was submitted in writing to DADS

Summary • Identification of TxHmL Authority Principles Related to CDS

• Identification of MRA and SC Responsibilities

• Key changes to the CAO Process and identification of acceptable evidence for annual TxHmL Authority review

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Questions and Answers, Wrap-up

consumer directed services

Documents

medicaid number

contract number

slot tracking number

l00auth data entry menu

type of entry

ama main menu

l11 client

patty client id