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National Home and Community Based Services Conference Atlanta, GA. Texas’ Money Follows the Person Addressing Barriers to Successful Community Placement. Marc S. Gold Texas Department of Aging & Disability Services Dena Stoner Texas Department of State Health Services September 27, 2010.

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slide1

National Home and Community Based Services Conference

Atlanta, GA

Texas’ Money Follows the Person Addressing Barriers to Successful Community Placement

Marc S. Gold

Texas Department of Aging & Disability Services

Dena Stoner

Texas Department of State Health Services

September 27, 2010

slide2

TexasDemographics

  • Population: 25,373,947 (2010)
  • Counties: 254
  • Regional Divisions: 11
  • Nursing Facilities: @1,196
  • ICFs/MR: 868
  • Local Mental Health Authorities: 39
  • Local Mental Retardation Authorities:39
  • Area Agencies on Aging: 28
  • Centers for Independent Living: 26 (164

counties)

slide3

2010 Population Statistics

  • Nursing Facility: 55,000
  • ICFs/MR: @10,300

Interest Lists

  • CBA: @34,050 -- Wait time: 1-2 years
  • STAR+: @5630 -- Wait time: 1-2 years
  • MDCP: 18,113 -- Wait time: 3-4 years
  • CLASS : 32,121 -- Wait time: 3-4 years
  • HCS: 45,884 -- Wait time: 4-5 years
slide4

Fundamental Issues

  • Texas has stringent criteria for admission
  • Interests Lists: 139,929 (probable

eligibility (93,419)

  • Fixed Waiver Services Arrays
  • Large institutional ICF/MR structure
slide5

Waivers: Background Information

  • 1915 (c) waivers :
  • Nursing Facility:
    • Community-based Alternatives

(CBA)

    • STAR+PLUS
    • Medically Dependent Children’s

Program (MDCP)

slide6

Waivers: Background Information

  • 1915 (c) waivers :
  • ICF/MR:
    • Home and Community-based

Services (HCS)

    • Texas Home Living
    • Community Living Assistance

and Support Services (CLASS)

    • Deaf-Blind Multiple Disabilities
slide7

PromotingIndependence: History

  • June 1999: Olmstead Decision
  • September 1999: Governor George W. Bush’s

Executive Order GWB 99-2 (1999)

  • June 2001: Texas Senate Bill 367, Rider 37

Texas Money Follows the Person

promoting independence history
PromotingIndependence: History
  • Governor Rick Perry’s Executive Order RP-13
  • TX Health and Human Services Consolidation
  • June 2005: House Bill 1867
  • 2007: CMS’ MFP National Demonstration
slide9

Interagency Collaboration

  • Promoting Independence Advisory

Committee (1999)

  • 2004: Health and Human Services

Consolidation

  • Community Transition Teams
  • Housing and Health Services Coordinating

Council (2009)

  • Several interagency councils on children
  • Interagency council on behavioral health

transformation (2007)

slide10

Waiver Services

  • NF: services most used:
      • Adaptive Aids/DMS
      • Medical Supplies
      • Nursing Services
      • Attendant Services
  • HCS: services most used:
      • Dental
      • Day habilitation
      • Nursing
      • Residential Support
slide11

MFP and Priority Populations

  • MFP and nursing facility populations
  • Priority Populations and Intermediate Care

Facilities for Persons with MR

slide12

MFP Statistics (August 31, 2010)

  • More than 21,000 individuals have transitioned

from Texas Medicaid-certified nursing facilities

  • More than 8,000 individuals remain active in

the community

  • 0-21 years of age: 2,046 children
  • 22-44 years of age: 9 percent
  • 45-64 years of age: 34 percent
  • 65-74 years of age: 20 percent
  • 75-84 years of age: 22 percent
  • 85+ years of age: 15 percent
slide13

MFP Statistics

  • 56 percent: female
  • 44 percent: male
  • 39 percent living with a family member

24 percent living in assisted living

32 percent living alone

1 percent living in adult foster care

3 percent with other waiver individual

1 other

  • Retention Rates: @95 percent
slide14

PriorityPopulations

  • Over 3,000 from nine or more bed

private ICFs /MR and State Supported

Living Centers

  • Individuals with complex

medical/behavioral needs

  • Placement of choice: HCS-Residential
slide15

Barriers to Relocation

  • Long-term institutionalization
  • Information/knowledge of options
  • Co-occurring behavioral health issues
  • Lack of a statewide provider base to serve

individuals with complex needs

  • Stabilized direct services workforce
  • Lack of rural service providers / transportation
slide16

Barriers to Relocation

  • Health and welfare concerns
  • Family/guardian concerns
  • Personal fears
  • Provider liability
  • Loss of community supports
  • Service array flexibility
  • Lack of housing
slide17

Barriers to Relocation

  • Coordination of services/SSI address change
  • Criminal History Checks
  • Home Modifications
  • Durable Medical Equipment
slide18

Communication: NF population

  • Relocation Specialists
  • NF Ombudsman and Social Workers
  • Minimum Data Set, Section Q
  • Developing new PASRR process
  • Community Transitions Teams
  • Aging & Disability Resource Centers
  • Family Councils
slide19

Communication: IDD population

  • Community Living Options

Information Process

  • Community Living Options
slide20

Family/Guardian Concerns

  • Family concerns/resistance
  • Guardian issues
  • Physician resistance
slide21

Relocations Contractors

  • Nine catchment areas:
    • Centers for Independent Living
    • Area Agency on Aging
  • Case Management activities:
    • Pre-relocation services
    • Outreach/Education
    • Facilitation/Coordination
    • Housing Navigation and Supports
    • Coordination with local organizations
    • Post-relocation services
    • Coordination with managed care
slide22

MFP Demonstration

  • NF and ICF/MR populations
  • Behavioral Health project
  • Housing Initiatives
  • Overnight supports
  • Post-relocation Services
  • Voluntary Closure of private ICFs/MR
  • 1,599 individuals from NFs
  • 1,400 individuals from ICFs/MR
  • Met all benchmarks in July 2010 and

now exceed: 3,113

slide23

MFP Behavioral Health Pilot

  • Bexar County (2010 expansion in progress)
  • Goals:
    • Transition adults with mental health and/or

substance use disorders from NFs to the

community and help them be successful

    • Improve services and supports in the long-

term care system for people with mental

health and substance use disorders

a true collaboration
A True Collaboration
  • DADS (long term care) operates the overall MFP Project and provides relocation assistance.
  • DSHS (state mental health and substance abuse) operates the MFP BH Pilot.
  • The Local Mental Health Authority provides the BH Pilot services.
  • HHSC (State Medicaid) provides community-based long term services and supports through HMOs.
  • UT Health Science Center in San Antonio provides technical assistance, training and evaluation.
slide26

Behavioral Health Pilot Services

  • Substance abuse / dependence

treatment services (individual and group)

  • Cognitive Adaptation Training (CAT)
  • Pilot services are closely coordinated with

acute and long term services

  • Pilot services are available six months

prior to discharge from the NF and up

to 365 days after discharge

slide27

Substance Abuse / Dependence

  • Individual and group counseling, including

specialized groups

  • Peer Support
  • Linkage to community resources
slide28

Cognitive Adaptation Training

  • Evidence-based service, recovery-oriented
  • Provides assistance and simple

environmental modifications to help people

establish daily routines, organize their

environment and function independently

  • Uses motivational interviewing to facilitate

the person’s initiative and independence

  • Coordinated with HCBS services
slide29

CAT Intervention: Organization

Apathy Disinhibition Mixed

slide30

Did I take

my medication

today?

CAT Intervention: Medication

slide31

Behavioral Health: IDD

  • Positive Behavior Management
  • New project to explore including more

intensive behavioral health services

slide32

Housing

  • State Housing Agency (TDHCA)
  • Public Housing Authorities
  • Disability Advisory Workgroup
  • Housing and Health Services

Coordinating Council

  • Transition Assistance Services/

Transition to Life in the Community

slide33

Texas Dept. of Housing and Community Affairs

  • Grants to local agencies
      • Tennant Based Rental Assistance – 24

months (30% of income for rent).

      • Amy Young Barrier Removal Program –

$15,000 w/Additional $5,000

    • Project Access Vouchers
      • Only available for NF and ICF/MR

relocations

      • From 65 to 100 on January 1, 2011
      • 80 for non-elderly disabled (<62)
      • 20 for 65+
    • Resident only pays 30% of adjusted gross

income for rent and utilities

slide34

Local Housing Programs

  • Housing Voucher Programs
    • Relocation contractors work with state and

local Public Housing Agencies (PHAs) to assist individuals find affordable, assessable, and integrated housing.

    • Local Public Housing Authorities - Housing units and Section 8 Vouchers
    • Resident only pays 30% of adjusted gross

income

slide35

Health and Welfare

  • Individual Responsibility Agreement
  • Overnight Companion Services
  • Working with provider base to serve

individuals with complex needs

slide36

Workforce

  • High turnover of community-based

direct service workers

  • Consumer Directed Services
  • Workforce Advisory Council: e.g.,

Realistic Job Preview

  • Major issue: reimbursement
slide37

MFP Demonstration - New Projects

  • Behavioral Health Expansion
  • Dedicated staff to focus on workforce
  • Housing navigators
  • Staff to focus on individuals leaving

large ICFs/MR

    • Creating specific databases
    • Ongoing training
slide38

The Future

  • New Money Follows the Person Demonstration funding opportunities
  • Waiver service array
  • HUD Notice of Funding Availability: additional Section 8 type vouchers
slide39

The Future

  • Working with provider base
  • Managed Care
  • Institutional diversion programs: risk slots

and community living program

  • Specialized waivers
  • Children’s efforts
slide40

Contact Inf

ormation

Marc S. Gold

Director, Promoting Independence Initiative

512.438.2260

marc.gold@dads.state.tx.us

www.dads.state.tx.us/business/pi/index.html

Dena Stoner, Senior Policy Advisor

512.206.4851

dena.stoner@dshs.state.tx.us