701 W. 51st St. P.O. Box Austin, Texas (512)

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1 INTERIM COMMISSIONER Jon Weizenbaum September 4, 2009 To: Home and Community-based Services (HCS) Providers, Texas Home Living (TxHmL) Providers and Mental Retardation Authorities (MRAs) Subject: Information Letter No Client Assignment and REgistration (CARE) System Implementation Matrix of Process Steps for Responding to the Required Transition Activities to Accommodate Necessary CARE Changes The purpose of this letter is to provide the MRA s, HCS and TxHmL program providers with a set of process steps for complying with the transition activities that must be completed prior to CARE changes which will be implemented on September 14, These CARE changes will include converting nursing (NU) on the Individual Plan of Care (IPC) to four new nursing categories, removing daily respite and implementing rate changes for the following program services: The matrix developed by Program Enrollment Utilization Review (PE/UR) staff with the MRA section, Access and Intake (A&I) outlines the responsibilities of program providers, PE staff and MRA staff, when applicable. It also includes instructions regarding when to use the 3608-New and the 3608-Transition IPC forms. If you have any questions about the matrix or need additional information, please contact Geoff Shute, Psychologist, for PE/UR, MRA section, A&I at (512) or geoff.shute@dads.state.tx.us. You may also contact Dana Marin, Program Specialist for PE/UR, MRA Section, A&I at (512) or dana.marin@dads.state.tx.us. Sincerely, [signature on file David Rollins Director Mental Retardation Authorities [signature on file] Tommy Ford Director Community Services DR:gm c: Susanne Elrod Carole Smith Attachment 701 W. 51st St. P.O. Box Austin, Texas (512)

2 Actions Completed before 9/1/09 Enrollment Staffing Held; IPC developed on old 3608 IPC form; All CARE screens entered; and PE/UR follows standard enrollment process. INITIAL IPCS: IPC Begin Date prior to 9/1/09 using 3608 IPC form (prior to the 3608-New IPC form being available on 8/12/09) To be completed by PE/ETD on 9/1/09 To be completed by MRA or later Verify the Service Begin Date with the Program Provider; Change the Service Begin Date to the date services actually began (9/1/09 or later); and Change the slot type when applicable. The MRA will complete all the Program Provider steps if the waiver program is TxHmL. To be completed by HCS Program Provider after the enrollment is approved by Program Enrollment on the implementation date or later (Note: IPC Begin Date will not change.) If the total nursing hours remain the same but will be redistributed among the applicable RN/LVN categories: Verify the IPC in CARE matches the hard copy IPC provided by the MRA; Generate a hard copy 3608-New IPC revision with an effective date of 9/1/09 indicating NU hours as either RN and LVN or RNS and LVNS* whichever is applicable; Indicate on the 3608-New IPC form signature lines: Administrative Revision required by DADS ***; Generate an IPC revision in CARE using C02**; Indicate on the C02 signature lines: Administrative Revision required by DADS ***; and Complete data entry in CARE on or after the implementation date. If the total nursing hours will not remain the same but need to be changed: Convene a meeting to revise the IPC** using the 3608-New IPC form; Indicate the nursing hours as either RN and LVN or RNS and LVNS* whichever is applicable on the 3608-New IPC form; and Complete data entry in CARE on or after the implementation date**. Revised 9/1/09 1

3 Actions Completed before 9/1/09 INITIAL IPCS: IPC Begin Date of 9/1/09 or later using old 3608 IPC form (prior to the 3608-New IPC form being available on 8/12/09) To be completed by PE on 9/1/09 or later To be completed by MRA To be completed by HCS Program Provider after the enrollment is approved by Program Enrollment on the implementation date or later. (Note: IPC Begin Date will not change.) Enrollment Staffing PE/UR will Route the completed Verify that the IPC in CARE matches the hard copy IPC Held; Verify (and enter if necessary) the nursing hours New IPC form received from provided by the MRA; IPC developed on indicated on the old 3608 IPC form; PE/UR to the Program Determine if any services need to be changed; old 3608 IPC form; Contact the MRA to verify the applicant s Provider. If yes, hold a meeting to revise the services using the 3608-New All CARE screens ventilator or tracheotomy status and the number of IPC form; and entered; and hours for the new nursing categories; Enter the IPC revision in CARE after the implementation date PE/UR follows Generate a 3608-New IPC form (hard copy) and and the correction of the hours in the new nursing categories is standard enrollment redistribute the NU hours to the applicable RN and accomplished by PE/UR to match the 3608-New IPC form process. LVN or RNS and LVNS*categories; Indicate on the 3608-New IPC form signature lines: Administrative Revision completed by DADS ***; and via encrypted or fax the completed 3608-New IPC form to the MRA. PE/ETD will Verify the Service Begin Date with the Program Provider; Change the Service Begin Date to the date services actually began (9/1/09 or later); and Change the slot type when applicable PE/UR will after implementation, error correct the initial IPC in CARE; Indicate on the L02 signature lines: Administrative Revision completed by DADS ***. (Note: all respite must be indicated as hourly on the 3608-New IPC form.). The MRA will complete all the Program Provider steps if the waiver program is TxHmL. Revised 9/1/09 2

4 Actions Completed before 9/1/09 Enrollment Staffing Held; IPC developed using 3608-New IPC form; All CARE screens entered; and CARE screen C61 Packet Status shows Incomplete INITIAL IPCS: IPC Begin Date 9/1/09 or later using the 3608-New IPC form (available on 8/12/09) To be completed by PE/UR beginning 9/1/09 To be completed by MRA To be completed by HCS Program Provider after enrollment is approved by Program Enrollment on the implementation date or later Contact the MRA to verify the number of The MRA will complete all the Determine if the any services need to be changed; nursing hours noted on the 3608-New IPC Program Provider steps if the If yes, hold a meeting to revise those services using the 3608-New IPC form; waiver program is TxHmL. form; and Combine the nursing hours indicated on the Enter the IPC revision in CARE after the implementation date and the 3608-New IPC form and enter the total number correction of the hours in the new nursing categories is accomplished of all the nursing hours in CARE; by PE/UR to match the 3608-New IPC form. Error correct the initial IPC in CARE using L02 beginning 9/1/09 to reflect the total number of nursing hours; Screen print C62 noting the hours in the new nursing categories; Complete the A05 recommendation; and PE/ETD will verify and correct slot type if needed. (Note: 1. Until the implementation date, CARE will only designate hours in one nursing category. 2. After implementation, the nursing hours will be corrected in CARE to the hours in the new nursing categories.) Revised 9/1/09 3

5 Actions completed 9/1/09 through the implementation date Enrollment PDP Staffing held; IPC was developed using old 3608 IPC form; and MRA is data entering the enrollment CARE Initial IPCs: IPC Begin Date 9/1/09 or later using the old 3608 IPC form (prior to the 3608-New IPC form being available on 8/12/09) To be completed by PE To be completed by MRA To be completed by HCS Program Provider after enrollment is approved by Program Enrollment on the implementation date or later No action can be taken until all the enrollment Enter nursing hours indicated on old N/A screens are entered in CARE IPC form; and Complete remaining CARE enrollment After the above steps are completed; and All the CARE screens are entered by MRA. PE/UR will Verify (and enter if necessary) the nursing hours indicated on the old 3608 IPC form; Contact the MRA to verify the applicant s ventilator or tracheotomy status and the number of hours for the new nursing categories; Generate a 3608-New IPC form (hard copy) and redistribute the NU hours to the applicable RN and LVN or RNS and LVNS* categories; Indicate on the 3608-New IPC form signature lines: Administrative Revision completed by DADS ***; and via encrypted or fax the completed 3608-New IPC form to the MRA. Route the completed 3608-New IPC form received from PE/UR to the Program Provider. Verify that the IPC in CARE matches the hard copy 3608-New IPC form provided by the MRA; Determine if any services need to be changed; and If yes, hold a meeting to revise those services using the 3608-New IPC form; and Enter the IPC revision in CARE after the implementation date and the correction of the hours in the new nursing categories is accomplished by PE/UR to match the 3608-New IPC form. The MRA will complete all the Program Provider steps if the waiver program is TxHmL. PE/ETD will Verify the Service Begin Date with the Program Provider; Change the Service Begin Date to the date services actually began (9/1/09 or later); and Change the slot type when applicable PE/UR will after implementation, error correct the initial IPC in CARE; Indicate on the L02 signature lines: Administrative Revision completed by DADS ***. (Note: all respite must be indicated as hourly on the 3608-New IPC form.). Revised 9/1/09 4

6 Actions completed 9/1/09 through the implementation date Enrollment PDP Staffing held; IPC was developed using 3608-New IPC form; and MRA is data entering the enrollment CARE Initial IPCs: IPC Begin Date 9/1/09 or later using the 3608-New IPC form (available 8/12/09) To be completed by PE/UR To be completed by MRA To be completed by HCS Program Provider after (on or after 9/1/09) enrollment is approved by Program Enrollment on No action can be taken until all the enrollment screens are entered in CARE. Combine the nursing hours indicated on the 3608-New IPC form and enter the total number of all the nursing hours in CARE; and Complete the remaining CARE enrollment the implementation date or later N/A After the above steps are completed; and All the CARE screens are entered by MRA PE/UR will Contact the MRA to verify the number of nursing hours noted on the 3608-New IPC form; and Follow the standard enrollment process. PE/ETD will Verify the Service Begin Date with the Program Provider; Change the Service Begin Date to the date services actually began (9/1/09 or later); and Change the slot type when applicable PE/UR will after implementation, error correct the initial IPC in CARE; and Indicate on the L02 signature lines: Administrative Revision completed by DADS ***. Route the completed 3608-New IPC form received from PE/UR to the Program Provider. Verify that the IPC in CARE matches the hard copy 3608-New IPC form provided by the MRA; Determine if any services need to be changed; and If yes, hold a meeting to revise those services using the 3608-New IPC form; and Enter the IPC revision in CARE after the implementation date and the correction of the hours in the new nursing categories is accomplished by PE/UR to match the 3608-New IPC form. The MRA will complete all the Program Provider steps if the waiver program is TxHmL. (Note: all respite must be indicated as hourly on the 3608-New IPC form.). Revised 9/1/09 5

7 For Enrollment meetings on or after the implementation date Actions to be completed To be completed by PE To be completed by MRA To be completed by HCS Program Provider after enrollment is approved by Program Enrollment Enrollment PDP Staffing scheduled or held; IPC to be developed or will be modified using 3608-New IPC form; and Not all the enrollment CARE screens are entered Standard enrollment process to be followed when all the enrollment screens are entered in CARE. During the Enrollment Meeting: Determine the applicant s ventilator or tracheotomy status; Indicate on 3608-New IPC form the following nursing hours (if not determined otherwise by the team): 6 hours for each of the RN and LVN nursing categories or 15 hours for each of the RNS and LVNS* categories; and Complete all required enrollment CARE (Note: all respite must be indicated as hourly on the 3608-New IPC form.) Verify that the IPC in CARE matches the hard copy 3608-New IPC form provided by the MRA; Determine if any services need to be changed; If yes, hold a meeting to revise those services using the 3608-New IPC form; and Enter the IPC revision in CARE after the implementation date and the correction of the hours in the new nursing categories is accomplished by PE/UR to match the 3608-New IPC form. The MRA will complete all the Program Provider steps if the waiver program is TxHmL. Revised 9/1/09 6

8 Actions Completed before implementation date Renewal staffing held; and IPC generated using old 3608 IPC form. (IPC begin date is before 9/1/09 and has been entered into CARE.) To be completed by PE/UR NA CURRENT IPCS IN EFFECT: Individual already enrolled prior to implementation date Nursing (NU) converting to the 4 New Nursing Categories To be completed by To be completed by HCS Program Provider on or after the implementation date MRA The MRA will complete all the Program Provider steps if the waiver program is TxHmL. If the total nursing hours remain the same but will be redistributed among the applicable RN/LVN categories: Generate a hard copy 3608-New IPC revision with an effective date of 9/1/09 converting the unused NU**** hours to either RN and LVN or RNS and LVNS* whichever is applicable; Generate a 3608-Transition IPC form indicating any daily respite and the previous nursing (NU) hours provided prior to 9/1/09, if applicable (see Note below); Indicate on the 3608-New IPC form signature lines: Administrative Revision required by DADS ***; Generate an IPC revision in CARE using C02**; Convert daily respite to hourly respite if not already completed****; Indicate on the C02 signature lines: Administrative Revision required by DADS ***; and Complete the data entry in CARE on or after the implementation date. Note: The 3608-Transition IPC form can be copied and should be attached to any subsequent IPC revisions until this IPC year ends. This 3608-Transition form is only applicable through 8/30/2010. If the total nursing hours will not remain the same but need to be changed: Convene a meeting to revise the IPC** using the 3608-New IPC form; Indicate the nursing hours as either RN and LVN or RNS and LVNS* whichever is applicable on the 3608-New IPC form; Generate a 3608-Transition IPC form indicating any daily respite and the previous nursing (NU) hours provided prior to 9/1/09, if applicable (see Note below); Convert daily respite to hourly respite if not already completed****; and Complete the data entry in CARE on or after the implementation date**. Note: The 3608-Transition IPC form can be copied and should be attached to any subsequent IPC revisions until this IPC year ends. This 3608-Transition form is only applicable through 8/30/2010 Actions completed before the implementation date Renewal staffing held; and IPC generated using 3608-New IPC form. (IPC begin date is on or after 9/1/09) To be completed by PE/UR NA To be completed by MRA The MRA will complete all the Program Provider steps if the waiver program is TxHmL. To be completed by HCS Program Provider on the implementation date or later. If IPC was data entered before the implementation date: Error correct the renewal IPC in CARE to reflect the nursing hours indicated on the hard copy 3608-New IPC form using C02 on or after the implementation date. If IPC is data entered on or after implementation date: Follow standard data entry process. If entered into CARE after renewal date, submit request for backdating as per standard procedure. Revised 9/1/09 7

9 Key for footnotes: *Nursing, Specialized RN or LVN is selected if an individual has a need for skilled nursing assistance for a ventilator or tracheotomy ordered by a physician. When Nursing, Specialized RN or LVN is selected, all nursing activities performed are billed at the nursing, specialized reimbursement rate for either RN or LVN. ** The IPC revision effective date must be 9/1/09 in order for the provider to bill and be reimbursed for the new nursing categories on this date. This revision must be data entered prior to the data entry of any subsequent revisions. An IPC revision with a later effective date will prevent billing and reimbursement for nursing under the new nursing categories until that date. ***This information needs to be typed on the signature lines of the case manager and nurse or CARE will indicate an error message if these lines are left blank. ****Nursing units provided prior to 9/1/09 can not be converted to the new nursing categories. Daily Respite units provided prior to 9/1/09 can not be converted. IPC INITIALS, RENEWALS AND REVISIONS: For Enrolled Individuals with an IPC Begin date on or after the implementation date Actions Completed after the implementation date FOR INITIAL IPCs that begin on or after the implementation date Actions completed by PE/UR Actions completed by MRA Actions completed by HCS Program Provider NA Initiate standard procedures for an initial IPC using the 3608-New IPC form After enrollment is approved by Program Enrollment on the implementation date or later: Verify that the IPC in CARE matches the hard copy 3608-New IPC form provided by the MRA; Determine if any services need to be changed; and If yes, hold a meeting to revise those services using the 3608-New IPC form; and Enter the IPC revision in CARE after the implementation date and the correction of the hours in the new nursing categories is accomplished by PE/UR to match the New IPC form. FOR RENEWAL IPCs that begin on or after the implementation date NA The MRA will complete all the Program Provider steps if the waiver program is TxHmL. The MRA will complete all the Program Provider steps if the waiver program is TxHmL. Initiate standard procedures for a renewal IPC using the 3608-New IPC form FOR REVISION IPCs that have an effective date on or after (implementation date) NA The MRA will complete all the Program Provider steps if the waiver program is TxHmL. Initiate standard procedures for revisions to the IPC using the 3608-New IPC form; Note: Continue using the 3608-New IPC form. Revised 9/1/09 8