Community First Choice: Technical Assistance PRESENTED ON: JULY 13, 2015
Announcements This webinar will be recorded and posted to the Texas Council Intranet site. An announcement will be sent to the IDD Consortium listserv when the recorded webinar is posted. Questions may be submitted during the webinar via the chat box. Questions may be submitted after the webinar to Erin Lawler at elawler@txcouncil.com.
Agenda Intake and communicating with MCOs (Sheri Talbot and Maribel Burgos, Texana Center) LOC determinations (Fabian Aguirre and Valerie Roberts, DADS) CFC for children served in Fee for Service Medicaid / working with DSHS (Velma Gonzalez and Diana Barajas, DSHS)
Intake and Communicating with MCOs
MCO Referral Spreadsheet Referrals are sent to the MCO on a monthly basis using the referral spreadsheet via the FTP site. Where do you get the referral spreadsheet? Texas Council Intranet site. How do you access the Texas Council Intranet site? Contact Karen Justice at kjustice@txcouncil.com. How do you choose which individuals you plan on referring to the MCO for any given month? We have sorted our priority list by the DID date and chose to begin individuals with a current DID Establish a monthly benchmark for how many referrals to manage monthly Filtered out individuals on the TxHmL/HCS pipeline
MCO Referral Spreadsheet June MCO Priority Referral List example (Texana Benchmark: 32 Referrals Monthly) Step 1: Complete one spreadsheet per MCO. Step 2: For each June referral, enter Medicaid ID, Names, DID Date, and DID Results. Submit to the FTP site. Maintain a working copy to be updated as changes occur during the month. Step 3: Enter the date the ID/RC was completed by the SC, the Current Status and the Date ID/RC sent to DADS when ID/RC is entered into CARE. Upload to the FTP site. Step 4: Enter DADS response date, LOC begin date and LOC end date, and update the Current Status to reflect DADS decision when CARE reflects an approval or denial. Upload to the FTP site. Current Status should be updated to reflect DADS decision. Step 5: Submit the updated spreadsheet to the MCO via the FTP site on a weekly basis.
MCO Referral Spreadsheet July MCO Priority Referral list example (Texana Benchmark: 32 Referrals Monthly) Step 1: Retain the names and information for everyone entered on the June referral list. (Names will not be deleted. Eventually all names from the Priority List will be listed. The Local Authority decides when they are added based on capacity to determine eligibility.) Step 2: For each July referral, Enter Medicaid ID, Names, DID Date, and DID Results. Submit to the FTP site. Maintain a working copy to be updated as changes occur during the month. Repeat Steps 3, 4, and 5 for June. At the end of July, the Spreadsheet will include information for all June and July names; there will be ongoing progress or completion status for all names.
How to work the priority list? See Texana CFC Implementation working the list handout.
Common Scenarios Encountered Individual/family declines services Complete Identification of Preference form (Texana Center) Complete during the Intake SC s face-to-face meeting to explain services, or if families choose not to meet, request families to return via mail Inform families who decline due to lack of service needs that they may request enrollment into CFC services at any time in the future when needs change Individual/family is on the MCO referral list, but is unreachable Complete Unable to contact form (Texana Center) to document all efforts to contact the individual Completed by the Intake SC
Common Scenarios Encountered Individual/family requests CFC services, but is not on MCO referral ( Raised Hand ) Under the age of 21 with traditional Medicaid and has not previously accessed IDD services and/or is not on the HCS Interest List Refer to DSHS Medical Necessity LOC determination. Under the age of 21 with traditional Medicaid and has a DID and is on the HCS Interest List Follow the process for Justification of CFC Eligibility and Diversion Criteria. All ages enrolled with an MCO Follow the process for Justification of CFC Eligibility and Diversion Criteria. Process for Justification of CFC Eligibility and Diversion Criteria Evaluate the individual s needs Complete the Justification of CFC Eligibility with Diversion Criteria form (Texana Center) Does not meet criteria, inform them that they will be contacted and give an estimated date Does meet criteria, prioritize DID completion and move forward with the enrollment process Enrolled with an MCO and potentially may meet Medical Necessity LOC eligibility Refer to MCO
Common Scenarios Encountered Individual calls requesting services and is on our priority list, but does not have a current DID Explain that there is a list and that they are on the list Estimate the month(s) that they will most likely be contacted to begin the enrollment process (based on monthly benchmark and Center planning) Provide an estimated calendar month(s) for them to receive a call from the Intake CFC SC Individual is on our priority list, but no longer lives in our service area Complete the LIDDA Reassignment form (Texana Center)
Community First Choice (CFC) Non-Waiver Eligibility CFC LOC Determinations Technical Assistance Information for Local Intellectual and Developmental Disabilities Authorities (LIDDAs) Presenters: Fabian Aguirre, PhD, LPA Valerie Roberts, QIDP 12
Improving CFC Non-Waiver LOC Determination Process - Documentation 13
Documentation required to determine LOC Eligibility for CFC Non-Waiver: Form 2007: CFC Non-Waiver Eligibility LOC Determination Review Cover Sheet Current Determination of Intellectual Disability (DID) Current Adaptive Behavior Level (ABL) assessment Form 8662: Related Conditions Eligibility and Screening Instrument (RCESI), if primary diagnosis is a related condition Form 8578-CFC: Intellectual Disability/Related Condition (ID/RC) assessment for CFC DADS Required Documentation 14
Form 2007 LOC Determination Cover Sheet Form 2007 is now available Use this link: http://www.dads.state.tx.us/forms/2007/ Technical Assistance Form 2007 15
Determination of Intellectual Disability (DID) If submitting a DID Update or Endorsement, please include the following in the DID (or attachment previous DID): Primary Diagnosis Diagnosis; ICD Diagnostic Code*; Age of Onset IQ IQ Score; Name of Assessment; Date of Administration ABL ABL and Score; Name of Assessment; Date of Administration Date of Administration must be within 5 years. Technical Assistance - DID *Use ICD-10 diagnostic codes after October 1, 2015. 16
Adaptive Behavior Level (ABL) ABL assessment must be conducted within 5 years If using ICAP or SIB-R verify ABL with conversion table below: ICAP Service Score Technical Assistance - ABL SIB-R RMI Score ABL Conversion 70-99 82/90 100/90 I 40-69 34/90 81/90 II 20-39 5/90 33/90 III 0-19 0/90 4/90 IV 17
Related Conditions Eligibility Screening Instrument (RCESI) If the primary diagnosis is a related condition on DADS-approved list (LOC I, or VIII), submit the RCESI (Form 8662). For RCESI instructions: http://www.dads.state.tx.us/forms/8662/ Complete entire form For children under the age of 10, two of the six major life activities do not apply (i.e., Self-direction and Capacity for Independent Living) Must be signed by: Case Manager/Nurse; and Applicant and/or Informant Technical Assistance - RCESI 18
Intellectual Disability/Related Condition (ID/RC) for CFC (Form 8578-CFC): Primary Diagnosis (#19), Code (#20), Version (#21), Onset (#22) (#19) ONLY use an IDD or RC diagnosis If recommending LOC I or VIII, DO NOT use Borderline Intellectual Functioning (#20 and #21) Use ICD codes* (NOT DSM codes) (#22) Use onset supported in documentation ABL Instrument and Score (#69) Only use one ICAP and SIB-R Use service score for ICAP and RMI for SIB-R Vineland and AAIDD Use X AAIDD Use this field if a different ABL instrument was used (e.g., ABAS-II or 3) Related Condition (#75) Use summary score from the RCESI Technical Assistance 8578-CFC *Use ICD-10 diagnostic codes after October 1, 2015. 19
Intellectual Disability/Related Condition (ID/RC) for CFC (Form 8578-CFC): Plan Code (#82) DO NOT use Plan Code 17 if the individual has an assigned MCO ONLY use Plan Code 17 for DSHS referrals MCO Mailing address (#83) This item will be removed Social Security # (#11) and Medicaid # (# 8) Ensure items are correct LIDDA Certification (#56 -#58) A LIDDA representative must sign and date this form Physician s Attestation Indicated in CARE Required for all individuals with a primary diagnosis of a related condition Technical Assistance 8578-CFC 20
Improving CFC Non-Waiver LOC Determination Process - Returns in CARE 21
Client Assignment and Registration (CARE) errors Individual s personal information does not match Form 8578-CFC Assessment information does not match form Signature does not match form Physician s attestation not marked Y (because primary diagnosis is entered incorrectly) for individuals with a related condition Technical Assistance - CARE 22
Checking ID/RC status: K68 CARE header screen Technical Assistance-CARE 23
Checking ID/RC status: K68 CARE screen (1 of 1) Technical Assistance-CARE 24
Making corrections in CARE: K23 CARE header screen Technical Assistance-CARE 25
Making corrections in CARE: K23 CARE screen (1 of 5) Technical Assistance-CARE 26
Making corrections in CARE: K23 CARE screen (2 of 5) Technical Assistance-CARE 27
Making corrections in CARE: K23 CARE screen (3 of 5) Technical Assistance-CARE 28
Making corrections in CARE: K23 CARE screen (4 of 5) Technical Assistance-CARE 29
Making corrections in CARE: K23 CARE screen (5 of 5) Technical Assistance-CARE 30
For technical assistance: General Line: 512-438-2484 Email: CfcLocElig@dads.state.tx.us Technical Assistance Phone/Email 31
Thank you!! 32
Question and Answer Session Questions may be submitted during the webinar via the chat box. Questions may be submitted after the webinar to Erin Lawler at elawler@txcouncil.com. 33