I C Jon Weizenbaum - Texas Health and Human Services ...

INTERIM COMMISSIONER

Jon Weizenbaum

September 29, 2009

To:

Deaf-Blind with Multiple Disabilities (DBMD) Providers and

Consumer Directed Service Agencies (CDSAs)

Subject: Information Letter No. 09-116 Addition of Support Consultation and Requisition Fees and Fiscal Year (FY) 2010 Rate Changes

Effective October 1, 2009, the Texas Department of Aging and Disability Services (DADS) will implement support consultation as an optional service component for individuals participating in the consumer directed services (CDS) service delivery option.

Support consultation is provided by a certified support advisor and includes:

skills training related to recruiting, screening, and hiring staff, preparing job descriptions, verifying employment eligibility and qualifications, completion of documents required to employ an individual, managing staff and development of effective back-up plans for services considered critical to the individual's

health and welfare in the absence of the regular provider or an emergency situation.

Case managers are responsible for informing those who select the CDS option of the availability of support consultation. In addition to reviewing the CDS Forms (Forms 1581, 1582, 1583 and 1584) with the individual, case managers must review Form 1586, Acknowledgement of Information Regarding Support Consultation in the CDS option. Form 1586 should be completed for individuals participating in CDS in order to verify that the individual was offered a choice in participating in support consultation services. This form is available under the forms section of the DBMD online handbook.

If the individual wants to use support consultation or the case manager thinks support consultation would be beneficial, case mangers must indicate the number of hours authorized for support consultation on the service plan. The service code for support consultation in the DBMD program is 57V.

The cost for support consultation comes from the individuals CDS budget, which includes residential habilitation, respite or intervener. Therefore, the cost for support consultation should NOT be included in the Individual Service Plan (ISP) total. It is expected that individuals, on average, will need anywhere from two to four hours of support consultation per year.

Requisition fees:

In addition, requisition fees for adaptive aids and minor home modifications will be available in DBMD effective October 1, 2009. Requisition fees are reimbursements paid to the DBMD provider agency for their efforts in acquiring adaptive aids and minor home modifications for DBMD

701 W. 51st St. ? P.O. Box 149030 Austin, Texas 78714-9030 ? (512) 438-3011 ? dads.state.tx.us

Information Letter No. 09-116 September 29, 2009 Page 2

participants. The adaptive aids service code for requisition fees is 41 and for minor home modification 41B.

If an adaptive aid or minor home modification is authorized on the ISP, the provider must also authorize requisition fees. The requisition fee will vary, based on the cost of the total adaptive aid or minor home modification.

When submitting a request for an adaptive aid or minor home modification, the ISP should reflect the total dollar amount of the bid selected for the adaptive aid or minor home modification along with the requisition fee in the appropriate columns. The requisition fee is not included in the total service cap for adaptive aids and minor home modifications.

Any service provided by the DBMD provider related to the procurement of the adaptive aid or minor home modification should be reimbursed by the requisition fee, not under case management services.

The revised ISP will be available on the DADS website October 1, 2009. DBMD case managers must use the revised ISP form for all initial ISPs, reassessment ISPs, and ISP amendments as of October 1, 2009.

Rate changes:

In addition to adopting rates for support consultation and requisition fees for adaptive aids and minor home modifications in DBMD, the Health and Human Services Commission (HHSC) has approved rates for other DBMD services effective September 1, 2009. The rates for DBMD are attached to this letter, and will be posted at a later date on the HHSC Rate Analysis website at: .

New payment rates for employment assistance and supported employment have not been approved at this time. If approved, these rates will be effective October 1, 2009.

Claims for all services provided after September 1, 2009 will automatically be paid at the new rates, with the exception of claims submitted by a Consumer Directed Service Agency (CDSA).

ISP's already submitted for individuals participating in the agency option for all services will not require re-submission to reflect the new rates; however a manual rate adjustment to CDS residential habilitation (SVC 17), and CDS intervener (SVC 45), will be required for those using the CDS option. This rate change will take effect retroactive to August 1, 2009.

Procedures for ISP revisions for CDS rate changes (minimum wage increase)

To adjust claims submitted by a CDSA for services provided from August 2009 forward, the case manager (CM) must submit a revised ISP. The DBMD provider agency must complete the following steps for each individual receiving services under the CDS option by November 30, 2009:

CDSA identifies and provides the number of residential habilitation and/or intervener hours remaining on the individual's ISP, as of August 1, 2009, to the DBMD case manager.

CM Initiates an ISP amendment on the current DBMD Form 6500, Individual Service Plan.

Information Letter No. 09-116 September 29, 2009 Page 3

CM includes all other service authorizations as stated on the previous ISP.

CM revises only the estimated annual cost for residential habilitation (SVC 17V) and/or CDS intervener (SVC 45) services reflected on the ISP. The estimated annual cost for residential habilitation (SVC 17V) and intervener (SVC 45) services includes: o The dollar amount calculated from residential habilitation (SVC 17V) and/or intervener (SVC 45) service units available to the individual from the ISP start date until July 31, 2009 multiplied with the old unit rate. The number of available units includes the number of utilized and non-utilized units for residential habilitation (SVC 17V) and/or intervener (SVC 45) services as outlined on the last authorized ISP (Form 6500). Added to: o The dollar amount calculated from residential habilitation service units and/or intervener service units to be provided from August 1, 2009 until the ISP end date multiplied by the new unit rate. The number of units for residential habilitation (SVC 17V) and/or intervener (45) services is based on the information outlined on the last authorized ISP (Form 6500). o The number of estimated units will remain unchanged in this process.

CM calculates the CDS total estimated annual cost of the ISP on Form 6500.

CM writes the phrase "CDS Rate Change" at the top of the Form 6500 (page 1 and 2).

The CM signs Form 6500. Signatures of other Interdisciplinary team (IDT) members are not required for this process.

CM submits the ISP change to the DADS DBMD program staff.

This process outlined above is only applicable to the ISP revision to accommodate the CDS rate increase for residential habilitation (SVC 17) and CDS intervener (SVC 45) services. Please do not combine other ISP revisions with the CDS rate adjustment.

If you have any questions about the information contained in this letter, please contact the DBMD Policy Specialist at (512) 438-2622. If you have questions regarding the DBMD rates, please contact Sarah Hambrick, HHSC Rate Analysis, at (512) 491-1431 or sarah.hambrick@hhsc.tx.us. If you have questions related to the CDS services, please contact the CDS Specialist, Elizabeth Jones at (512) 438-4855 or elizabeth.jones@dads.state.tx.us.

Sincerely,

[signature on file]

Tommy Ford Director Community Services

TF:ss

Attachment

Deaf-Blind with Multiple Disabilities Waiver Program

FY 2010 Payment Rates

Service

Case Management - per hour Pre-Enrollment Assessment - per hour Day Habilitation - per hour Residential Habilitation - Less than 24 Hours - per hour Residential Habilitation - 24 Hours - per day Assisted Living - 24 Hours - per day Assisted Living - Less than 24 Hours - per day Registered Nurse (RN) - per hour Specialized RN - per hour Licensed Vocational Nurse (LVN) - per hour Specialized LVN - per hour Behavioral Support - per hour In-Home Respite - per hour Out-of-Home Respite Ceiling - per hour Intervener - per hour Chore Services - per hour Physical Therapy (PT) - per hour Occupational Therapy (OT) - per hour Speech/Language Therapy (S/LT) - per hour Dietary Services - per hour Orientation/Mobility Specialist - per hour Employment Assistance ? per hour Supported Employment ? per hour Transition Assistance Services - one time

Payment Rate

$37.62 $37.62 See Attached Chart See Attached Chart $131.25 $131.25 $113.19 $43.39 $49.90 $29.69 $34.14 $79.53 $238.60 $236.17 See Attached Chart See Attached Chart $77.43 $72.95 $76.29 $55.28 $40.57 $28.21 $28.21 $158.28

Deaf-Blind with Multiple Disabilities (DBMD) Waiver rates

Effective September 1, 2009

Deaf-Blind with Multiple Disabilities Waiver Program

FY 2010 Payment Rates

Service Requisition Fees - Adaptive Aids, and Medical Supplies

New service effective September 1, 2009 Under $500 $500 to $999.99 $1,000 to $1,499.99 $1,500 to $1,999.99 $2,000 to $2,499.99 $2,500 to $2,999.99 $3,000 to $3,499.99 $3,500 to $3,999.99 $4,000 to $4,499.99 $4,500 to $4,999.99 $5,000 and over Requisition Fees - Minor Home Modifications Supplies

New service effective September 1, 2009 under $500 $500 to $999.99 $1,000 to $1,499.99 $1,500 to $1,999.99 $2,000 to $2,499.99 $2,500 to $2,999.99 $3,000 to $3,499.99 $3,500 to $3,999.99 $4,000 to $4,499.99 $4,500 to $4,999.99 $5,000 to $5,499.99 $5,500 to $5,999.99 $6,000 to $6,499.99 $6,500 and over

Payment Rate

10% of cost $54.03 $92.85 $105.66 $118.86 $134.21 $140.81 $147.02 $153.62 $160.22 $168.96

10% of cost $80.04 $118.86 $131.67 $163.89 $196.50 $227.19 $258.27 $284.28 $309.90 $335.91 $361.92 $395.15 $428.76

Deaf-Blind with Multiple Disabilities (DBMD) Waiver rates

Effective September 1, 2009

Deaf-Blind with Multiple Disabilities Waiver Program

Day Habilitation Residential Habilitation-Less Than 24

Hours and Intervener FY 2010 Payment Rates

Nonparticipant Participant - Level 1 Participant - Level 2 Participant - Level 3 Participant - Level 4 Participant - Level 5 Participant - Level 6 Participant - Level 7 Participant - Level 8 Participant - Level 9 Participant - Level 10 Participant - Level 11 Participant - Level 12 Participant - Level 13 Participant - Level 14 Participant - Level 15 Participant - Level 16 Participant - Level 17 Participant - Level 18 Participant - Level 19 Participant - Level 20

Attendant Cost Area

$10.64 $10.69 $10.74 $10.79 $10.84 $10.89 $10.94 $10.99 $11.04 $11.09 $11.14 $11.19 $11.24 $11.29 $11.34 $11.39 $11.44 $11.49 $11.54 $11.59 $11.64

Supervisor, Administration and Facility Cost Area

$3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21 $3.21

Total

$13.85 $13.90 $13.95 $14.00 $14.05 $14.10 $14.15 $14.20 $14.25 $14.30 $14.35 $14.40 $14.45 $14.50 $14.55 $14.60 $14.65 $14.70 $14.75 $14.80 $14.85

Deaf-Blind with Multiple Disabilities (DBMD) Waiver rates

Effective September 1, 2009

Deaf-Blind with Multiple Disabilities Waiver Program

Chore FY 2010 Payment Rates

Nonparticipant Participant - Level 1 Participant - Level 2 Participant - Level 3 Participant - Level 4 Participant - Level 5 Participant - Level 6 Participant - Level 7 Participant - Level 8 Participant - Level 9 Participant - Level 10 Participant - Level 11 Participant - Level 12 Participant - Level 13 Participant - Level 14 Participant - Level 15 Participant - Level 16 Participant - Level 17 Participant - Level 18 Participant - Level 19 Participant - Level 20

Attendant Cost Supervisor, Administration

Area

and Facility Cost Area

$8.34 $8.39 $8.44 $8.49 $8.54 $8.59 $8.64 $8.69 $8.74 $8.79 $8.84 $8.89 $8.94 $8.99 $9.04 $9.09 $9.14 $9.19 $9.24 $9.29 $9.34

$2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07 $2.07

Total

$10.41 $10.46 $10.51 $10.56 $10.61 $10.66 $10.71 $10.76 $10.81 $10.86 $10.91 $10.96 $11.01 $11.06 $11.11 $11.16 $11.21 $11.26 $11.31 $11.36 $11.41

Deaf-Blind with Multiple Disabilities (DBMD) Waiver rates

Effective September 1, 2009

Deaf-Blind with Multiple Disabilities Waiver Program Consumer Directed Services

FY 2010 Payment Rates

Service

Consumer Directed Services Agency ? per month Residential Habilitation - Less Than 24 Hours and Intervener Client Payment Rate - per hour In-Home Respite Client Payment Rate - per day

Out-Of-Home Respite Client Payment Rate - per day Support Consultation ? per hour

New service effective September 1, 2009

Payment Rate $202.00

$13.05

$214.60 $224.17

$15.37

The client's 12-month budget is calculated using the Client Payment Rate times the number of units authorized during the 12-month budget period.

Deaf-Blind with Multiple Disabilities (DBMD) Waiver rates

Effective September 1, 2009

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