Revision 20-1; Effective March 16, 2020

The Service Responsibility Option (SRO) is a service delivery option that empowers the member or legally authorized representative (LAR) to manage most day-to-day activities. This includes supervision of the employee providing personal assistance services and respite services.

The member or LAR decides how services are provided. SRO leaves the business details to the member's managed care organization's contracted provider. The rules for the SRO are found in Texas Administrative Code, Title 40, Chapter 43.

See Appendix XVII, It's Your Choice: Deciding How to Manage Your Personal Assistance Services, for a comparison of all available service delivery option features.

8310 SRO Roles and Responsibilities

Revision 20-1; Effective March 16, 2020

Form 1582-SRO, Service Responsibility Option Roles and Responsibilities, specifies the roles and responsibilities assigned to the member or legally authorized representative (LAR), provider and managed care organization (MCO). The member, provider and MCO receive and sign Form 1582-SRO indicating their agreement to accept the service responsibility option (SRO) responsibilities.

8311 Managed Care Organization Responsibilities

Revision 20-1; Effective March 16, 2020

The intake, referral and assessment procedures for members or legally authorized representative (LARs) requesting service delivery through the service responsibility option (SRO) are handled in the usual way. The managed care organizations (MCOs) are responsible for:

• ensuring the member or LAR has an opportunity to make an informed choice by providing an objective and balanced review of the options; and
• monitoring the quality of services and service delivery.

Once the assessment is complete, the MCO is required to:

• inform the member or LAR about all options for managing eligible services; and
• review Appendix XVII, It's Your Choice: Deciding How to Manage Your Personal Assistance Services, with the member or LAR to determine if the SRO is an appropriate choice.

In addition, the MCO's responsibilities include:

• presenting all service delivery options;
• documenting the member's or LAR's choice on Form 1584, Consumer Participation Choice;
• providing a list of contracted SRO agencies;
• explaining SRO rights, responsibilities and resources to the member or LAR;
• presenting the MCO-contracted provider list and the support consultation provider to the member or LAR;
• making a referral to the provider(s) selected by the member, LAR or representative;
• processing the member's or LAR's request to change service delivery options;
• redeveloping the individual service plan (ISP) when a member's needs change;
• serving as a resource if the member has health or safety concerns, issues involving the attendant or other service-related concerns;
• convening service planning team meeting in instances where the member:
  • has health and safety concerns;
  • is having difficulty selecting or keeping an attendant; or
  • has other issues relating to services that cannot otherwise be resolved; and
  • monitoring services in accordance with 8322, Monitoring.

8312 Agency Responsibilities

Revision 20-1; Effective March 16, 2020

The agency contracted with the managed care organization (MCO) is the attendant's Consumer Directed Services (CDS) employer and handles the business details (for example, paying taxes and doing the payroll). The agency also orients attendants to policies and standards before sending the attendants to members' homes.

The agency:

• discusses and negotiates potential back-up plans for those times when the attendant is absent from work;
• sends a maximum of three attendants, including any individuals recommended by the member, for the member to review;
• explains to the selected attendants that the agency is the CDS employer of record and the member is the day-to-day manager;
• provides agency time sheets to the member and orients the member to the time sheet submission process, including how frequently time sheets must be completed;
• receives and processes attendant time sheets;
• sends new attendants within the required time frame to interview at the member's or legally authorized representative's (LAR's) request; and
• orients the member or LAR to the agency's attendant evaluation process, including forms and the schedule for evaluating attendants.

8313 Member Responsibilities

Revision 20-1; Effective March 16, 2020

The member, legally authorized representative (LAR) or representative is responsible for most of the day-to-day management of the attendant's activities, beginning with interviewing and selecting the person who will be the attendant. To participate in the service responsibility option (SRO), the member must be capable of performing all management tasks as described below, or may identify a representative to assist or perform those management tasks on the member's behalf.

The member is responsible for:

• choosing the SRO;
• choosing the SRO service and support provider(s);
• meeting with the SRO support provider within 14 days of selecting the SRO;
• coordinating with the agency supervisor as part of the service planning process by:
  • negotiating the type, frequency and schedule of quality assurance contacts;
  • discussing any concerns about care management;
  • requesting on-site assistance while orienting a new attendant, if desired; and
  • negotiating to develop a back-up plan for when the attendant cannot come to work;
• selecting personal attendant(s) from candidates sent by the agency (including someone the person recommends to the agency supervisor or someone who has completed the agency pre-employment screening);
• informing the agency supervisor within 24 hours:
  • of the personal attendant selected;
  • if the attendant gives notice of his intention to quit;
  • if the attendant quits; or
  • if the member wants to dismiss the attendant;
• training the personal attendant on how to safely perform the approved tasks in the manner desired;
• supervising the personal attendant;
• ensuring the attendant only does the tasks authorized in the individual service plan (ISP) and works only the number of hours authorized in the ISP;
• complying with agency payroll and attendance policies;
• evaluating the attendant's job performance at the time designated by the agency;
• reviewing, approving and signing agency employee time sheets after the attendant completes them;
• ensuring employee time sheets are submitted to the agency within the time frames designated by the agency;
• notifying the agency as soon as possible if the personal attendant will be absent and a substitute is needed;
• taking responsibility for liability risk if the member or attendant is injured while doing tasks under the member's training and supervision;
• using the following complaint procedures:
  • If the agency is not fulfilling the expected responsibilities, address those issues directly with the agency. If the agency and the member or LAR are not able to resolve the concerns/issues, the member or LAR should contact the managed care organization (MCO).
  • If concerns and issues are still not resolved, the member or LAR may select another agency. The member or LAR must contact the MCO to transfer from one agency to another. The MCO will make all necessary arrangements for the transfer.
• notifying the MCO and/or agency supervisor of any health or safety concerns or issues with the attendant (the member or LAR may, at any time, request a service planning team (SPT) meeting); and
• notifying the MCO and agency supervisor if a change to either the agency option or Consumer Directed Services (CDS) is desired. An SPT meeting will be held to plan for the change.

8320 Managed Care Organization (MCO) Procedures

Revision 20-1; Effective March 16, 2020

The service responsibility option (SRO) is not a service; it is a service delivery option. All financial and non-financial eligibility criteria, including unmet need and "do not hire" policy, continue to apply for each program area. Unless otherwise stated in this section, MCO procedures are not impacted by the member's choice of SRO.

Complete all forms currently required, including the assessment of functional needs on Form H2060, Needs Assessment Questionnaire and Task/Hour Guide, Form H2060-A, Addendum to Form H2060, and Form H2060-B, Needs Assessment Addendum. Continue to identify any caregivers who are currently providing for the member's needs.

8321 Initial Authorization of Services

Revision 20-1; Effective March 16, 2020

The member's or legally authorized representative’s (LAR’s) decision to receive services using the service responsibility option (SRO) does not change the manner in which initial services are authorized. See 3300, Administrative Procedures, for specific information.

8322 Monitoring

Revision 20-1; Effective March 16, 2020

All monitoring for service responsibility option (SRO) members is done by the managed care organization (MCO) according to the mandated schedule for its specific services. When health and safety issues arise, the MCO staff:

• discuss the issues with the agency staff;
• talk to the member or legally authorized representative (LAR) to determine if the issues can be resolved; and
• convene a service planning team meeting if the issue cannot be resolved.

Because the member or LAR now shares responsibility for service delivery, the MCO, in addition to other monitoring requirements, must monitor the member's or LAR's:

• satisfaction with the SRO; and
• ability to comply with SRO requirements.

If it is evident that the member or LAR is having difficulty in the management of SRO responsibilities, the MCO staff must:

• consult the agency staff; and
• advise the member or LAR of the option to transfer back to the agency option.

8323 Presentation of the SRO

Revision 20-1; Effective March 16, 2020

Members or legally authorized representative (LARs) must be offered the service responsibility option (SRO) by the managed care organization (MCO) annually, and may request a transfer to the SRO at any time. Additionally, the SRO must be presented to ongoing members or LARs at each annual reassessment or upon request. If the member or LAR is interested in transferring to the SRO, the member or LAR must sign Form 1582-SRO, Service Responsibility Option Roles and Responsibilities.

The MCO must ensure the member or LAR understands the responsibility they are assuming. The MCO must:

• send Form H2067-MC, Managed Care Programs Communication, to the agency to advise the agency of the member's or LAR's selection;
• notify the agency the member or LAR will be contacting the agency for training;
• request the agency to advise the MCO, using Form H2067-MC, when the transition planning is complete; and
• negotiate a start date with the member and the agency.