Person-centered Planning for Waiver Program Providers

Not only is person-centered planning the right thing to do, it’s the law. The laws governing this process are:

• Section 2402(a) of the Affordable Care Act (PDF) requires a person-centered service plan for each person receiving Medicaid waiver services, to include long-term services and supports.
• Senate Bill 7 (83rd Texas Legislature, Regular Session, 2013) directs the Texas Health and Human Services (HHS) to promote integrated person-centered planning and person-centered services.
• The Centers for Medicare & Medicaid Services (CMS) [PDF] released updated survey guidance in April 2015 for intermediate care facility (ICF/IID) compliance, which includes person-centered planning and outcomes for people.

Who Should Have A Person-Centered Plan?

The rules in the Texas Administrative Code requires the following programs to use person-centered planning:

• 1915c waivers
  • Community Living Assistance and Support Services (CLASS)
  • Deaf Blind with Multiple Disabilities (DBMD)
  • Home and Community-based Services (HCS)
  • Medically Dependent Children Program (MDCP)
  • Texas Home Living (TxHmL)
  • Youth Empowerment Services (YES)
• 1915i state plan services
  • Home and Community Based Services Adult Mental Health
• 1915k state plan services
  • Community First Choice
• 1115 waiver
  • STAR+PLUS Home and Community-based Services
  • STAR Kids Home and Community-based Services
• Home and Community Based Services delivered through STAR Health

What Must Be In a Person-Centered Plan?

The final CMS Home and Community Based Services (HCBS) rule provides requirements for person-centered planning. HHS is educating people on person-centered planning and initiating changes in processes and systems to ensure that the planning process meets the HCBS settings rule.

This process will take a few years to fully implement. In the meantime, HHS is implementing policies to ensure the person-centered planning process will be:

• Driven by the person getting services and reflective of his or her perspective.
• Made up of people the client chooses.
• Conducted at a time and place convenient to the person getting services.

The plan must be reviewed and revised annually with a functional needs assessment, when circumstances or needs change, or when the client asks for a review.

Certain elements have to be included in each plan.

• It must be written using plain language.
• It must consider the person’s cultural preferences.
• It has to include strategies for solving disagreements during the planning process.
• It must provide choice regarding services and providers.
• It must have a way for clients to request an update.
• It must include risk factors and mitigation strategies.
• It must be signed, with copies given to the person getting services and her or his representatives.

The final service plan must reflect:

• The client's choice of setting and how that setting is integrated in and supports access to the community.
• Opportunities to seek competitive employment and work in integrated settings.
• Ways to engage in community life, control personal resources and receive services in the community to the same degree of access as people not receiving HCBS.
• The client's strengths and preferences.
• Clinical and support needs.
• Goals and desired outcomes, as defined by the person getting services.
• Services that will be provided, including self-directed services.
• Who will provide services and supports, including unpaid natural supports, such as family and friends.

Questions?

Questions can be sent to PersonCenteredPlanning@hhsc.state.tx.us.