Revision 22-2; Effective May 1, 2022

15100 Quality Oversight of Home and Community-based Services Program Local Intellectual and Developmental Disability Authority Responsibilities

Revision 22-2; Effective May 1, 2022

Texas Health and Human Services Commission (HHSC) ensures contract accountability and oversight of Local Intellectual and Developmental Disability Authorities (LIDDAs) through a variety of methods including, but not limited to, ongoing review and monitoring of the HHSC data system’s data, service encounter data, financial data and an annual Home and Community-based Services (HCS) review.

Ongoing Monitoring

HHSC conducts ongoing monitoring reviews in several areas. These activities are part of HHSC's broad oversight of LIDDA performance and include HCS authority functions. This includes review of enrollment activity, utilization review, verification of service encounter data, integrity review of service encounter data and review of financial data. Detailed information regarding HHSC requirements for LIDDAs can be found in the LIDDA Performance Contract.

Review of Requirements for Service Coordination

HHSC conducts an annual review of HCS authority functions. This review is announced and includes LIDDA requirements for HCS service coordination. The HCS authority review may result in findings cited in the HHSC LIDDA quality assurance review. This occurs if non-compliance with HHSC rules or LIDDA performance contract requirements is determined to be present, but is beyond the scope of the LIDDA requirements for HCS service coordination.

Prior to the Review

HHSC assigns a facilitator to coordinate the review activities for a given LIDDA. The facilitator drafts an announcement letter to the LIDDA executive director, which is copied to the LIDDA board chair and the LIDDA's designated contact person for coordinating the review. This letter is followed by direct communications between the facilitator and the LIDDA contact person. The facilitator sends the LIDDA contact person an authority review information and instructions packet that includes the sample of participants and forms to be completed and returned to the facilitator prior to the review.

Entrance Conference

HHSC staff conduct an entrance conference meeting at the beginning of the review. The entrance conference is between available review team members and key LIDDA staff who will be involved in the review. It serves as an opportunity to review the general agenda, provide information about the review and answer any questions.

Service Coordinator Qualifications and Training

Qualifications and training requirements for new service coordinators assigned to HCS sample participants are checked using the service coordination staff checklist.

Home and Community-based Services Participant Review

HHSC review team members perform record reviews using the HCS electronic tool. Follow-up meetings with assigned service coordinators occur at the discretion of the review team members. Review team members may also determine whether there is a need to contact participants and their legally authorized representatives (LARs).

Formal Debriefing

Throughout the review process, the review team members may point out concerns, identify potential findings, ask for additional information or seek clarification on issues. After completion of the review, the HCS Authority Review Report of Findings is drafted. A formal debriefing is held and identified items of non-compliance are shared with the LIDDA. The LIDDA is then given up to one hour following the formal debriefing to provide additional information that may alter or clear findings.

Exit Conference

After conclusion of the HCS authority review, a final copy of the HCS Authority Review Report of Findings is provided to the LIDDA. Barring a successful request for reconsideration of findings as described below, if any item is cited as "Not Met," a corrective action plan (CAP) is required.

Reconsideration of Findings

A LIDDA may request reconsideration of finding(s) of the HCS authority review based on the evidence originally submitted at the time of the review. Instructions to the LIDDA for requesting reconsideration are included at the bottom of the HCS Authority Review Report of Findings. This request for reconsideration must be submitted via email to the facilitator within 10 business days of receipt of the HCS Authority Review Report of Findings. Requests for reconsideration received later than 10 business days after the exit conference are not considered. The facilitator emails a written response to the LIDDA staff requesting reconsideration within 15 calendar days after receiving the LIDDA's request. If a revision to the HCS Authority Review Report of Findings is necessary as a result of the reconsideration, the facilitator ensures a written notification and copy of the revised report is emailed to the LIDDA contact person. If changes in the CAP requirements result, the facilitator emails a revised CAP template to the LIDDA contact person.

Amended Report of Findings

The HCS Authority Review Report of Findings is amended when the team determines that the final report shared at the exit conference contains an error. The correction is made and the corrected report becomes the Amended HSC Authority Review Report of Findings. The facilitator ensures any resulting changes in the CAP requirement are forwarded with the amended report to the LIDDA contact person with an amended CAP due date 30 days from the date of the amendment.

Corrective Action Plan

Submission of a CAP is required for any remaining items of non-compliance. The facilitator provides the LIDDA contact person with a CAP template and instructions and guidelines for completing the CAP. The CAP is due to Performance Contracts Management within 30 days after receipt of the HCS Authority Review Report of Findings. The due date for the CAP is identified on the bottom of the final draft of the HCS Authority Review Report of Findings. The facilitator coordinates HHSC review of the CAP. If a need for revision to the CAP is identified, the facilitator communicates that need to the LIDDA contact person. Any revisions to the CAP are submitted by the LIDDA to the facilitator until the review team recommends approval of the CAP by the contract manager.

Once the CAP is approved, the CAP acceptance letter is sent out.