3200, Diverting from NF Admission

Revision 22-1; Effective Nov. 28, 2022

HHSC may make available a targeted NF HCS diversion slot to a person with intellectual disability (ID) or developmental disability (DD) who is determined to be at imminent risk of a long term stay in a NF. After a positive PASRR Level 1 (PL1) screening for preadmission is completed and entered in the Long-Term Care (LTC) online portal, a LIDDA must conduct a PASRR Evaluation (PE) on the person to determine if the person:

  • has ID or DD; and
  • meets medical necessity.

3210 Criteria for Diverting from NF Admission

Revision 23-1; Effective Dec. 20, 2023

To be eligible for a targeted NF HCS diversion slot, a diversion coordinator must document the following:

  • the person is at imminent risk of a long term stay in a NF;
  • the person has a PE, conducted within the past 21 calendar days, that indicates he or she  has ID or DD, meets NF medical necessity and is appropriate for community placement;
  • the person has a diagnosis that will meet HCS diagnostic eligibility criteria, meaning he or she has an intermediate care facility (ICF) Level of Care (LOC) I or VIII*; and
  • other adequate and appropriate community resources, excluding SSLCs, are unavailable to meet the person’s needs after attempts to obtain community-based services and supports, such as:
    • for a person 21 years or older:
      • Medicaid State Plan services;
      • community-based intermediate care facilities for people with an intellectual disability or related conditions (ICF/IIDs) with six beds or fewer; and
      • general revenue-funded services; or
    • for a person 20 years or younger:
      • Medicaid State Plan services;
      • supports through the local school district;
      • general revenue-funded services; and
      • community-based ICF/IIDs with six beds or fewer unless out-of-home placement is not desired.

*If a LIDDA determines that the person meets the criteria for both ICF LOC I and VIII, then the LIDDA documents “ICF LOC I.” If the person only meets the criteria for ICF LOC VIII, then the LIDDA documents “ICF LOC VIII.”

3220 Requesting a Targeted NF HCS Diversion Slot

Revision 22-1; Effective Nov. 28, 2022

If a LIDDA determines that a person meets the criteria for a targeted NF HCS diversion slot, the diversion coordinator requests a targeted NF HCS diversion slot for the person by completing and submitting Form 1047, Request for HCS Targeted NF Diversion Slot, per the form’s instructions.

Upon receipt, HHSC staff reviews the completed Form 1047. HHSC staff may request more information or documentation. Within three business days after receipt of Form 1047 and any necessary additional documentation, HHSC determines whether the person meets the criteria for a targeted NF HCS diversion slot.

  • If it is determined the person does not meet the criteria, HHSC will notify the LIDDA and the person or legally authorized representative (LAR) in writing of the denial of an offer of a targeted NF HCS diversion slot within one business day. HHSC will   provide the person or LAR with an opportunity for a fair hearing.
  • If it is determined the person meets the criteria and a targeted NF HCS diversion slot is immediately available, HHSC will send a letter authorizing the LIDDA to offer the person the opportunity to enroll in HCS.

3230 Enrolling in HCS as a Diversion to NF Admission

Revision 23-1; Effective Dec. 20, 2023

A LIDDA enrolls a person in the HCS program as an alternative to NF admission, per the requirements in the HCS rules, LIDDA Handbook, and this section. A LIDDA ensures an assigned enhanced community coordination (ECC) coordinator completes the following:

  • develops and revises as necessary a diversion plan, using Form 1050, Nursing Facility or Crisis Diversion Plan, with the person and LAR;
  • develops Form 8665, Person-Directed Plan, per the HCS program rules, using all available assessments and to include the person’s:
    • strengths and preferences; and
    • medical, nursing, nutritional management, clinical and other support needs; 
  • conducts a pre-move site review using Form 1042, Pre-Move Site Review, to:
    • ensure any concerns of the program provider, staff or family member are being addressed; and
    • determine whether all essential supports identified on Form 1050, Nursing Facility or Crisis Diversion Plan, are in place before the person enrolls in HCS; and
  • completes the following activities before the person enrolls in HCS if, during the pre-move site review, any one of the essential supports is not in place or if issues are raised about the suitability of the site
    • convenes the SPT to resolve the issues; and
    • conducts another pre-move site review following resolution.
       

3230.1 Enhanced Community Coordination Funds

Revision 23-1; Effective Dec. 20, 2023

Enhanced community coordination (ECC) funds are available to LIDDAs through the  performance contract for a person enrolling in HCS as a diversion to NF admission. The purpose of the funds is to enhance a person’s natural supports and promote successful community living. Funds are intended to pay for:

  • one-time emergency assistance, such as:
    • rental or utility assistance;
    • nutritional supplements;
    • clothing; and
    • medication;
  • items to address a person’s special needs, including minor home modifications not funded by other sources;
  • transportation to and from trial visits with community providers; and
  • educational tuition assistance, such as for vocational programs through community colleges so a person can develop job skills.

A LIDDA should contact IDDMFPSupport@hhs.texas.gov to discuss processes and how to access funds prior to any purchases.

3240 Post Enrollment in HCS as a Diversion to NF Admission

Revision 23-1; Effective Dec. 20, 2023

For one year* after a person has enrolled in the HCS program as a diversion to NF admission, an enhanced community coordination (ECC) coordinator must:

  • conduct at least three onsite visits of community service delivery sites at the intervals described below to determine whether supports continue to be in place and any areas of concern are being addressed using Form 1043, Post-Move Monitoring: 
    • within the first seven calendar days after enrollment in the HCS program;
    • between eight and 45 calendar days after enrollment in the HCS program; and
    • between 46 and 90 calendar days after enrollment in the HCS program. 
    • Note: More frequent onsite visits may be required to determine whether supports continue to be in place and any areas of concern are being addressed during the first 90 calendar days after enrolling in HCS.
  • conduct monthly in-person visits with the person, or more frequently if determined by the HCS SPT based on risk factors, and monitor the delivery of all services and supports;
  • conduct HCS service planning team (SPT) meetings quarterly, or more frequently if there is a change in the person’s needs or if requested by the person or LAR;
  • revise the HCS person-directed plan (PDP), as necessary, and coordinate the person’s services and supports;
  • ask about any recent hospitalizations, emergency department contacts, increased physician visits or other crises, including medical crises, and if the person experiences such, convene the HCS SPT to identify all necessary revisions to the HCS PDP to address other need for services;
  • ensure the person receives timely assessments of behavioral, medical, nursing, specialized therapies and nutritional management needs, as necessary, and as indicated on the HCS PDP;
  • record health care status sufficient to readily identify when changes in the person's status occurs;
  • conduct service planning, ensure the program provider’s implementation of services, and monitor all services identified on the HCS PDP, including:
    • reviewing the HCS program provider’s implementation plans and provider records;
    • visiting service delivery sites as needed to determine the person’s needs are being met; and
    • monitoring critical incidents involving the person and convening the HCS SPT to develop a plan for needed prevention or intervention services for the person; and
  • monitor the person while on suspension from the HCS program at least monthly, maintain communication with the program provider and provide reports to HHSC upon request.

*If, after one year of ECC, the SPT feels the person requires further enhanced monitoring, the ECC coordinator must contact IDDMFPSupport@hhs.texas.gov for further guidance.