5800, Community Living Options, Visits to Community Programs, and Educational Opportunities

Revision 22-1; Effective Nov. 28, 2022

5810 Presenting CLO

Revision 22-1; Effective Nov. 28, 2022

The habilitation coordinator provides information and discusses with a person and LAR the range of community living services, supports and alternatives. They identify the services and supports the person will need to live in the community, if the person or LAR has chosen to transition to community living, and identify and address barriers to community living. This activity is referred to as “CLO.”

Present CLO in a manner that allows the person and LAR to fully understand the options available. Therefore, CLO duration may vary but should last as long as needed to completely and meaningfully present all available community living options. If there are barriers to the person’s or LAR’s full understanding of CLO, the habilitation coordinator must document these barriers in Form 1054, Community Living Options, and how they will be addressed in Form 1057, Habilitation Service Plan (HSP).
 

5810.1 When CLO is Presented

Revision 22-1; Effective Nov. 28, 2022

CLO is presented at the following times regardless of whether the person is receiving or has refused habilitation coordination*:

  • Six months after the initial CLO (which was presented during the PE) and at least every six months thereafter. HHSC recommends that CLO be completed no more than 30 days before the scheduled second quarterly SPT meeting or annual IDT and SPT meeting, so that it can be discussed during the meeting.
  • When requested by the person or LAR.
  • When the habilitation coordinator is notified or becomes aware that the person or LAR is interested in speaking with someone about transitioning to the community.
  • When notified by HHSC that the person’s response in Section Q of the MDS assessment indicates the person is interested in speaking with someone about transitioning to the community.    

Note: CLO is presented anytime a PE is completed, including for a resident review or change of ownership.

*Some people and LARs who have refused habilitation coordination or are not interested in transitioning to the community may be reluctant to receive CLO every six months. As part of a person-centered approach, the habilitation coordinator should remain sensitive to the person’s or LAR’s preferences, ensure the person and LAR understand the importance of presenting CLO, and conduct CLO activities in a way that is responsive to the person’s or LAR’s concerns.

5810.2 Six-month Base Schedule

Revision 22-1; Effective Nov. 28, 2022

The habilitation coordinator presents CLO to the person or LAR six months after the initial CLO and at least every six months thereafter while the person continues to reside in the NF. The habilitation coordinator must maintain the every-six-month base schedule beginning with the initial CLO, even if an additional CLO was presented before the next six-month CLO is due.

5810.3 CLO Materials Provided to Individual or LAR

Revision 22-1; Effective Nov. 28, 2022

The habilitation coordinator uses the following materials to present CLO and explains each of the materials using the person’s preferred method of communication, taking the time necessary to ensure that the person and  LAR fully understand the materials and each of the person’s community options:

*CLO booklets are available by ordering from Pinnacle Cart.

5820 Documenting CLO

Revision 22-1; Effective Nov. 28, 2022

The HC documents the CLO presentation and discussion on Form 1054, Community Living Options. The habilitation coordinator must fill out Section 4 on Form 1054 whether the person is interested in transitioning to the community or not.

Note: The habilitation coordinator also documents barriers from Sections 6 or 7 of Form 1054 in Section 7 of Form 1057, Habilitation Service Plan (HSP). See Section 5460.2, Habilitation Service Plan.

5830 Habilitation Coordinator Actions Following CLO

Revision 22-1; Effective Nov. 28, 2022

The habilitation coordinator complies with the requirements in this section following:

  • the habilitation coordinator’s receipt of CLO information from the PE evaluator per Section 2430.5, Presenting Information about Community Services as Part of the PE; and
  • the habilitation coordinator’s presentation of CLO to the person or LAR.

5830.1 Individual or LAR Wants to Transition and has Selected a Community Program

Revision 22-1; Effective Nov. 28, 2022

If a person wants to transition to the community and has selected a community program, the habilitation coordinator must, within three business days after receipt of CLO information from the PE evaluator, or within three business days after the habilitation coordinator’s presentation of CLO,

  • send a referral using Form 1579, Referral for Relocation Services, to the person’s  managed care organization (MCO) (see Appendix II, MCO Contact Information) so that a relocation specialist (RS) can be assigned and an assessment and evaluation completed within 14 calendar days; and
  • notify the appropriate LIDDA staff to assign a service coordinator (SC) or an enhanced community coordinator (ECC) to begin transition planning with the person and LAR.

The habilitation coordinator must:

  • ensure receipt of the RS’s assessment and evaluation;
  • review the RS’s assessment and evaluation to determine if specialized services can help the person transition to the community and, if so, follow up with an SPT meeting to discuss the issue;
  • ensure the assigned SC/ECC receives a copy of the RS’s assessment and evaluation;
  • share a copy of the person’s habilitation packet with the RS and SC/ECC; and
  • inform the RS of the name and contact information of the SC/ECC who will be facilitating transition planning for the person.

5830.2 Individual or LAR Wants to Transition, but has NOT Selected Community Program

Revision 22-1; Effective Nov. 28, 2022

If a person wants to transition to the community, but has not selected the community program to pursue, the habilitation coordinator must, within three business days after receipt of CLO information from the PE evaluator or after the habilitation coordinator’s presentation of CLO, send a referral, using Form 1579, Referral for Relocation Services, to the person’s MCO (see Appendix II, MCO Contact Information) so that an RS can be assigned and an assessment and evaluation completed within 14 calendar days.
The habilitation coordinator must:

  • ensure receipt of the RS’s assessment and evaluation;
  • review the RS’s assessment and evaluation to determine if specialized services can help the person transition to the community and, if so, follow up with an SPT meeting to discuss the issue;
  • share a copy of the person’s habilitation packet with the RS;
  • work with the RS to help the person and LAR in selecting a community program that best suits the person’s needs. Note: Waiver comparison chart is available here; and
  • if the person has not refused habilitation coordination, ensure that if barriers to selecting a community program are identified in Section 7 of the completed Form 1054, Community Living Options, they are included in Section 7 of Form 1057, Habilitation Service Plan (HSP) for SPT discussion.

When the person or LAR has selected a community program, the habilitation coordinator must:

  • notify the appropriate LIDDA staff to assign an SC or an ECC to begin transition planning with the person and LAR;
  • share with the SC/ECC:
    • a copy of the RS’s assessment and evaluation; and
    • a copy of the person’s habilitation packet; and
  • inform the RS of the name and contact information of the SC/ECC who will be facilitating transition planning for the person.

5830.3 Individual or LAR Does Not Want to Transition, is Undecided or Desire of Individual or LAR Cannot be Determined

Revision 22-1; Effective Nov. 28, 2022

For a person who has not refused habilitation coordination, if the person or LAR does not want to transition, is undecided or the desire of the person or LAR cannot be determined, the habilitation coordinator must:

  • ensure that if barriers preventing a transition to the community are identified in Section 6 of Form 1054, Community Living Options, they are included in Section 7 of Form 1057, Habilitation Service Plan (HSP);
  • ensure the barriers are discussed at the next quarterly SPT meeting with the SPT identifying possible solutions to the barriers, how the SPT can implement the solutions and any needed follow-up activities; and
  • document the resolutions and actions for implementation in Section 7 of Form 1057.

5840 Exploring Community Programs

Revision 22-1; Effective Nov. 28, 2022

The habilitation coordinator arranges exploratory visits to community programs for a person, if requested, and addresses concerns about community living from the person and LAR. Additionally, the habilitation coordinator may assist a person and LAR with exploring different types of community programs using print and digital media, such as brochures, magazines, DVDs, virtual visit apps and virtual tours.

5850 Educational Opportunities

Revision 22-1; Effective Nov. 28, 2022

The habilitation coordinator offers a person and LAR the educational and informational opportunities that are required to be arranged by the LIDDA semiannually pursuant to the performance contract. The habilitation coordinator must document that the offer was made, including the specific educational or informational opportunity (i.e., description, location, date and time).