CLASS Webinar May 17, 2017 · 2017-10-05 · CLASS Webinar Agenda for May 17, 2017 • Contract...

CLASS WebinarMay 17, 2017

CLASS WebinarAgenda for May 17, 2017• Contract Monitoring • Contracting for CLASS• Provider Manual Revisions• Rules Revisions• Transportation Habilitation• Provider Portal update• Enrollment IPC call-back process• Requesting STAR PLUS and STAR Kids closures for

CLASS enrollment• IDD PES Message Line

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Contract Compliance & Performance ManagementSarah SchmidtMay 17, 2017

CLASS Contract Management & MonitoringUpdate on Contract Compliance and Frequent Citations

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Contract Compliance Points to Remember:

TAC §49.302:(c)- ensure that an employee, subcontractor, or volunteer can effectively communicate with an individual/LAR concerning service planning and the provision of services, which may require the contractor to provide an interpreter for the individual(d)- must not allow an individual to perform services under the contract or perform other work that benefits the contractor (e)- comply with the terms of the contract, which requires compliance with federal and state laws, rules, and regulations, including TAC Chapter 49, rules governing services provided under the contract, and applicable reimbursement rules in TAC Chapter 355

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Contract Compliance Points to Remember:

TAC §49.302:(g)(1)- subscribe to receive DADS/HHSC e-mail updates, using the link provided at the DADS/HHSC websitehttps://service.govdelivery.com/accounts/TXHHSC/subscriber/new(h)- notify DADS/HHSC of a change of ownership or change in legal entity in accordance with §49.210(a)(1) (i)(1-2)- notify DADS/HHSC of a change to contract’s contact information (mailing, physical, e-mail address, phone, fax numbers, etc)

• At least 30 days before the change• Within 3 days after the change if a natural disaster

or unforeseen disaster prevents compliance with above 6

https://service.govdelivery.com/accounts/TXHHSC/subscriber/new

CLASS Contract MonitoringFrequent Citations- Case Management Agency

• Please see CLASS CMA Monitoring Workbook for reference information

https://hhs.texas.gov/Doing-Business-HHS/Provider-Portals/Resources/Contract-Fiscal-Compliance-Monitoring-Tools

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Contract Compliance and Performance Management

• The CMA must explain to the individual/LAR or person actively involved with the individual, orally and in writing the mandatory participation requirements of an individual as described in §45.302.

• The SPT meeting must be convened at least annually, between 30 and 90 calendar days before the end of the IPC period.

Standard III.5. Renewal SPT


• Within 10 business days of DADS notification of approval, the case manager must provide copies of the DADS authorized IPC, IPPs, habilitation plan/habilitation training plan, SPT notes and ID/RC to all members of the SPT and to any additional CLASS service providers (FMSA, Continued Family Services [CFS], and Support Family Services [SFS]), as necessary.

Standard III.6. Renewal SPT


• Therapy Justifications (8606As) and Request for Adaptive Aids, Medical Supplies, or Minor Home Modifications (3660) must also be provided with the DADS authorized IPC, IPPs, habilitation plan/habilitation training plan, SPT notes and ID/RC, if applicable.

Additional Documents


• The CMA must submit revision documentation to DADS at least 30 calendar days before the proposed effective date.

• Within five business days of DADS transmission of the authorized IPC, the case manager must provide copies to the individual/LAR and any additional CLASS service providers (DSA, FMSA, CFS, and SFS), as necessary.

Standard III.8. Revision SPT


• The CMA must in accordance with the CLASS Provider Manual meet with the individual/LAR to complete Form 3595, IPP Service Review, reviewing the individual’s progress toward achieving the goals and objectives as described on the IPP.

• That includes the following documentation for all services on the IPC:

Standard III.9. IPP Service Reviews


• Documentation of progress or lack of progress toward goals/objectives as identified on the IPPs /IPC;

• Assess the individual’s satisfaction with the provision of CLASS program services;

• Identify any changes to the individual’s needs, if applicable; and

• If applicable, FMS option.

Standard III.9. IPP Service Reviews (cont.)


• Refer to Appendix X: Quarterly Due Dates Chart

• The CMA must provide a copy of the IPP Quarterly/90-Day Service Review to the individual/LAR, DSA, and FMSA (if applicable) within 5 business days of the review date.

Standard III.9. IPP Service Reviews (cont.)


• The CMA must verify the individual’s Medicaid eligibility monthly.

Standard III.10. Medicaid Eligibility

Standard IV.7 Billing• The CMA must complete Form 3625 supported by written

documentation or case note.• Timekeeper must sign Form 3625.

CLASS Contract MonitoringFrequent Citations- Direct Service Agency

• Please see CLASS DSA Monitoring Workbook for reference information


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• Habilitation/CFC Habilitation staff must receive orientation before the first date of service delivery.

Standard II.2: Staff Qualifications / Training

• All DSA staff must receive annual training every 12 months on A/N/E, Rights and Responsibilities, and review of the CLASS rules in TAC Chapter 45.

Standard II.3: Staff Qualifications / Training


• Annually, the DSA must explain orally and in writing to the individual and LAR or person actively involved with the individual:

• Rights and responsibilities including complaint procedures

• How to report an allegation of abuse, neglect, or exploitation

• How to make a complaint

Standard VI.2: Renewal


IPP Service Summaries required for the following: • Auditory enhancement training• Behavioral support• Dietary services (nutritional services)• Habilitation training• Occupational therapy• Physical therapy• Prevocational services

IPP Service Summaries Section 3350


[cont.…]• Specialized therapies• Speech therapy• Supported employment services• Copies of the completed IPP Service Summaries

must be provided to the CMA within five business days of completing the IPP Service Summary.

IPP Service Summaries Section 3350


• The DSA quarterly review/90-Day Service Summary must include the following elements:

• Current observable/measurable goals and objectives

• Frequency and duration of sessions attended • Rationale for missed sessions

IPP Service Summary

Refer to Appendix X: Quarterly Due Dates Chart


• The DSA quarterly review/90-Day Service Summary must include the following elements:

• Progress or lack of progress • Actions taken, as applicable (e.g., in-servicing,

counseling, etc.)• Revisions of goals and objectives, as applicable

IPP Service Summary

Refer to Appendix X: Quarterly Due Dates Chart


• Copies of the identified records must be delivered to the receiving DSA within five calendar days of notification by the case manager of the individual's decision to transfer to a different DSA.

• The transferring DSA is required to maintain documentation of the specific records that were delivered to the receiving DSA, as well as the date of the delivery.

Transfers


CORRECTIVE ACTION PLANS NEVER EXPIRE!• CMAs and DSAs must continue to adhere to any

CAP approved by DADS/HHSC .• Any Corrective Action Plan (CAP) that has been

approved by DADS/HHSC will be included in all future monitoring reviews.

Corrective Action Plans (CAP)

Who To Contact?• Contract Enrollment and Administration

• Paul Straka, Manager (512) 438-3460• Anne Tanner, Contract Specialist V (512) 438-3618• Fax Number (512) 438-5528• Email

[email protected]• Unit Voicemail Box (512) 438-3550

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mailto:[email protected]

Who To Contact?• Contract Compliance and Performance Management

• Sarah Schmidt, Manager (512) 438-5370• Tinia Collins, Program Consultant (512) 438-2232• Angie Campos, Program Consultant (512) 438-2544• Joseph Cantu, Program Consultant (512) 438-3639• Fax Number (512) 438-3639

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Thank You For Your Attention.

Contracting for Community Living Assistance and Support Services (CLASS)

Anne Tanner, Contract Specialist V

Contracted Community Services (CCS)

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CLASS Contracting Requirements• Applicants who wish to contract for the CLASS program must

reference 40 Texas Administrative Code (TAC) §49.205 (a) (1) (2), which states the following:• To be a contractor, an applicant must have a license,

certification, accreditation, or other document as follows:• CLASS/Support Family Services (SFS) requires a permit to

operate a child-placing agency issued by the Department of Family and Protective Services (DFPS) in accordance with Chapter 745; or

• A Home and Community Support Services Agency (HCSSA) license issued by the Department of Aging and Disability Services (DADS) in accordance with Chapter 97 with: • Licensed Home Health Services (LHHS) category; or• Licensed and Certified Home Health Services (L&CHHS)

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CLASS Contracting Requirements (cont.)

• CLASS/Direct Services Agency (DSA) requires a HCSSA license issued by HHS in accordance with 40 TAC Chapter 97 with:• LHHS category; or• L&CHHS category

• CLASS/Case Management Agency (CMA) contracts do not require a license

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• An entity may apply for either a CLASS/CMA contract or a CLASS/DSA contract, but not both, in any particular catchment area.

• A CLASS provider must be able and willing to provide the entire array of services to the CLASS individuals they’re serving.

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• A CLASS provider must have a business location in the catchment area (service area) for which they wish to provide services.• In order to provide direct services in a specific

catchment area, a CLASS/DSA provider must have a licensed office location in that catchment area.

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• If you already have an existing contract with Health and Human Services (HHS) (i.e. DBMD contract), you can simply request to add a contract for CLASS.

• The request must be signed by an authorized representative for your agency.

• The request can be faxed to CCS at:(512) 438-5522.

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CLASS Contracting Information• More information about the CLASS program can be

found at: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/community-living-assistance-support-services-class.

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https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/community-living-assistance-support-services-class

CLASS Contracting Information (cont.)

• More information on how to become a CLASS provider and the address for submitting an application can be found at:

https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/community-living-assistance-support-services-class/how-become-a-class-provider.

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https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/community-living-assistance-support-services-class/how-become-a-class-provider

CLASS Contracting Information (cont.)

• The Form 5830, Application Packet Checklist, includes all required forms and documents. • This form can be found at:

https://hhs.texas.gov/laws-regulations/forms/5000-5999/form-5830-application-packet-checklist-state-office-enrolled.

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https://hhs.texas.gov/laws-regulations/forms/5000-5999/form-5830-application-packet-checklist-state-office-enrolled

Requesting Contract ChangesProviders must notify HHSC of changes affecting their contracts such as:• An ownership update (or stock transfer) at least

60 days in advance of the date of the change

• A change in the name of the individual(s) authorized to negotiate contracts on behalf of the provider within 30 days of the date of the change.

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Requesting Contract Changes (cont.)

• A change in the provider’s telephone number, fax number, physical address, mailing address or email address within 30 days of the date of the change or within 3 days after the change if reason is due to natural or unforeseen disaster.

• Note that all requests must come from an individual having signature authority.

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Requesting a Change of Ownership or Change of Legal Entity

• A change of legal entity will be processed when there’s a change in the EIN, which generally indicates a change in the legal entity responsible for the contract.

• A change of ownership will be processed when, as the result of a stock transfer, one or more persons who collectively had less than 5 percent ownership before the stock transfer will now have at least 50 percent ownership after the stock transfer.

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Requesting a Change of Ownership or Change of Legal Entity (cont.)

• Must provide HHSC with at least sixty (60) days advance notice prior to the anticipated effective date of the contract assignment.

• Please refer to 40 Texas Administrative Code (TAC) §49.210 to review the applicable rule.

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More CLASS Providers Needed• Past CLASS Provider Alerts have indicated the

need for more CLASS providers in the following service areas (catchment areas):

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• Amarillo• Abilene• Eagle Pass-Uvalde• El Paso• Lubbock

• Lufkin• Midland/Odessa• Waco/Temple• Wichita Falls

More CLASS Providers Needed (cont.)

• A list of the counties in each catchment area can be found on the HHS website under the instructions for Form 3691, Service Area Designation.• This list can be found at:

https://hhs.texas.gov/sites/hhs/files//documents/laws-regulations/forms/3691/CountiesbyCatchmentArea.pdf.

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https://hhs.texas.gov/sites/hhs/files/documents/laws-regulations/forms/3691/CountiesbyCatchmentArea.pdf

Contact Information for CCS• Email:[email protected]• Phone, Unit Voice Mail: (512) 438-3550• Fax: (512) 438-5522• Mail: Health and Human Services

Contracted Community ServicesMail Code W-357P.O. Box 149030Austin, Texas 78714-9030

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CLASS Rules Revision40 TAC Chapter 45

Bob Scott, CLASS Policy Specialist

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CLASS Rules Revision• Address changes in the authority of the DFPS

Adult Protective Services Provider division• APS Provider division investigates allegations of

ANE of an adult or child receiving CLASS or CFC• CMAs will receive intake reports and final

investigative reports for individuals using CDS option.

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CLASS Rules Revision• Annual verification of choice between waiver and

ICF/IID.• Require tracking systems for LOC and IPC

Renewal.• CFC PAS/HAB providers must meet same

requirements as CLASS habilitation-transportation providers.

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CLASS Rules Revision• Rules approval process has been expanded to

allow sufficient review of changes before adoption.• Revision process will include 30 day comment

period from external stakeholders prior to submission to Medical Care Advisory Committee (MCAC).

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CLASS Rules Revision• Revised rules will be published in Texas Register

for all public comments.• Effective date of September 1, 2018.

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CLASS Provider Manual RevisionsBob Scott, CLASS Policy Specialist

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CLASS Provider Manual Revisions• Comment period from 1/23/17 through 2/13/17.

• Policy change on faxing IPCs.

• CLASS IPCs will continue to be faxed until further notice.

• CLASS CMAs must provide authorized IPC to SPT members.

• 10 business days for Enrollment and Renewal• Five business days for Revision

• Monthly Medicaid Verification51

CLASS Provider Manual Revisions• CLASS IPP Addendum complements SPT notes.• IPP Service Summary completed by DSA service

provider.• CMAs are encouraged to schedule renewal as early

as possible.• Therapist recommendations preceding SPT

meeting.• CMA explaining EVV.

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CLASS Provider Manual Revisions• Provider Manual comments incorporated into draft

version.• Revised draft is under review for publication.• Expect publication during summer of 2017.

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Provider Choice in CLASS• CLASS encourages open enrollment process that

guarantees an individual’s right to choose each service provider and provider agency.

• CLASS providers cannot require an individual to choose the same agency to provide multiple functions for the individual.

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CLASS Transportation-Habilitation• Transportation may be provided as an adaptive aid

through bus passes, taxi vouchers, or similar payment system.

• CLASS also offers transportation-habilitation which allows the CFC PAS/HAB provider to transport individual within their community.

• If transportation is identified on the IPC as an authorized service, the DSA must reimburse service provider.

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IDD Program Eligibility & Support (IDD PES)Fabian Aguirre, Unit ManagerAngie Hutchison, Program Specialist

Presentation Topics• Provider Portal Update

• Requesting STAR+PLUS (SPW) & MDCP STAR Kids (SK) Closures for CLASS Enrollment

• IDD PES Message Line

Provider Portal Update• The IDD Provider Portal is coming your way!!• Starting Sept. 1, 2017, HHSC is saying good-bye

to paper submissions and hello to a new online system to send and receive documents from long term care providers and Local Intellectual / Developmental Authorities (LIDDA) who provide services to individuals with diagnoses of Intellectual or Developmental Disabilities (IDD).

Provider Portal Update• The IDD Provider Portal is coming your way!! • The new system, called the HHSC IDD Provider

Portal, will be piloted with the HCS, CLASS, TxHmL, ICF-IID, DBMD and CFC non-waiver programs at the end of May.

• The system will be implemented across all provider communities on Sept. 1.

Provider Portal Update• The IDD Provider Portal is coming your way!!

• This system will allow HHSC employees, contracted case management staff, LIDDAs and providers to securely transfer documents electronically

• Resulting not only in a more efficient submission processing time period, but also increased data accuracy and fewer follow-up phone calls and faxes.

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Provider Portal Update• Who will use the portal?

• These programs will begin using the portal September 1.

• Community Living Assistance and Support Services • Case Management Agencies• Direct Services Agencies

• Deaf Blind with Multiple Disabilities Providers

Provider Portal Update• Who will use the portal?

• Home and Community-based Services Providers• Intermediate Care Facility for Individuals with

Intellectual Disabilities Providers • Local Intellectual Developmental Disability

Authorities • Texas Home Living Providers

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Provider Portal Update• Why is this better?

• No more guessing if the right forms are being submitted; the portal will indicate any required form(s) for the submission type selected and include a link to the handbook/manual to ensure accurate uploading of all required documents for the submission type selected.

• Some forms that previously had to be faxed or mailed to the agency can be completed and submitted through the portal. • HHSC policies related to maintaining paper copies

in the comprehensive client record will continue to apply.


• Signed forms can be scanned and submitted electronically.

• Providers can track the status of their requests at any time

• The submitter will receive an email when the status of a submission changes during the review process.

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• If HHSC employees have questions about a submission or if documentation is missing, they can use the portal to contact the provider instead of returning documents through the mail, or via fax.

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Provider Portal Update• Where do I learn how to use it?

• HHSC will be providing more information about how to register for and use the online portal prior to implementation.

• This information will come in the form of:• Email alerts • Information letters• Portal training webinars• Computer-based training • In-person communications via existing

stakeholder meeting events

Provider Portal Update• Where do I learn how to use it?

• HHSC will also make available a dedicated troubleshooting email address

• Currently developing of a user guide for this new resource.

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SPW & MDCP SK closuresRequests for SPW & MDCP SK closures must be received by the 20th day of the previous month

Why must we receive this request by the 20th?

• Allows time for staff review of the enrollment IPC packet.

• Allows time to coordinate necessary closure of a future 1st of the month CLASS start date.

SPW & MDCP SK closuresRemand letter will read:• HHSC must receive the corrected Enrollment IPC

by the 20th day of the month preceding the requested effective CLASS enrollment begin date.• For example, if the requested effective begin

date is 4/1• HHSC must receive the remand response by

3/20 in order to close out SG 18 or SG 19 and process the authorization.

SPW & MDCP SK closuresRemand letter will read:• If corrections and/or documentation are not received

by the 20th day prior to the requested effective CLASS enrollment begin date, the CMA is required to provide a revised IPC with the following first of the month begin date. • For example, if HHSC receives the remand response

on 3/28 and the requested effective begin date for the individual’s CLASS enrollment IPC is 4/1

• The CMA will receive a request from the reviewer to provide revised documents with a 5/1 effective begin date.

IDD PES Message LineBeginning today, May 17, 2017, CLASS CMAs and DSAs should use the IDD PES message line for CLASS inquiries related to:

• Eligibility

• Enrollments

• Transfers, Suspensions, and Terminations

512-438-2484

IDD UR Message LineBeginning today, May 17, 2017, providers should use the CLASS/DBMD IDD UR message line for inquiries related to:

• CLASS IPCs

• DBMD

512-438-4896

Message Lines TableCLASS DBMD

IDD PES: Eligibility (ID/RCs and Programmatic) 512-438-2484 N/A

IDD PES: Enrollments (Enrollment IPCs, Pre-Enrollment Assessments)

512-438-2484 N/A

IDD PES: Transfers, Suspensions,Terminations 512-438-2484 N/A

IDD UR: IPCs(Revisions, Renewals) 512-438-4896 512-438-4896

IDD UR: DBMD (Eligibility, Enrollments, Transfers, Suspensions, Terminations)

N/A 512-438-4896


[email protected]

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Wrap Up• Next Webinar is scheduled for August 17, 2017• Announcement to go out by GovDelivery• Please keep up-to-date with DADS email alerts to

learn when this webinar is posted to the CLASS webpage.

Wrap Up• Your feedback will assist DADS in refining this

communication format to suit the needs of CLASS providers and other interested parties.

• If you have comments regarding this webinar, please send them to the CLASS mailbox at [email protected]


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