Consumer Directed Services CDS Implementation Training for the Home and Communitybased Services HCS

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Consumer Directed Services CDS Implementation Training for the Home and Communitybased Services HCS

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Title: Consumer Directed Services CDS Implementation Training for the Home and Communitybased Services HCS

1
Consumer Directed Services (CDS) Implementation
Training for the Home and Community-based
Services (HCS) and the Texas Home Living (TxHmL)
Programs
2
(No Transcript)
3
Consumer Directed
Services

HCS TxHmL
Enrollment Screens
Individual Plan of Care
CHANGES

4
Presentation Agenda

Topic Target Audience
Enrollments ???? MRA Staff
Revisions/Annual ?? Provider and MRA Staff
Renewals
Transfers (Adding/ ? Provider and MRA Staff
Changing providers
- PE Staff)

5
MRA ENROLLMENT STEPS

(L01) - Enrollment (HCS TxHmL) Change
(L23) - MR/RC No Change
(L02) - IPC (HCS TxHmL) Change
(L03) - Enrollment Checklist - No Change
(L09) - Register Client Update - No Change
(L05) - Provider Choice - Change

6
Consumer Demographic Update ScreensNO
CHANGES!

(L11) Client Name Update
(L12) Client Address Update
(L10) Client Correspondent Update
(L20) Guardian Information Update

7
Permanency Planning Review (339)

MRA Only Screen (If Applicable)
No Changes

L01 - CONSUMER ENROLLMENT

01-08-08 L01CONSUMER ENROLLMENT
ADD/CHANGE/DELETE VC060220
PLEASE ENTER ONE OF THE
FOLLOWING
CLIENT ID
__________
COMPONENT CODE/LOCAL CASE NUMBER
___ / __________
PLEASE ENTER THE
FOLLOWING
TYPE OF ENTRY _
(A/ADD,C/CHANGE,D/DELETE)
PRESS ENTER

01-08-08 L01CONSUMER ENROLLMENT ADD
VC060225
NAME CAKE, PATTY
CLIENT ID 29653
MEDICAID NUMBER 010119400 LOCAL
CASE NUMBER 0001011940
(Contract Number-REMOVED)
COMPONENT 030
ENROLLMENT REQUEST DATE 03012002 (MMDDYYYY)
WAIVER TYPE 1 (1-HCS,4-TXHML)
PRIOR DISCHARGE FROM A MEDICAID CERTIFIED NF OR
ICF-MR? N (Y/N)
ADMIT FROM1(1COMM,2ICF-MR,3STATE
SCH,4REFINANCE,5STATE HOSP)
ENTER ONE OF THE FOLLOWING
SLOT TYPE 30_ (5-OBRA, 7-MDU, 9-ICF-MR, 12-PI,
13-PI4, 16-LA/REF,
18-TXHML/WL, 20-ICFMR2, 25-PI3, 26-CPS-HCS,
27-SM-MED ICFMR, 29-HOPE, 30-IL REDUCTION,
31-PI-08, 32-PI5, 33-SMICF2, 34-CPS-08, 35-NF-08)
SLOT TRACKING NUMBER 649999999
MFP DEMO? N (Y/N)
COUNTY OF SERVICE 227
GUARDIAN
LAST NAME SELF__________ SUFFIX
____
FIRST NAME ____________ MIDDLE
INITIAL _
C/O _____________________________
PHONE ( ___ ) ___ - ____
STREET 12345 MUDPIE__________________
CITY AUSTIN_______________ STATE TX
ZIP CODE 78701 ____

L05 - PROVIDER CHOICE

01-08-08 L05PROVIDER CHOICE ADD/DEL
VC060227
PLEASE ENTER ONE OF THE
FOLLOWING
CLIENT ID
__________
COMPONENT CODE/LOCAL CASE NUMBER
030 / __________
MEDICAID NUMBER _________
PLEASE ENTER THE FOLLOWING
TYPE OF ENTRY _
(A/ADD,D/DELETE)
PRESS ENTER

01-08-08 L05PROVIDER CHOICE ADD
VC060228
NAME
CLIENT ID
MEDICAID NUMBER
LOCAL CASE NUMBER
COMPONENT
SLOT TYPE
SLOT TRACK NO
PROGRAM PROVIDER (PRGP)
COMPONENT ___
LOCAL CASE NUMBER __________ CONTRACT
NUMBER _________
LOCATION CODE ____
CONSUMER DIRECTED SERVICE AGENCY (CDSA)
COMPONENT ___
LOCAL CASE NUMBER __________ CONTRACT
NUMBER _________
SERVICE BEGIN DATE 01082008 (MMDDYYYY) SERVICE
COUNTY 227 TRAVIS
READY TO ADD? _ (Y/N)

L02 - INDIVIDUAL PLAN OF CARE
(HCS)

01-08-08 L02INDIVIDUAL PLAN OF CARE
VC060230
PLEASE ENTER ONE OF THE
FOLLOWING
CLIENT ID 37613
COMPONENT CODE/LOCAL CASE NUMBER
030 / __________
MEDICAID NUMBER _________
PLEASE ENTER THE
FOLLOWING
TYPE OF ENTRY I IINITIAL
NRENEWAL
EERROR CORRECTION TTRANSFER
RREVISION DDELETE
PLEASE ENTER FOR INITIAL
PLANS ONLY
BEGIN DATE 01082008
(MMDDYYYY)
PLEASE SELECT FOR INITIAL PLANS WITH THE
FOLLOWING SLOT TYPES
16LA/REF, 17TXHML/REF,
18TXHML/WL
_ 365 DAYS _ 270 DAYS _
180 DAYS

16
HCS

01-08-08 L02INDIVIDUAL PLAN OF CARE
ENTRYINITIAL VC060232A
NAME RANGERS, POWER A. CLCN 020 0000222996
CLIENT ID 37613
BEG DT 01082008 REV DT (MMDDYYYY)
END DT 01062009
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
CMM CASE MANAGEMENT 12 MONS SP
SPEECH/LANGUAGE ___ HRS
SHL SUPPORTED HOME LIV 900 HRS OT
OCCUPATIONAL THERA HRS
FC HCS FOSTER CARE DAYS PT PHYSICAL
THERAPY HRS
SL SUPERVISED LIVING DAYS DI DIETARY
HRS
RSS RES SUPPORT SVC DAYS PS
PSYCHOLOGY HRS
NU NURSING 20 HRS AU
AUDIOLOGY HRS
REH RESPITE HR 300 HRS SW SOCIAL
WORK HRS
RE RESPITE DAYS DE DENTAL
DOL
DH DAY HABILITATION 240 DAYS AA ADAPTIVE
AIDS 100 DOL
SE SUPPORTED EMP HRS MHM MINOR
HOME MODS 1009 DOL
SCV SUPPORT CONSULTAT 20 HRS FMSV FMS
MONTHLY FEE 12 MO

01-08-08 L02INDIVIDUAL PLAN OF CARE
ENTRY INITIAL VC060234A
NAME RANGERS, POWER A. CLCN 020
0000222996 CLIENT ID 37613
IPC BEGIN DATE01-08-2008 REVISE DATE
END DATE01-06-2009
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
CMMB CASE MANAGEMENT 12 HRS SHLV SUPP
HOME LIV 900 HRS REHV RESPITE (HOURS)
300HRS SCV SUPPORT CONSULT 20 HRS
FMSV MONTHLY FEE 12 MO
WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N)
CALCULATE? N(Y/N) CDS ESTIMATED ANNUAL TOTAL
20,121.00

18
HCS

01-01-08 L02INDIVIDUAL PLAN OF CARE ENTRY
INITIAL VC060237A
NAME RANGERS, POWER A. CLCN020 0000222996
CLIENT ID37613
IPC BEGIN DATE01-08-2008 REVISE DATE
END DATE01-06-2009
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
CMMA CASE MANAGEMENT 12 MO NU
NURSING 20 HRS
DH DAY HABILITATION 240 DAYS AA ADAPTIVE
AIDS 100 DOL
MHM MINOR HOME MODS 1009 DOL

19
HCS

01-08-08 L02INDIVIDUAL PLAN OF CARE ENTRY
INITIAL VC060238A
NAME RANGERS, POWER A. CLCN 020 0000222996
CLIENT ID 37613
PRGPCONTRACT COMPONENT LOCAL
CASE NUMBER
CDSACONTRACT COMPONENT LOCAL
CASE NUMBER
IPC BEGIN DATE 01/08/2008 REVISE DATE
01/08/2008 END DATE 01/06/2009
TOTAL ANNUAL COST 36,436.60 COST CEILING
78,967.75
ARE ANY DIRECT SERVICES STAFFED BY A
RELATIVE/GUARDIAN? N (Y/N)
CONTRACTED PROVIDER NAME ______________
DATE (MMDDYYYY)
____________
IDT CERTIFICATION STATEMENT
NAME
DATE(MMDDYYYY)
CASE MANAGER FOREST SERVICE__________________
12292007

L02 - INDIVIDUAL PLAN OF CARE
(TxHmL)

01-08-08 L02INDIVIDUAL PLAN OF CARE
VC060230
PLEASE ENTER ONE OF THE
FOLLOWING
CLIENT ID 40011
COMPONENT CODE/LOCAL CASE NUMBER
010 / __________
MEDICAID NUMBER _________
PLEASE ENTER THE
FOLLOWING
TYPE OF ENTRY I IINITIAL
NRENEWAL
EERROR CORRECTION TTRANSFER
RREVISION DDELETE
PLEASE ENTER FOR INITIAL
PLANS ONLY
BEGIN DATE 01082008
(MMDDYYYY)
PLEASE SELECT FOR INITIAL PLANS WITH THE
FOLLOWING SLOT TYPES
16LA/REF, 17TXHML/REF,
18TXHML/WL
_ 365 DAYS _ 270 DAYS _
180 DAYS

22
TxHmL

01-08-08 L02INDIVIDUAL PLAN OF CARE ENTRY -
INITIAL VC060233A
NAME TURTLE,NINJA CLCN 010 0000002217
CLIENT ID 40011
BEG DT 01082008 REV DT ________ (MMDDYYYY)
END DT 01062009
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
AU AUDIOLOGY ___DOL OT
OCCUPATIONAL THERAPY ___HRS
BES BEHAVIOR SUPPORT 12 HRS PT PHYSICAL
THERAPY ___HRS
CS COMMUNITY SUPPORT 100HRS RE RESPITE
10 DAYS
DH DAY HABILITATION 120DAYS REH RESPITE HR
10 HRS
DI DIETARY ___HRS SP
SPEECH/LANGUAGE ___HRS
EA EMP ASSISTANCE ___HRS SE SUPPORTED
EMP ___HRS
NU NURSING 20 HRS DE DENTAL
500DOL
MHM MINOR HOME MOD ____DOL AA ADAPTIVE
AIDS ___DOL
MHMR MINOR HOME MOD RE ___DOL AAR ADAPTIVE
AIDS REQ. ___DOL
SCV SUPPORT CONSULTAT 10HRS FMSV FMS
MONTHLY FEE 12 MONS

23
TxHmL

01-08-08 L02INDIVIDUAL PLAN OF CARE ENTRY
- INITIAL VC060234A
NAME TURTLE,NINJA CLCN 010 00002217
CLIENT ID 40011
IPC BEGIN DATE01-08-2008 REVISE DATE
END DATE01-06-2009
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
BESV BEHAVIOR SUPPORT 12 HRS REV RESPITE
10 DAYS
CSV COMMUNITY SUPPORT 100HRS REHV RESPITE HR
10 HRS
DHV DAY HABILITATION 120DAYS DEV DENTAL
500 DOL
NUV NURSING 20 HRS FMSV FMS
MONTHLY FEE 12 MONS
SCV SUPPORT CONSULTAT 10HRS
WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N)

24
TxHmL

01-08-08 L02INDIVIDUAL PLAN OF CARE ENTRY
- INITIAL VC060234A
NAME TURTLE,NINJA CLCN 010 00002217
CLIENT ID 40011
IPC BEGIN DATE01-08-2008 REVISE DATE
END DATE01-06-2009
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
BESV BEHAVIOR SUPPORT 0 HRS REV RESPITE
10 DAYS
CSV COMMUNITY SUPPORT 100HRS REHV RESPITE HR
10 HRS
DHV DAY HABILITATION 0 DAYS DEV DENTAL
0 DOL
NUV NURSING 20 HRS FMSV FMS
MONTHLY FEE 12 MONS
SCV SUPPORT CONSULTAT 10HRS
WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N)

25
TxHmL

01-08-08 L02INDIVIDUAL PLAN OF CARE ENTRY
INITIAL VC060237A
NAME TURTLE,NINJA CLCN 010 0000222996
CLIENT ID 37613
IPC BEGIN DATE 01-08-2008 REVISE DATE
END DATE 01-06-2009
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
BES BEHAVIOR SUPPORT 12 HRS DH DAY
HABILTATION 120 DAYS
DE DENTAL 500 DOL
PROGRAM PROVIDER ESTIMATED ANNUAL
TOTAL 4,337.36
READY TO CONTINUE? Y(Y/N) ANNUAL COST 11,961.36
COST CEILING 13,000.00

26
TxHmL

01-08-08 L02INDIVIDUAL PLAN OF CARE ENTRY
INITIAL VC060238A
NAME TURTLE,NINJA CLCN 010 0000002217
CLIENT ID 40011
PRGPCONTRACT COMPONENT LOCAL
CASE NUMBER
CDSACONTRACT COMPONENT LOCAL
CASE NUMBER
IPC BEGIN DATE 01/08/2008 REVISE DATE
END DATE 01-06-2009
TOTAL ANNUAL COST 11,961.36
COST CEILING 13,000.00
ARE ANY DIRECT SERVICES STAFFED BY A
RELATIVE/GUARDIAN? N (Y/N)
CONTRACTED PROVIDER NAME _______________________
____ DATE
(MMDDYYYY) _________
IDT CERTIFICATION STATEMENT
NAME
DATE(MMDDYYYY)
CASE MANAGER FORREST SERVICE_________________
12272007

HCS TxHmL
IPC HARD COPY

HCS IPC HARD COPY
HCS CDS SERVICES THAT CAN BE SELF-DIRECTED
Supported Home Living
Respite Hourly
Respite Daily

29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32

Entering the information from
the hard copy IPC into CARE

TxHmL HARD COPY IPC
TxHmL CDS SERVICES THAT CAN BE SELF-DIRECTED
Audiology Respite
Behavior Support Respite Hourly
Community Support Speech/Language
Day Habilitation Supported Employment
Dietary Dental
Employee Assistance Minor Home Mod
Nursing Adaptive Aids
Occupational Therapy
Physical Therapy

34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37

Entering the information from
the hard copy IPC into CARE

TxHmL HCS
RENEWALS REVISIONS

39
TxHmL

01-08-08 L02INDIVIDUAL PLAN OF CARE ENTRY
RENEWAL VC060233A
NAME HAMMER, M C JR CLCN 070
0000004321 CLIENT ID 11007
BEG DT 03022008 REV DT 03022008 (MMDDYYYY)
END DT 03012009
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
AU AUDIOLOGY HRS OT
OCCUPATIONAL THERAPY 2 HRS
BES BEHAVIOR SUPPORT 10 HRS PT PHYSICAL
THERAPY HRS
CSV COMMUNITY SUPPORT 80 HRS REV RESPITE
30 DAYS
DH DAY HABILITATION 104DAYS REH RESPITE HR
HRS
DI DIETARY HRS SP
SPEECH/LANGUAGE DOL
EAV EMP ASSISTANCE 10 HRS SE SUPPORTED
EMP _HRS
NU NURSING 8_ HRS DE DENTAL
DOL
MHM MINOR HOME MOD DOL AA ADAPTIVE
AIDS DOL
MHMR MINOR HOME MOD RE DOL AAR ADAPTIVE
AIDS REQ. DOL
SCV SUPPORT CONSULTAT 1_ HRS FMSV FMS
MONTHLY FEE 12 MONS

40
TxHmL

01-08-08 L02INDIVIDUAL PLAN OF CARE ENTRY
RENEWAL VC060234A
NAME HAMMER, M C JR CLCN 070 00004321
CLIENT ID 11007
IPC BEGIN DATE03022008 REVISE DATE 03022008
END DATE03012008
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
CSV COMMUNITY SUPPORT 80 HRS REV
RESPITE 30 DAY
EAV EMP ASSISTANCE 10 HRS SCV
SUPPORT CONSULTAT 1 HRS
FMSV MONTHLY FEE 12 MON

41
TxHmL

01-08-08 L02INDIVIDUAL PLAN OF CARE ENTRY
RENEWAL VC060237A
NAME HAMMER, M C JR CLCN 070 00004321
CLIENT ID 11007
IPC BEGIN DATE 03022008 REVISE DATE 03022008
END DATE 03012009
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
BES BEHAVIOR SUPPORT 10 HRS DH DAY
HABILTATION 104 DAYS
NU NURSING 8 HRS OT
OCCUPATIONAL THERAPY 2 HRS
PROGRAM PROVIDER ESTIMATED ANNUAL
TOTAL 3,912.44
READY TO CONTINUE? Y(Y/N) ANNUAL COST 12,923.74
COST CEILING 13,000.00

42
TxHmL

01-08-08 L02INDIVIDUAL PLAN OF CARE ENTRY
RENEWAL VC060238A
NAME HAMMER, M C JR CLCN 070 00004321
CLIENT ID 11007
PRGPCONTRACT 001007000 COMPONENT 9DS LOCAL
CASE NUMBER 000911
CDSACONTRACT 009777777 COMPONENT OMY LOCAL
CASE NUMBER 009311
IPC BEGIN DATE 03022008 REVISE DATE 03022008
END DATE 03012009
TOTAL ANNUAL COST 12,923.74
COST CEILING 13,000.00
ARE ANY DIRECT SERVICES STAFFED BY A
RELATIVE/GUARDIAN? N (Y/N)
CONTRACTED PROVIDER NAME _ICAN
DUIT__________________
DATE (MMDDYYYY) 01292008_________
IDT CERTIFICATION STATEMENT
NAME
DATE(MMDDYYYY)
CASE MANAGER DON KING JR _________________
01272008

43
TxHmL

01-08-08 L02INDIVIDUAL PLAN OF CARE ENTRY
REVISE/RENEWAL VC060233A
NAME HAMMER, M C JR CLCN 070
0000004321 CLIENT ID 11007
BEG DT 03022008 REV DT 03022008 (MMDDYYYY)
END DT 03012009
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
AU AUDIOLOGY HRS OT
OCCUPATIONAL THERAPY 2 HRS
BES BEHAVIOR SUPPORT 10 HRS PT PHYSICAL
THERAPY HRS
CSV COMMUNITY SUPPORT 80 HRS REV RESPITE
30 DAYS
DH DAY HABILITATION 104DAYS REH RESPITE HR
HRS
DI DIETARY HRS SP
SPEECH/LANGUAGE DOL
EAV EMP ASSISTANCE 10 HRS SE SUPPORTED
EMP _HRS
NU NURSING 8_ HRS DE DENTAL
DOL
MHM MINOR HOME MOD DOL AA ADAPTIVE
AIDS DOL
MHMR MINOR HOME MOD RE DOL AAR ADAPTIVE
AIDS REQ. DOL
SCV SUPPORT CONSULTAT 1_ HRS FMSV FMS
MONTHLY FEE 12 MONS

44
CHANGING SERVICE DELIVERY OPTION(SDO) FOR A
SPECIFIC SERVICEREVISION RENEWAL(currently
TxHmL Only)

PrgP SDO CDS SDO
Behavior Support Community Support
Day Habilitation Employment Assistance
Nursing Respite
Occupational Therapy

45
CONTACT INFO

PATRICK MARTIN
Patrick.martin_at_dads.state.tx.us
(512) 438-4916
GEOFF SHUTE
Geoff.shute_at_dads.state.tx.us
(512) 438-5020

46
BREAK
47
Questions and Answers
48
Transfers adding, changing, and discontinuing an
individuals participation in the CDS option
49
A transfer occurs whenever a contract number
(vendor number) associated with an individual is
added, ended, or changed.A transfer in CARE
occurs when a individual moves from a1. Program
Provider (PrgP) to PrgP,2. PrgP to Consumer
Directed Services Agency (CDSA),3. CDSA to CDSA,
or4. CDSA to PrgP.
50
When the individual has selected a PrgP and/or a
CDSA, the transfer effective date must be agreed
upon by the all of the appropriate entities
involved the transferring program provider,
the receiving program provider, the current
program provider, the CDS Agency (ies), and the
individual/LAR.
51
The receiving/current PrgP or the MRAs service
coordinator must mail or fax a copy of the
Request for Transfer Form and a copy of the
transfer IPC to the appropriate Program
Enrollment (PE) staff person after the data entry
has been completed.
52
Subchapter D 41.403Transfer Process

(a) An individual's CDSA must process a request
by the individual or LAR to transfer from one
CDSA to another CDSA in accordance with transfer
procedures and requirements of the individual's
program.
(b), (d), and (e) apply to the transferring CDSA,
employer or Designated Representative (DR), and
the receiving CDSA, respectively.

(c) Within five working days after the receipt of
a request to transfer, the case manager (HCS) or
service coordinator must (TxHmL)
(1) process the individual's request to
transfer from one CDSA to another CDSA in
accordance with the requirements of the
individual's program and this chapter
(2) calculate the number of units or amount of
funds needed to complete the service plan (IPC)
period based on the individual's current service
plan (use CDSA Transfer Information Form
1742/1743)
(3) revise the service plan to indicate the
number of units or amount of funds calculated in
this subsection effective the date of transfer
and

(A) approve only the units and funds
calculated as needed if units and funds remaining
in the budget meet or exceed the needed number or
units or amount of funds to complete the service
period, or approve only the amount remaining in
the budget for the period remaining in the
individual's service plan and
(B) provide a copy of the transferring
service plan to the receiving CDSA and employer
before the effective date of the transfer and
(4) provide a copy of the individual's revised
service plan to the transferring CDSA, the
receiving CDSA, and the employer or DR.

55
HCS CARE Screen Sequence 1. C06 Transferring
Provider 2. C09 Receiving Provider3. C06
Receiving Provider 4. C02 Receiving Provider
5. C06 Receiving ProviderTxHmL CARE Screen
Sequence1. L09 Transferring MRA2. L06
Transferring MRA 3. L02 Transferring MRA 4.
L06 Transferring MRA
56
HCS Transfer Example

In this transfer example, the individual will
transfer from the current Program Provider to a
new Program Provider and initiate the CDS option
(adding a CDSA).

07-01-08 C06 TRANSFER CONTRACT/SERVICES
A/C/D VC060311
PLEASE ENTER ONE OF
THE FOLLOWING
CLIENT ID 1234_______
COMPONENT CODE/LOCAL CASE NUMBER
8XX / __________
MEDICAID NUMBER _________
PLEASE ENTER THE
FOLLOWING
CONTRACT NUMBER
001001500
TRANSFER EFFECTIVE DATE 07012008
(MMDDYYYY)
FOR ADD ONLY
1. CHANGING PrgP OR CDS AGENCY? Y (Y/N)
2. ADDING A PrgP OR CDS AGENCY? Y (Y/N)
3. CHANGING SERVICE DELIVERY OPTIONS? Y (Y/N)
TYPE OF ENTRYA
(A/ADD,C/CHANGE,D/DELETE)

Matrix for CARE Screen C06
Questions Answer Combinations
Valid Valid Valid
Valid Valid Valid Valid InValid
1. ARE YOU CHANGING YOUR Y N N
Y Y N Y N
PROGRAM PROVIDER OR CDS
AGENCY?
2. ARE YOU ADDING A PROGRAM N N
Y Y N Y Y N
PROVIDER OR CDS AGENCY?
3. ARE YOU CHANGING SERVICE N Y
N N Y Y Y N
DELIVERY OPTIONS?

Service Delivery Option (SDO) means having waiver
services delivered by a PrgP and/or by the
Individual self-directing the services (with
support from the CDSA).
Explanations of the questions on CARE Header
Screen C06/L06
1. Changing a PrgP or CDSA occurs when the SDO
currently exists.
2. Adding a PrgP or CDSA occurs when a SDO will
be added where it does not exist.
3. Changing SDO occurs when an existing service
(s) is moved from one SDO to the other SDO
(contract/vendor numbers do not change).

60
07-01-08 C06 TRANSFER CONTRACT/SERVICES
ADD VC060311 NAME TYE,BEAU
CLIENT ID 1234
EFFECTIVE DATE 07012008 (MMDDYYYY)
SERVICE SDO CLAIM - PD/UNPD REMAIN TO
USE UNITS ADAPTIVE
AIDS PRGP 100.00 30.00 70.00
0_____ CASE MANAGEMENT PRGP 12
6.00 6.00 0_____
DAY HABILITATION PRGP 240 110.00
130.00 4_____ MINOR HOME MODS
PRGP 1009.00 1009.00
00.00 0_____ NURSING
PRGP 20 7.00
13.00 0_____ RESPITE HOURLY PRGP
30 16.00 14.00
0_____ SUPPORTED HOME LIVING PRGP 900
430.00 470.00 0_____
READY TO ADD? Y (Y/N)
61
07-01-08 C06 TRANSFER CONTRACT/SERVICES
ADD VC060316

NAME TYE,BEAU
CLIENT ID 1234 TRANSFER EFFECTIVE
DATE 07-01-2008 TRANSFERRING

SERVICE COUNTY 006 LOCATION CODE OHFH
PRGP COMP/LCN 8XX / 0110111946 CONTRACT
NUMBER 001001500 CDSA COMP/LCN ___ /
__________ CONTRACT NUMBER ________
RECEIVING
Enter only if changing/adding provider(s)
SERVICE
COUNTY ____ LOCATION CODE ____ RESDENTIAL
TYPE ___ PRGP COMP/LCN 8YY / __________
CONTRACT NUMBER 001001510 CDSA COMP/LCN 8ZZ /
__________ CONTRACT NUMBER 001001600

DOLLAR AMTS AA MHM
DENTAL OTHER SVCS TO BE PROV NOW TO TRANS
DT 0.00 0.00 0.00
73.88 TRANSFER ACCEPTED? _ (Y/N) BY
_________________________ DATE ________
(MMDDYYYY) C.O. AUTHORIZE TRANSFER? _ (Y/N)
BY __________________ DATE ________ (MMDDYYYY)
READY TO ADD? Y (Y/N)

ACT ____ (C00/HCS DATA ENTRY MENU,
A/HCS MAIN MENU, HLP(PF1)/SCRN DOC
62

07-01-08 C09REGISTER CLIENT
UPDATE VC060420
PLEASE ENTER AT LEAST ONE OF
THE FOLLOWING
CLIENT ID
1234 __________
COMPONENT CODE/LOCAL CASE NUMBER
8YY / __________
NOTE TO ASSIGN A PROVIDER'S LOCAL CASE
NUMBER FOR NEW ENROLLMENTS
USE THE PROVIDERS COMPONENT CODE IN
THE ABOVE FIELD.
PRESS ENTER

07-01-08
C09REGISTER CLIENT UPDATE
VC060425
CLIENT LAST NAME/SUF TYE
CLIENT ID 1234
CLIENT FIRST NAME BEAU
COMPONENT 8YY
CLIENT MIDDLE NAME
LOCAL CASE NUMBER Y420__________
SEX M_
ETHNICITY W_
CLIENT BIRTHDATE (MMDDYYYY) 10231955
SOCIAL SECURITY NUMBER 66677999
(NNONE, UUNKNOWN)
MEDICAID NUMBER 123456789
MEDICARE NUMBER ____________
PRESENTING PROBLEM 2 (1MH, 2MR,
3ECI/DD, 4SA, 5RC)
REGISTRATION EFFECTIVE DATE 072398 (MMDDYY)
TIME (HHMM A/P) _____
LEGAL GUARDIANSHIP 1
MARITAL STATUS 2 ESTIMATED ANNUAL GROSS
FAMILY INCOME 7258
FAMILY SIZE 1
SERVICE PARTICIPANT GROUP TS (CB, SB, PD,
HC, TS, EC, UC)

07-01-08 C09REGISTER CLIENT
UPDATE VC060420
PLEASE ENTER AT LEAST ONE OF
THE FOLLOWING
CLIENT ID 1234__________
COMPONENT CODE/LOCAL CASE NUMBER
8ZZ / __________
NOTE TO ASSIGN A PROVIDER'S LOCAL CASE
NUMBER FOR NEW ENROLLMENTS USE THE PROVIDERS
COMPONENT CODE IN THE ABOVE FIELD.
PRESS ENTER
ACT ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN
MENU, HLP(PF1)/SCRN DOC)

07-01-08
C09REGISTER CLIENT UPDATE
VC060425
CLIENT LAST NAME/SUF TYE
CLIENT ID 1234
CLIENT FIRST NAME BEAU
COMPONENT 8ZZ
CLIENT MIDDLE NAME
LOCAL CASE NUMBER Z420__________
SEX M_
ETHNICITY W_
CLIENT BIRTHDATE (MMDDYYYY) 10231955
SOCIAL SECURITY NUMBER 66677999
(NNONE, UUNKNOWN)
MEDICAID NUMBER 123456789
MEDICARE NUMBER ____________
PRESENTING PROBLEM 2 (1MH, 2MR,
3ECI/DD, 4SA, 5RC)
REGISTRATION EFFECTIVE DATE 072398 (MMDDYY)
TIME (HHMM A/P) _____
LEGAL GUARDIANSHIP 1
MARITAL STATUS 2 ESTIMATED ANNUAL GROSS
FAMILY INCOME 7258
FAMILY SIZE 1
SERVICE PARTICIPANT GROUP TS (CB, SB, PD,
HC, TS, EC, UC)

07-01-08 C06 TRANSFER CONTRACT/SERVICES
A/C/D VC060311
PLEASE ENTER ONE OF THE
FOLLOWING
CLIENT ID 1234_____
OMPONENT CODE/LOCAL CASE NUMBER 8YY /
__________
MEDICAID NUMBER
_________
PLEASE ENTER THE
FOLLOWING
CONTRACT NUMBER 001001510
TRANSFER EFFECTIVE DATE 07012008
FOR ADD ONLY
CHANGING PrgP OR CDS AGENCY? _ (Y/N)
ADDING A PrgP OR CDS AGENCY? _ (Y/N)
CHANGING SERVICE DELIVERY OPTIONS? _ (Y/N)
TYPE OF ENTRY C
(A/ADD,C/CHANGE,D/DELETE)

07-01-08 C06 TRANSFER
CONTRACT/SERVICES ADD VC060311 NAME
TYE,BEAU CLIENT
ID 1234 EFFECTIVE DATE 07012008
(MMDDYYYY) SERVICE SDO CLAIM - PD/UNPD
- TO USE REMAIN
NEW UNITS SDO ADAPTIVE AIDS
PRGP 100.00 30.00 0.00 70.00
P____ CASE MANAGEMENT
PRGP 12 6.00 0.00 6.00
P____ DAY HABILITATION
PRGP 240 110.00 4.00 126.00
P____ MINOR HOME MODS
PRGP 1009.00 1009.00 0.00
0.00 P____ NURSING
PRGP 20 7.00 0.00
13.00 P____ RESPITE HOURLY
PRGP 30 16.00
0.00 14.00
C____ SUPPORTED HOME LIVING PRGP 900 430.00
0.00 470.00 C____
READY TO CHANGE? Y (Y/N)

68
07-01-08 C06 TRANSFER CONTRACT/SERVICES
ADD VC060311 NAME TYE,BEAU
CLIENT ID 1234
EFFECTIVE DATE 07012008 (MMDDYYYY) SERVICE
SDO CLAIM -PD/UNPD - TO USE
REMAIN NEW UNITS
SDOADAPTIVE AIDS PRGP
100.00 30.00 0.00 70.00
P____CASE MANAGEMENT PRGP
12.00 6.00 0.00 6.00
P____DAY HABILITATION PRGP
240.00 110.00 4.00
126.00 P____MINOR HOME MODS
PRGP 1009.00 1009.00 0.00
0.00 P____NURSING
PRGP 20.00 7.00
0.00 13.00 P____RESPITE HR
CDSA 30.00
16.00 0.00 14.00
C____SUPPORTED HOME LIVING CDSA 900.00
430.00 0.00 470.00
C____ CONFIRM NEW SDO? Y (Y/N)

07-01-08 C06 CONSUMER TRANSFER
CONTRACT/SERVICES CHANGE VC060316
NAME TYE,BEAU
CLIENT ID 1234
TRANSFER EFFECTIVE DATE 07-01-2008
TRANSFERRING
SERVICE COUNTY 006 LOCATION CODE OHFH
PRGP COMP/LCN 8XX / 0110111946 CONTRACT
NUMBER 001001500
CDSA COMP/LCN ___ / __________ CONTRACT
NUMBER _________
RECEIVING Enter only if changing/adding
provider(s)
SERVICE COUNTY 006 LOCATION CODE OHFH
RESIDENTIAL TYPE 3
PRGP COMP/LCN 8YY / Y444_____ CONTRACT
NUMBER 001001510
CDSA COMP/LCN 8ZZ/ Z420 _____ CONTRACT
NUMBER 001001600
DOLLAR AMTS AA MHM
DENTAL OTHER SVCS
TO BE PROV NOW TO TRANS DT 0.00
0.00 0.00 73.88
TRANSFER ACCEPTED? _ (Y/N) BY ___________________
______ DATE____________

07-01-08 C02INDIVIDUAL PLAN OF
CARE VC060230
PLEASE ENTER ONE OF THE
FOLLOWING
CLIENT ID
1234__________
COMPONENT CODE/LOCAL CASE NUMBER
8YY / __________
MEDICAID NUMBER
_________
PLEASE ENTER THE
FOLLOWING
TYPE OF ENTRY T IINITIAL
NRENEWAL
EERROR CORRECTION TTRANSFER
RREVISION
DDELETE
PLEASE ENTER FOR INITIAL
PLANS ONLY
BEGIN DATE ________
(MMDDYYYY)
PLEASE SELECT FOR INITIAL PLANS WITH THE
FOLLOWING SLOT TYPES
16LA/REF, 17TXHML/REF,
18TXHML/WL

07-01-08 C02INDIVIDUAL PLAN OF CARE
ENTRY TRANSFER VC060232A
NAME TYE,BEAU CLCN 8YY 000000Y420
CLIENT ID 1234
BEG DT 01012008 REV DT 07012008 (MMDDYYYY)
END DT 12312008
SERVICE CATEGORY UNITS
SERVICE CATEGORY
UNITS
CMM CASE MANAGEMENT 12___ MONS SHLV
SUPPORTED HOME LIVING 900 HRS
SP SPEECH/LANGUAGE _____ HRS FC
HCS FOSTER CARE __ DAYS
OT OCCUPATIONAL THERA _____ HRS SL
SUPERVISED LIVING __ DAYS
PT PHYSICAL THERAPY _____ HRS RSS
RES SUPPORT SVC __
DAYS
DI DIETARY _____ HRS
NU NURSING
20 HRS
PS PSYCHOLOGY _____ HRS
REHV RESPITE HR
30 HRS
AU AUDIOLOGY _____ HRS
RE RESPITE
__ DAYS
SW SOCIAL WORK _____ HRS
DH DAY HAB
240 DAYS
SE SUPPORTED EMP _____ HRS
FMSV FMS MONTHLY FEE 6
MONS
SCV SUPPORT CONSULTAT _____ HRS DE
DENTAL
__ DOL
AA ADAPTIVE AIDS 100__ DOL
MHM MINOR HOME MODS 1009 DOL

07-01-08 C02INDIVIDUAL PLAN OF CARE
ENTRY TRANSFER VC060233A
NAME TYE,BEAU CLCN 8ZZ 000000Z444
CLIENT ID 1234
IPC BEGIN DATE 01-01-2008 REVISE DATE
07-01-2008 END DATE 12-31-2008
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
REHV RESPITE HR 14.00 HRS SHLV
SUPPORTED HOME LIVING 470 HRS
FMSV FMS MONTHLY FEE 6.00 MONS
CDS ESTIMATED ANNUAL
TOTAL 9,206.86

07-01-08 C02INDIVIDUAL PLAN OF CARE
ENTRY TRANSFER VC060237A
NAME TYE,BEAU CLCN 8YY 000000Y420
CLIENT ID 1234
IPC BEGIN DATE 01-01-2008 REVISE DATE
07-01-2008 END DATE 12-31-2008
SERVICE CATEGORY UNITS SERVICE
CATEGORY UNITS
CMMB CASE MGMT SELF DIR 12.00 MONS NU
NURSING 20.00 HRS
DH DAY HABILITATION 240 DAYS REH
RESPITE HR 16.00 HRS
SHL SUPPORTED HOME LVG 460 HRS
AA ADAPTIVE AIDS 100.00 DOL
MHM MINOR HOME MODS 1009.00 DOL
PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL
27,561.92
READY TO CONTINUE? Y (Y/N) ANNUAL COST
36,768.78 COST CEILING 78,967.75
ACT ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA
MAIN MENU,HLP(PF1)/SCRNDOC)

07-01-08 C02INDIVIDUAL PLAN OF CARE
ENTRY TRANSFER VC060238A
NAME TYE,BEAU CLCN 0000000001
CLIENT ID 1234
PRGP CONTRACT001001510 COMPONENT 8YY
LOCAL CASE NUMBER 000000Y420
CDSA CONTRACT001011600 COMPONENT 8ZZ
LOCAL CASE NUMBER 000000Z444
IPC BEGIN DATE 01-01-2008 REVISE DATE
07-01-2008 END DATE 12-31-2008
TOTAL ANNUAL COST 36,078.88 COST CEILING
78,967.75
ARE ANY DIRECT SERVICES PROVIDED BY A
RELATIVE/GUARDIAN? Y (Y/N)
CONTRACTED PROVIDER NAME APRIL
MAY____________________
DATE (MMDDYYYY) 07012008
IDT CERTIFICATION STATEMENT
DATE
NAME
(MMDDYYYY)

07-01-08 C06TRANSFER CONTRACT/SERVICES
A/C/D VC060311
PLEASE ENTER ONE OF THE
FOLLOWING
CLIENT ID
1234_____
COMPONENT CODE/LOCAL CASE NUMBER
8YY / __________
MEDICAID NUMBER
_________
PLEASE ENTER THE
FOLLOWING
CONTRACT NUMBER 001001510
TRANSFER EFFECTIVE DATE 07012008
FOR ADD ONLY
CHANGING PrgP OR CDS AGENCY? _ (Y/N)
ADDING A PrgP OR CDS AGENCY? _ (Y/N)
CHANGING SERVICE DELIVERY OPTIONS? _ (Y/N)
TYPE OF ENTRY C
(A/ADD,C/CHANGE,D/DELETE)

07-12-08 C06 TRANSFER CONTRACT/SERVICES
CHANGE VC060316
NAME TYE,BEAU
CLIENT ID 1234
TRANSFER EFFECTIVE DATE 07-01-2008
TRANSFERRING
SERVICE COUNTY 006 LOCATION CODE OHFH
PRGP COMP/LCN 8XX / 00101500 CONTRACT NUMBER
001001500
CDSA COMP/LCN ___ / ________ CONTRACT NUMBER
_________
RECEIVING Enter only if changing/adding
provider(s)
SERVICE COUNTY 8YY LOCATION CODE OHFH_
RESIDENTIAL TYPE 3
PRGP COMP/LCN 8YY / Y420 ____ CONTRACT
NUMBER 001001510
CDSA COMP/LCN 8ZZ / Z444_____ CONTRACT
NUMBER 001011600
DOLLAR AMTS
AA MHM DENTAL OTHER SVCS
TO BE PROV NOW TO TRANS DT 0.00
0.00 0.00 73.88
TRANSFER ACCEPTED? Y (Y/N) BY ART
WORK_______________ DATE 07012008
C.O. AUTHORIZE TRANSFER? _ (Y/N) BY _______
DATE ________ (MMDDYYYY)

77
TxHmL Transfer Example

In this transfer example, the individual will
transfer from the current Program Provider to a
new Program Provider and initiate the CDS option
(adding a CDSA).

78
10-15-08 L09REGISTER CLIENT
UPDATE VC060420PLEASE ENTER
AT LEAST ONE OF THE FOLLOWING

CLIENT ID
9876______ COMPONENT
CODE/LOCAL CASE NUMBER 8SS / __________
NOTE TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER
FOR NEW ENROLLMENTS USE THE PROVIDERS
COMPONENT CODE IN THE ABOVE FIELD.
PRESS ENTER

ACT ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN
MENU, HLP(PF1)/SCRN DOC)
79

10-15-08 L09REGISTER CLIENT
UPDATE VC060425
CLIENT LAST NAME/SUF ABSENT
CLIENT ID 9876
CLIENT FIRST NAME MARCUS
COMPONENT 8SS
CLIENT MIDDLE NAME
LOCAL CASE NUMBER S777
SEX M
ETHNICITY W
CLIENT BIRTHDATE (MMDDYYYY) 02181974
SOCIAL SECURITY NUMBER 987654321 (NNONE,
UUNKNOWN)
MEDICAID NUMBER 123456789
MEDICARE NUMBER ____________
PRESENTING PROBLEM 2 (1MH,
2MR, 3ECI/DD, 4SA, 5RC)
REGISTRATION EFFECTIVE DATE 022391 (MMDDYY)
TIME (HHMM A/P) 1005A
LEGAL GUARDIANSHIP 2
MARITAL STATUS 2 ESTIMATED ANNUAL GROSS
FAMILY INCOME 7252
FAMILY SIZE 1
SERVICE PARTICIPANT GROUP __ (CB, SB, PD, HC,
TS, EC, UC)

80
10-15-08 L09REGISTER CLIENT
UPDATE VC060420PLEASE ENTER
AT LEAST ONE OF THE FOLLOWING

CLIENT ID
9876______ COMPONENT
CODE/LOCAL CASE NUMBER 8TT / __________
NOTE TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER
FOR NEW ENROLLMENTS USE THE
PROVIDERS COMPONENT CODE IN THE ABOVE FIELD.
PRESS ENTER

ACT ____ (L00/MRA DATA
ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

81