Content by Keyword: Waivers

There were some issues among those interviewed regarding the content of the state's licensing and regulatory requirements for ALFs, although no one felt that regulations posed a major obstacle to affordable assisted living in Texas. The legislature has moved to set up a more punitive environment related to the assignment of administrative pe

There was a consensus among all those interviewed that the CBA waiver program was a very good program and that coverage of assisted living was a success for a variety of reasons. The assisted living program has made extraordinary progress and is considered a model for other states. For example, our mandated disclosure statements are being us

Because residential care facilities serve both private pay and Medicaid residents, a few respondents expressed views about the industry as a whole, and about particular issues the long term care system is facing, including a liability insurance crisis.

In addition to consulting with ten state staff and policy makers regarding the technical details of the state's programs, we also interviewed four of them. In addition, we interviewed nine stakeholders, including representatives of residential care provider associations, consumer advocates, the state ombudsman program, aging services providers, th

Texas believes that services provided in assisted living facilities should enhance a person's ability to age in place while receiving increasing or decreasing levels of service as the person's needs change. 10  The key distinction between nursing homes and assisted living facilities is that the former provides regular nursing care. Licensing ru

The reimbursement methodology for CBA waiver Assisted Living/Residential Care (AL/RC) services is based on clients' needs as determined by their TILE classification (Texas Index for Level of Effort). The state developed the TILE classification system to group nursing home residents on the basis of the level of effort needed by a licensed nurse

The AL/RC provider is responsible through their contract with DHS for medication administration, which is defined as either the direct administration of all medications or assistance with or supervision of self- medication. This includes injections if needed. Only licensed personnel can give injections.

Required services in licensed assisted living facilities include but are not limited to: assistance with activities of daily living (ADLs), 24-hour supervision (periodic checks or visits to a client during each eight-hour shift to ensure that the client is safe), three meals a day and special diets, housekeeping and laundry, transportation and

Texas limits the amount that can be charged for room and board to Medicaid waiver clients in assisted living facilities. The amount is equal to the SSI federal benefit rate minus a personal needs allowance of $85.00, which equals $467. There are no restrictions on the amount that private pay residents can be charged.

A big hurdle in developing the waiver was obtaining consensus among the consumer advocates and providers regarding occupancy rules in assisted living facilities. The consumer advocates wanted single occupancy to be required for waiver clients, while the providers wanted double occupancy to be the standard because existing providers already had dou

The Department of Human Services (DHS) contracts directly with qualified providers on an open enrollment basis. Any provider agency that meets the enrollment or licensing criteria for the service it proposes to provide under the waiver is eligible to apply for a contract with DHS. Providers are required to maintain current certifications or licens

In Texas, assisted living is a service delivery model not an architectural model. It is defined as a housing plus services arrangement for persons who, because of a physical or mental limitation, are unable to live their own homes. Assisted living settings provide food, shelter and personal care services to four or more persons who are unrelated t

Adult Foster Care Homes provide a 24-hour living arrangement with supervision for individuals 18 years of age and older who, because of physical or mental limitations, are unable to continue independent functioning in their own homes.

Historically, personal care facilities (sometimes called personal care homes) and adult foster care were the primary residential care options in Texas. In 1999, personal care facilities were renamed assisted living facilities, which are defined as any facility that serves four or more adults who are unrelated to the proprietor. Adult Foster Care h

The Residential Care program provides services to eligible adults who require 24-hour access to care, do not require daily nursing interventions, and do not meet waiver level-of-care criteria. Services include, but are not limited to personal care, home management, 24-hour supervision, social and recreational activities, and transportation. Servic

Adult Foster Care is provided in homes enrolled with the Department of Human Services. This service provides 24-hour living arrangements and may include meal preparation, housekeeping, minimal personal care to help with activities of daily living, and provision of, or arrangement for, transportation.

Community Care for Aged and Disabled (CCAD) is a state program that provides services in a person's own home or community for aged or disabled persons who are not able to take care of themselves, and who might otherwise be subject to unnecessary institutionalization or to abuse, neglect, or exploitation.

All clients receiving long term care services under STAR+PLUS receive care coordination for acute and long term services from the HMO. Care Coordination services include the development of an individual plan of care with the client, family members and provider, and authorization of long term care services for the client.

There are two types of Medicaid in Texas: traditional and STAR. People in both programs get the same benefits. Under the traditional program, individuals get medical care from any doctor or provider who accepts Medicaid. Under the STAR program, the enrollee has one provider who coordinates and manages their care.