How does HCS work?
The State of Texas contracts with providers such as Advantage Community Services to ensure services under the umbrella of HCS is provided to individuals that have received an HCS slot (funding) from the State of Texas. Although there are programs that are similar in other states, your HCS slot (funding) does not go with you if you move to another state. If you move or do not like your provider, you can change providers at anytime as long as you reside within the State of Texas. The State of Texas funds a certain amount of HCS slots each year and that number is split among the local MHMR centers. To find out how many new HCS slots are to be given out to your local MHMR center, please go to http://www.dads.state.tx.us/services/interestlist/index.html. Example:  If a local MHMR center indicates you are number 300 on the waiting list and there are only 22 slots for fiscal 2010.  You can expect it may take several years for you to finally come up on the waiting list for funding.”If a consumers name is passed over do to various circumstances (e.g., moved out of state), then the next person on the list will receive funding unless he/she is also passed over.

How do I get Started?
The first thing we suggest you do in order to receive an HCS slot (funding) is to go to your local Mental Health and Mental Retardation center. For example for Dallas County, you would go to Dallas MetroCare Services and request that you (consumer) be put on the HCS waiting list. There have been reports that there are more than 30,000 people in Texas waiting to get an HCS slot. Based upon our experience, it can take on average up to 7 years before a person becomes eligible to receive an HCS slot. There are very few cases in which a person can receive an HCS slot without having to wait as long (e.g., a person coming out of a state hospital). Do not confuse HCS program with other programs in the state such as an Intermediate Care Facility for the Mentally Retarded (ICF-MR), general revenue funding, or state schools. HCS is a specific program that many in our industry consider it the GOLD standard for services in Texas. Depending upon what type of statistic, Texas is generally ranked between 42nd to 47th regarding services to people with developmental disabilities.

I am on the HCS waiting list with my local MHMR center, now what do I do?
The MHMR center will contact each family as his/her number comes up on the waiting list. However, you will need to keep your contact information current with the MHMR center because if you don’t and your number gets called with no answer, you may be taken off of the list and the next person will get your slot.

My family member/friend received an HCS slot and the MHMR center stated I have been assigned a Level of Need (LON) 5. What is a Level of Need?
A level of need directly correlates to “How much money” is funded to an HCS slot. He/She will still get the same array of services, however, it may cost more to provide a particular service. A Level of Need is based upon an individual’s abilities and needs. A Level of Need in large part is based upon an assessment tool called and ICAP (Inventory for Client and Agency Planning). The ICAP is initially conducted by an MHMR center and thereafter is usually completed every 3 years no matter who your provider is. An ICAP can be completed earlier than 3 years if a person has a significant change in his/her life (e.g., persons legs become amputated and now needs a wheelchair). Anyways, a Level of Need is assigned 5 different numbers in the following order

1-Intermittent
5-Limited
8-Extensive
6-Pervasive
9-Pervasive Plus

An example of a Level of Need 1 would consist of an individual that would generally be described as a person with a high level of functioning and needs some assistance to complete daily living skills. A Level of Need 9 is an individual that is both medically and behaviorally challenged. An example of this is someone that needs total assistance in bathing, hygiene, use of a wheelchair, and has significant inappropriate behaviors such as hurting oneself or others. It is estimated that less than 1 percent of people receiving services fall into this category.

I have been called from my local MHMR center and have to choose a provider from a list of at least a 100 HCS providers. How would I go about picking one that is right for me?
There is not a right/wrong answer. There are several techniques. One is to call all of the providers until you feel you have a good interaction. Another technique is to randomly pick a few until you find one you are comfortable. We believe the best technique is to compare “apples to apples” and “oranges to oranges.” We suggest a list of 5-10 questions that you ask each provider and try to come up with the provider that answers your questions to your liking. Please see below:

I am new at this process, what questions should I ask?
Here is a list of questions you may want to ask. We encourage you to ask other questions that may be specific to your particular situation (e.g., do you work with people that also are diagnosed with Autism?).

• How did you (provider) perform on your last program audit?
  All providers are audited by the State of Texas at least one time per year. You can also get this information from the State just in case you believe the provider is not telling you the truth at:
  http://facilityquality.dads.state.tx.us/qrs/public/qrs.do?page
  
  You will need to then click on the "Home and Community Based Services (Waivers) link and this will lead you to what county you want to look."  This site can also tell you how many consumers are currently on the contract within that particular region.  There are 254 counties in Texas that is broken down into 9 Contract Waiver Areas (CWA) or regions(e.g., Dallas in located in CWA 3).

• Have you ever been on vendor hold?
  Vendor Hold is a serious life/safety violation by the provider. This means the State basically will stop funding the provider until all violations are cleared up. This is generally one of the last steps before the doors of the company will shut down. However, if you are able to still contact the provider, this means the provider did get off of vendor hold in order to continue operations. Take into account that if a provider was on vendor hold 15 years ago, it is not likely to be an indication of how the provider is operating currently.

• What is your turnover rate for your staff?
  Most companies will likely give you the previous year regarding staff turnover rate.  Just make sure that you have the same timeline when you ask each company.  You don’t want to get fooled by a company stating it had a 90% turnover rate that pertained only to the past month!  Also, ask if this includes ALL staff or just full time staff?

• How does your company maintain consistency with your staff in order to negate staff turnover.
  You want to find out what the company is doing in order to keep consistency regarding staff turnover. This helps with continuity of care. If you are changing out Case Managers 2-3 per year, it becomes hard on the family to have to constantly repeat what is going on with your individual.

• How many people do your Case Managers get assigned?
  As of June 1, 2010, you will be assigned a Service Coordinator from the local MHMR center (also mostly known as the MRA for Mental Retardation Authority).  Both the MRA Service Coordinator and your HCS provider Case Manager can have in upwards to 45 (maybe even more?).  However, most quality HCS providers are going to want to have a staff ratio of less than 1:45.   The MRA on the other hand will likely have a high ratio in relation to your HCS provider. As a “rule of thumb”, the less consumers assigned per CM is an indicator that the CM being able to dedicate more time to your consumers caseload. In turn, you may be able to get better quality of services. However, you should not be fooled. If a provider tells you that their CM has a 1:6 caseload, it may be because the provider only serves 6 people in the whole company! Be sure to check out their total census!!!

• How many cases of abuse and neglect have been confirmed?
  In our industry, abuse and neglect are allegations are taken seriously. We encourage you to ask how many of the allegations of abuse and neglect have been “confirmed.” You also want to ask how long ago. If there as confirmed case of abuse and neglect 15 years ago, you need to make a decision if that is an indication of if they provide good services currently.

• Can I have references from family members that are currently with your company?
  This is a good way of being able to ask questions about a company without as much of a bias opinion.

I have chosen a provider, now what happens?
The local MHMR center will ensure you are qualified and get your paperwork in order. You will fill out several more pieces of paperwork to choose your provider. Generally, a meeting will be made between the provider, local MHMR center, and you/family. At this time, most all of the paperwork will be filled out depending on what type of service you have chosen.

What services are offered in the HCS program?
All providers offer the same array of services. They include the following:

• Supported Home Living (SHL)
• Residential Support Services (RSS)
• Supervised Living (SL)
• HCS Foster Care/Companion Care (FCC)
• Day Habilitation
• Nursing
• Supported Employment
• Dental Treatment
• Adaptive Aids
• Minor Home Modifications
• Respite (hourly)
• Respite (daily)
• Speech/Language Pathology
• Occupational Therapy
• Physical Therapy
• Dietary
• Psychology
• Audiology
• Social Work
• Case Management (consumers and not self-directing)
• Case Management (consumers self directing)

Wow! I get all of these services! No, due to the fact that a consumer can only be in one of three sub-programs, FCC, SHL, and RSS/SL. The aforementioned are simply services that your HCS provider has to provide. All services must be justified (e.g., you probably won’t be able to ask for Physical Therapy when nothing is wrong with your physical functioning). There are 3 significant SUB-PROGRAMS under the HCS umbrella.

We will break them down in an attempt to make it simpler to our readers.

• Residential Support Services/Supervised Living (RSS/SL)
  This is 24-hour care (group home setting) in which 3-4 consumers may reside. Most of the time, consumers have either a job or go to school during the weekdays. There is a staff member that stays with the consumers throughout the evening/weekends. The consumer will receive the majority of other services aforementioned, however cannot be enrolled into FCC or SHL. Also, the consumer will be enrolled either in RSS or SL, not both. The significant difference between RSS and SL pertains to if the staff is AWAKE or SLEEPING in the house at night?

• Supported Home Living (SHL):
  To ACS, this is the most intrusive type of service. This is generally where a provider (ACS) hires a staff member and the staff member comes out to the home to provide a service. This service is generally something to do with promoting some type of independence with the consumer (e.g., cooking skills, laundry, hygiene, or community skills). The consumer receives most of the other types of services on the IPC (e.g., dental, nursing, speech, etc.). However, again it is generally very intrusive due to the fact you may have a staff member that you do not fully know. In many cases you can work with your provider of who may be hired. In fact, if you choose the Consumer Directed Services option, you can hire your own staff member and be responsible for in-servicing/training/coordination of work times, etc.
  
  
• Foster Care/Companion Care (FCC):
  READ THIS! You cannot be in SHL or RSS/SL (the 2 aforementioned programs) if you choose FCC. For the most part, you will receive all of the other services. This is predominately what ACS offers. Over 90% of our company is made up of the FCC component. The reason for reading this information is that many parent or family members overlook this subprogram because they say, “I am the parent, I don’t want my son/daughter in the Foster Care/Companion Care program!” Well, good news! If your son/daughter is 18 years or older, you as the parent or family member can become the Foster Care Provider. Care/Companion Care (FCC). Advantage Community Services will pay at least 100% of what the direct rate is for what the State of Texas pays Advantage Community Services, Inc.