HCBS-AMH Individual Recovery Plan

The HCBS-AMH Individual Recovery Plan is a functionality in CMBHS application which allows Recovery Managers to submit a request for HCBS-AMH Services (both Provider Agency and Recovery management) for a participant. Services on the HCBS-AMH Individual Recovery Plan, as developed through the Interdisciplinary Team meeting, is intended to support a participant’s mental health and community service needs. For more information, refer to HCBS-AMH Policy Manual and Billing guidelines document.

HCBS-AMH Individual Recovery Plan (IRP’s) are either auto- approved by system (CMBHS) or reviewed by HHSC to verify that submissions follow policy requirements. Services should not be rendered to a HCBS-AMH participant until they have been approved by HHSC staff or auto-approved by the system. HCBS-AMH Services also needs an authorization from Accenture/Texas Medicaid and Healthcare Partnership (TMHP).

There are two types of HCBS-AMH Services: Recovery Management Services and Provider Agency Services

Before You Start

• The user must be assigned a CMBHS role that allows you to utilize “HCBS-AMH Individual Recovery Plan” functionality in the CMBHS application. Click here to view CMBHS Roles and their Read-Only and Read-Write Page Rights.
• The Client must have Client Profile in CMBHS
• The Client must be enrolled in the HCBS-AMH Program.
• The Client must have Diagnosis, HCBS-AMH ANSA, Provider Selection Form, Notification of Individual Rights and Clinical Eligibility on record.
• Documents such as "Diagnosis, HCBS-AMH ANSA, Provider Selection Form, Notification of individual Rights, Clinical Eligibility (Enrolled)" must be in Closed complete status and should exist in “Client Workspace” of assigned Recovery Manager location. 
• These HCBS-AMH documents can be shared through consent process from LMHA or through Provider Selection Form or Provider Selection Update Form (in the case of changing the provider).

   Note:

• Diagnosis, HCBS-AMH ANSA, Provider Selection Form, Notification of Individual Rights, Clinical Eligibility (Enrolled) are authored by LMHA (Local Mental Health Authority) or state Hospital staff. So, Consent is required to authorize the release of Diagnosis, Assessment, Provider Selection Form, Notification of Individual Rights, Clinical Eligibility (Enrolled) documents to assigned Recovery Manager location.
• If there is no document shared through Consent process, Recovery Managers can contact LMHA/State Hospital staff to release the required documents prior to the documentation of the HCBS-AMH Individual Recovery Plan.

         System displays the following error messages, if the user does not satisfy the Pre-conditions to access the Individual Recovery Plan

• If there is no consent on record from state hospital or from LMHA staff to Recovery Manager location, and Recovery Management Entity staff wants to access “Individual Recovery Plan” menu from the left- hand side services toolbar, then the system should display an error message: "There is no consent on record.  A consent must be on record prior to accessing the Individual Recovery Plan."
• If one of the document is missing from the following document list: "Diagnosis, Assessment, Provider Selection Form, Notification of individual Rights, Clinical Eligibility (Enrolled), and Recovery Management Entity staff tries to access “Individual Recovery Plan” from service toolbar, then the system should not allow the user to access “HCBS-AMH Individual Recovery Plan” screen and should display an error message "The following documents must be indicated in the written consent prior to accessing the Individual Recovery Plan: Diagnosis, HCBS-AMH ANSA, Provider Selection Form, Notification of Individual's Right and Clinical Eligibility ".
• If the existing version of the IRP exists in draft status and user tries to access “Individual Recovery Plan” from services toolbar, then the system must display an error message "An Individual Recovery Plan in 'draft' status already exists for this individual"
• If the existing version of the IRP exists in ready for review status and user tries to access “Individual Recovery Plan” from services toolbar, then the system must display an error message “An Individual Recovery Plan in 'ready for review' status already exists for this individual ".

How to access “Individual Recovery Plan” to document HCBS-AMH Individual Recovery Plan

From Client Workspace

How to access Client Workspace: Use Find/Add in the Client Services toolbar to locate the client’s record in CMBHS and then select “Client Workspace”.

When the assigned Recovery Manager is on “Client Workspace”, CMBHS application will display “Individual Recovery Plan” along with other values in the Services Toolbar menu.

How to edit “Individual Recovery Plan” record

1. From Client Workspace

Individual Recovery Plan documents which are in draft document status can be selected from Client Workspace to make the required changes. Recovery Managers can open the IRP document in view mode and clicks on “Edit” button to make the required changes.  

Types of the HCBS-AMH Individual Plan Types

• Emergency Action Request
• Initial IRP
• Update IRP

Details about HCBS-AMH Individual Recovery Plan types:

Emergency Action Request

It is optional to document “Emergency Action Request” in the CMBHS application but, critical services like Nursing Services and Residential Services can be provided through the usage of Emergency Action Request. Emergency Action Request can be created just after the enrollment of the individual in the CMBHS application. Emergency Action Request can only be created within 21 calendar days of enrollment and prior to Initial IRP.

Initial IRP

It is required to document Initial IRP in the CMBHS application. Initial IRP should be done within 21 calendar days of enrollment. If the user document “Initial IRP” after 21 calendar days of enrollment, it would have an impact on the billing process of the providers. Services on the Initial IRP are decided by the combined efforts of Interdisciplinary Team members as per the needs of the HCBS-AMH Client.

Interdisciplinary Team members: Recovery Manager, Provider Agency, LMHA/LBHA (optional), HCBS-AMH Individual, LAR (Legally Authorized Representative)

Update IRP and Annual IRP

• In the First year of Enrollment, the frequency of updating the IRP record is every 90 calendar days in the future. After the first year, the frequency of updating the IRP must be 180 calendar days in the future. 
• Update IRPs can be completed anytime, but it will only count toward the required 90 or 180 days IRPs if done no more than 30 days prior to the due date.
• An update can be completed up to 30 days prior to the 'Due Date of Next IRP' reflected on the last approved version of IRP.
• Documentation of Update IRP needs Interdisciplinary team meeting to discuss on the services needed by the HCBS-AMH client.  

Description about HCBS-AMH Individual Recovery Plan screen:

List of Tabs on the HCBS-AMH Individual Recovery Plan screen

• General: Tab is used to capture Assessment, Demographics, Diagnosis, Setting Verification Types, Effective and due date of next IRP details.
• Narrative: Tab is used capture Narrative, Change in Services Summary, History of Narrative, Strengths and Resources, Barriers, Immediate Needs, Personal Interests, Non-HCBS-AMH Services (private and public).
• Goals: Tab is used to capture Goal, Objectives and Domain Details.
• Services: Tab is used to add “Provider Agency” services to the HCBS-AMH Plan of Care or to revise the units/amount of the added services.
• Recovery Management (RM) Services: Tab is used to add “Recovery Management (RM) Services to the Plan of Care or to revise the units/amount of the added HCBS-AMH RM services.
• Modifications: Tab is used to capture types of modifications to the Plan of Care.
• Contacts and Signatures: Tab is used to capture signatures of Recovery Managers, Alternate Recovery Managers, Provider Agency, HCBS-AMH Individual and LAR
• Safety Plan: Tab is used to capture Safety Plan details of the HCBSAMH Individual.
• ANE Prevention Plan: Tab is used to capture ANE Prevention Plan details of the HCBS-AMH Individual.

General Tab

The general tab is organized in the following sections:

1. HCBS-AMH Qualifying Assessment: HCBS-AMH Qualifying Assessment considers the assessment records that are linked to the Clinical Eligibility screen. 

2.Current Assessment: Current Assessment consider the most recent "Assessment" records on file.

When the Plan of Care type is "Emergency Action Request/Initial/Update)", and there is no other current assessment being performed on the individual (other than HCBS-AMH Qualifying Assessment), then the system attaches the same HCBS-AMH Qualifying Assessment document in the "Current Assessment" link until or unless a new assessment is being created and shared on the RME locations.

 

3. Plan of Care (Required)

a. If there is no existing “Emergency Action Request, Initial, Update” on record, and user access “Individual Recovery Plan” screen. Then, Plan of Care field on “General” tab is defaulted as “None Selected” and other values in the drop-down list are Emergency Action Request and Initial IRP.

• If the user selects “Initial IRP” from the drop-down list prior to the selection of Emergency Action Request, the system displays a pop up on the screen “No Emergency Action Request exists for the participant.  Proceeding with the creation of an Individual Recovery Plan IRP will prevent access to the Emergency Action Request.  If you would like to proceed with the creation of an Individual Recovery Plan, please select ‘Yes’.  However, if an Emergency Action Request is needed, please select ‘No’ and proceed with creating an Emergency Action Request by choosing this option from the ‘Plan of Care’ drop-down menu. (This warning message must have "Yes" and "No" options)
• If the user selects “Yes” in the pop- up message, then the user can proceed with the Initial IRP.
• If the user selects “No”, then the system will default the Plan of Care field to “None Selected” and the user can make a new selection from the drop-down.

b.  If “Emergency Action Request” exists in a closed complete status, and user access “Individual Recovery Plan” menu from services toolbar. On General Tab, Plan of Care drop-down is defaulted as “Initial IRP” and there is no other value in the drop-down list.

c.  If “Initial IRP” exists in a closed complete status, and user access “Individual Recovery Plan” menu from services toolbar. On General Tab, Plan of Care drop-down is defaulted as “Update IRP” and there is no other value in the drop-down list.

d. If “Annual IRP” is due in 30 days, and the user accesses the "General" tab of the HCBS-AMH Individual Recovery Plan, the Plan of Care field is defaulted to “Update IRP” but the drop-down will have “Annual IRP” value also. And it will be available until unless the user is done with the “Annual IRP”.

e. If Annual IRP exists in "Closed Complete" status in the system and the user accesses the General tab of the HCBS-AMH Individual Recovery Plan to draft “Update IRP”, the Plan of Care field will be defaulted to “Update IRP”.

4. Is the individual currently in a state hospital? (Required)

1. If the user selects “Yes” radio button, then the system conditionally displays a drop-down box named as “Please select one of the following”

• Austin State Hospital
• Big Spring State Hospital
• El Paso Psychiatric Center
• Kerrville State Hospital
• North Texas State Hospital - Wichita Falls
• Rio Grande State Center
• Rusk State Hospital
• San Antonio State Hospital
• Terrell State Hospital
• Waco Center for Youth 

b. If the user selects “No” to “Is the individual currently in a state hospital” field, then the system should not conditionally display a drop-down box and the user can proceed with the IRP 

5.  Effective Date (Required)

1. If the "Plan of Care" type is Emergency action Request type, then the Effective Date would be defaulted to "Enrollment Date" (read only)
2. If there is no existing “Emergency Action Request” in the Client Workspace, and the Plan of Care type is selected as Initial IRP, and the user wants to do "Initial IRP" within 21 calendar days of enrollment, then the "Effective Date" is shown blank and user can manually enter the date. This date can be backdated to the "Enrollment Date" and the user cannot future date the Effective Date.
3. If there is an existing "Emergency Action Request " in the system, and the user selects "Initial IRP" in the Plan of Care drop-down list within 21 calendar days, then the "Effective Date" of the Initial IRP must be defaulted as system's current date.
4. If the Plan of Care type is Initial IRP, and the user wants to do "Initial IRP" after 21 calendar days of enrollment, then the "Effective Date" must be defaulted to system's current date and it must be in "read only form.
5. If the Plan of Care is "Update IRP" or "Annual IRP", then the Effective Date cannot be future dated and backdated. It will be defaulted to system's current date. and it must be in read only form.

 

6. Due Date of Next IRP (Read Only Form)

• On Emergency Action Request, Due Date of Next IRP” will be defaulted to 21 calendar days in the future from the enrollment date in read only form.
• On “Initial IRP”, “Due Date of the Next IRP” will be defaulted to 90 calendar days in the future from the “Effective Date of the Initial IRP in read only form
• In the first year of the enrollment after Initial IRP, Due Date of Next IRP is defaulted as 90 calendar days in the future for consecutive 4 times in a row. On Annual IRP (i.e 4^th regular 90 days period), Due Date of Next IRP is defaulted as 180 calendars in the future and so on.

7. Program Type Approved for Medicaid Billing (Read Only)

 

• The system will update the field with a yes/no response based on the Medicaid Eligibility Verification, MEV, process response received in the CMBHS application from the TIERS system.
• if the 'Program Type' on the MEV list response matches with the program type (approved Medicaid Type/Pending Review list given below), then the system will default the 'Program Type Approved for Medicaid Billing' field with 'Yes' and the system will send the IRP for TMHP authorization after the IRP document is in closed complete status. 
• If the Program Type is not on the list or does not match approved Medicaid types pending review, then the field will default to No and the system will not send the IRP for authorization to TMHP after the IRP document is in closed complete status.
• The system must have a 'Yes' or 'No' value in the 'Program Type Approved for Medicaid Billing' field to save the IRP in 'Ready for Review' status. 

Note: The system will check for the MEV process to be completed prior to saving the ‘HCBS-AMH Individual Recovery Plan’ in ‘Ready for Review’ status. The process Date of the MEV response should be one day prior or the same day, when the user is trying to create an Individual Recovery Plan in the CMBHS application. (It is applicable to all the versions of IRP – EAR, Initial, Update and Annual).

8. Demographics Section

1. Recovery Management Entity, Provider Agency, LBHA/LMHA Service Region, Service County:

• If there is no change in the providers after the enrollment, then the value in the field must be defaulted from the "Provider Selection Form".
• If there is a change in the providers after enrollment, then the most recent value must be defaulted from the Provider Selection Update Form.
• If pre-populated RME and PA values are same, then the system displays a conditional message "You selected and affirmed the same organization for both Provider Agency and Recovery Management Entity on the Provider Selection Form or Provider Selection Update Form; hence, you are the provider of last resort." below "Recovery Management Entity" and "Provider Agencies" fields in the "Demographic" section 

 

b. Primary Address (Read Only)

• The value is pre-populated from the "Client Profile".
• When Assisted Living or Supervised Living is requested on an Individual Recovery Plan, IRP, the system will compare the 'Primary Address' with the list of addresses that exist on 'View Failed Settings Address List' screen and use the following rules:
• If there is a 100% match of both the addresses from (IRP/Client Profile and View Failed Settings Address List, the Recovery Manager will not be able to select ‘Assisted Living or Supervised Living’ from ‘Services’ tab of the IRP screen.
• If there is no match between the two addresses, the Recovery Manager will be able to select ‘Assisted Living and Supervised Living’ from ‘Services’ tab of IRP screen. 
• If there is a possible match between the two addresses, the system will display a message with a list of suggested address that match the address on View Failed Settings Address List screen and allow the choice to continue with the IRP or update the Client Profile address. 

c. Current Setting Type (Required)

Select one of the values in the drop-down. Following values are displayed in alphabetical order.

• Apartment
• Assisted Living
• Host Home/Private Residence
• Homeless
• Jail/Prison
• Medical Facility
• Nursing Home
• State Hospital
• Supported Home Living/Private Residence
• Supervised Living
• Other
• If the user selects ‘Other’ from the drop-down list of Current Setting Type, then the system conditionally displays a “Other” free text box, and it is required to add text into the free text box. 

d. Legal Status (Required)

1. Select one the value from the drop-down and following values will be displayed in the drop-down list in alphabetical order

• Charges Pending
• Civil Outpatient Commitment/AOT
• Inpatient, 46B, Incompetent to Stand Trail
• Inpatient, 46C, Not Guilty by Reason of Insanity
• Outpatient Commitment, 46B, Incompetent to Stand Trail
• Outpatient Commitment, 46C, Not Guilty by Reason of Insanity
• Parole
• Probation
• N/A

 

9. Setting Verification Types section

• If the user chooses "Assisted Living" or Supervised Living" from the drop-down list of Current Setting Type, then the system display Recovery Manager has reviewed the individual's current setting and attests the setting meets HCBS-AMH requirements (applies to supervised living and assisted living settings only)" field in the Setting Verification Type section with two radio buttons "Yes" and "No". and, it is required to select either "Yes" or "No" to save the document in ready for review status.
• If the user selects values other than "Assisted Living" or "Supervised Living" then the system does not display the following field
• Recovery Manager has reviewed the individual's current setting and attests the setting meets HCBS-AMH requirements (applies to supervised living and assisted living settings only)" field in the Setting Verification Type section with two radio buttons "Yes" and "No".
• Individual agrees that they have chosen their current setting

• The control type for the field is radio button functionality having "Yes" and "No" values.
• If the user selects "Yes", then the user can proceed with the entire IRP.
• if the user selects "No", then the system populates a "Reason" with drop-down values and this is a required field to save the document.

• Court-Ordered
• LAR Request
• Natural Disaster
• Other
• if the user selects "Other" value from the drop -down list, then the system will conditionally display a free text box., ‘Other’. The character limit for the box is 100. This free text box cannot be left blank as it is a required field

 

 

10. Diagnosis, Current Medication, and Physical Examination

a. HCBS-AMH Qualifying Diagnosis: HCBS-AMH Qualifying Diagnosis considers the diagnosis records that are linked to the Clinical eligibility screen.

b. Current Diagnosis: Current Diagnosis consider the most recent "Diagnosis" records on file.

When the Plan of Care type is "Emergency Action Request/Initial/Update)", and there is no other current diagnosis being performed on the individual (other than HCBS-AMH Qualifying Diagnosis), then the system attaches the same HCBS-AMH Qualifying Diagnosis document in the "Current Diagnosis" link until unless new assessment is being created and shared on the RME locations

c. Current Medication (Optional) – Free text box with 5000- character        limit.

d. Date of Individual’s Last Annual Physical Examination

• On Emergency Action Request’, then then field will be greyed out
• On Initial IRP, Date of Individual’s Last Annual Physical Examination is defaulted to system’s current date and it can be backdated to the Client Profile Date. This date cannot be future dated.
• On “Update” IRP, the system must default the date (Date of Individual's Last Annual Physical Examination) from the most recent approved version of the IRP. This date can be edited but, not future dated. to edit the date.
• On “Update” IRP, then the system must default the date (Date of Individual's Last Annual Physical Examination) from the most recent approved version of the IRP. And, the date can be edited, not future dated.

Narrative Tab

1. All the fields on the Narrative Tab will be greyed out for Emergency Action Request, but would be active for Initial, Update and Annual versions of the IRP.
2. Change in Services Summary (Optional)

• On Initial IRP, the system does not display “Change in Services Summary”. But, would be displayed for Update and Annual versions of the IRP. The control type of the field is a free text having 1000-character limit. There is no population of the text data from the most recent version of the IRP.

3.  Narrative (Optional) – Free text box with 3000-character limit.

4.  History (Read only running history)

• It captures the history of the Narrative free text box on the subsequent versions of the IRP.

5.  Strengths and Resources, Barriers, Immediate Needs and Personal Interests (Optional)- Free text box with 1000-character limit.

6.  Other Non-HCBS-AMH Services (private and public) – Optional - Free text box with 5000-character limit.

Goals

• Goals tab will be greyed during Emergency Action Request Plan of Care. However, will be active during Initial, Update and Annual versions of the IRP.
• The user can add unlimited number of goals to any version of the IRP.
• The user can add goals to Individual Recovery Plan by clicking on “Add” control button.
• The user can use “Previous” and “Next” control buttons to navigate to the added goals back and forth.

 

1. Goal

1. Goal Number (System generated numeric number)

•  Each Goal has an add button and when the user clicks on the add button a goal will be added, and each goal will be addressed by a numeric number.

 b.  Goal Statement (Optional) -Free text box with 1000-character limit          

 c.  Goal Date (Read only)

• When the user adds a "Goal" into the treatment plan of the individual, then the "Goal Date" will be defaulted as "Effective Date of the IRP, they are working on and the same date would be carried onto the subsequent versions of the IRP. 

 c.  Goal Status (Optional)

• Whenever the user will add new Goal, Goal Status is always defaulted to Active (read only), but it would be converted to drop-down and system must display following values in the drop-down box
• Active
• Achieved
• Deferred
• Withdrawn

• If the user selects "Active" or "Deferred" from the drop-down of 'Goal Status' on the most recent approved version of the IRP, only then the system defaults the most updated information onto subsequent versions of the IRP.
• However, if "Achieved" or "Withdrawn" is chosen from the drop-down for a Goal on current version of the IRP and is in closed complete status, then that specific Goal (including domain details, objectives and services) should not be defaulted on the subsequent versions of the IRP.

 

d.  Status Change Date (Optional)

• Status Change Date has dependency on "Goal Status".
• The system displays the "Status Change Date", only, if the user is changing the Goal Status. It would be defaulted from Effective Date of the IRP, they are working on.

 

 e.  Explanation of Status (Optional)

• If the "Goal Status" is defaulted to Active and is in read only form, then, Explanation of Status does not on the screen. But, if the Goal Status is drop-down control type, then the system displays “Explanation of Status” in the section
• There is no pre-population of the field and the data onto the next subsequent versions of the IRP.

Domain Details

1. Domain Name (Optional)

• Select one of the values from the drop-down and following values must be displayed in the drop-down
• Behavioral Health Needs
• Culture
• Life Functioning

 

b. Area of Need (Optional)

• The control type of the field is a drop-down functionality.
• The functionality of "Area of Need" drop-down box must be depended on "Domain Name" field. The values in Area of Need will be displayed based on the selection in the Domain Name drop-down.
• If the user selects "Behavioral Health Needs" from the drop-down list of "Domain Name", then, the drop-down of "Area of Need" field will be defaulted to "None Selected" and should display following values in the drop-down list. 
• Adjustment to Trauma 
• ‎Anger Control 
• ‎Antisocial Behavior 
• ‎Anxiety 
• ‎Cognition 
• ‎Depression 
• ‎Eating Disturbance 
• ‎Impulse Control 
• ‎Interpersonal Problems 
• ‎Mania 
• ‎Psychosis/Thought Disturbance 
• ‎Substance Use

• If the user selects "Culture" from the drop-down list of "Domain Name", then, the drop-down of "Area of Need" field will be defaulted to "None Selected" and should display following values in the drop-down list 
• Cultural Stress 
• Identity ‎ 
• Language 
• Ritual
• If the user selects "Life Functioning" from the drop-down list of "Domain Name", then, the drop-down of "Area of Need" field will be defaulted to "None Selected" and should display following values in the drop-down list.
• Decision Making
• Employment 
• ‎Family 
• ‎Intellectual/Development 
• ‎Involvement in Recovery 
• ‎Legal 
• ‎Living Skills 
• ‎Physical/Medical 
• Recreational 
• Residential Stability 
• ‎Self-Care 
• ‎Sexuality 
• ‎Sleep 
• ‎Social  
• Transportation

 

c. Need Status

• For new Domain, Need Status would be defaulted to Active (read only). But, for the subsequent versions, system displays following values in the drop-down.

• Active
• Achieved
• Deferred
• Withdrawn

• If the “Need Status” is selected as “Active” or “Deferred” on the most recent version of the IRP, then the system pre-populate the data related to “Domain Details” and Objective to the next subsequent version of the IRP
• If the “Need Status” is selected as “Achieved” or “Withdrawn” on the most recent version of the IRP, then the system does not pre-populate the data related to Domain Details section and Objective section onto the next subsequent version of the IRP.

 

d. Need Date (Read only)

Whenever the user adds a "Domain" into the specific goal, then the "Need Date" must be defaulted as "Effective Date of the IRP, they are working on and the same date should be carried onto the subsequent versions of the IRP. 

e. Need Description (Free text) with 1000-character limit

f.  Explanation of Status (Optional)

• If the "Need Status" is defaulted to Active and is in read only form, then, Explanation of Status should not be displayed on the screen.
• Whenever the user will have an ability to edit the "Need Status", then the "Explanation of Status" must be displayed in the Domain details section. 

 

 f. Status Change Date (Read only)

• The functionality of "Status Change Date" must be dependent on "Need Status".
• It is a conditionally displayed field that should only be displayed in the section, when the user will change the "Need Status".  It will be defaulted to the Effective Date of the IRP they are working on.

 

Objective section

• The system allows the user to add only four objectives per goal.
• The user can add “Objective” by clicking on “New Objective” control button. When the user will click on “New Objective” control, then the system will display the following fields

• Objective Description
• Objective Date
• Objective Status

1. 1. Objective Description (Required free text box with 1000-character limit)
   2. Objective Date (Read only)

• When the user clicks on "New Objective " button in the objective section, then the "Objective Date" must be defaulted as "Effective Date of the IRP, they are working on. and the same date should be carried onto the subsequent versions of the IRP.

1.     c. Objective Status

• If the user selects "New Objective" button in the Objective Section, then, Objective Status should always be defaulted to Active. The same objective would have drop-down for the Objective Status with following values
• Active
• Achieved
• Deferred
• Withdrawn
• If the user selects "Active" or "Deferred" from the drop-down of 'Objective Status' on the most recent approved version of the IRP, only then the system will default the most updated information onto subsequent version of the IRP for that specific objective.
• However, if "Achieved" or "Withdrawn" is chosen from the drop-down for an Objective on current version of the IRP and is in closed complete status, then that specific Objective will not be defaulted onto subsequent versions of the IRP.

1.     d. Status Change Date (Conditionally displayed field)

• The system displays Status Change Date in the scenarios when there is a change in the Objective Status. It will be the date from the “Effective Date” of the IRP, they are working on.

               e. Explanation of Status (Conditionally displayed field – required) 

• The control type of the field is "Free Text" box functionality with 1000-character limit
• If the user selects "New Objective" control button in the Objective Section on any version of the IRP, then the Explanation of Status will not be displayed in the section, but, it will be displayed onto the subsequent versions of the IRP.

Click here to view the table grid functionality

Summary Section: In this section, the user can enter comments and can have a look at the previously added comments on the most recent version of the IRP. This is free text box with 1000-character limit. 

Services 

• On “Emergency Action Request” /Initial/Update or Annual IRP, Services tab would be active
• Services tab will be used to capture “Provider Agency Services”.
• The user can use “Type of Services” control button to add “HCBS-AMH PA Services” to the Individual Recovery Plan.
• The Top section of the Services section would change with changes happening to the Type of the Service drop-down.

 

1. Type of Services (Required)

• On “Emergency Action Request” Plan of Care, the user can request only residential and nursing services.
• HCBS-AMH Residential services are Assisted Living, Host Home/Companion Care, Supported Home Living, and Supervised Living.
• HCBS-AMH Nursing Services are Nursing LVN and Nursing RN.
• However, the user can request all the HCBS-AMH PA services on Initial, Update, and Annual version of the Individual Recovery Plan.
• During Emergency Action Request, the user can select only one of the nursing services (either Nursing -LVN or Nursing - RN), while the user can add both the nursing services to the Initial, Update and Annual version of the IRP.
• During EAR/Initial/Update/Annual version of the Individual Recovery Plan, the user can add only one residential service.
• If the user selects “Assisted Living” in the drop-down list of Current Setting Type on “General” Tab, then the system displays only Assisted Living in the drop-down list of Type of Service.
• If the user selects “Host Home/Companion Care” in the drop-down list of Current Setting Type on “General” Tab, then the system displays only Host Home/Companion Care in the drop-down list of Type of Service.
• If the user selects “Supported Home Living” in the drop-down list of Current Setting Type on “General” Tab, then the system displays only “Supported Home Living” in the drop-down list of Type of Service.
• If the user selects “Supervised Living” in the drop-down list of Current Setting Type on “General” Tab, then the system displays only “Supervised Living” in the drop-down list of Type of Service.
• If the user has selected values other than "Assisted Living/Host Home/Supervised Living/Supported Home Living in the "Current Setting Type" drop-down, then the system must provide "Assisted Living, Host Home, Supervised Living and Supported Home services in the drop-down list of Type of Service. But, the user can add only one of the residential services to the treatment plan of the individual" during any version (Emergency Action Request/Initial/Update and Annual) of the IRP. 
• The data from the most recent approved version of the IRP must be pre-populated on to the following next version of the IRP. And when the user will select one of the services from the table grid and clicks on “Edit” control button then the pre-populated "Type of Service" field must be in read only form.
• The system would not display the name of the service in the drop-down of Type of Service, if it is already been added onto the treatment plan. 
• If the user has added "Transition Assistance" to Individual Recovery Plan, then it is required to add "Transition Assistance -Requisition Fee" to the same plan in order to save the document in “Ready for Review” status.
• The system must display ‘Minor Home Modifications -Maintenance” service in the “Type of Service” drop-down only when the individual Is done with all the 7500 -dollar limit per enrollment.
• The user must add a residential service from the Type of Service drop-down list prior to the selection of Transition Assistance.
• The user must add a "Transition Assistance" from the Type of Service drop-down prior to the selection of "Transition Assistance -Requisition Fee". 
• Transition Assistance and Transition Assistance - Requisition Fee can be requested only one time in the entire life time of enrollment. 

2. Service Description (Free text box with 1000-character limit). 

3. Unit of Measure (Read Only) 

• The system will default the value in "Unit of Measure" field based on the selection made in the "Type of Service" drop-down. 

4. Clinical Need (Required) 

• Clinical Need is a drop-down field with two values: 
• High Need
• Standard Need

• On Emergency Action Request, when user will click on “Add Type of Service” control button, then Clinical Need would always be defaulted to "High Need " (read only) for added services. But, the same added service would have drop-down for Clinical Need field having “Standard Need and High Need” drop-down values.
• On Initial, Update and Annual version of the IRP, when the user will click on “Add Type of Service” control button, Clinical Need would have a drop-down control with “Standard Need and High Need” value options
• The data will be pre-populated from the most recent to next subsequent version of the IRP and the user will have an ability to edit the pre-populated value in the drop-down. 

5. Service Date

• Whenever the user adds a "Service" into the treatment plan of the individual (Individual Recovery Plan), then the "Service Date" must be defaulted to the "Effective Date of the IRP, they are working on and the same date should be carried onto the subsequent versions of the IRP

5.Requested Amount (Required)

• The functionality of the field is a caped controlled means the user can request the number of units based on the selected clinical need.
• If the user selects "Emergency Action Request" from the "Plan of Care", and user accesses "Services" tab of the "HCBS-AMH. On "Services" tab, "Clinical Need" is defaulted as "High Need" (read only), then "Requested Amount" will be defaulted to "High Need amount" and it will be in read only. 
• During Initial/Update/Annual IRP, whenever the user clicks on “New Type of Service” control button, then, the system displays empty "Requested Amount" field. The user can enter the value (dollar amount) into the field.
• If the requested service on the most recent approved version of the IRP is more than the high need, then there will be no pre-population of the Requested Amount data onto the next following working version of the IRP.

6.Requested Units

• The functionality of the field is a caped controlled means the user can request the number of units based on the selected clinical need.
• On Emergency Action Request Plan of Care, Requested Units for the added service will be defaulted to its High Need (Read only). But on Initial/Update/Annual IRP, Whenever the user will click on “Add Type of Service” control button, then the Requested Units field would be empty to enter the required data.
• If the requested service on the most recent approved version of the IRP is within Standard or high need, then the system must pre-populate the data onto the next following version of the IRP.
• If the requested service on the most recent approved version of the IRP is more than the high need, then there should not be a pre-population of the Requested Units data onto the current working version of the IRP.

7. Flat Fee (Read only)

• if the user selects any of the flat fee service from the drop-down value of Type of Service, then the system pre-populates applicable value for selected service.

 

8. Maximum Occurrence (Read only): This field is applicable only to Adaptive Aids and Minor Home Modifications services.

9. Clinical Justification (Required)

• Clinical Justification is needed when the user requests more than the high need of the service.
• The control type is the free text box functionality having 1000 -character limit.

Summary Section: In this section, the user can enter comments and can have a look at the previously added comments on the most recent version of the IRP. This is free text box with 1000-character limit.

Note: For more information please see the Table of grid section.

Recovery Management (RM) Services

1.Type of Service (Read Only)

• If the client is in the state hospital at the time of the enrollment, then the client is eligible for Recovery Management Transition Fee and Recovery Management Transition Day rate services.
• The individual can have “Recovery Management Transition Fee up to 90 days from initial IRP, while Recovery Management Transitional Day Rate can be provided from 90 calendar day to 180 calendar day only if the individual is in the state hospital at the time of enrollment.
• But, after 180 calendar day from enrollment, when the user access “HCBS-AMH Individual Recovery Plan”. on RM Services tab, Type of Service field must be defaulted to “Recovery Management Services”.
• If the individual is not in a state hospital at the time of enrollment, then, the user can only request for “Recovery Management Services”.

2. Service Description (Read Only)

• Standard text would be pre-populated based on the selected in the Type of Service field.

 

3. Clinical Need

• On Emergency Action Request, The Clinical Need will be defaulted to High Need.
• But, on Initial, Update and Annual Need, Clinical Need would be defaulted to None Selected. Other values must be Standard Need and High Need.

4. Units of Measure (Read only)

• Unit of Measure field has a direct dependency on "Type of Service" drop-down. (Type of Service drop-down selection will decide the pre-population value of "Unit of Measure".

5. Service Date (Read only)

Whenever the user adds a "RM Service" into the treatment plan of the individual, then the "Service Date" must be defaulted to the "Effective Date of the IRP, they are working on and the same date should be carried onto the subsequent revise versions of the IRP, until unless the service is removed from the system.

6. Requested Units (Conditionally displayed)

• The functionality of the field is a caped controlled means the user can request the number of units based on the selected clinical need.
• On Emergency Action Request Plan of Care, Requested Units for the added service will be defaulted to its High Need (Read only).
• If there no EAR in the system, then Requested Units would be displayed as empty for initial version of the IRP.
• There is a pre-population of the text onto the next version of the IRP, if the user has requested within the standard needed or high need of the service on the most recent version of the IRP. But, there is no pre-population of the data, if the user has requested greater than the high need of the service on the most recent version of the IRP.

7. Flat Fee

• if the user selects any of the flat fee service from the drop-down value of Type of Service, then the system pre-populates applicable value for selected service.

8. Clinical justification (conditionally required)

• The control type of the field is a free text box having 1000 -character limit.
• If the user requests more than the high need of the Recovery Management service, then it is required to provide “Clinical Justification” for the service.
• Clinical Justification is required, if the user requests the high need of the Recovery Management Service on the initial version of the IRP, but it is required to provide on Update and Annual versions of the IRP.

 

Summary Section: In this section, the user can enter comments and can have a look at the previously added comments on the most recent version of the IRP. This is free text box with 1000-character limit.

Modifications

• It is optional to enter data onto the Modifications tab of the HCBS-AMH Individual Recovery Plan
• During Emergency Action Request, Modifications tab would be greyed out, but would be conditionally enabled during Initial, Update and Annual versions of the IRP.

1. Does the IRP have a modification (Optional)  

1. If the user selects "No" to the "Does the IRP have a modification" field, then the system must grey out all the fields on the Modification tab. The Modification tab must have following fields on the screen:

• Type of modification
• Next review date of modification
• Interventions and supports will cause no harm to the individual
• Less intrusive methods previously utilized
• Effectiveness of modification (based on review)
• Persons involved in modifications

b. If the user selects "Yes" to the "Does the IRP have a modification" field, then, the system should allow the user to enter the details on the Modification tab. The Modification has following fields on the screen:

• Type of modification (Drop-Down): Drop down values are “Individual Autonomy, Medication Safety and Management, Personal Restraint, Setting Requirement, Other.
• If ‘Other’ is selected from the Type of modification drop-down, then the system displays a free text box of 250- character length and is a required field.
• Next review date of modification (Read Only): If there is a modification, It will be defaulted to 30 days in the future from the IRP version they are working on.
• Interventions and supports will cause no harm to the individual (Radio buttons: Yes and No). During Initial/Update/Annual IRP, If the user selects "No" to the "Interventions and supports will cause no harm to the individual" data field, then, the system conditionally displays a free text box named as "If no, please explain". The character limit for the box must be 1000 characters and it must be optional to enter the text into the free text box.
• Less intrusive methods previously utilized (Free text box with 1000 – character limit)
• Effectiveness of modification (based on review) (Free text with 1000-character limit)
• Persons (s) involved in modifications (drop-down): The values in the drop-down will be pre-populated from Contact and Signature tab

Safety Plan

1. Safety Plan must be greyed out during Emergency Action Plan of Care. However, must be active during Initial, Update and Annual versions of the IRP.
2. It is optional to add data in the Safety Plan during Initial, Update and Annual version of the IRP.
3. On Safety Plan, the system displays following fields:

• Warning signs that tell me a crisis may be developing (examples: thoughts, images, mood, situations, behaviors). – three free text boxes with 100-character limit
• Coping strategies that help me feel better (examples: relaxation techniques, physical activities, cultural or spiritual rituals, hobbies, etc.) - three free text boxes
• Social settings that provide a distraction and/or help me feel better - three free text boxes with 100- character limit
• Ways to keep my environment safe. - three free text boxes with 100 -character limit.
• Professionals I can contact in an emergency or crisis situation (examples: Recovery Manager, service provider, etc.)
• The user can unlimited number of Professionals to the Safety Plan by clicking on “Add New”.

Note: Add New: Using “Add New” control button, the system expands out to capture the “Name” and Phone Number” of Professional contact information.

Name: The control type of the “Name” field is a drop-down functionality. The drop-down values of the ‘Name’ field will be pulled from the “Interdisciplinary Teams (IDT)” section drop-down values on “Contacts and Signatures” tab.

Phone: It is a free text field to enter the phone number of the contact.

• Supportive people whom I can ask for help in an emergency or crisis situation.
• The user can add unlimited number of Supportive People to the Safety Plan by clicking on “Add New” button.

Note: Add New: Using “Add New” control button, the system expands out to capture the “Name” and Phone Number” of Supportive people contact information.

Name (Required): The control type of the “Name” field is a drop-down functionality. The drop-down values of the ‘Name’ field will be pulled from the “Additional IDT members” on “Contacts and Signatures” tab.

Phone (Required): It is a free text field to enter the phone number of the contact.

 

Note: For more information please see the Table of grid section.

 

• Contact Information for LMHA/LBHA, state hospital social worker, and local crisis hotline 

             

• LMHA/LBHA Contact Name ----------> Free Text Field
• Phone Number                     ---------> Free Text Field  
• State Hospital Social Worker Contact Name ----------> Free Text field 
• Phone Number                                               ----------> Free Text field
• Local Crisis Hotline                                         ----------> Free Text field

 

• Contact Information for legal Status: The section would be greyed out if the user selects “N/A” in the drop-down list of Legal Status on Safety Plan.
• LMHA/LBHA Contact Name    ------------------------> Free Text field             
• Phone Number                       ------------------------> Free Text field              

 

• FACT Contact Name                  ------------------------> Free Text field                        

• Phone Number                          ------------------------> Free Text field        

 

• Parole or Probation Officer Contact Name ------------------------> Free Text field                
• Phone Number                                           ------------------------> Free Text field          

 

• District Attorney Contact Name      ------------------------> Free Text field               
• Phone Number                                ------------------------> Free Text field                         

 

• Defense Attorney Contact Name     ------------------------> Free Text                                         
• Phone Number                                ------------------------> Free Text field                         

 

• Court of Jurisdiction Phone Number ------------------------> Free Text field                                
• Name of Assigned Judge                ------------------------> Free Text field         
• Forensic Commitment Expiration Date --------------------->Date Field (User Input)                                          

 

ANE Prevention Plan

Does the individual have a heightened risk of Abuse, Neglect, and/or Exploitation (ANE) due to a history of victimization and/or current circumstances”? (Optional)

• The control type of the field is a radio button functionality having “Yes” and “No” radio buttons.
• If the user will click on “Yes” to the above-mentioned field, then it is required to add Type of Risk/Abuse to the IRP. But, if the selects “No”, then the “Type of Risk/Abuse” control button would be greyed out.
• If the user clicks on “Add Type of Risk/Abuse” control button, then it is required to add following information to the ANE Prevention Plan
• Type of Risk/Abuse                                      ------------------------->      Drop-Down

    Please one of the values from the Type of Risk/Abuse drop-down:

• None Selected
• Emotional/Mental
• Financial Exploitation
• Neglect
• Physical
• Sexual
• Specific measures to minimize risk.             ------------------------->      Three free text boxes with 250-character length. Out of three, one free text box is required to save the Type of Risk/Abuse in the table grid.
• What should I do I feel like I need help.        ------------------------->      Three free text boxes with 250-character length. Out of three, one free text box is required to save the Type of Risk/Abuse in the table grid. 
• How and where to report threats/concerns. Organizations                                    ---------------------->        Read Only
• The pre-populated values in the ‘Organization’ will be based on the value selected in the Type of Risk/Abuse. The list of ‘Organization’ values also has ‘Other’ value. When the user selects ‘Other’ value, then the system conditionally displays free text box of 250 -character limit.

Note: For more information please see the Table of grid section.

 

Contacts and Signatures

1. Interdisciplinary Team section captures information related to Recovery Managers, Alternate Recovery Managers and Provider Agency.

• For Recovery Managers, following information would be captured out:
• Organization (Read only): Updated information would be defaulted from Provider Selection or from the Provider Selection update Form in read only.
• Name (Required): The Drop-Down would pull the values from Find/add staff associated with Organization of RME.
• Email (Optional): Defaulted from User Profile or user can manually enter the data.
• Phone Number (Optional): Defaulted from User Profile or user can manually enter the data.
• Sign (Required): Check box
• For Alternate Recovery Managers, following information would be captured out:
• Organization
• Name (Optional): Free text field
• Email (Optional): Free text field.
• Phone Number (Optional): Free text field
• Sign (Optional): Required
• For Provider Agency, following information would be captured out:
• Organization (Read only): Updated information would be defaulted from Provider Selection or from the Provider Selection update Form in read only.
• Name (Required): The Drop-Down would pull the values from Find/add staff associated with Organization of PA.
• Email (Optional): Defaulted from User Profile or user can manually enter the data.
• Phone Number (Optional): Defaulted from User Profile or user can manually enter the data.
• Sign (Required): Check box

2. Alternative IDT Members

• Using “Add New” control button, the user can add unlimited number of Additional IDT members to the Individual Recovery Plan.

 

Note: For more information please see the Table of grid section.

 

3. Signature Section

• 1. By signing below, I agree that I created my own Safety Plan in collaboration with my providers. I believe that everything listed on my Safety Plan will benefit me. I can request to review my Safety Plan at any time.
  2. By signing below, I agree that I created my own ANE Prevention Plan in collaboration with my providers and have provided informed consent to all interventions. I believe that everything listed on my ANE Prevention Plan will benefit me. I may request to review the plan at any time.
  3. By signing below, I am consenting to the HCBS-AMH Services I have chosen on my Individual Recovery Plan.
  4. Individual
     • Sign
     • Unable to sign
     • Refuse to sign
  5. Legally Authorized Representative
• Sign
• Unable to sign
• refuse to sign
• No LAR

Medicaid Eligibility Verification, MEV, check at the ‘Document Status’ level

The system will check that the MEV process is complete prior to saving the ‘HCBS-AMH Individual Recovery Plan’ in ‘Ready for Review’ status. The Process Date of the MEV request/response should be one day prior or the same day, when trying to create Individual Recovery Plan in the CMBHS application. (It is applicable to all the versions of IRP – EAR, Initial, Update and Annual).

• If there is a recent MEV (with response from TIERS), for the current IRP in the CMBHS application, and a save is attempted for ready for review status or closed complete status, then the system will allow the document to be saved in ready for review status. 
• if the system is missing the MEV response (one day prior or same day) for the current IRP, then the system will not allow a save of the current IRP in ready for review status until this is complete.

Process Flow to capture PA signatures

1. It is important/required to capture “PA signatures” on the initial, update and annual version of the IRP, but signatures are not required on “Emergency Action Request” version of the IRP.
2. When the Recovery Management Entity staff saves the document in ‘Ready for Review’ status, then the document should be routed to the Provider Agency location’s Document Status List screen” to capture PA signature.
3. When the Recovery Manager saves the document in ‘Ready for Review’ status, then the system would send an email to the indicated PA on the given IRP.

    After receiving the email in their outlook, PA staff can log in to the CMBHS application on their given location and can follow the following navigation to do signature on the IRP

    Log in to the CMBHS application > Provider Tools > PA Document Status List

   When the PA staff is on the list screen, click on ‘Edit’ control button and review the IRP and then go to ‘Contacts and Signatures’ tab of the IRP and check the check box given to capture PA signature’s and then save the document.

HHSC Review and Approval

This section would be active only for HHSC staff. The section would capture following information

1. Radio Buttons: Approve, Return for Correction, Deny
2. Reviewer Notes (C/R)
3. HHSC Authorized Reviewer (R) 
4. Document Status (R)

 

Document Status (Required):

a. The drop-down values are Draft, Ready for Review and Closed Complete.

If the user selects “Draft” drop down value, then the user can make the changes in the document later or in the future, only if the document is in Edit View.

If the Document status is selected as “Ready for Review”, then the document would be routed to Document Status List screen of Provider Agency.

The drop-down value “Closed Complete” is only effective at the approver location.

b. Document Status Date: It is a system generated date/pre-populated date in the Document Status Date field. It is in Read only form.

 

Audit Information

This section provides following details to the user, when the document is saved in the system

• Created By: It is a system generated value. It displays the name of the user who has the initiated to complete the document.
• Created Date: It is a system generated value. It displays document saved date and time.
• Last Saved by: It is a system generated value. The system displays the name of the user, who saved the document in the system.
• Last Saved Date: It is a system generated value. The system displays the document last saved date.
• Approved By: This information is displayed only when the document is in closed complete status.
• Approved Date: It is a system generated value. The system displays the last saved date of document and time.

Table grid level functionality

• Add Using this control button, the user will be able to save the ‘Type of Risk/Abuse’ in the table grid
• Edit Using this control button, the user will be able to make edits to the existing record in the table grid.
• Cancel Using this control button, the system can undo the changes.
• Remove Using this control button, the user will be able to remove the record from the table grid. 
• Restore Using this control button, the user will be able to restore back the removed record from the table grid.

 

Blank English Form

Blank PDF form in English is available to be used to avoid any inconvenience caused by system down time or technical issues.

The navigation path to locate the forms in CMBHS Data > Print Blank Form.