Recovery Manager

OVERALL PURPOSE:

Recovery Management includes services to assist the individual in gaining access to needed Medicaid services; as well as medical, social, educational, and other resources—regardless of funding source. Individuals providing recovery management, Recovery Managers (RM), are responsible for monitoring the provision of services included in the IRP to ensure that the individual’s needs, preferences, health, and welfare are promoted. The following section outlines the roles and responsibilities but is not limited to the roles of the Recovery Manager:

Meet the minimum training and credentialing requirements for the provision of recovery management;

RMs have at least 2 years of experience working with people with serious mental illness (SMI); have a master’s degree in human services or a related field; demonstrate knowledge of issues affecting people with severe mental illness and community-based interventions/resources for this population; and complete DSHS-required training in the HCBS-AMH program and Person-Centered Recovery Planning Process.

• Be Available to the Individual;

Caseload sizes for the individual RM shall preferably be 10 individuals or less and shall be no more than 15 individuals. It is anticipated that the RM will provide recovery management at an intensive level, three contacts per week, for the first three months of the individual’s participation in HCBS-AMH services while in the community. It is anticipated that the RM and the individual will update the individual’s IRP every 90 days to ensure IRP is a reflection of the individual’s current needs and desires. Documentation generated by the RM and service encounters shall provide evidence of compliance with the requirements.

The RM’s availability shall be identified as part of the individual’s crisis plan. If the RM is not available to the individual 24/7 then alternative contacts must be identified on the Crisis Plan.

If the RM is part of an LMHA, The RM may also utilize the LMHA Crisis Services Program as an alternate contact for the individual. This crisis services program includes a hotline for the individual to utilize when they are experiencing a crisis as well as a response staff. RM must coordinate with the LMHA to ensure they are notified when the individual access the Crisis Services Program.

• Meet with the individual within 5 days of notification of Recovery Management Entity selection;

During the initial meeting with the individual, the RM should begin the Person-Centered Recovery Planning (PRCP) process. This includes explaining PCRP, assisting the individual in the identification of the individual’s interdisciplinary team (IDT), and educating the individual regarding his/her selection of and role on the IDT.

• Educate and inform the individual about HCBS-AMH services, the Person-Centered Recovery Planning Process, recovery resources, client rights, and responsibilities;

The RM shall do the following:

• Explain the individual’s rights as an individual enrolled in HCBS-AMH;
• Explain the services available in HCBS-AMH as they relate to the individual’s recovery goals;
• Assist the individual with fair hearing requests when needed and upon request;
• Assist individual with completing necessary consent forms and other program documentation; and
• Assist the individual with retaining HCBS-AMH and Medicaid eligibility.

• Coordinate with the referring entity (i.e. State Hospital Staff, LMHA) to complete the necessary functions to facilitate a successful transition to and tenure in the community for individuals enrolled in HCBS-AMH;

If the individual is in a state hospital at the time of enrollment in HCBS-AMH, the RM will be responsible for recovery management transitional services— coordinating the provision of allowable HCBS-AMH services inside the state hospital for up to 180 days before discharge from the hospital. Planning for the recovery management transitional services is a collaborative effort between the RM and the interdisciplinary team (IDT) at the state hospital.

During Recovery Management Transitional services RM will:

• Complete fingerprinting form and credentialing instructions (See 13620 Credentialing for Service Provision Within the State Hospitals);
• Meet with the individual and hospital IDT and complete the Initial Individual Recovery Plan (IRP) and Provider Selection Form (See 6410 Recovery Manager Meets with the Individual Residing in the State Hospital);
• Provide selected service providers with instructions to complete fingerprinting form and credentialing needed before working in a state hospital (See 13620 Credentialing for Service Provision Within the State Hospitals);
• Coordinate services with providers and meet with the individual one time per week to monitor the provision of services, unless otherwise specified due to distance between RM location and state hospital
• Meet with the individual two weeks before discharge from the hospital;
• Monitor service provision, ensure coordination of services, and address potential barriers for the individual;
• Update the individual’s IRP as necessary; and
• Assist the SHSW with the Social Security Administration Pre-Release Application Process, while the individual is still in the hospital as applicable (See 14110 Social Security Administration Pre-Release Program).
• When applicable, coordinate with courts, probation or parole officers, hospital staff, and crisis service providers;

RM will coordinate with applicable parties involved in the individual’s care (e.g. criminal justice system, EDs, or crisis service providers) to ensure the individual gains access to any needed services.

• Coordinate with other HCBS Programs in the disenrollment of the individual;

If the individual is currently enrolled in another HCBS program that precludes the individual from participating in HCBS-AMH (Long-term Services and Supports (LTSS), Community Living Assistance and Support Services (CLASS), Deaf-Blind with Multiple Disabilities (DBMD), Home and Community-based Services Waiver (HCS), Texas Home Living Waiver (TxHml), Youth Empowerment Services (YES), or STAR+PLUS HCBS Waiver) but is interested in receiving services in the HCBS-AMH program. RM will coordinate with the HCBS program for the disenrollment/enrollment process. This coordination will include the following:

• Obtaining preauthorization through DSHS for RM conversion services;
• Contacting individual’s HCBS program and obtaining necessary documentation about the individual; and
• Identifying needs of the individual and identifying new providers and resources
• Provide recovery management conversion service;

Conversion services are offered to individuals disenrolling from another HCBS program, individuals in correctional facilities, or those individuals residing in nursing facilities.

To provide RM conversion services, the RM must obtain preauthorization.

• Coordinate the development of the IRP using Person-Centered Recovery Planning and submit the IRP to DSHS for approval;

The RM identifies services that will help the individual achieve his/her recovery goals and meet the needs of the individual as identified on the UA. As the IRP serves as the Recovery Plan/Treatment Plan, the initial IRP must be completed with the individual within 10 days of enrollment, per TAC Chapter 412G Rule §412.322 relating to Provider Responsibilities for Treatment Planning and Service Authorization.

• Assist the individual in the selection of HCBS-AMH Provider Agency and direct service staff within the HCBS-AMH Provider Agency, when applicable;

The RM shall work with the individual to choose a contracted HCBS-AMH Provider Agency for the provision of services; this includes completion of the Provider Agency Selection Form. When

applicable, the RM shall further assist the individual in choosing direct service staff for the provision of individual services identified on the IRP.

• Facilitate the provision of services to support the individual’s recovery goals;

The RM will ensure the provision of services occur through the following methods:

• Facilitation of the person-centered recovery planning process to help the individual identify and obtain needed services
• Development and pursuit of resources including:
  1. Non-HCBS-AMH Medicaid services;
  2. Services provided under Medicare, and/or private insurance or other community resources; and
  3. Identifying and developing natural supports (family, friends, and other community members) and resources to promote the individual’s recovery;
• Integration and coordination with managed care organizations, private insurances, private providers, and Local Mental Health Authorities providing services essential to physical and/or behavioral services for the individual to ensure that other services are integrated and support the individual’s recovery goals, health, and welfare; and
• Advocating on behalf of the individual to resolve issues that impede access to needed services.
• Monitor the health, welfare, and safety of the individual through regular contacts (visits with the individual, paid and unpaid supports, and natural supports);
• Respond to and assesses emergencies and incidents and ensures that appropriate actions are taken to protect the health, welfare, and safety of individuals;
• Monitor and update the IRP as clinically indicated using PCRP to meet the needs and recovery goals of the individual;
• Aid in the accuracy of the HCBS-AMH Uniform Assessment;

The RM is instrumental in the accuracy of the UA. Through his/her role in HCBS-AMH and work with the individual, the RM will be able and is responsible to aid DSHS in its role in the assessment and evaluation process (See 4000 HCBS-AMH Uniform Assessment). The RM shall:

• Provide supporting documentation to be considered by individuals completing the HCBS-AMH Uniform Assessment as requested;
• Verify that services on the IRP are identified on the UA (See 7000 Individual Recovery Plan and 7300 IRP Requirements);
• Notify DSHS if another HCBS-AMH UA is clinically indicated; and
• If necessary, complete an additional assessment of the individual. These assessments may identify the needs of the individual that may not be present on the UA but are essential to the individual’s success in their preferred community. (See 4600 Secondary Assessments Co-Occurring Diagnoses Needs Assessment for an example of a functional assessment).