Rider 28 & the “Money Follows the Person” rule

Update

Procedures for Requesting a Limited Nursing Facility Stay
Individuals who request MDCP services through the Money Follows the Person (MFP) option must:
– complete a limited nursing facility stay if the individual is determined to be too medically fragile to complete an extended nursing facility stay;
– obtain documentation from the individual’s physician on Form 2406, Physician Recommendation for Length of Stay in a Nursing Facility, regarding his recommendation for the length of stay the individual can complete in a nursing facility;
– and obtain admission and discharge documentation from the nursing facility.If the individual’s physician recommends a limited stay, a DADS state office physician will review the documentation and determine if the individual meets the medically fragile criteria to complete a limited stay in a nursing facility.

Form 2406 will be used as the physician’s verification that the individual meets the medically fragile criteria. Form 2406 must be completed by the individual’s physician and returned to the case manager within 30 calendar days of the initial contact with the individual, or the individual’s parent or guardian.

Individuals who request MDCP services through the Money Follows the Person (MFP) option, but are too medically fragile to reside in a nursing facility (NF) for an extended period of time, may request to complete a limited NF stay. Medically fragile is defined as a chronic physical condition that results in a prolonged dependency on medical care.

The Department of Aging and Disability Services (DADS) physician will evaluate the medical fragility of an individual requesting a limited NF stay. Medical judgment of the DADS physician will be applied on a case-by-case basis when the below criteria do not capture the severity/fragility of the individual’s medical condition. An individual must meet two or more of the following criteria to be considered medically fragile:
– Ventilator dependent with a tracheostomy
– Renal dialysis
24 hour/day oxygen dependence
– Total parenteral nutrition (TPN)
– Tracheostomy
– Daily recurrent seizures within the past six months requiring medical intervention during the seizure activity (e.g., medication administration, oxygen)
– Documented immune deficiency (e.g., severe combined immunodeficiency, or an immunosuppressive therapy)
– Total nutrition via enteral tube feeding

Go to Form 2406.

More details in MDCP Handbook section 3520.

(Print this information)
As you can see in the box at the bottom of the page, there are several pieces of Texas legislation that are for the purpose of “Promoting independence of persons with disabilities in Texas“. One strategy to do this was establishing the “Money Follows the Person” policy by transferring funds to community-based programs when an individual leaves a nursing facility to live in the community with the assistance of community-based services.

In plain English – if you spend some time in a nursing home, you may be able to skip the Interest list for a Medicaid waiver.

I have been told to do this for CLASS, you would need to be in the nursing home for 30-60 days before you could ask to the State to consider processing your request for “Money Follows the Person” to put you on the CLASS Medicaid Waiver.

BUT for MDCP, you only need to be in a nursing home for 24 hours ask to the State to consider processing your request for “Money Follows the Person” to put you on the MDCP Medicaid Waiver. (link to page in MDCP Handbook http://www.dads.state.tx.us/handbooks/cm-mdcp/3000/3000.htm)
AND you can make the request BEFORE going into the nursing home.

Here’s the procedure 1 family followed:

  1. MAKE REQUEST: Call 1-877-438-5658 to request Rider 28 consideration. They will direct you to a case worker near you to begin the process.
    • Alternative option: If you are already on the MDCP Interest List, call Vicki Edmonsen 713-967-7540 to make request.
    • Give following information:
      • Doctor’s name, address, phone number, & fax number
      • Child’s diagnosis
      • Medications child is on
      • Child’s number on the MDCP Interest list
  2. INITIAL NURSING EVALUATION: Once you have spoken to a case worker, they have 14 days to contact you to set up an appointment. Your case worker will set up an appointment for your child to be evaluated by a nurse, who will come to your home. This appointment takes approximately 2 hours to complete paperwork, answer questions and provide information about your child.
    • It is best in advance to make a list of all medications, diagnoses, medical conditions, and/or equipment that your child has or uses.
  3. PAPERWORK PROCESSED:
    • Once the initial evaluation takes place, the nurse and the case worker will write reports.
    • They will contact your child’s primary care physician and have them sign off on the information.
    • The nurse will submit the nursing evaluation to a committee in Austin.
    • The committee will determine if your child meets the criteria for MDCP.
  4. 24-HOUR NURSING HOME ADMISSION: If your child is considered eligible, then your case worker will contact you and inform you that you must check into a nursing facility approved for children and stay overnight with your child.

    The date you are discharged is the date “the money follows the person” kicks in.

  5. APPROVAL:
    • After you complete your nursing home stay, the state of Texas has 30 days to get final approval from a doctor who must sign the eligibility form for your child.
    • When this final step is approved, you will be informed of your effective date into the program.

Here is an article about another family’s experience:

Here’s the official information (mentioned at top of page) regarding Promoting independence of persons with disabilities in Texas.

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