Local Intellectual Developmental Disabilities Authority

Local Service Area Plan

FY2023 and FY2024

Table of Contents

I. Vision, Mission, Guiding Principles

A. Vision Statement

B. Mission Statement

C. Philosophy & Values

D. Goals

E. Aim Higher

II. Agency Overview

A. History and Organizational Overview

B. El Paso Catchment Area/Region

C. Emergence Health Network IDD Services Demographics

D. Populations Served

E. IDD Services and Supports

1. Screening

2. Eligibility Determination

3. Service Coordination

4. Habilitation Coordination

5. Continuity of Services

6. IDD Community Services

7. Crisis Intervention Services

a. Crisis Respite

8. Medicaid Waiver Programs

a. Home and Community Based Services (HCS)

b. Texas Home Living (TxHmL)

9. Intermediate Care Facilities for Individuals with Intellectual and Disabilities

(ICF/IID)

10. Other Programs

a. PASRR

b. Benefits Eligibility

c. Permanency Planning

d. HCS and TxHmL Interest List Maintenance

e. Community Living Options Information Process (CLOIP)

III. Local Planning

A. Local Planning

B. Community Needs & Service Gaps

C. Community Partnerships

D. Strategic Initiatives

I. VISION, MISSION, PHILOSOPHY & VALUES AND GOALS

A. Vision Statement: EHN will lead behavioral and developmental services in the El Paso

region ensuring access to quality services, advocating for a better quality of life, and

providing strength, hope and recovery for persons with mental illness and

intellectual/developmental disabilities and substance use disorders.

B. Mission Statement: EHN ensures superior recovery-based services for mental health,

intellectual/developmental disability, and related conditions for the people of El Paso

County.

C. Philosophy & Values:

• Engage our customers by communicating the benefits of services and recovery

• Celebrate our customers strengths when participating in services

• Foster hope in every service delivered

• Demonstrate evidence of our customers successes toward recovery

• Recognize our customers and staff for all achievements made

D. Goals

• Ensuring Quality

• Improving Access

• Increasing Communications

• Enhancing Resource Development

• Strengthening the Organization

E. Aim Higher

• The mission, vision, and goals of EHN are to improve and protect the health and

wellbeing of the persons receiving IDD services.

• Promote positive, productive, and profitable performance.

• Be dedicated to excellence.

• Be the recognized authority in mental health/IDD care.

II. AGENCY OVERVIEW

A. History and Organizational Overview

El Paso Emergence Health Network (EHN) and its dedicated staff are committed to assisting El

Paso’s most vulnerable citizens, residents with mental illness, intellectual/development

disabilities and/or substance abuse disorders. At EHN we help individuals, and their families

find the resources and treatments needed to help improve their quality of life and function as

independently as possible.

EHN is proud to have created impactful change in the delivery of mental health, IDD, and

addiction services in the West Texas region. In 2021, EHN celebrated its 55

year anniversary

and although we have undergone name changes, our commitment to our residents has remained

a top priority. As the Local Mental Health and IDD Authority in El Paso County, it is our

responsibility to meet the needs of our residents through service delivery and planning, policy,

and resource development.

We believe the quantity and quality of services we provide is unmatched in our area. EHN has

dedicated employees and staff leaders who have contributed to the growth of the organization

and expansion of services benefiting our residents. As the largest mental health, IDD and

substance use treatment provider in El Paso, we have multiple service locations and clinics

where we assist a wide array of our population to include adults, children, veterans, the

homeless and justice-involved individuals.

In 1966, the Local Mental Health Authority (LMHA) was opened in El Paso and Emergence

Health Network born. EHN is now one of 39 LMHA in Texas. As the largest mental health

provider in El Paso County, we currently have 18 service locations where we assist a wide

array of our population to include adults, children, veterans, the homeless and justice-involved

individuals.

B. El Paso County Catchment Area/Region

Most recent information from the U.S. Census Bureau

County

El Paso

Population- 2020

865,657

Median Income 2016 - 2020

$48,292

Average Persons per Household 2016-2020

3.00

White

98,684

Hispanic

717,629

African American

36,357

Number of Individuals in Poverty

152,355

Percentage in County

17.6%

High School Graduate

683,869

Percentage in County

79.0%

Bachelor’s Degree or above

207,757

Percentage in County

24.0%

*Source: U.S. Census Bureau,

https://www.census.gov/quickfacts/fact/table/elpasocountytexas,US/PST045221.

Accessed September 2022.

C. Emergence Health Network IDD Services Demographics

Total People Served in FY22

Program

Total Served

HCS

861

TxHmL

136

PASRR (Nursing

Facilities)

Crisis Intervention

152

ICF

D. Populations Served

Intellectual and Developmental Disabilities, eligibility definition:

The priority population for intellectual and developmental disabilities (IDD) services includes

those persons who request and need services and possess one or more of the following conditions:

• Intellectual Disability, as defined by §591.003, Title 7, Health and Safety Code; the IQ

requirement has been lowered from 70 or below to 69 or below as of April 1, 2016. Individuals

found eligible with an IQ of 70 prior to April 1, 2016, remain eligible despite the change.

• Autism Spectrum Disorder as defined in the Diagnostic and Statistical Manual (DSM-V),

which encompasses all previous sub-types (autistic disorder, Asperger’s Disorder) of the DSM

IV-TR category “pervasive developmental disorder (PDD).

• Nursing facility residents eligible for PASRR mandated services for individuals with

intellectual disabilities or a related condition per federal guidelines.

For persons with IDD and autism, the priority population includes only those individuals whose

needs for services can be most appropriately met through programs currently or potentially offered

by the IDD services division of HHSC.

E. IDD Services and Supports

Intellectual and Developmental Disability Services (IDD)/Center for Developmental

Services (CDS):

The EHN IDD department serves individuals with IDD beginning with Eligibility

Determination at Intake, Service Coordination, and a variety of community services intended

to promote independence. In addition, EHN IDD department is responsible for Continuity of

Services, including implementing the Community Living Options Information Process

(CLOIP) for residents of the El Paso State Supported Living Center (SSLC), Permanency

Planning for children in residential facilities, Home and Community Based Services (HCS)

and Texas Home Living (TxHmL) interest list maintenance, enrollment into Intermediate Care

Facilities (ICF), and the TxHmL and HCS Programs. The Center provider functions include

TxHmL, HCS, ICF, and PASRR programs. EHN is the HUB for Money Follows the Person

Transition Support Team. EHN provides TST support in the designated service area that

consist of MHMR Services for the Concho Valley, Permia Care, West Texas Centers.

HCS & TxHmL provides an array of services; transportation, respite, personal assistance to

support the individual with individual needs and preferences. The HCS program contracts with

numerous individuals to provide host homes (foster care) for individuals interested in that

service. In the ICF/ID program, the Center operates two homes serving a capacity of twelve

individuals. The day habilitation program serves individuals across HCS, TxHmL, GR, and

ICF programs. Day Habilitation offers a wide variety of activities including individualized and

group activities designed to enhance independent living skills, social and/or adaptive skills,

and to accommodate individual needs for community integration.

Summary of IDD services currently provided:

1. Screening - Gathering information to determine a need for services. Screening includes the

process of documenting individual’s initial and updated preferences for services and the

LIDDA’s biennial contact of individuals on the HCS and TxHmL Interest List. For

individuals who will not be eligible for services, referrals to the most appropriate service

resource are made.

2. Eligibility Determination - An interview and assessment or an endorsement conducted in

accordance with Texas Health and Safety Code, §593.005, and 40 TAC Chapter 5,

Subchapter D, and in conjunction with HHSC Eligibility Determination Best Practices

Guidelines to determine if an individual has an intellectual disability or is a member of the

IDD priority population.

3. Service Coordination - Assistance in accessing medical, social, educational, and other

appropriate services and supports that will help an individual achieve a quality of life and

community participation acceptable to the individual as described in the Plan of Services

and Supports. Service Coordination is provided to people in the General Revenue, HCS,

TxHmL, and Community First Choice (CFC) programs. Service coordination functions

are assessment, service planning and coordination, monitoring, and Crisis prevention and

management.

The plan of services and supports is based on a person-directed discovery process that is

consistent with the HHSC’s Person and Family Directed Services Planning Guidelines and

describes the individual’s desired outcomes, services and supports including service

coordination services to be provided to the individual in order to meet the desired

outcomes.

4. Habilitation Coordination - Assistance for a designated resident residing in a Nursing

Facility (NF) to access appropriate specialized services necessary to achieve a quality-of-

life band level of community participation acceptable to the designated resident and

Legally Authorized Representative (LAR) on the designated resident’s behalf.

5. Continuity of Services - Activities performed in accordance with:

• 40 TAC Chapter 2, Subchapter F, for an individual residing in a SSLC whose

movement to the community is being planned or for an individual who formerly

resided in a state facility and is on community-placement status, or;

• Article II. B. 6 of the current HHSC Contract for an individual enrolled in the

ICF/ID program to maintain the individual’s placement or to develop another

placement for the individual;

• HHSC-LIDDA Performance Contract, which requires the completion of PASRR

Level II evaluations and the implementation of Habilitation Coordination to

residents of Nursing Facilities.

6. IDD Community Services in the General Revenue Program - Services provided to

assist an individual to participate in age-appropriate, community-integrated activities and

services. The type, frequency, and duration of support services are specified in the

individual’s Person-Directed Plan and the Implementation Plans specific to the services

provided. The Local IDD Authority (LIDDA) ensures that an array of support services is

available in the local service area. Some IDD Community Services are required by HHSC

contract; others are optional based on the ability to provide the service. The services that

may be available include Community Support, Respite, Employment Assistance,

Supported Employment, Behavioral Supports, Nursing, and day habilitation.

7. Crisis Intervention Services - Crisis Intervention Services, including IDD Crisis Respite,

are mandated and funded through the HHSC Performance Contract. These services are

intended to be used in a way that allows people with challenging behaviors the support

they need to avoid interactions with law enforcement and subsequent admission to

emergency rooms or inpatient mental health treatment facilities.

8. Medicaid Waiver Programs - Home and community-based programs providing services

and supports to persons with IDD who live in their own or their family home or in other

home-like settings in the community. They are called "waivers" because certain ICF/IDD

requirements are "waived." In most situations an individual who is eligible for the

ICF/IDD Program is also eligible to participate in one of the waiver programs. An

important and distinguishing feature of funding provided in the waiver program is the

ability to move that funding source with the individual to any part of the state. For

example, if an individual enrolled in a waiver program in El Paso, then moves to Houston,

they can continue to participate in the waiver program in Houston. An individual also can

change providers within the same city or county. Public or private entities may provide

waiver program services and supports. All waiver providers are certified by HHSC initially

who then reviews each provider at least annually to ensure the provider continues to meet

the program certification principles. The two waiver programs are:

a. Home and Community-based Services (HCS) Program: The HCS Program

provides services to individuals with IDD who live with their family, in their own

home, in a foster or companion care setting, or in a residence with no more than four

individuals who also receive services. The HCS Program provides services to meet

an individual's needs so that they can maintain themselves in the community and

have opportunities to participate as a citizen to the maximum extent possible.

Services consist of adaptive aids, minor home modifications, counseling and

therapies, dental treatment, nursing, residential assistance, respite, day habilitation,

employment assistance and supported employment. In the HCS Program, individuals

who are in a residential program contribute to their room and board. Service

coordination is provided to the individual by the Local Authority. There is a cost-cap

to the yearly cost of services provided through the HCS Program.

b. Texas Home Living (TxHmL) Program: The TxHmL Program provides essential

services and supports so that individuals with IDD can continue to live with their

families or in their own homes in the community. TxHmL services are intended to

supplement instead of replace the services and supports an individual may receive

from other programs, such as the Texas Health Steps Program, or from natural

supports such as his or her family, neighbors, or community organizations. Services

consist of community support, nursing, adaptive aids, minor home modifications,

specialized therapies, behavioral support, dental treatment, respite, day habilitation,

employment assistance, and supported employment. Service coordination is provided

to the individual by the Local Authority. Like HCS, TxHmL Program services are

limited to an annual cost cap. The cap is lower because there is no residential option

in TxHmL.

• An individual is typically on both the TxHmL Waiver IL and the HCS IL. If the

individual accepts an offer to enroll in the TxHmL program, their name will

remain on the Interest List for the HCS program.

• If an individual is offered an opportunity to enroll in either the HCS or TxHmL

Program, the Center will provide information about the applicable timelines for

enrollment.

• If an individual receiving services in the General Revenue program is offered

either TxHmL or HCS and declines participation, the Local Authority will

terminate General Revenue services in accordance with the rules governing the

HCS and TxHmL programs.

• A review of the Medicaid Estate Recovery Program is provided by the Center’s

enrollment staff in accordance with Texas Administrative Code, Title 1, Part

15, Chapter 373 Medicaid Estate Recovery Program (MERP), to all individuals

and their legally authorized representatives, who seek enrollment in a SSLC, a

community ICF/ID, HCS or TxHmL

9. Intermediate Care Facilities for Individuals with an Intellectual and Developmental

Disability (ICF/IDD) - The ICF/IDD program is a residential program providing

habilitation, medical, skills training, and adjunctive therapies such as dietary, speech,

occupational or physical therapy, audiology, and behavioral health services. Group homes

provide a home environment for individuals who are in need of a more structured

environment to live in the community. Individuals receive training and assistance as

needed in performing basic self-help and home management skills. Individuals are also

involved in activities outside of the home such as day habilitation, vocational services,

supported employment, and community activities. Each home provides twenty-four-hour

supervision. To qualify for ICF services, an individual must have a determination of an

intellectual developmental disability, meet specific level of care criteria, and be Medicaid

eligible.

10. Other Programs

a. PASRR Evaluations – LIDDA developmental services is mandated by Title 26. HHS,

Part 1. HHSC, Chapter 303, the PASRR IDD Handbook and the FY2020-2021 HHSC

Performance Contract to complete Level 2 PASRR Evaluations for individuals residing

in Nursing Facilities who are identified as possibly eligible for IDD Specialized

Services. The intent of this requirement is to identify those individuals with IDD in

Nursing Facilities that need additional advocacy and support to assure they receive the

services they need and to possibly transition from the nursing facility to a community

setting.

b. Benefits Assistance Program – EHN provides individuals with assistance in

completing applications for Medicaid, Medicare, Medicare Part D, and other third-party

assistance. The initial and annual fee assessment identifies individuals who may be

eligible for benefits, but who are not currently receiving benefits. Identified individuals

are referred to the Benefits Assistance department and staff work through the entire

process of application, approval, and when necessary, appeal.

c. Permanency Planning Requirements – EHN conducts and documents that

permanency planning for persons under the age of 22 years who is enrolling in or

currently residing in an ICF/IDD or HCS residential setting is completed in accordance

with HHSC rule 40 TAC, Chapter 9, Subchapter D (HCS) and 40 TAC, Chapter 9,

Subchapter E – ICF/IDD – Contracting.

d. HCS and TxHmL Interest List Maintenance – The Local Authority is responsible for

managing and updating the local TxHmL and HCS Interest Lists, which connect to the

state-wide HCS and TxHmL Interest Lists. The Local Authority adds people to the list

and makes biennial contacts with individuals on the list to confirm their continued

interest in the HCS and TxHmL Waiver programs.

e. Community Living Options Information Process (CLOIP) – In FY 2009, DADS

added CLOIP requirements to those Centers with a State Supported Living Center

(SSLC) within its local service area. The CLOIP Coordinator on an annual basis

provides specific community living program and resource information to residents of

the SSLC or their LAR, and to help facilitate provider tours and transition activities.

III

LOCAL PLANNING PROCESS

A. Local Planning

EHN has successfully implemented planning processes since its inception in 1966. Both

informal and formal planning takes place on a continuing basis at all levels of the

organization through staff meetings, management meetings, case reviews, staff supervision,

workgroups, the Planning Network and Advisory Committee (PNAC), and the Board of

Trustees.

Formal planning typically takes place as one fiscal year is concluding, and the Center is

preparing for the next fiscal year. The Center’s performance, community needs, anticipated

changes in state contracts, data analysis, budget analysis, and input from stakeholders are

considered in the planning process that develops the current strategic initiatives and the

Center’s specific work plans derived from the strategic initiatives.

Most ongoing planning takes place through workgroups and committees which address

specific issues in the Center’s work plan, or needs that have been identified through data,

surveys, interviews, advisory committees, community involvement, client rights,

departmental directives, and budget issues.

EHN values the meaningful participation of individuals, family members, community

stakeholders, and current and past employees into the development and improvement of

Center programs. Input is gathered in a variety of ways including meeting with

stakeholders in regular group meetings with individuals in service and their families,

distribution of satisfaction surveys, informal individual interviews, community

collaborative committees, provider network meetings, etc., and feedback received from

other community organizations, such as the HHSC Regional Legacy DADS Services, the

Heart of Texas Council of Governments and the Area Agency on Aging, and the Region 12

Education Service Center and individual school districts.

B. Community Needs & Service Gaps

The Center has a history of meeting with stakeholders and community partners to identify

needs and to collaborate on services.

C. Community Partnerships

The Center values its relationship with stakeholders, collaborators, and partners in the

community. The following is a summary of the Center’s interaction with them.

1. The Planning and Network Advisory Committee (PNAC) is composed of nine

members who are family members of persons served, individuals who receive or have

received services, representatives from sister agencies, and other professionals with

experience and a continued interest in mental health and/or IDD service provision. The

PNAC reviews and advises the Center on plans for and implementation of the various

programs. The Committee meets at least once each FY quarter.

• October 2019- New Executive Director introduction and review of new workgroups

related to CCBHC certification. Chief Financial Officer reviewed funding and other

revenue sources. Overviews of IDD, ECI, adult and children’s mental health

services.

• January 2020- Review of Local Provider Network Development Plan. Update on

ECI services and United Way funding. Update on adult and children’s mental health

services. Update on IDD services including ICF/ID group homes and telemedicine

services. Update on workgroups formed by Executive Director. Workgroups are tied

to pursuit of CCBHC certification.

• May 2020- Review of Consolidated Local Service Plan and update on Local

Provider Network Development Plan. IDD services update to include information

about COVID-19 precautions and effects on services. Executive Director update

reviewed COVID-19 precautions. Chief Financial Officer, ECI, AMH, and CMH

updates reviewed effects of COVID-19 on services.

• August 2020- Review of Consolidated Local Service Plan, update on Local Provider

Network Development Plan, and PNAC Needs Assessment Survey. IDD services

update to include information about COVID-19 precautions and effects on services.

Executive Director update reviewed CCBHC and electronic health record project

status. Chief Financial Officer, ECI, and AMH updates reviewed effects of

COVID19 on services. CMH update included information about Youth

Homelessness Demonstration Program funded by HUD.

D. Ongoing and Revised Strategic Initiatives

1. IDD services will provide goal-oriented, person-directed care coordination services that

are efficient, effective, and that maximize the potential and quality of community life

for persons with intellectual or developmental disabilities or related conditions.

2. EHN will facilitate access to, monitor participation in, and follow-up to assess the value

of services and supports to each individual.

a. To assess the effectiveness and thoroughness of current resources and service

provision, regular opportunities for public feedback will be offered throughout the

year to individuals receiving services, local HHSC agencies, private waiver service

providers, the programs within the El Paso Local Area, area school districts, nursing

facilities, behavior support providers, peer and family support organizations, and

other individuals and entities that serve the IDD population.

b. IDD Crisis response procedures and services will be assessed through systematic

outreach to and analysis of data from Mental Health crisis response teams, law

enforcement, hospital emergency departments, and private waiver providers.

Feedback from these entities will drive the strengthening of IDD crisis response

services.

3. Individuals with IDD who need relocation or transition from one living situation to

another will be placed in the least restrictive environment appropriate to their care.

a. Through the Community Living Option Information Process (CLOIP), SSLC and

NF Diversion, Enhanced Community Coordination, Habilitation Coordination, and

other means, EHN will continue to provide education regarding community living

options to individuals and families considering more restrictive residential settings

than may be required.

b. Through the PASRR process, EHN will ensure that individuals in a nursing facility

receive necessary services and supports, will receive education regarding

community living options, and will be diverted or transitioned from Nursing Facility

placement when possible.

4. EHN will identify opportunities for innovation in services and service delivery, with a

focus on the effects of services and service delivery in Managed Care for people with

IDD.

a. The Center routinely engages with other local social service providers to understand

resources and better coordinate the multiple service needs of individuals including

CRCG, Transition Planning with ISDs, Volar Independent Living for Individuals

with IDD, The Arc of El Paso, Autism Society of El Paso, Project Amistad, and

Project Higher.

5. EHN will continue to improve the variety of services and supports to individuals in their

home or in the community to fill service gaps and continue the focus on individual

independence.

a. Providing case consult, educational opportunities, and technical assistance through

the Money Follows the Person Transition Support Services.

b. Continuing education and awareness information regarding individuals with

Intellectual Disabilities and Autism Spectrum Disorders to EHN MCOT team,

emergency room personnel, Crisis Intervention Team (CIT), cadets, and Sheriff

departments.

c. Expand IDD crisis respite services for individuals with challenging behavioral

issues, with the intent on serving internal and external service providers.