Weekly Insight: January 23, 2017

23rd Jan 2017

This past week witnessed several major events and meetings related to Health and Human Services in Texas.

The Transition Legislative Oversight Committee met on Tuesday, January 17, 2017 at 3:30pm to hear only invited testimony. After hearing an overview from the Commission and from the Department of State Health Services and the Department of Family and Protective Services, Chair Nelson and several other committee members expressed their frustration with the collective departments’ failure to meet legislatively established guidelines for the submission of reports.  Senator Schwertner stated that with all the agencies that had gone under Sunset Review last session, only the HHS agencies had failed to meet all the statutory requirements. The Senator stated that out of 111 required reports, only 59 were submitted on time.  In addition, the discussion with the Executive Commissioner of Health and Human Services focused on the Commission’s transfer of legal staff from the Office of the Inspector General, required under SB200.  SB207, members argued, restricted the transfers to only administrative legal staff.  HHSC has delayed the transfers until after the Legislature can provide clarifying language in law regarding transfer of legal staff from the OIG to the Executive Commissioner’s Office.

Both the House and Senate released their relative appropriations bills.  The bills could not be more different regarding health and human services.  The House provides for case load growth, assumes funding of the supplemental appropriations bill, bases costs on 2017 service costs, provides increase for selected programs, including community based services and associated attendant pay.

The Senate Bill does not address any of these.  The Senate provides an appropriations Bill totaling 213.4 billion which is 296 million below the current biennium.  The General Revenue portion (state funds) accounts for $103.6 billion. Of that fund’s amount,  $77.4 billion is for Article II, Health and Human Services.  This is also a reduction from the current biennium of $1.2 billion or 1.5% lower than the present biennium.

The House provides an appropriations Bill totaling $221.3 billion which is an increase over the present biennium of $5.1 billion.  The General Revenue portion (state funds) accounts for  $108.7 billion.  Of that all funds amount, $81.9 billion is for Article II, Health and Human Services.  This is also an increase of $736.4 million over the present biennium.

On Wednesday, January 18th, the Employment First Taskforce met providing members with an update of activities at the different participating agencies and laid out the legislation that they would be following for the coming session.

Also on Wednesday, the Policy Council for Children and Families met with a significant discussion about services provided by the Texas Workforce Commission to blind and visually impaired children.  There is a disconnect between the promise of service delivery for visually impaired children made last session and the delivery of service through the Texas Workforce Commission.  A parent related how services previously provided through the former system under DARS were no longer available.  There seems to be a need for better communication with parents.  TWC stated they have held, and are holding, stakeholder meetings and that written comments are still being accepted on children’s visually impaired services. The most egregious gap in services is related to children ages 10-13 years of age.

At the same time this meeting was discussing the problems experienced under the program for Visually Impaired Children, The Employment First Task Force was receiving a report from TWC that stated that program was working very well.  Some sharing of information appears appropriate.

On Thursday, January 19th the Promoting Independence Advisory Committee met and addressed a number of issues.  Some of the policy issues emerging from the discussion included problems with the switch from “transition to life” services to using other services like food stamps.  The issue appears to be that the eligibility staff for food stamps are not actively engaging Medicaid clients in many of the community programs.  Another issue is that a person must be in the community already before they can apply for food stamps and then they have to wait 45 days.

HHSC expressed some optimism that CMS may extend the deadline for requirements and compliance under the final regulations for Home and Community Based Services.  Originally HHSC was pursuing a path that would phase out DayHAB facilities but is now rethinking the issue and may allow them to continue as a service option but expanding them to be more community focused.  Part of the issue is that since they are not regulated, no one really knows how many of them there are.

One of the bright spots in the meeting was related to the Money Follows the Person Section 811 Housing.  More than 390 units have been secured and occupancy should follow.  Since the contracts with the unit providers goes for 30 years, one unit has the potential to serve numerous people.

There was discussion about the new administration and HHSC stated they are proceeding as if all programs are remaining the same until told otherwise.  The issue of Block Granting Medicaid was raised and HHSC stated that developing a block grant takes time and a lot of thought.

Personal Attendant Services were a focus of the meeting.  The HHSC LAR exceptional item request of $8.50 wage adjustment for attendant care was viewed as a step backward. The sentiment was that the request should be closer to $13 per hour.  The Committee was warned that failure to address the staffing issues in attendant care will make community services the next CPS-like crisis.  There was considerable discussion about the need for attendant care during non-waking hours.

And finally, Friday, January 20th The Behavioral Health Advisory Committee met.    Major policy discussions included notification that the NorthSTAR transition has been completed.  Services are now being provided through MCOs and two behavioral health authorities.  The 21st Century Cures Act is a major piece of legislation that is providing a grant opportunity to Texas for Opioid treatment.

Rules related to Targeted Case Management and Rehabilitation Services have been drafted and HHSC is responding to the CMS rules related to parity for mental health services compared to medical and surgical services.  Concern was raised that MCAC, the required oversight and advisory entity for Medicaid rules, does not have the appropriate membership to address behavioral health issues.

The Thirty visit limit was ended for all but psychotherapy services.  The self-directed care pilot will be guided by an advisory committee that will be a subcommittee of the Behavioral Health Advisory Committee.  Concern was raised that the YES Waiver only covers children up to the age of 18 years and 11 months.  This leaves youth without services in some instances.  A concern was also raised that the expectation is that “children will graduate from the program after just one year.”  HHSC clarified that is not true. There was concern raised that the self-directed care pilot, starting at age 21, does not address the gap in services created by the YES waiver age restriction.

The Committee voted and approved two of their four recommendations in their Legislative Report and also voted to send the revised report on to the Legislature for consideration.


The Week Ahead
January 23rd through 27th

Health and Human Services:

January 23, 2017
Texas Insight will be covering the following meetings:

January 23, 2017
• Value-Based Payment and Quality Improvement–10:00 am — Austin

January 24, 2017
• Perinatal Advisory Council –10:30 am — Austin

January 25, 2017

January 26, 2017
• Intellectual and Developmental Disability System Redesign –10:00 am — Austin

January 27, 2017
• Drug Utilization Review Board –9:00 am — Austin

The Texas House has no hearings scheduled for the week. The Texas Senate Finance Committee will meet but on Article III. Texas Insight will not be covering the hearings on Article III.

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