Health and Human Services Commission: HHSC Releases the 2016 Revised Texas Promoting Independence Plan

11th Sep 2017

The revised 2016 plan is the eighth revision of the plan originally submitted in January 2001 as required by Governor George W. Bush’s Executive Order GWB 99-2. Texas’ plan is a direct response to the Supreme Court Olmstead ruling.  Governor Rick Perry issued Executive Order RP-13 which broadened the scope of the initiative.  The Olmstead Ruling requires states, within certain conditions, to provide individuals an opportunity to live in the most integrated setting to receive LTSS. The plan amended released by HHSC describes how Texas will provide community-based options within the Long-Term Services and Supports (LTSS) system.

The plan articulates values which are the framework for the delivery of LTSS and future system improvements.  Through the plan:
  • Individuals are well informed about their program options, including community-based programs, and allowed the opportunity to make choices among affordable services and supports.
  • A family’s desire to care for their children with disabilities at home is recognized and encouraged by the state.
  • Services and supports are built around a shared responsibility among families, state and local government, the private sector, and community-based organizations, including faith-based organizations.
  • Programs are designed to be flexible, to encourage and facilitate integration into the community, and accommodate the needs of individuals.
  • Programs foster hope, dignity, respect, and independence for the individual.
According to the report, Since the plan’s beginning in 2001, Texas has made significant progress transforming its LTSS system from an institutional-based to a community-based system, that includes:
  • Transitioning over 44,000 individuals from institutional settings to living in the community; and
  • Shifting LTSS system expenditures from institutional costs to less costly services delivered in the community.
The effort is guided by the Promoting Independence Advisory Council.  The Council is charged to:
  • study and make recommendations on developing a comprehensive, effective working plan to ensure appropriate care settings for persons with disabilities by submitting a stakeholder report to HHSC on an annual basis;
  • advise HHSC on giving primary consideration to methods to identify and assess each person who resides in an institution but chooses to live in the community and for whom a transfer from an institution to the community is appropriate, as determined by the person’s treating professionals;
  • advise HHSC on determining the HHS system agencies’ availability of community care and support options and identifying, addressing and monitoring barriers to implementing the plan; and
  • advise HHSC on identifying funding options for the plan.
The Texas system includes:
  • expanding managed care incrementally to statewide coverage by September 1, 2014, for individuals with physical disabilities or who are elderly, replacing the Community Based Alternatives (CBA) program;
  • including nursing facilities in a managed care model in March of 2015;
  • providing acute care services for most adults receiving waiver services for individuals with intellectual and development disabilities (IDD) through a managed care model as of September 1, 2014;
  • increasing appropriations since 2010 to transition individuals from institutions to fee-for-service waiver and community attendant services;
  • adding diversion opportunities for adults and children at imminent risk of institutionalization to community fee-for-service waiver programs;
  • implementing Community First Choice (CFC), effective June 1, 2015;
  • providing acute care and some long-term services to children through a managed care model in November 2016; and
  • participating in the federal Money Follows the Person Rebalancing Demonstration Grant (MFPD) since 2008, earning approximately
  • $91 million in enhanced funding through fiscal year 2018 to support individuals who want to relocate from an institution to a community setting.
The plan addresses in detail the following:

Community-Based Services—including transition to community services; diversion strategies for persons with IDD at risk of institutionalization; Funding issues to reduce the interest lists; expansion of community-based services; Medical issues; and Day Habilitation.

Children’s Initiatives—including transitioning children to family based settings; Community based supports for children with serious behavioral challenges; Parent Child safety; Access to mental health services for children in the conservatorship of the Department of Family and Protective Services.

Managed Care Initiatives—addressing LTSS Medicaid Managed Care expansions

Mental and Behavioral Health—including use of peer specialists in mental health service delivery; Mental Health Peer re-entry program; Use of innovative models like Clubhouses; Mental Health workforce training;  Centralized training infrastructure for evidence based practices; Two pilots including Money Follows the Person Demonstration Behavioral Health Pilot and Money Follows the Person Demonstration Self-directed Services Pilot; Home and Community Based services adult mental health program; Special program for individuals with mental illness.

Relocation Services—addressing issues around ventilator usage and community transition.

Housing—including multi-agency collaboration; A section 811 project providing rental assistance; Section 8 Choice vouchers; programs addressing access, HOME investment partnerships, and barrier removal.

Employment–Money Follows the Person Demonstration Supported Employment

Workforce and Provider Stabilization—including recruitment and retention of direct service workforce; Money Follows the Person Demonstration Funded Direct Workforce Training  

The full plan can be accessed here.

Thomas Valentine




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