Print 🖨

The Sunset Advisory Commission met to discuss staff and agency responses for the following agencies under Sunset review:

  • Texas Council for Developmental Disabilities
  • Governor’s Committee on People with Disabilities
  • Texas Council on Purchasing from People with Disabilities
  • Texas Health Services Authority
  • Health and Human Services Commission and System Issues
  • Office of Inspector General (Health and Human Services Commission)
  • DFPS — Presentation on the Child Protective Services Transformation Report to the Sunset Commission

 

  • Sunset staff explored the reasoning for three separate councils regarding people with disabilities and recommends that Texas Council for Developmental Disabilities and the Governor’s Committee on People with Disabilities be restructured and the Texas Council on Purchasing from People with Disabilities be abolished and duties moved to the Comptroller
  • Staff explained that the Texas Council on Purchasing from People with Disabilities lacks expertise and has not set meaningful goals or performance measures
    • Has not implemented previous Sunset recommendations and does not have the data necessary to show their worth
    • Simmons – only state purchasing?
      • Preference given to non-profit organizations that have employees with disabilities
    • Hinojosa – was there an issue with the way items are priced?
      • Staff observed 3  different pricing subcommittee meetings and discovered that prices were set above and below market price
      • Couldn’t find any comprehensive data to see historical pricing
    • Buckingham – there has been concern voiced that people with disabilities would be discriminated against if moved to the Comptroller
      • Staff recommends an advisory committee be established at the Comptroller’s office to ensure needs and rights are met
    • Nelson – 2002 Federal law integrated employment but had no account for wages or sheltered workshops – state has adopted a policy that individuals with disabilities no be paid under minimum wage
  • Nelson – why did the Governor’s Committee on People with Disabilities leave 641K of appropriated dollars on the table?
    • Told staff that it was their prerogative to do so, cannot answer for the governor
    • The council has 27 members; considered reducing its size but it is prescribed in federal law

 
Mary Durheim and Roger Whip, Texas Council for Developmental Disabilities

  • Support Sunset recommendations
  • Appreciate opportunity for external review to improve efficiencies
  • Provide 500M in grants a year for a 3-5 year period (45-50 grants)
  • Appreciate recommendations on how to collect data

 
Angie English, Joe Bonke, Governor’s Committee on People with Disabilities

  • Sunset was the first group to identify that they were not receiving their full appropriation; they have been significantly underfunded and want to do more
  • Formed in 1950, oldest and strongest in US
  • 4.75 staff with 12 committee members appointed by the governor (7 must have developmental disabilities)
  • Hinojosa – how did you not receive the full appropriation?
    • Office of the governor gives them an operating budget that is much less than the appropriation

 
John Luna, Dietrick Bettingfield, Texas Council on Purchasing from People with Disabilities

  • Supports creating an advisory committee
  • Disagrees with transfer to the Comptroller; they have diverse expertise that people in the Comptroller’s office won’t necessarily have
  • They are the top ranking in many performance measures in the US
  • Require community rehabilitation programs for individuals to regain employment
  • Transferring would add unnecessary government oversight
  • Comptroller has told them that they do not have the expertise or support to help individuals with disabilities to gain employment
  • Price asked for them to elaborate on what recommendations that were made for them in 2003 that were not implemented
    • Language was that they “may have” and advisory committee but they already hold 12 open meetings a year
    • Could have hired an additional 2 staff but they didn’t need it
  • Gonzales – the Comptroller said they don’t have the capability? We need to look at the population that we are trying to help, every disability is different
  • Nelson – what expertise can the council provide that an advisory committee at the Comptroller can’t?
    • Passion, and knowing all the local supports
  • Hinojosa believes that there needs to be more proper oversight on pricing and the entire council
  • Simmons asked about TIBH, the central contractor and why there hasn’t been a competitive bid since 2002 – should there be a discussion about negotiating price structure?
    • Yes, it has gone up then down to 6%
    • Simmons asked for this data that is subject to the state audit program
  • Schwertner asked if there were any conflicts or dual roles between TIBH and the Council
    • No, that wouldn’t be allowed

 
THSA
Sunset Staff

  • Recommend removing from state statute
  • It would continue as an independent non-profit organization responsible for HIT in Texas
  • Currently have no state rule making authority or regulatory function
  • Current funding should last through 2017
  • Nelson – by removing from statute would this remove privacy protections in the law?
    • Recommending to move privacy language regarding the THSA to another statute

 
Tony Gilman, Ed Marx, THSA

  • They don’t fit the mold of a typical agency
  • They ensure that the right medical information is provided to the right provider at the right time
  • HIE is just getting started in the US, standards will be evolving for the next 5 years
  • There is already a significant amount of funding invested, working to ensure all medical providers have a local HIE option
  • Schwertner – if providers can set up their own networks, why the need for the agency?
    • Federal requirements
  • The majority of HIE is happening at a local level – 10 HIE operators and some larger facilities have their own network with the ability to interconnect
  • Schwertner – original funding for this was from the Stimulus – not sure if the state should continue to fund them
  • The Privacy and Security Certification volunteer program
    • Texas is the only state to have this
    • Mechanism for providers who are doing the right thing to have a mitigating factor against penalties
    • Cost is 5K
  • Confident in their sustainability approach – they do not receive any GR
    • Received some money from the closure of the high risk pool
  • Burkett – what consumer consent is needed to allow a doctor to access PHI?
    • Texas law follows HIPAA, consent is not required through Texas law
    • More stringent protections on sensitive PHI
  • There is the ability to opt out of a HIE network
  • Information cannot be accessed by just any provider
  • Most funding comes from membership fees from hospitals
  • Birdwell – how do we ensure Texans are protected out of state?
    • Stringent requirements
  • Birdwell – does the state lose the ability to protect THSA from the feds if it goes private?
  • Campbell – if there is a leak in HIE who is liable?
    • Docs are concerned with this – one of the barriers to uptake due to lack of case law in this area

 
HHSC

  • Nelson – we need to address problems highlighted in the report head on, no matter how the agency is structured
  • Staff –
    • Builds on previous Sunset recommendations from HB 2292 in 2003
    • Addresses fragmentation
    • Follows on the heels of big bills changing delivery of care from last session
      • Medicaid Managed Care
      • Integrated behavioral health care
      • Women’s health services
    • Need the ability to argue that the system is organized in the best way to deliver quality and efficient care, and staff couldn’t do that now
    • HB 2292 consolidated HHSC agencies from 12 to 5
    • 5 agencies still allow for system fragmentation, duplication, silos, blurred accountability

Issues/Recommendations
1. The Vision for Achieving Better, More Efficiently Run Services Through Consolidation of Health and Human Services Agencies Is Not Yet Complete

  • Nelson – consolidating 12 agencies to 5 in 2003 was driven by money, but it is not the case this time
  • Consolidation and direct accountability with the Executive Commissioner (EC) will not affect the prominence of behavioral health (BH) and the Women’s Health Program (WHP) correct?
    • Correct, divisions will be created grouping similar services
    • Will help with IT and data fragmentation
  • Nelson asked for a list from the LBB of everywhere in the budget where there is funding for BH
  • Schwertner – theoretical benefits are great, but too much consolidation could marginalize delivery
    • Grouping would be done by the EC by 9/16, recommends a legislative oversight committee to determine structure
  • Schwertner – Why was savings due to consolidation not specified like it was in 2003
    • Couldn’t  guarantee figures
  • Price – Schwertner has legitimate concerns – there is no designation of a state division in agency; we would lose federal dollars
    • Realizes this is the first draft but there a little pieces that we can’t miss
    • No intent to eliminate services
  • Raymond – there will be good ideas that will come through the process and maybe the legislature should give finite directions in some areas
    • If we save money we may be able to use the money to help more people
  • Birdwell – why can’t the EC consolidate now?
    • Prohibitive statutes
    • Divided accountability at the top
  • Nelson – IT consolidation will cost money
  • Nelson – wants to make 100% sure they prioritize BH
  • Schwertner questioned the ambitious transition schedule, suggested using external experts
  • Raymond – we have a head start because the EC is already familiar with the silos

2. Incomplete Centralization of Support Services Deprives the State of Benefits Envisioned in Consolidating the Health and Human Services System

  • Schwertner asked for a deadline for consolidation

3. Fragmented Administration of Medicaid Leads to Uncoordinated Policies and Duplicative Services and Could Place Future Transitions to Managed Care at Risk

4. HHSC Has Not Fully Adapted Its Processes to Managed Care, Limiting the Agency’s Ability to Evaluate the Medicaid Program and Provide Sufficient Oversight

  • Schwertner asked for reasoning for combining the P&T and DUR committees
    • Sunset staff said that both advisory groups make decisions to restrict access to drugs in the Vendor Drug Program based on safety, cost and utilization, and both use the same data to make their determinations
    • Believes that one group can make both decisions; what drugs go on the Preferred Drug List and what clinical restrictions should be placed on them
  • Senator Schwertner then asked what the benefit is in keeping these two advisory groups as we move more and more into managed care and not allowing MCOs to control their own formulary
    • Sunset staff couldn’t verify the potential cost savings by having MCOs control their formularies
    • Uncomfortable in removing the oversight HHSC has over the PBMs
    • Allowing for MCOs to have their own formularies is a pure policy decision and staff didn’t want to comment on that
  • Schwertner – what authority does HHSC have to exert control on PBMs?
    • Through MCO contracts

5. Fragmented Provider Enrollment and Credentialing Processes Are Administratively Burdensome and Could Discourage Participation in Medicaid

6. The State Is Missing Opportunities to More Aggressively Promote Methods to Improve the Quality of Health Care

7. HHSC Lacks a Comprehensive Approach to Managing Data, Limiting Effective Delivery of Complex and Interconnected Services

8. Administration of Multiple Women’s Health Programs Wastes Resources and Is Unnecessarily Complicated for Providers and Clients

  • Nelson asked for staff to describe the modeling for proposed eligibility requirements
    • Took the 3 current program numbers and the broadest eligibility
    • Moving to FFS
    • Provides for help in the rural areas
    • Based on WHP model, client must be already enrolled to get services
      • If a woman walks into a clinic that isn’t in the program, it incentivizes the provider to determine eligibility or access other funding options
  • Nelson wants more money in the WHP and wants to expand eligibility and benefits

9. NorthSTAR’s Outdated Approach Stifles More Innovative Delivery of Behavioral Health Services in the Dallas Region

  • Birdwell – Navarro and Ellis Counties have expressed their concerns; NorthSTAR (NS) has accomplished great savings in behavioral health, concerned that efficiencies will be lost
  • Nelson – working on a modification that doesn’t throw out anything that is working
  • Schwertner – understands that counties in NS have taken a lot of money from NS and put it to DSRIP projects – needs to be addressed in the modification
  • Luce – state is so diverse, need local flexibility while meeting Sunset objectives

10. Poor Management Threatens the Office of Inspector General’s Effective Execution of Its Fraud, Waste, and Abuse Mission

11. Credible Allegation of Fraud Payment Hold Hearings Do Not Achieve the Law’s Intent to Act Quickly to Protect the State Against Significant Cases of Fraud

12. HHSC’s Uncoordinated Approach to Websites, Hotlines, and Complaints Reduces Effectiveness of the System’s Interactions With the Public

13. HHSC’s Advisory Committees, Including the Interagency Task Force for Children With Special Needs, Could be Combined and Better Managed Free of Statutory

  • Nelson – We should have direction on which advisory Councils (AC) continue

14. HHSC Statutes Do Not Reflect Standard Elements of Sunset Reviews

15. Allow the Texas Health Services Authority to Promote Electronic Sharing of Health Information Through a Private Sector Entity
 
Kyle Janek, EC of HHSC

  • Raymond – so how do you envision this?
    • Plans on continuing to be the EC but has not had that conversation with Gov-Elect Abbott
    • Has already changed some processes to try and consolidate areas like contract policies, oversight of vendors, legal services
    • Doesn’t want to create disruption in services  as divisions are integrated
    • Need to do this in a smart way
    • Fragmented programs like Medicaid make no sense – have to do inter-agency contracts to administer all Medicaid programs
    • Emphasis on public health is paramount
    • Legislative oversight in the transition is really important to make sure HHSC is hitting the mark
    • ACs provide transparency and public input
      • Would like to see MCAC meet every month to get rules regarding the ACA passed
    • Luce – pitfalls in not integrating IT and Legal – would you agree that you are capable with legislative oversight to make the transition happen?
      • Yes, good with deadlines
    • Hinojosa – appreciates Janek’s honesty and experience, the healthcare arena is never static
    • Nelson – do you believe I consolidated agency can better serve our most vulnerable populations?
      • Yes
  • Nelson formed a workgroup to answer these questions:
    • Should we consolidate agencies per issue 1 or modify?
    • Should we accept, adjust or reject the recommendation related to the legislative oversight committee?
    • Accept or reject advisory council proposal in Rec 13?
      • Price, Schwertner, Birdwell, Dutton, Burkett and Luce

 
Office of Inspector General (OIG)
Sunset Staff:

  • 774 FTEs with a 48.9M annual budget to combat fraud, waste and abuse
  • This is the first evaluation of OIG
  • Lack of results has garnered attention
  • Inconsistent results
  • Poor communication and transparency
  • Limited oversight
  • Recommend a special Sunset review in 6 years
  • Recommend not letting the OIG be a gubernatorial appointment
  • The ACA requires suspension of Medicaid payments to providers under investigation of fraud, but the hearings are blown out of proportion
    • Need to provide a truly expedited hearing process at SOAH
  • Hinojosa – the report confirms all the complaints they have heard
    • Casting too wide of a net and investigating providers due to clerical errors and putting them on payment holds – extrapolation techniques used are questionable
  • Nelson – the intent was to not have the OIG report to the EC when the position was created to try and keep them independent, though federal law requires the OIG to be located at HHSC
    • They regularly investigate employees at HHSC
  • Raymond – Questionable if OIG is doing their job – want anyone who has stolen from Medicaid to be prosecuted and go to jail
  • Raymond – providers having to put up a share of the money to have a SOAH hearing is not right
  • Hinojosa – with the backlog many healthcare providers go bankrupt due to payment holds
    • The problem is that the definition of “fraud” in statute is very broad
    • Lack of clearly defined guidelines and procedures makes the OIG not able to back up their decisions
  • Hinojosa – head that there was IB in fraud, yet the recoupment rate is only 5-10%
  • Dutton – there is a fine line between going to the OIG or refer a situation to the licensing board
  • Dutton – are there specific experience requirements to work at OIG? No
  • Staff – Janek doesn’t feel empowered to go in and make changes to OIG even though it is a division of HHSC
    • OIG is not familiar with HHSC programs

 
Doug Wilson, OIG

  • Have essentially rebuilt the office in the past year
  • Greatest area of improvement  is in transparency and communication
  • Raymond – Discussed the Xerox contract, investigations on hearing aid providers and situations where TMHP approved a procedure and the OIG went after them anyway
  • The Medicaid Fraud Unit investigates for criminal fraud
    • Discussed the investigation process step by step
  • Dutton asked about the OIG employee that committed fraud and ensured that the OIG has gone back to look at all the claims this person handled
  • Dutton – how do you detect claims to go after?
    • The system identifies outliers or potential fraud is reported by a person
  • Price – the VDP has a different due process
  • Schwertner – is the bottleneck with SOAH hearings or at the OIG?? Why can providers not get finality on payment holds?
    • OIG cannot control when a case is set for hearing at SOAH, many get pushed back
  • Deputy IG – OIG pays SOAH for hearings split with the providers due to remove the fiscal note in the bill that passed this into law
    • Cases take a long time, SOAH has a full docket, need three judges at every hearing
  • Hinojosa – SOAH is not the problem, read from the report about the number of cases bottlenecked at OIG in the investigation phase
    • 2011 – payment holds on 200 cases that take around three years to finalize
  • Schwertner – the OIG doesn’t have an external review of extrapolation and only instated one when the OIG employee was investigated; lost faith in OIG and wants an agency that actively goes after fraud
  • Burkett – the OIG went from 19 investigators to 103 due to recent appropriations
    • Working to get the backlog done by the end of 2015, 1100 outstanding cases
  • Nelson asked about the annual reports an performance records
  • Nelson – there may be some modifications that need to be made in the Sunset recommendation
    • Announced a workgroup: Raymond, Campbell, Hinojosa, Gonzales and Buckingham

 
DFPS
Judge Specia, Commissioner

  • Have produced a 160 page report explaining changes they have implemented and any statutory changes they need to give the agency flexibility
  • Transformation to make Texas CPS program best in the nation
  • Key milestones:
    • Developing a professional and stable workforce
    • Partnering with colleges to find passionate and resilient employees
    • Revamped training, 80% in the field
    • Pilot on training will begin in January
    • Creating a statewide mentoring program – 34 pairs are working together now and there will be another rollout in May
    • Created a risk assessment tool in decision making
    • Opening a casework support center
    • Relieving administrative burdens by reducing the paperwork to one form
  • Listed statutes that they would like to have removed and established through rulemaking to gain flexibility and accountability

 
Public Testimony on Disability Councils
Sandra Bitter, Texas State Independent Living Council

  • Amend labor code to add people with disabilities who have self-disclosed which would allow for collection of this employment data

 
Bob Kafka, ADAPT Texas

  • Support recommendations for continuation of agency
  • In regards to Council on Developmental Disabilities –  time to broaden name to functional level and call council “Texas Council on People with Disabilities”

 
Cathy Cranston, ADAPT Texas

  • People with disabilities should be paid minimum wage

 
Al Madsen, Andrews Center and Texas Council member

  • Have lost contracts because they are not competitive in pricing
  • Would love to see everyone integrated into the community making a living wage
  • If try to go to a pure minimum wage policy then a lot of people end up going home

 
Kevin Jackson, Member of Texas Council of Purchasing for People with Disabilities 

  • Pricing of products – TPASS is critical part of pricing structure
  • TIBH does not set any prices, that is done solely by CRP
  • Many contracts going to private entities are coming back to the state

 
David Wells, West Texas Lighthouse for the Blind

  • Small business that uses for blind and visually impaired for employment
  • Dismantling Texas State Use Program would impact thousands 

 
Jean Langendorf, Disability Rights of Texas

  • Main concern is over 600 identified under minimum wage
  • Sub-minimum wage programs is not in alignment with other programs

 
David Dodson, Owner of Fort Worth Texas Company

  • Pays some employees sub-minimum wage
  • Staff works there because they want to be there
  • Have dynamic outplacement operation as well
  • Have people working there that are at 20%-30% productivity and without sub-minimum wage then they would not be working

 
Charlie Graham, Peak Performers

  • Encourages not to throw baby out with bathwater in light of discussions of sub-minimum wage

 
Stacy Ford, Parent

  • Feels education piece is missing
  • Thinks other entities can be involved to support parents
  • Gonzales said McNeil HS is a cluster site for special needs kids and is familiar with the issues – they are working on special education legislation
  • Simmons is filing legislation to require school districts to have an advocate for the families but doesn’t want this to be an unfunded mandate

 
Alan Warrick, CEO of World Technical Services

  • Many people would not have employment because of sub-minimum wage

 
Jerry Mayfield, Austin Lighthouse

  • Does not support recommendation to dissolve Texas Council For Purchase of Products from People who are Disabled
  • Have seen opportunities flourish with Council

 
Platt Allen, Lighthouse for Blind in Fort Worth

  • In support of the program – TIBH assistance, guidance from purchasing committee
  • Would like to see the Council kept in place

 
Debbie Agnant, Member of SUPRA

  • In support of program, Texas program is creative, effective and successful
  • Gonzales thanked her for testimony about how she has seen the program in other states and how Texas is a better model
  • Gonzales said he was concerned some of the “passion” of moving this program to Comptroller
    • Witness said great think about Council is selected of people with expertise and knowledge and focuses more on human nature of the program

 
John Moore, Director at Lighthouse in Corpus Christi

  • There are a huge number of obstacles for disabled when applying for jobs
  • Have saved state over $439k in toilet paper because of this program – this program works
  • Does not want Council dissolved but wants to see it continued

 
Linda Leitzinger, Parent and advocate

  • Have seen wages paid through the contracts and thinks there are issues with the program that should be looked into   

 
Shawn Quigley, ED On Our Own Services

  • Elimination of Texas Council would have a significant impact on the services they can provide 

 
David Whitte, ADAPT Texas

  • He worked with many underperforming employees in his past and none of them were paid sub-minimum wage
  • Thinks people should be paid what they are worth, people should be valued as human beings

 
Michelle Dully, President of Community Now

  • Have worked with people in disabilities and not happy with sub-minimum wage
  • Sub-minimum wage is criminal and should value people

 
Robert Coontz, Association for Persons Affected by Addictions (APAA)

  • Important that their services continue to be provided, relationship with value option needs to continue

 
Sandra Simpson, APAA

  • Value options appeared and things changed
  • MRO that just started this September may have eliminated the funding for their organization

 
Alonzo Grape, APAA

  • Provided details on the organization
  • Issue #9 of discontinuing of NS system – supports keeping the program

 
Public Testimony on THSA
No registered witness
 
Public Testimony on HHSC and OIG
Amanda Stuckenburg, self

  • Issue #8 Women’s Health – concerns on prescriptive details listed in Sunset Report
  • Could be limited in ability to serve the population
  • Would like some flexibility in how issue 8 is structured

 
Sandra Bitter, Texas State Independent Living Council

  • Testifying on 1.1 – fragmented approach has posed challenges
  • Funding for all core services should originate from one entity
  • Believes dissolving councils would interfere with stakeholder input – people who serve on the councils/advisory committees can have a role in providing testimony directly to agencies

 
Trey Berndt, AARP in Texas

  • Sunset Commission needs to go a bit further and specify broad areas where consumer input will be needed
  • MCAC is federally required issued but only considers Medicaid issues – other public issues need to come in front of committee as well
  • SB 7 created Statewide Managed Care Advisory Committee is one worth keeping
    • There needs to be a committee that looks across the program and see what is going right and wrong
  • HHSC has become a contract management agency instead of fee-for-service
  • Contract management particularly in the area of network adequacy is the weakest part right now – this areas needs a lot of strengthening
  • There are a lot of issues surrounding network adequacy particularly around members access specialist care
  • Standards HHSC uses in contracts are dated and out of step with best practices
  • Recommend looking at Medicare Advantage Network Adequacy Standards
  • Schwertner – are there any other states that utilize Medicare Advantage Standards?
    • Not aware of other states that have specifically adopted the entire standards
    • Other states have adopted provider ratios – at least 4
    • Access to specialists can be 75 miles away and does not make sense – Advantage Standards breaks Texas into more logical geographic areas
    • Schwertner – come by and visit office later and discuss with staff
  • Simmons – do any recommendations made promote expanding ACA or use influence on committee to encourage Texas to expand Medicaid?
    • They did not recommend expanding ACA
    • He will not use his position to promote expanding Medicaid

 
Bob Kafka, ADAPT Texas

  • Thinks Texas is too siloed
  • If going to consolidate in any way, consumer input needs to be taken into account
  • Comprehensive functional assessment needs to be done on STAR+PLUS
    • Needs to be about function not label
    • Wages of workers can be varied for same work
  • Integrated employment – all employment services in one entity 

 
Arlene Wohlgemuth, Texas Public Policy Foundation

  • Believes it is time to take the next step – agrees with Sunset that HHSC needs to consolidated
  • Would change PDL and way drug utilization occurs in the state
  • Since Texas has moved so dramatically toward managed care, believes managed care should be given authority over the formulary
    • Will result in cost savings and improved service delivery
  • Formulary needs to be handled by Managed Care as well
  • Disappointed in OIG – office was to distinguish between billing errors and criminal activity and does not believe that has happened – time to move them to supervision under HHSC
  • Thinks NS was a good interim step but model not able to make changes needed now
    • Important to have system that can integrate and does not believe NorthSTAR is the model for that
  • “Hallelujah” in regards to Sunset recommendation of advisory committees
    • Thinks committees should be formed when needed and un-formed when not needing them 
  • Integration not happened before when it could – leadership at the top is the determining factor in many of these cases
  • TPPF will be recommending the ability to allow the Executive Commissioner to do state waivers for local communities
  • Schwertner – “In reference to PDL and testimony to abolish P&T and PDL and roll it all over to MCOs” there is criticisms there would be many formularies making the system difficult to navigate and not really save money –
    • Move toward managed care allows consumer to make choices and moves away from agency providing direct services to contracting
    • Success of consolidation now will depend in large part of agency being good contract managers – put out right RFP, select best companies and then hold companies accountable and oversight direction
    • Yes, it will be complicated but not more complicated than seeking prior authorization, etc.
  • Schwertner – Should contracting/procurement be its own division, Deputy Level position?
    • Allow Executive Commissioner to decide what’s best  
    • Legislature needs to give Commissioner flexibility to hire outside counsel
  • Tom Luce – issue #9 abolish of NS, would witness support time being given to community to come up with alternative
    • Contract could be radically altered
    • Would amend testimony to say “NS as it is today should be abolished”
  • Would say Executive Commissioner should appoint OIG and not Governor
    • There  are valid arguments for either side
    • The independence of OIG is done for a purpose but unsure of the effectiveness
    • Raymond – pointed out other states are doing the way the Sunset is recommending
    • Agrees – we tried it one way now let’s try it the other way
    • Birdwell asked if the issue was the personality of the OIG office
      • Office has grown
      • Birdwell does not want to make structural changes because of a personality
  • Campbell – how many employees at OIG are actively working on caseload? Or other comments in regards to OIG?
    • TPPF said point well taken but has not done that research
    • At one point hear that providers were being treated like criminals for billing errors and does not know if that has changed
    • Difference between billing errors and criminal activity and need to do a better job of differentiating
  • Hinojosa – agrees with comments on OIG, there are structural deficiencies, need to focus on those committing fraud because system currently is throwing out a large net and some honest health care providers are being discouraged from participating in the system
    • Witness noted she has heard complaints from nursing home facilities that there is more of a gotcha mentality when inspectors visit
    • Need an incentive for inspectors to help the nursing homes, or any provider, to become better – maybe practices improved instead of mindset they need to be shut down  
  • Raymond – wanted to respond to Birdwell, does not think it is OIG personality but he likes him less today than yesterday
    • The whole operation is misguided and not doing job well

ADAPT Texas

  • Support consolidation
  • Concerned with network adequacy of direct care workers
  • In order to retain, must pay adequately

 
Ed Hammer, Professor of Pediatrics Health Science Center Amarillo

  • Trains physicians to work with persons with disabilities. 
  • Hinojosa – how we can improve the performance of individuals with intellectual disabilities who reside in the community?
    • Research shows that only a fraction of those individuals require constant care if there are supports within the community

 
Bee Morehead, Texas Impact

  • Asked for Texas Non-Profit Council be removed from recommendation 13 
  • Need to establish at least on statutory AC in final decisions
  • AC’s are crucial for public input

 
Sharon Brockea, Foster parent of a person with disabilities

  • Attends to her daughter all day every day for very little pay

 
John Holcombe, TMA

  • Stressed the need for the state public health officer to be empowered to deal with public health outbreaks
  • Concerned with removing ACs from statute

 
Sherry Cusumano, NAMI Dallas

  • Strongly advocates for the retention of the NS system
  • Expressed the importance of open networks and transparency

 
Andy Wolfskill, Child and Family Guidance Center

  • Discussed the patients his center serves and the importance of the NS system

 
Carol Lucky, Child and Family Guidance Center

  • Discussed the importance of the NS system and its importance to the community
  • Birdwell – there is a speed and pricing advantage that is realized in NS

 
Rachel Hammon, Texas Association for Homecare and Hospice

  • Supports the majority of the Sunset report
  • Need to streamline homecare services
  • Concerned with the abolition of all advisory boards
  • Provided suggestions for removing duplication and maximizing effectiveness

 
Tom Collins, CEO Green Oaks Hospital

  • Has worked in psychiatric hospitals over the past several decades
  • Stressed the importance of the NS system and the role his hospital system plays in serving BH patients

 
Adrianna Cuellar Rojas, United Ways of Texas

  • Stressed the importance of the 211 system in delivering information and services to Texans

 
Allison Shalinsky, NAMI Dallas

  • Discussed her experience managing her own care and as a certified care manager
  • In support of the NS system
  • Hinojosa asked about the issues relating to the integration of mental and physical health treatment
    • Agreed that mental health and physical health are integrally tied

 
Dennis Borel, Coalition of Texans with Disabilities

  • Need to scale up a Medicaid Managed Care Ombudsman office to ensure better access
  • Discussed the cure for Hep C, concerned that it isn’t available to Medicaid patients
    • Need a representative of intended beneficiaries on P&T or DUR

 
George Linial, Leading Age Texas

  • Supports quality initiatives and incentive based programs
  • Discussed the informal dispute resolution process for nurses, process is not effective – move to independent third party
  • Medicaid eligibility approval in nursing homes takes too long

 
Janie Metzinger, North Texas BH Authority

  • Maintain NS services

 
Jane Boote, speech therapist

  • Need to maintain the Traumatic Brain Injury Council

 
Todd Wright, ADAPT

  • Supports the NS system because they don’t have waiting lists

 
Will Francis, National Association of Social Workers Texas

  • Concerned with the shortage, becoming crisis, of BH workforce in Texas
  • Need expansion and loan repayment programs

 
Texas Office for IDD

  • Concerned with consolidation, wants to maintain current structure
  • They are a model public-private partnership

 
Individual who is a NS psychiatrist

  • The prospect of removing NS has created a lot of tension in the community
  • Concerned about funding structure
  • Burkett – concerned about the service to patients and that the replacement needs to have the same open door policy
  • Hinojosa – isn’t one of the problems with NS that they cannot pull down as much IGT for the 1115 waiver?

 
Jamie Dudensing, TAHP

  • Medicaid Managed Care is a benefit for the state
    • Fully integrated benefits allows for accountability
    • New to preserve flexibility
    • Should carve in the formulary for MCO’s to control
    • Need a standardized credentialing system
  • Schwertner – appreciates the information she provided to the committee regarding the formulary – is the state doing enough to ensure network adequacy?
  • MCOs are held very accountable on quality measures, outcomes and networks

 
Kalumba Wilson – child with mental illness

  • Need to maintain advisory committees

 
Regina G. Calvert, Texas Dentist Group Practice Association

  • Supports strengthened contract processes at HHSC
  • Dental home designation by DMOs is confusing
  • Supports elevating data initiatives
  • Streamline OIG payment hold authority

 
Liam Mulvaney, CEO Lifenet 

  • Provider in the NS system “don’t throw the baby out with the bathwater”
  • Portions of the system must be preserved
  • Hinojosa – concerned with the timeframe for changing NS because it could impact federal funds

 
Matt Roberts, Mental Health America of Greater Dallas

  • Supports the NS system, opposes recommendation 9

 
John Dornheim, self

  • In support of NS and related his personal experiences with his friends and family who have benefited from their services

 
Constance Smith, son with schizophrenia

  • Supports NS and discussed personal story

 
Tina Adler, NAMI Dallas and Certified Peer Specialist

  • Discussed personal story regarding the NS system and its importance  

 
Debra Rosales Elkins, Texans Care For Children

  • Opposed to recommendation 13 regarding advisory board elimination

 
Jerry Teague, Dentist Anesthesiologist

  • Serves children and special needs patients
  • Difficulties contracting with DMOs  due to low reimbursement rates
  • Campbell asked about his practice and procedures he provides
    • She voiced concern that he does anesthesia in his office and not in an ASC or hospital

 
Jill Martinez, Metro Care Services

  • Discussed her participation and difficulties in the NS system and the difficulties
  • Supports recommendations regarding NS

 
Michelle Dulley, Community Now

  • Discussed personal story about her son with IDD and his treatment

 
Cheryl Hunt, Austin Council of the Blind

  • Opposed to the consolidation of the services for the blind

 
Paul Hunt, Austin Council of the Blind

  • Spoke about the services he has received through DARS and advocates for the retention of all services through existing agencies

 
Edgar Sheppard, Visually Impaired Advocates

  • Discussed personal experiences in the DARS program, concerned about services that might be lost in consolidation

 
Vantril Lewis, Visually Impaired Advocates

  • Testified about his disabilities and his personal experience as a consumer of DARS

 
Stephen Freeman, Texas Rehab Action Network

  • Opposed to recommendation 1 regarding agency consolidation and supports the alternative proposed by TRAN
  • Concerned that it could result in the loss of  Federal funding

 
Cheryl Williams, County Commissioner of Collin County

  • In full support of recommendation 9 as regarding restructuring NS
  • Discussed details of issues in dealing with NS and its services
  • Buckingham asked about the myth of the waitlist
    • NS provides a little bit of services to a large amount of people – leads to more crisis situations

 
Janet Realini, Texas Women’s Healthcare Organization

  • Need to promote access to preventative care
  • Supports recommendations in #8
  • Appreciates increased funding from last session

 
Steve Mayfield, Parent of child at Denton SSLC

  • Concerned with the closure of the Austin SSLC
  • Not everyone can live in the community with fragile medical conditions
  • Concerned with the abolishment of ACs
  • Concerned HHSC will become autocratic
  • Raymond – working really hard on SSLCs – any money gained from the sale of the Austin property will only go to the other SSLCs
  • HHSC – we need to address SSLCs with safety issues, not just shut them down

 
Amanda Stevenson, Researcher at UT

  • Recommendation 8 regarding consolidation of women’s health programs is excellent
  • Need to expand the program to women who are already sterilized
  • Many women want LARCs but do not have access

 
Susan Murphree, Disability Rights Texas

  • Management of contracts has put HHSC into more of an operational mode
  • Commends HHSC on managed care expansion – believes there needs to be more time until we consider restructuring
  • Opposes abolishing ACs

 
Sheila Adama, Timberlawn BH System

  • Psychiatric hospital
  • Blended funding is the cornerstone of their model, prevents a waiting list
  • Supports the NS model

 
Gregory Ware, self

  • Opposes consolidation of DARS into HHSC
  • Would limit resources and federal dollars in the vocational rehab program

 
Carlos Higgins, Texas Silver haired Legislature

  • Seniors are the most rapidly growing population
  • ACs are extremely valuable
  • Do not take away the independence of the OIG
  • Need a sound basis for consolidation

 
Rochelle Owens, Texas Rehab Action Network

  • Opposes the consolidation of DARS into HHSC
  • Dramatic transition for people with disabilities
  • Need to maintain employment related programs

 
Chris Kyker, Texas Silver haired Legislature

  • Participated in the transition in HB 2292
  • No agencies or groups on aging referenced in consolidation plan
  • Price – EC can create divisions, allows for flexibility – asked specifically about aging yesterday

 
Ricky Brussard, ARC of Texas

  • Sits on the IDD redesign committee, please keep the committees together

 
Dr. Barreilles, One Voice Texas

  • Need to strengthen and have one central ombudsman office

 
Julie Borne, parent

  • Need ACs
  • Parents voices are crucial, need to continue the Texas System of Care Consortium

 
Jill Switzer, Mental Health America Texas

  • Don’t want to lose focus on BH and substance abuse
  • Wholeheartedly support upgrading technology
  • Maintain ACs

 
Norma Crosby, National Federation of the Blind

  • Concerned about vocational rehabilitation
  • Suggested moving DARS into TWC

 
Candace Ayler, parent

  • Maintain ACs BH system in Texas is broken
  • Youth and family voices are crucial – maintain the System of Care Consortium

 
Kenneth Dick, single dad

  • Maintain ACs
  • Need informed family members on committees

 
Ana Defrates, National Latina Institute for Reproductive Health

  • Advocates for immigrant health and rights
  • Supports recommendation 8
  • Appreciates the 17% increase for the WHP
  • Wants to extend eligibility to 15 year olds and waive the parental consent for minors

 
Michelle Carter, FQHC in Greenville

  • Contractor in the WHP
  • Participate in all three programs, supports consolidation
  • Changing enrollment to point of service could delay payment

 
Jose Camacho, Texas Association of Community Health Centers

  • Served 1.31M people last year
    • 28% eligible for WHP
  • Supports consolidation, cautions to problems with payment complications
  • Inclusions of primary care services and family planning in WHP is important

 
Andrew Home, CASA

  • Concerned about the timing of consolidation of DFPS into HHSC
  • DFPS just took a “time out” and now working on transformation plan
  • Will detract from DFPS progress, constrain resources

 
Susan Hayes, Pro Choice Texas

  • Supports recommendation 8 and the WHP
  • Postpartum access to contraception, especially LARCs, is really important
  • Expensive upfront but cheaper in the long run
  • Need effective contraception for teens, remove parental consent

 
Gavin Gadbury, Texas Health Care Association

  • Utilization review contract requirement for MCOs, but also under OIG purview – wants clarification and to stay with MCOs
  • Need to look at the single portal and insure it won’t alter DADS procedures that work well now

 
Josette Saxton, Texans Care for Children

  • Need to break down silos for children BH services
  • Texas System of Care Consortium is a great benefit for the state
  • Need to focus on consumer needs
  • Need consolidated early childhood intervention programs

 
Dr. Paul Dunn

  • General dentist, 90% Medicaid
  • Discussed the payment hold OIG put him on for pre-approved procedures from TMHP
  • Cannot pay the upfront cost to have a SOAH hearing
  • Supports payment holds only for serious investigations of fraud

 
Dr. Vizary

  • Dentist, placed on payment hold
  • SOAH hearing 13 months after payment hold
  • Judges found no allegations of fraud but HHSC ignored SOAH ruling

 
Dr. Chad Evans, Dentist

  • Placed on a payment hold 1.5 years ago
  • Had to lay off 100 employees
  • OIG offered a deal to delay SOAH hearing and cut his fine in half
  • Hearings postponed for no reason
  • OIG too loose in applying payment holds

 
Jason Ray, Lawyer

  • Represents Medicaid providers improperly charged with fraud
  • Wait for SOAH hearings too long
  • OIG doesn’t actually want to try any of these cases, but apply long payment holds
  • Raymond – HHSC not accepting SOAH judgment is something that needs to be addresses either by Sunset or the legislature – it doesn’t make sense

 
Craig Martins, pharmacist

  • OIG ordered a performance audit and no fraud was found though through extrapolation declared overpayments
    • No methodology for extrapolation
    • Was given 30 days to pay or establish a payment plan, no other due process

 
Maureen Milligan, THOT

  • Supports quality recommendations
  • Supports data analytics recommendations
  • Room for improvement on ACs but they are critical for public input
  • Critical to have sufficient expert staffing at HHSC

 
Nancy Lewis, Texas Physical Therapy Association

  • Challenges navigating the MCO structure and Medicaid enrollment that causes gaps in care
  • MCOs have an arbitrary number of providers in service areas
    • Should be any willing provider
  • Every payor has a different authorization process, difficult to navigate

 
David Witty, ADAPT

  • Supports the consolidation of admin functions, pour the savings back into services and supports
  • Equal pay for attendants
  • Need more quality indicators and data across the enterprise

 
Scott McCowen

  • Represents children in CPS cases
  • Consolidating DFPS will lose resources and expertise
  • Need to maintain leadership under Judge Specia

 
Danny Saenz, ADAPT

  • Care needs to be based on functional assessments, not labels
  • Attendants need higher wages and pay equality

 
Jennifer Riggs, Attorney

  • Represents pharmacies with problems with payment holds from the OIG just to coerce settlements with OIG
  • Supports recommendations regarding the OIG