The Senate Committee on Health & Human Services has published their Interim Report to the 84th Legislature. See below for interim charges assigned to the committee and recommendations related to those charges:
Interim Charge I – Child Protective Services – Review the Department of Family and Protective Services’ efforts to reduce child fatalities. Review the process by which the Department of Family and Protective Services collects and uses data to evaluate agency performance and improve outcomes for children in the Child Protective Services system. Make recommendations to ensure the process effectively uses data to strategically improve caseworker performance, and identify and improve upon deficiencies within the system and improve overall outcomes for children and reduce child fatalities.
The Committee concluded that they fully supported and endorsed the recommendations adopted by the Sunset Advisory Commission at their August 13 decision meeting, which aimed to improve child safety and caseworker retention, and strengthen the overall management structure of the agency.
Noted in the Interim Report to the 84th, on August 13, 2014, the Sunset Advisory Commission adopted all of Sunset’s recommendations, in addition to several member modifications that will:
- Statutorily require CPS to develop an annual business plan that will be reported to the Legislature;
- Require DFPS to implement appropriate changes identified in the Stephen Group Operational Review with an immediate focus on changes related to retaining caseworkers, process changes that will improve the computerized casework system and facilitate structured decision making, and streamlining policy to refocus team members on spending time with children and families;
- Require DFPS to report CPS performance measures to the Sunset Advisory Commission every six months, including staff turnover rates and recidivism into the CPS system;
- Direct CPS to expand its connection to the faith-based community, beyond adoption and permanency, to fill gaps in contracted services; and
- Elevate the Prevention and Early Intervention programs within CPS to a separate division that reports directly to the Commissioner.
Interim Charge II – Mental Health and Substance Abuse – Monitor the implementation of programs that were created or expanded by the 83rd Legislature to improve mental health and substance abuse services and assess these efforts' contribution to improved outcomes such as reduced recidivism in state hospitals, diversion from emergency rooms and county jails, and access to permanent supportive housing. Identify and address gaps in the current mental health and substance abuse system and make recommendations to better coordinate services across agencies and programs.
Recommendations:
Structural reform
- Mental health and substance abuse programs should be elevated from their current status as a division within the Department of State Health Services to a more highly visible position within the Health and Human Services Enterprise that will ensure adequate leadership and accountability
Early Intervention and Identification
- Expand Mental Health First Aid to include additional school personnel
Mental Health Workforce
- Create a loan repayment program for mental health professionals
- Promote the use of Certified Peer Specialists
Diversion from Higher Cost Settings
- Ensure crisis stabilization services are available in all areas of the state to avoid more costly and restrictive treatment settings such as Emergency Rooms and county jails
- Carefully evaluate the Harris County Jail Diversion Pilot Program to determine if expansion is warranted
Collaboration
- Encourage jails to allow Mobile Crisis Outreach Teams into their facilities
- Create a centralized online source of information about behavioral health prevention, treatment, and recovery for patients, families, providers and advocates
Integration
- Encourage integration of substance abuse and mental health services by providing grants for the co-location of providers
Interim Charge III – Women’s Health – Build on previous legislative achievements in women's healthcare by examining women's access to preventative health care, pregnancy services, and post-partum care, and exploring ways to expand access and improve quality, particularly in rural and underserved areas of the state. Monitor the implementation of women's health programs in Texas. Assess these programs' impact on outcomes such as improving access to preventative services, reducing unplanned pregnancies, and achieving cost savings. Recommend ways to better coordinate the various programs in a manner that increases the number of women served, ensures adequate provider capacity statewide, and maximizes efficiencies to the state.
Recommendations:
- Consolidate women's health programs at one state agency
- Reduce gaps in family planning coverage
- Add-on payment for LARCs
Interim Charge IV – Alternatives to the Affordable Care Act – Identify cost-effective alternatives to Medicaid and the Affordable Care Act to better connect low income individuals to health care services through private market-based solutions, including Medicaid block grants and waivers. Recommendations should strive to encourage cost sharing, promote personal responsibility, reduce uncompensated care costs, contain increasing health care costs, improve access to care, address access to emergency department care issues in rural areas, promote the use of existing private coverage or employee sponsored coverage, reduce non-emergency use of emergency departments, and reduce the need for federal approval to the state Medicaid plan.
Recommendations:
- Texas should encourage congressional action to operate Medicaid as a block grant program and should simultaneously continue to pursue a waiver from the Centers for Medicare and Medicaid Services (CMS) to allow the state increased flexibility in the operation of our Medicaid program
- Support successful programs and entities that have local buy-in and include local funding sources
Interim Charge V – Temporary Assistance for Needy Families – Evaluate the Temporary Assistance for Needy Families (TANF) program structure. Make recommendations to improve the program's operations and ensure the program achieves outcomes that allow TANF recipients to find employment and achieve self-sufficiency. Recommendations should seek to ensure Texas is using the most effective work-related requirements and drug testing protocols.
Recommendations:
- Require Drug Screening for adult TANF applicants
- Remove exemption from work requirements for adults in child-only cases who have been disqualified from TANF for non-compliance or reaching lifetime benefit limits
- Require the Personal Responsibility Agreement (PRA) signed by adults in child only cases, where applicable, to include a requirement to fulfill work requirements and to attend parenting classes, if referred
Interim Charge VI – Prescription Drug Abuse – Evaluate the current state of prescription drug abuse and strategies for reducing prescription drug abuse in Texas. Make recommendations on how these policies can be improved or modified to enhance the State of Texas' handling of services, treatments and education related to prescription drug abuse and to reduce the overall prevalence of prescription drug abuse.
Recommendations:
- Transfer the PAT system and associated appropriations from DPS to the Texas State Board of Pharmacy (TSBP)
- Give TSBP authority to join the national Prescription Monitoring Program (PMP) InterConnect
- Enhance usability of the PAT system by enabling the TSBP to make the following changes:
- Create push notifications to notify current PAT users when certain criteria for a patient is met that may indicate doctor shopping, such as obtaining and filling prescriptions from multiple providers;
- Allow data to be integrated into electronic health records; and
- Automatically notify pharmacies via PAT if a physician's prescriptive identity has been compromised.
- Automatically register providers in PAT upon receipt or renewal of their Controlled Substance Registration permit to encourage use
- Align the Controlled Substance Registration permit for advanced practice registered nurses and physicians' assistants with license renewal, similar to the aligning of these requirements for physicians in House Bill 1803, 83rd Regular Session
- Enhance services, education, and outreach to communities and providers in order to reduce the prevalence of and treat the symptoms of NAS
Interim Charge VII – Implementation of 83rd Legislation – Monitor the implementation of legislation addressed by the Senate Committee on Health and Human Services, 83rd Legislature, Regular Session, and make recommendations for any legislation needed to improve, enhance, and/or complete implementation, including but not limited to:
- Monitor implementation of initiatives aimed at improving the quality and efficiency of Medicaid long-term care services and supports, including the redesign of services for individuals with intellectual and developmental disabilities
- Monitor implementation of initiatives aimed at reducing fraud, waste, and abuse in Texas Medicaid and other health and human services programs
- Dental Board Reforms: Monitor implementation of initiatives aimed at improving the State Board of Dental Examiners' ability to protect public safety, including strengthening the Board's authority and enforcement powers, improving the complaint review and resolution processes, and increasing staffing to improve the Board's ability to respond to complaints and potential fraudulent activity. Determine whether there are additional changes necessary to ensure that the Board is able to regulate the practice of dentistry and ensure public safety
- Cancer Prevention and Research Institute: Monitor implementation of initiatives aimed at restructuring the governance structure, eliminating conflicts of interest, and increasing transparency at the Cancer Prevention and Research Institute of Texas (CPRIT)
Recommendations:
Senate Bill 7
- HHSC should carefully and continuously monitor the adequacy of the acute care provider network for the IDD population in STAR+PLUS and focus on developing that network in all areas of the state
- HHSC should continue and enhance communications with consumers, families, providers, and advocates impacted by the expansion of managed care for the IDD population to proactively identify and address issues
Senate Bill 8
- HHSC should continue to carefully monitor the performance of MTOs contracting with the agency to provide services in MTP to ensure clients receive timely access to transportation and to ensure transportation providers are appropriately staffed during peak hours of demand for services
- Continue to improve the regulation of the EMS industry to reduce the incidence of fraud, waste and abuse.
- Enact whistleblower protections for EMS personnel who report violations to the state oversight agencies;
- Require prior written approval from a governmental authority in the area in which an EMS provider plans to operate prior to expansion of an existing EMS provider's service area; and
- Direct DSHS to determine the potential benefits of regulating non-medical stretcher and wheelchair transportation in Texas as a means to reduce fraud and contain costs.
Dental Board Reform (HB 3201) – The Texas State Board of Dental Examiners should:
- Clarify its existing statutory authority to regulate the activities of non-dentists which impact the practice of dentistry, and identify potential statutory changes necessary to effectively prohibit undue influence on dental practices;
- Continue to improve transparency in their rule-making process; and
- Continue to utilize the increased Full-Time Equivalent employees (FTEs) appropriated by the 83rd Legislature to further reduce the average time that cases are open and the number of unresolved complaints.
Cancer Prevention and Research Institute of Texas (SB 149) – CPRIT should:
- Continue to operate the agency and the Oversight Committee in a transparent way and allow for ongoing public input; and
- Begin developing a plan to transition the Institute to a fully self-sufficient entity by their Sunset date of 2021, as envisioned when the agency was created.
