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The HHS Transition Legislative Oversight Committee met on August 26 to hear an update from the Health and Human Services Commission and the Department of Family and Protective Services regarding agency operations and the progress of system transformation.

This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. It is not a verbatim transcript of the hearing, but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

Opening Comments

  • Nelson – Welcomes new members, provides a history of the committee; Sunset review found lack of accountability, turf battles between agencies, etc., SB 200 tried to consolidate programs within divisions of HHSC with DSHS as an independent agency focusing on public health
  • Nelson – SB 200 passed with broad support, but understanding was that this committee would provide strong oversight
  • Nelson – Major moves of transformation are complete, continuing to work to make it easier for clients to access services, eliminate blurred lines of authority, eliminate barriers, and improve efficiency
  • Nelson – HHSC will be providing a general update on transformation, must also ensure strong collaboration between DFPS and HHSC with retirement of Hank Whitman; DFPS will be called up for an update at the end of the hearing, will be asking questions during

 

Health and Human Services Commission

Courtney Phillips, Executive Commissioner HHSC

  • Walking through contracting, services and supports, business plan, etc.
  • Presents current agency organization chart
  • Some retention issues exist at facilities still, dollars appropriated helped but there is a ways to go
  • Nelson – Both this committee and Senate Finance have discussed staff vacancies at length, concerned about the number of high-profile vacancies; what steps are being taken to recruit and retain qualified staff?
    • Phillips – Looking at how we recruit and proactively reaching out to professional orgs, universities, etc.; not competitive on salary rates at higher level and causes issues with retention
    • Looking at reasons some are leaving external agencies and coming back to HHSC, have heard reasons like not wanting to travel due to in-state families
    • Have gotten more involved with Internal Audits area/vacancies
  • HHSC put in a request this past legislative for contracts, did not get full appropriation so looked at areas where funding would be most effective; each purchaser is managing complex procurements far above industry standard, difficult for employees to handle and also mentor new employees, new FTEs will lighten workload and creating training program focusing strictly on training
  • Nelson – When can we start to see improvements?
    • Phillips – Have improved, down to 15% vacancies; not where we want to be but have made great strides
  • Price – Looking at number of vacancies in Financial Services which affects rate setting, are the vacancies causing a problem in this area? 115 seems like a high number to me, curious why this number is so high as a percentage
    • Have opportunities to improve and workload is high, trying to get people in there to recruit and retain over time; working on this area to alleviate current strain
  • Price – What is the biggest barrier?
    • Salaries compared to private market
  • Raymond – All this seems like something is wrong, large number of vacant positions in a variety of areas; how do we expect HHSC to perform with these large numbers of vacancies? FTEs are approved for needed positions; perhaps need to shave FTEs and up salaries for the remaining personnel
  • Nelson – Have you thought about doing things differently?
    • Taking an intentional effort with recruitment and retention
  • Raymond – Is the biggest thing salaries?
    • In some areas, have reduced legal FTEs and raised salaries in some areas
  • Raymond – FTEs provided are the number that we determined we need, very important area & concerned when I see the big holes
  • Nelson – I’m particularly concerned about our leadership positions open, CIO of IT is departing, Women’s Health is running at 50% vacancy, etc.; what are you doing with the key leadership positions?
    • Making sure we have the right people in the right positions to move the agency toward our goals
  • Phillips notes that Financial Services has been moved to COO to be nearer to procurement etc.
  • In FY18, HHSC focused on corrective actions for procurements, establishing foundation for complex procurements, developing Compliance and Quality Control Division, Ernst & Young partnership resulted in improvement plan
  • In FY19, HHSC focused on systemic improvements, including procurement planner and tracker, developing performance metrics to target fixes, spot auditing procurements for key issues, started working on procurement plan
  • Price – Mentioned this at our last hearing, I think there is a still a culture issue where vendors and the agency can’t communicate due to fears about what communication is allowed, have you heard of this and are you taking steps to allow for flow of appropriate info between the agency and vendors?
    • I have not heard it, have a vendor policy we put into place
    • Typically we do a check with procurements when we get a vendor request, make it known that we can engage in conversations, but cannot discuss in-flight procurements
  • Nelson – Is there something in legislation that needs to happen to make things clearer?
  • Hinojosa – We always had issues with contracting and procurement, HHSC has engaged an external entity for review?
    • Yes, contracted with Ernst & Young which resulted in contract improvement plan
    • HHSC developed 15 projects from the Ernst & Young plan
  • Raymond – Do we have specific examples of vendors trying to do business and the agency is being unreasonable?
  • Price – They have in the past and have addressed it with HHSC, but unsure if it changed the attitude or culture of the agency; trying to ensure we don’t have an ongoing problem
  • Raymond – We’ve set up a Catch 22; have gone after HHSC hard for things they’ve done on contacting and staff don’t want to cross lines; make sure the staff knows where the line is
  • Nelson – If this line is not clear, let us know if legislative action is needed
  • Phillips presents on continued opportunities on contracting, vacancies, etc.
    • Improving vacancy rates
    • Clearly delineating lines of authority and responsibility
    • Further defining the process for developing evaluation criteria
      • Phillips notes HHSC has ove4rcomplicated this and it need further work
    • Comprehensively reviewing the Request for Applications (RFA) process and establishing a dedicated grants team with expertise with RFA solicitations
      • Need to differentiate from RFPs to account for innate differences in RFAs
    • Further revising and streamlining procurement procedures for all types of competitive solicitations
    • Implementing a comprehensive training plan for PCS and program Staff
    • Enhancing CAPPS Financials
      • CAPPS 2.0 to be rolled out mid-October to address legislative changes and compliance changes
    • Increasing and improving communication between PCS and customer organizations (HHSC, DSHS, DFPS)
    • Improving quality assurance through procurement processes
  • Dr. Wayne Carson – Thrilled to see info about improving communication with consumers, can you talk about how this communication is designed to happen and does happen?
    • As we move forward in this process, looking to share with vendors about upcoming procurements and timelines
  • Regulatory Services Division
    • Complaint Intake: Expanded scope of long-term care (LTC) call center to also field complaints for acute health care facilities (hospitals, etc.)
    • Operational Support: Stood up new unit to centralize administrative functions (budget, HR etc.) for all five programs, enhancing consistency, efficiency
    • Licensing: Launched online portal for LTC providers with plans to roll out to other license types
    • Transformation: Ongoing work with Office of Transformation and Innovation to identify and apply best practices for functions such as enforcement
  • Price – Spoke this morning about provider cashflow issues re: wait times, HHSC has made some determinations on progress and timelines for working on the wait times
    • Will send info with the timeline & info on changes being made to streamline the process; focusing on solutions for current process, though these are not necessarily permanent practices
  • Will be working on movement of some advisory boards to the Behavioral Health Executive Council (Social Workers, Licensed Professional Counselors, Marriage and Family Therapists)
  • Birdwell – Came out of Sunset this session
  • Hinojosa – Have heard concerns regarding licensing during the transition, one board apparently lost their employees
    • Transferring 40 FTEs to handle some issues
  • Nelson – Are these 40 FTEs filled positions?
    • Might be some that are vacant, but can get you specifics
  • Health and Specialty Care System (HSCS) Improvement Efforts
    • Rebranded the State Operated Facilities division as HSCS
    • Established a business management department to unify business processes and oversight between state supported living centers and state hospitals
      • Increased revenue collection out of unification of business practices
    • Made policy, structure, and system changes to ensure efficiency, improve services
    • Invested significantly in deferred maintenance
  • Have a ways to go on retention for HSCS and deferred maintenance, appreciates the resources put in by the legislature during the session
  • Legislation passed allowed for HHSC to make determinations about competency restoration and place individuals in lower level of care when appropriate to free up beds
  • Looking at how to provide consulting services to jails to assist in psychiatric services
  • Looking at IDD/behavioral health and transition from state facilities to the community
  • Rose – Ask for information from HHSC regarding how many patients are waiting on forensic beds in the Dallas County jail
  • Hinojosa – SSLCs have always been a challenge for us, had a shortage of professional staff leading to transfers
    • Doing additional training for staff members to prevent transfers to state hospitals in two areas currently
  • Presents timeline on state hospital construction
  • Birdwell – We have the major hub hospitals, is there any thought in the future to have more and smaller 20-30 bed facilities rather than large hubs?
    • HHSC has been looking at purchasing beds in the community
  • Nelson – We partially funded the Austin and San Antonio hospitals last session, what is the agency plan to contain costs on the construction until we meet next session?
    • Working with project managers to determine where we are, currently have the same anticipated need to finish the construction on these hospitals; $124.1m for Austin & $152.4m for San Antonio
  • Nelson – So this basically is what we are looking at needing minimum next session to finish Austin and San Antonio
  • Hinojosa – What is the status of the 1115 waiver negotiation currently?
    • Next deliverable is due in October, this is the timeline
    • Working with stakeholders on ideas for DSRIP
    • Hoping to have ongoing conversation with CMS instead of receiving just a denial
  • HHSC working on several agency areas and looking forward to sharing with the legislature over the next few weeks, including
    • Recruiting and retention
    • Beginning work with disabilities and siloed segments across the system
    • Outcomes HHSC wants to see in managed care
    • Will not include all agency concerns, but just a beginning
  • HHSC Annual Business Plan
    • Provides tangible insight into HHS efforts to continuously improve services and be better stewards of tax dollars
    • Outlines key priorities and initiatives that will guide the work of HHS in FY 20 and sets measurable, reportable goals
    • Highlights collaboration with stakeholders, legislative partners, and HHS team members
    • Examples of plan initiatives include improving health outcomes for women and children, accountability and quality in Medicaid managed care, procurement and contracting processes and outcomes, and the behavioral health continuum of care
  • Nelson – Helpful for us for you to identify what outcomes you’re looking for and how to measure these
  • Price – Can you give us a brief status update on the managed care audit?
    • Putting a lot on attention to the audit findings, will be working towards this; have 6 work groups stemming from conversations with Rep. Raymond that will lead to conversations with stakeholders
  • Price – Asks for internal process details
    • Perform risk assessment, have the ability to ask auditors to look into specific areas
  • Frank – You mentioned recruitment and retention, will always have vacancies, but some particular areas have larger numbers of vacancies; if you identify issues are you able to lower the total number of positions and increase salaries, would you need legislative help?
    • Don’t know offhand, but we do have a range for certain positions; when competitive salaries are above this range is when HHSC runs into issues
    • Data presented includes reductions implemented during the 86th Session

 

Department of Family and Protective Services

Trevor Woodruff, Acting Commissioner DFPS

  • Provides an overview of DFPS’s establishment as an independent agency stemming from HB 5, including contracting with HHSC for admin services, independent agency operations
  • Nelson – Budget directed DFPS to consider how to modernize foster rate methodology and build foster capacity and incentivize foster care; concerned whether either HHSC of DFPS has the bandwidth to make this happen, what is the DFPS plan for implementation of third party contracting?
    • Woodruff – From DFPS’s perspective the rider directing this speaks mostly to HHSC as they have the rate setting expertise, DFPS will support them in any way to ensure we get the right rate
  • Nelson – So you’re saying it’s their decision?
    • DFPS will participate, but final say is with HHSC
    • Phillips, HHSC – A final decision hasn’t been made, would hope that we can work together
  • Rose – Could you give us an update on DFPS turnover?
    • At about 4% vacancy rate agency wide, beginning to see this stabilize due to the salary increases granted by 85th and 86th Legislature

 

Closing Comments

  • Nelson – We all share the same goals, transformation is a massive undertaking and will continue to work together

 

Committee to meet next subject to call of the Chair