The committee met to receive updates from Sunset staff and HHSC Executive Commissioner Chris Traylor.
Co-chair Sen. Jane Nelson
- Last year Sunset found serious pervasive problems that are hindering HHSC’s ability to deliver services in the best way possible
- Sunset recommended consolidation and reorganization of the agencies’ functions to help Texans navigate the system more effectively and for the HHSC to better carry out their services
- Primary focus needs to be making sure the agency is structured for success
Co-chair Rep. Four Price
- Looking forward to working with the committee to ensure the reorganization is carried out effectively
Sarah Kirkle, Sunset Advisory Commission
- Managed HHSC Sunset review
- Reorganization bill eliminated 11 entities within the Health and Human Services Enterprise and removed 40 advisory committees
- The consolidation is being carried out over a two year period which will allow for an additional legislative session before completion of the consolidation in case any of the statute needs to be amended
- Three main problems fueled the reorganization
- Blurred accountability – allows for plausible deniability
- Five agencies not acting as one cohesive system
- Fragmented responsibilities – potentially paying for duplicative or unnecessary services
- Purpose of the consolidation is to improve services to clients as well as to address the problems mentioned
- Nelson noted that SB 200 consolidates all client services at HHSC
- Correct, in September 2016
- HHSC commissioner must submit an organizational plan to the legislature including timelines, divisional structure for each group of functions, etc.; this is due March 1
- This committee is charged with overseeing the entire reorganization as well as the transfer of vocational services to the Texas Workforce Commission
- The committee is responsible for submitting a report to the legislature as well
- The committee will be meeting quarterly until 2017 then less frequently until 2023
- For each session, the committee must report to the legislature and the executive on the progress being made
- Must also make a recommendation in 2018 on whether DSHS and DFPS should remain independent agencies or be folded into the consolidated agency
- Nelson noted administrative consolidation was required in HB 2292 in 2003; that never happened; why is that and how do we prevent that from happening again
- Administrative consolidation is the hardest part to actually accomplish
- Nelson asked what advice can be given to ensure this doesn’t happen again
- The goal of the bill is to help clients navigate the system efficiently and effectively; people with co-occurring conditions can find it more difficult than others to navigate the system; the focus on that issue and similar issues is most important
- Sen. Charles Schwertner noted the consolidation of administrative functions at the executive level is the key to the entire reorganization; after that happens the rest of the solutions will flow down from there
- Rep. Richard Raymond noted there may be problems with consolidation because there are requirements attached to federal dollars
- Have not run into those types of problems at this point but flexibility was built into the statute for those situations
- Raymond noted if there are problems in the future the committee should be informed because they may be able to put pressure on CMS to allow for more flexibility
- Price noted preventing service interruption should be a key focus; want to ensure nobody falls through the cracks
- Schwertner asked if Sunset looked for outside expertise regarding company mergers, etc.
- During HB 2292 the state did use an outside consulting firm; the new recommendation contemplated that it may be helpful to do that this time as well; should rely on HHSC to expand on where they may be able to use that outside expertise
- Nelson noted 80% of services are delivered through managed care; how did the structure of the agency contribute to problems with contracting
- Contracting was the crux of pushing for consolidation; the blurred accountability comes into play with the contracting issue
- Not having full lists of contracts at HHSC is a prime example of the problem
- Raymond noted a lot of the contracts are federally funded; need to keep that in mind as well
Chris Traylor, Executive Commissioner, HHSC
- Transformation activities are guided to create a system that is easier for people to navigate
- Many HHSC clients come to the agency in crisis; want to ensure the system is easier to navigate for a person in a crisis situation
- Want to align the mission and business to be good stewards of taxpayer dollars
- Want to create clear lines of accountability within the organization
- The transformation should be conducted in a way that doesn’t diminish the programs already providing services
- Keeping the legislature and the public informed at every step in the process is a key goal of the agency
- Absolutely keeping in mind that there is a possibility of jeopardizing federal funding; working to ensure this is prevented when programs are moved and changed
- Schwertner noted the legislature has put a lot of faith in the agency and the executive commissioner to ensure the transformation is successful; how will the executive leadership be combined so the transformation is successful and goals are accomplished
- At its core, it must be a transformation of how services are provided to the citizens of Texas; if nothing else is done other than prioritizing the clients it will be a successful transformation; this starts at the top with organizational leadership and responsibility must flow from the top down
- Schwertner asked if Traylor envisions significant changes to the organizational structure such as additional offices and departments
- Have found that the further away an administrative function is moved from the end user, the worse services will get; the challenge will be consolidating administrative functions while keeping the focus at the local level
- Schwertner asked if outside expertise is being sought out
- Yes; currently putting together a procurement for those services
- Schwertner asked what type of plan should be expected on March 1
- Still making some overarching decisions; will try to give a pretty granular level of detail in the report
- There are 9 administrative functions outlined in statute; will be trying to keep a good balance at each agency/division to ensure commissioners have the proper level of support while also ensuring there is consolidation of the administrative structure overall
- Mr. John Colyandro asked what it will look like for the end user to get a “no wrong door” approach
- Want to ensure if a person comes to the agency for mental health services that they are filtered into other services they are eligible for without necessarily having them go out and seek those services separately; it also occurs when people are receiving services; properly providing long-term care services will reduce the need for acute emergency room stays, for example
- Colyandro asked if there will be additional measurable outcomes and if they will be outlined in the report on March 1
- Yes there will be; not sure if they will be detailed out in the March 1 report
- Mr. Billy Hamilton asked about staff being kept in the loop
- Agency values are constantly being voiced to staff; there are also various staff meetings to keep them abreast of the changes that will be taking place and the reason for those changes
- Nelson asked if there are expected to be cost savings in this transformation
- Potentially
- Sen. Brian Birdwell noted that while we focus on keeping federal streams flowing, it is also important to ensure the state maintains self-determination
The next meeting will be March 31.