The HHS Transition Joint Legislative Oversight Committee met on March 31 to receive an overview of the Health and Human Services Transition Plan.
Chris Traylor, Executive Commissioner, Health and human Services Commission
- The plan is organized in a way that allows each area of the agency to focus on the services they are expected to carry out
- Services will be provided in a much more streamlined and better way
- Mental health services facility operations and community operations are critical to be linked together
- Chair Four Price asked about the intent to develop a social services and medical division; looks like a lot of these services are broken out individually when they should be integrated; does that disrupt the current continuity of care
- The areas under the social services and medical division are so significant that they could each be an agency on their own; need to have a deputy commissioner for each section because of their significance
- Price noted he thinks those separations could risk some cost savings and it might be better to have those employees working together more closely; this may not follow the intent of the bill
- Chair Jane Nelson agreed and asked if there is any concern about the number of direct reports to the executive commissioner
- Somewhat; there are a few such as DFPS, DSHS, external relations and press that won’t function quite like a direct report
- Sen. Charles Schwertner asked about contracting; there seem to be divisions within that function as well
- Procurement and contracting services is there to ensure all laws are followed; the actual management of the MCO contracts is going to remain within CHIP/Medicaid services
- Nelson noted that she would like to dedicate a future hearing to the contracting aspect to see what will be taking place
- Price noted he does not see the administrative consolidation in the plan; the plan states that there will be a future plan that will address administrative consolidation
- Consolidation and reorganization is important but can only be done to the point that it is effective
- Price noted he is concerned that the plan breaks apart centralized administrative functions; it looks very similar to the way the system exists today
- Sen. Chuy Hinojosa noted the proposal seems to be off balance; curious about communication coordination
- Believe that responsibility lies with the chief executive of the agency
- Hinojosa asked about the Office of Inspector General; were they involved in the process
- Yes they were; both in the organizational structure and the operational structure
- Members raised concern over the structure of the plan as it relates to the OIG
Stuart Bowen, Inspector General
- Federal law does not require OIG to report to the head of HHSC
- Sunset did address this in detail; the single state agency rule ensures the prosecution of Medicaid fraud is separate from the operators of the program
- The way the system is currently structured complies with all federal law
- Nelson asked if the proposed plan will still comply
- Yes; the way the OIG is set up will remain the same
- Rep. Richard Raymond noted the Inspector General reports to the Governor and he believes he is committed to the job and doing things the right way; a little confused what other members think is missing
- Hinojosa noted the issue is trying to identify the responsibilities of the Inspector General
- Sen. Brian Birdwell noted the organization chart needs to reflect the function of the Inspector General and who he reports to and where he takes direction from for what functions
Traylor continued his testimony
- Price reiterated his concern that there doesn’t seem to be much consolidation represented in the plan; the bill requires an administrative division and it seems like that is being broken up in multiple places and reporting to different offices; seems like a deviation from the bill
- Traylor noted the current construction of the agencies has a COO for each; perhaps a similar function would be appropriate in the future
- Rep. Cindy Burkett noted it sounds that there is just more of a reshuffling going on as opposed to a true consolidation and reorganization
- Nelson asked if all of the heads of all of the administrative divisions would have a seat on the executive council
- Not sure they would all need to be there but some representation would be appropriate
- Elements and programs from various agencies are being brought together in this plan; there has been a consolidation of similar functions of the multiple agencies such as eligibility services, long term services, etc.
- Cost allocation is a large concern for the agency; do not want to impact the state’s ability to draw down federal funds
- Consolidation of support functions is important but if the connection to the end user is lost then the transition will not have been a success
- Price asked what details are to come in the future plan regarding administrative consolidation
- The agency will be putting together those details and will have something to present in the coming months
Judge John Specia, Commissioner, Department of Family and Protective Services
- As recommended by Sunset and directed by the Legislature the Texas Home Visitation program is being merged with prevention and early intervention (PEI) programs housed at DFPS
- The merger will be effective and completely done on May 1
- Both funding and staff are being transferred to DFPS
- Provides an opportunity to streamline and make services more efficient
- Community programs will be funded by the agency and this setup will allow for the most local control
- PEI will house the expertise that will be a resource for all community programs
- Will be working with community and philanthropic organizations to expand prevention services across the state
- Will provide a broader continuum of services and will focus on innovation and use of evidence based programs
- Nelson noted she has always been a strong believer in prevention but that is a tough sell when writing a budget without evidence
- Will be measuring outcomes through evaluations and will be reporting those outcomes
- Price noted the outcome measurement should be more than just number of people served but qualitative data
- Yes it will be
- It is incredibly important to note that innovation will be a focus and the agency will be creating a more holistic approach
- Have done an in-depth functional analysis and had stakeholder meetings all over the state to talk about the vision for the new PEI
- Hinojosa asked how the integration will be structured
- PEI will be an equal program within the agency
- Hinojosa asked about turnover
- Turnover is not as big of a problem in prevention services
Public Testimony
Susan Murphree, Disability Rights Texas
- Have been looking at how the advisory committee process is going to work; appreciate the consumer directed services advisory committee being continued as well as the children’s policy council
- The transition plan, as it currently exists, is not clear on how public input on rulemaking will happen
- Under the current structure the people who hear public testimony have expertise and are involved in development of the rules
- It is very helpful to increase oversight and hold facilities and providers accountable for the services they provide
- It is important to figure out how the continuum for SSLCs will work
Christopher Tab, Alliance of Visually Impaired Texans
- Encouraging the continuation of needs assessments in the consumers home for visually impaired and deaf/blind services
- Hoping some of the 33 new FTEs will be reserved for these services
Jerry Hall, Association of Substance Abuse Providers
- Every dollar spent on substance abuse disorders has a return of $4-10 in savings on criminal justice system and safety net programs
Amy Granbury, Charlie’s Place Recovery Center
- Want to ensure that vocational rehabilitation services are not lost as they become a small part of a much larger agency
- Have a good relationship with HHSC and DSHS and want to continue that
Cindy Zolnierek, Texas Nurses Association
- Combining state hospitals and SSLCs should be reconsidered; they are very different models
- Nurses were not involved in the committees and councils that were developing the transition plan; would like them to have more input
Marina Hench, Texas Association for Homecare and Hospice
- Community services and Medicaid/CHIP services are side by side in the plan; there are services and programs underneath both divisions and are very similar
- Hoping that these divisions will be managed in a unified way
- Since some of the agency councils are dissolving it will be important to focus on how input is received for rulemaking
- Communication between policy and rate setting needs to happen sooner and at a lower level than in the proposal
Paul Hunt, American Council of the Blind of Texas
- Impressed with the transition plan
- It appears that agencies are doing a good job of communicating and collaborating with each other
- There is nothing in the plan saying that services will be provided to older blind people in their homes; this is crucial
Amanda Frederickson, AARP
- As it relates to aging and disability services it seems like the structure is based on funding streams and not so much on coordination
- Not sure it makes sense to put quality monitoring under the Medicaid division; it should be more broad than that
Sean Whitley, Texas Society of Interpreters for the Deaf
- Would appreciate if the certification program for interpreters remains within the deaf and hard of hearing services
- It is a very specialized certificate and it just makes sense to leave it with the parent program
Sandy Frizzel, Providers Alliance of Community Services of Texas
- Would like for there to be more communication and coordination between policy making and rate setting
- Hinojosa noted that is a serious concern of the committee; rate setting can affect medical policy
Sonya Smith, Interpreter
- Keeping the interpreter certification program with the parent program and the people who understand its importance is crucial