The House Committee on Appropriations S/C on Art. II met on March 1 to hear invited testimony from HHSC and the OIG on budget recommendations. The committee also heard from a number of advocacy organizations, providers, and other stakeholders.
This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions 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.
Health and Human Services Commission
Julie Lindsey, LBB
- Link to presentation
- $84.1 billion in AF, $2.1 billion decrease, 2.4%
- Decrease of 332 FTEs
- Federal funds decrease due to less favorable FMAP assumption & loss of COVID funding
- Decreases incl. AF decrease for Medicaid & CHIP, 5% reduction, expiry of one0time construction funds
- $310 million in AF for Medicaid behavioral intervention
- $352.6 million for women’s health program, Healthy Texas Women saw an increase of $8.1 million AF, but $63.8 million in GR due to approval of 1115 waiver
- Mental health funding: $795.7 million AF for adult, $187.9 million AF for children, $145 for community grants, $23.6 million GR for waitlist reduction for substance abuse
- $1.4 billion AF for SSLCs, $896 million AF for state mental health hospitals
- No funding for construction of Austin or San Antonio, nor operations for Harris County state hospitals
- No funding related to foster care lawsuit, incl. in exceptional item 2
- Rider changes mostly streamlining or strengthening reporting, 14 added riders shifted from other HHS agencies
- 99 removed riders primarily due to one-time reporting or action
- Final requested amounts reflecting actual FMAP, etc. will be included in working docs
- Howard – Do COVID funds fully reflect funding?
- May not include all, but mostly would affect DSHS; COVID numbers likely not final for FY 2022
- Howard – Regarding 6.2% increased FMAP; looking at this for a limited period of time, Biden admin said this would continue through the calendar year, previously have included unsure federal funding with contingency that GR would be used if it did not occur
- Increased FMAP were only included through 2021 due to info at the time, can work on changing this with the S/C
- A little different situation, must maintain enrollees so there is a point where you stop having extra GR from the increased FMAP due to caseload costs
- Howard – Asks about pulling multiple 1115 Medicaid programs under one 1115 waiver
- Possibly can set this up, but would defer to agency
- Howard – Agency numbers don’t seem to align with LBB, family planning is down but Healthy Texas Women is up?
- LBB makes changes in base amounts assumed sometimes, possible for recommendations in 22-23 to be the same, but base amounts differ
- Howard and Lindsey discuss lack of shortfall, increased FMAP meant extra funding which meant lack of need for supplemental to cover Medicaid shortfall
- Howard – 5% cuts seem to primarily be for enrollment and eligibility?
- For 22-23 it is primarily related to admin and eligibility determination
- Howard – If I wanted to see the different programs that could be placed in one waiver and GR totals, do I ask you or the agency?
- Howard – Asking about Medicaid for pregnant women, breast cancer, Healthy Texas Women non-family planning, county indigent health care, correctional managed health care, community mental health services for adults and children, substance abuse programs, HIV medication assistance, kidney health care, disability-related Medicaid services, and HHS admin costs for overseeing IGT and LPPFs for UC waiver
- Howard – IF we lump them all together, could get better match
- Can provide this to you
- Howard – Do we have a COVID breakdown for homecare costs?
- Can get that that to you
- Howard – Is there an add-on payment available for COVID?
- HHS may be able to answer, can follow up
- Julie Johnson – What is the estimated enhanced funding is we annualize FMAP assumption; how much are we not factoring in?
- Estimated 3.2 billion in GR freed up over last biennium
- Likely $500 million more left, then freed up GR would likely be needed to cover increased caseload due to prohibition on disenrolling
- Would continue to see freed up GR at DFPS due to lack of this req
- Ann Johnson – Can you calculate how much more GR would be added with an additional 5%?
- Federal monitoring does track filed legislation, when finalized we can provide data
Cecile Young, HHSC
- Link to presentation
- Provides an overview of agency operations, structure, and COVID response actions
Trey Wood, HHSC
- Highlights financials on COVID response on slide 10, agency overview on slide 11
- First time in over a decade the state will not have a Medicaid shortfall or need supplemental funding, due to enhanced FMAP
- Key budget drivers incl. expected decrease of Medicaid caseloads after FMAP enhancement expires, CHIP caseloads expected to increase; cost per client is expected to increase 7% over each year of 22-23, total growth of .1%/year
- Medicaid cost growth in TX has averaged significantly lower than states
- Exceptional items total $31.4 million AF
- HB 1 is 345.7 million less than agency LAR, asking for restoration of $6.1 million
- HHS tried to minimize exceptional item requests this session, focused on essential client services & preventing agency operations from breaking
- Highlights EI 11 to fund construction and beds at state hospitals, and EI 15 on CAPPS updates
- Dean – Regarding HB 2536 directing HHSC to develop a website related to wholesale Rx costs; may be an update for later, but want info on this
- Can get something to you
- Capriglione – Effect of COVID will linger, budgeting for HHS very important
- Howard – No COVID fiscal impact to state? Slide 10
- Amounts freed up due to COVID aid, has been used to offset supplemental need
- Howard – We were anticipating ~$2 billion last session for supplemental, largely due to lack of need to fund Medicaid shortfall
- Anticipate we’ll reach a tipping point around November where monthly costs of retaining enrollees exceeds benefit of receiving enhanced FMAP
- Number of other states in similar situation, FMAP changes will change the outlook
- Howard – And FMAP based on wealth per capita?
- Yes, but also how we do in comparison to other states
- Howard – Texas was below the national average previously
- Howard – Looking at Medicaid eligibility, if we want to include programs at 138% of federal poverty level, need to look at current programs to compare
- Howard – For adults with children, what’s eligibility? I have $3,668 annually
- I believe that’s correct
- Howard – Adults without children can’t participate
- Generally believe that’s correct
- Howard – If we’re talking about Medicaid expansion or coverage for these people, this is that gap where you don’t qualify for subsidies, but you don’t make the required amount
- Howard – Do we just have to seek a waiver through CMS to modify eligibility
- Believe this is a state plan amendment to existing 1115 waiver
- Howard – Is there anything in that list of agencies I gave LBB that could not be included in the 1115 waiver?
- Young, HHSC – Would need to look at it, would need to decide all, part, etc. funding; may be people you still want to serve in these populations that would not be eligible
- Howard – Also wants GR so we can start looking at what we could get with a better match
- Howard – When does that 1115 waiver that we received expire?
- Wood, HHSC – I believe it’s a 5 year waiver, so 2025
- Howard – State requested that it be allowed to restrict providers associated with abortions?
- Young – Yes
- Howard – Given recent Biden admin actions, is HHS putting together a plan in case Biden admin requires TX to remove this?
- Not putting together a plan, would have to see what Biden admin does
- Howard – Because of the signal given, we need to anticipate
- Howard – Alternatives to Abortion has contingent funding of $20 million based on higher demand?
- Wood – Rider for this funding, thinks it was another mechanism
- Howard – How can there be increased demand if there is UB?
- Based on older report, they may have expected to get dollars sooner and as it didn’t happen, dollars may have shifted to 2021
- Howard – In Healthy Texas Women, provides have to show what funding is used for; did you do a similar review to find out if demand existed to justify the $20 million
- Young – Can get this to you
- Howard – Alternatives to Abortion must meet certain metrics, 20% enrolled and referred; can you get us the numbers?
- Can get this for you
- Howard – Trying to get the accountability for dollars spent, metrics will be important
- Howard – For maternal and infant health, CHIP health services initiatives, my understanding is that the state has not spent up to 10%
- Wood – Have spent under this cap consistently
- Howard – Do you know how much is remaining?
- Can get this to you
- Howard – Whatever those dollars are, we can use these for a low-income children program
- Possible, because CHIP is not an entitlement it because a GR thing if we exceed cap
- Howard – This is part of the problem we have with keeping children in Medicaid currently, can’t move them to CHIP which has a higher match
- This is an issue, starting to see services cost exceed benefit of FMAP enhancement
- Howard – On one hand we’re serving people who need it, they’re eligible
- Tricky to answer, don’t know who in Medicaid would still be eligible
- Howard – Wrote budget without concept of COVID, almost a pilot program for issues like children being continually enrolled, women with a year postpartum care, etc.; is there any data on outcomes?
- There might be some, there is a significant data lag of typically at least 8 months
- Will lapse dollars in Healthy Texas Women due to individuals staying in Medicaid
- Howard – What happens with those lapsed dollars?
- Goes back to state treasury
- Howard – Even though we know it’s an aberration? Are we anticipating increased enrollment?
- Yes; goes back to questions of how long public health emergency lasts, if it goes to 2023 we may have a shortfall in Health Texas Women
- Howard – Need to keep on top of this, this is an aberration, don’t want to see lack of services
- Howard – Regarding 5% cut and impact on enrollment and eligibility; if we don’t have staff to help people get into the system, this will have an impact on services too
- Implementing by delaying hiring, also doing contract revisions; taking a large cut to the smallest part of the agency, wanted to minimize client impact
- Howard – We weren’t approved to auto transfer eligibility from one program to another?
- Not familiar with this
- Howard – We want people to get into programs and transfer seamlessly, but can’t use tools we’re used to
- Young – This is my recollection, will get info to you
- Howard – Regarding homecare & hospice, do we have COVID costs?
- Wood – Not sure if it’s broken down by that, have some information, but data lags
- Howard – Asks after lessons learned
- Young – telehealth has worked well, regulations waived on face-to-face; looking at this
- Capriglione – Want to keep some regulations removed, but we’ve also seen additional costs; have we looked at the rules
- There are some things that will auto go away certain things we will have to undo
- Will get enhanced Medicaid match throughout the quarter, whenever that is
- Will continue to see heightened awareness of things like infection control
- Capriglione – Asks after 1115
- Don’t believe there’s anything in the 1115 significantly different than we’ve done before; wanted to ensure we maintained funding, i.e. as in DSRIP
- A Johnson – So potential additional increase of 5%, are you engaged in discussions?
- Have been monitoring
- A Johnson – Can we be sure HHSC will take whatever action necessary to secure these additional funds?
- Depends on if it’s something within our purview
- J Johnson – On revised exceptional items, slide 19, you have foster care litigation for $38 million? Why is coming out of HHSC budget instead of the AG?
- Wood – Will require additional staff in childcare monitoring and court-related fees
- J Johnson – Do we have dollar amount for mental health facility in North Texas? No dollar amount included in the exceptional item
- Mike Maples, HHSC – Construction projects are split into preplanning @~$1 million, planning @6-8% of expected total cost; for North Texas this is about $18.7 million to come back with docs
- In Dallas, we would also need to buy a parcel of land, roughly $25 million
- Roughly $44.7 million to get the planning phases done
- J Johnson – Do you have any numbers for Medicaid provider drop-off?
- Young – Can get this for you
- J Johnson – Also we like to see the last meaningful assessment of reimbursement rates
- Rose – Feds don’t like DSRIP? Can you explain?
- Not sure, may be because it is more locally driven, speculating
- Not just us, they don’t like DSRIP nationally
- Rose – Concerned as this is one of the good programs
- TX is large, DSRIP has always made sense to me
- Rose – Are the North Texas funds in the exceptional item now? Was a placeholder last week?
- I don’t believe there are
- Maples – Like we did last year, there’s just been a placeholder knowing that actual figures would be provided during the budget process
- Rose – But they’re not in number 11?
- They are in the exceptional item, only a placeholder
- Rose – Wasn’t just Dallas, also the Panhandle
- Panhandle and Terrell are also using placeholders
- Wood – Have been working with LBB to update, LBB decision docs will include
- Rose – How much has COVID increased the budget by?
- In the presentation, building a report that we can provide to the committee
- Probably between $9-$10 billion, but some of this like SNAP is not in our appropriations
- Dean – Last cycle, our HHSC was a mess; very impressed with the job you’re doing
- Dean – Do not have near enough hospital beds for mental health, should look at how much of our population needs beds; how many do we have and how many being built?
- Maples – When we’re done with the 3-biennium plan it will be close to 2,600 state hospital beds
- Dean – 2,600 beds, but we need 15k-20k; time to put this plan in place, we’ve done a pretty bad job of taking care of this population
- Current plan will add 350 beds, did a study in 2014 and found we need around 1,100 additional beds; have been making steps towards this
- Dean – Need a very comprehensive plan, 350 beds is good but we’re not getting ahead
- Becomes an issue in appropriations, have a comprehensive plan
- Dean – What number of beds are you trying to get to?
- Looked at this at the beginning of the three biennium plan, can get this to you
- Rose – Are the 350 beds included in the 2,600?
- That amount gets us to the 2,600
- Rose – How many are forensic?
- Roughly 65-70% are forensic
- Rose – So only 30% for general public?
- In state hospitals, also purchase beds in the community
- Rose – Are all current beds funded by the state?
- Would take more renovation money to make additional beds useable
- Rose – Asks for numbers for inmates waiting for placement at the Dallas County jail; hearing complaints of inmates waiting >1 year
- Howard – Now that we’re in 3rd phase for Austin state hospital, if we don’t fund this we would have to find beds elsewhere and pay a higher cost for those?
- We’ve built half of Austin and San Antonio with expectation that future funding would be available
- We haven’t demolished the old Austin hospital, continues to be funded
- For San Antonio, the expansion is on green space, so it has been operating as well
- Howard If we don’t fund these, ultimately we will need to buy beds and it would be more costly?
- Howard – Do the new money pools in the 1115 waiver allow service to uninsured individuals?
- Young – There are several possibilities, have been talking to feds about UC pool for behavioral/mental health
- Howard – These pools could have higher rates of reimbursement; could be some UC pools?
- For behavioral and public health
- Howard – Regarding feds not liking DSRIP; my understanding was that DSRIP was supposed to be transitional to explore services that could be incorporated into Medicaid, they don’t like it because they have to spend more federal money
- Not sure if they would have to spend more money; was seen as a bridge, but also about service delivery models
Office of the Inspector General
Sylvia Hernandez Kauffman, Office of the Inspector General
- Provides an overview of OIG history, mission, and operations; OIG targets fraud, waste, & abuse in HHS programs
- FY2020 recoveries were ~$550 million, despite COVID, OIG was able to maintain or exceed pre-pandemic operations
- Budget request and exceptional items total $22.7 million
- Exceptional item 1 – $1.9 million in GR, $4.8 million AF for clinical staff restoration needed due to federal match reduction; missing out on potential recoveries due to staff reduction
- Exceptional item 2 – funding to restore access to Equifax database
- No specific request for COVID funding
- Capriglione – Have any recoveries been related to COVID funding?
- Have started looking at data, increased usage doesn’t necessarily mean fraud
Marsha McLane, Texas Civil Commitment Office
- Provides over of TCCO operations; caseload growth has grown significantly, expected to reach 507 individuals civilly committed by 2023
- Highlights civil commitment process and altered COVID procedures; switched to pick ups during the pandemic to keep distancing, TDCJ collaborated very well with testing, release, etc.
- TDEM has worked very well providing tests to TCCO for staff and committed individuals
Stanley Muli, Texas Civil Commitment Office
- $39.9 million AF total
- Exceptional items: $3.1 million for caseload growth, $713k for ongoing care, $68k for career ladder for case managers, $50k private audit contracting, $215k for 2 new case managers
- A Johnson – Are you able to go back and look at offenders and see if they were victims as children?
- Majority have been
- A Johnson discusses patient statistics, including release, number, and cost
- Small portion released, costs are below other states
- Howard – Do you have any women?
- Not yet, 2 women referred that counties did not take to court
- Howard – Assume that’s because vast majorities of crimes were committed by men?
- Howard – Are you keeping receipts of COVID expenses, are you expecting these costs to be covered?
- We are, and we’re hoping to have costs covered, keeping track of our costs and vendor cost; 13k now
Adriana Kohler, Texans Care for Children
- Should make sure all eligible children are covered in Medicaid, don’t cut enrollment or eligibility capacity, maintain support for healthy Texas Women and family planning
- Budget should cover small cost for 12 month continuous coverage; passed the House last session
- Healthy Texas Women and family planning programs save money; should retain popular policy to auto-enroll into Healthy Texas Women
Katie Mitten, Texans Care for Children
- Requests restoration of funding for ECI to $155 million/FY
- ECI is an important lifeline for TX kids, worked well through telehealth over pandemic; ECI services have been cut heavily over past decade
Emily Briggs, Texas Medical Association, Texas Academy of Family Physicians
- Continued Medicaid coverage is essential for the health and safe of many Texans; direct impacts on women’s health
- COVID has had significant negative impact on state’s physician network; clinic closures, etc.
- Increasing Medicaid coverage must accompany increased physician payment
- Howard – Can address importance of comprehensive health care for women?
- Important prepartum, postpartum, and in-between times; between pregnancies there is not as much coverage, but many negative events can happen 12 months postpartum and beyond
- Want to expand access to care to be able to screen and treat patients, can avoid issues before subsequent pregnancies
- Howard – Prenatal care is very important, can’t get the services without being on the Healthy Texas Women program before pregnancies
- Accurate, one of the reasons intrapartum care is important
- Howard – Looking to extend postpartum care to 12 months which is important, but covering women of childbearing age entirely would be the most impactful
- Agree, need women to have access to affordable care during this time
Claire Bocchini, Texas Pediatric Society
- Ensure meaningful comprehensive coverage for children, establish clear funding guidelines for determining social drivers of health, & continue funding ECI
- Uninsured children see significant negative impacts in other areas of their life
- Should provide 12 months continuous coverage
Vance Ginn, Texas Public Policy Foundation
- Appreciates conservative Texas budget
- TPPF has been working to find ways to simplify safety net programs, incl. simplifying certification of SNAP, requiring audits of TANF to determine who funds are going to, independent study
Cathy Cranston, Personal Attendant Coalition of Texas
- Highlights role of personal attendants in health care, important for community living
- Attendant population is declining, poor base rate, not able to offer competitive wage or benefits
- Have not had sufficient PPE for workforce
- Do not support location tracking in the EVV protocols
- Howard and Cranston discuss stresses on personal attendants
Susan Murphree, Disability Rights Texas
- Important to focus on local efforts and rates for ECI, alarming to not see a request in the budget for this
- Exceptional item regarding waiting lists for in-home and community supports is very important
- Exceptional item 8 regarding rolling services into managed care also important
- Should be a Rider of a statewide IDD plan
Bob Kafka, ADAPT of Texas
- Provides overview of ADAPT, disability rights organizations with main focus of getting people out of nursing facilities, better wages, and accessible, affordable housing
- Have a crisis in community services, need workforce support, $15/hour is reasonable
- Congregate care is not appropriate, pandemic gives us opportunity to rethink LTSS
- STAR+PLUS waiting list needs to be looked at, along with all other HCBS programs
- Relocation specialists need to be better funded with priority of getting people out
Matthew Lovitt, NAMI Texas
- House should continue investment in critical mental health infrastructure
- State hospitals are critical, but outdated infrastructure stress services, should grant exceptional item for expansion
- Amounts provided for competency restoration are not adequate
- Should provide funding for increased rate for peer services
- Should allocate GR for safe & stable funding for those with severe mental illness
Ann Dunkelberg, Every Texan
- Should collect data on impact of FMAP, need estimates going through December
- Saw a decline in children’s Medicaid enrollment beginning in 2017, expected to continue after public health emergency; is combined with increase in uninsured Texans
- Concerned about cuts to eligibility staff during downturn, could affect SNAP & food stamps
Sandra Batton, Providers Alliance for Community Services of Texas
- Priorities include protecting HS program rates, adequately fund HHS proposal for changes to day habilitation, consider rider giving HHS flexibility to negotiate rates
- No proposed cuts in the base bill, but legislature will need to file directional rider to protect funds affected last session
Carole Smith, Private Providers Association of Texas
- Challenges for support staff have been magnified by COVID
- Despite recent measures, attendant wages are still not sufficient
- Providers continue to incur uncovered COVID expenses and losses
- Howard – Increase in attendant pay was something like 10 cents/hour, do you remember numbers?
- That was more for community based programs
Rachel Hammon, Texas Association for Homecare & Hospice
- Provides overview of TAHCH structure and operations
- COVID has had huge impact, homecare has assisted hospitals in managing care; have not seen any add-on relief, LTSS agencies have not seen a rate increase in 16 years
- Have done COVID impact surveys, COVID has increased costs by 10% or more, enhanced federal matching funds could offset costs for $162 million
Lee Johnson, Texas Council of Community Centers
- We believe 1115 waiver extension largely allows for retention of DSRIP programs
- Directed payment program is very beneficial for SMI services, public care provider pool will help those in SMI not in Medicaid
- Appreciates maintaining funding for community IDD care, supports exceptional item to add capacity for IDD programs
Ginger Mayeaux, The Arc of Texas
- Provides overview of the Arc of Texas
- Texans with IDD depend on Medicaid, waivers allow care to be given in the home
- Exceptional item 4 would fund >3k individuals, requesting this be fully funded & that legislature commit to plan for timely access to services by funding 20% of waitlist for the next 5 biennia
- Should also provide waivers for those wishing to move into community
Linda Litzinger, Texas Parent to Parent
- Supports comments made by others, highlights struggles in receiving care for people with IDD; waitlist is incredibly long, need a plan to do 10% or 20% per biennium
Steve Strakowski, Dell Medical School
- Provides overview of Dell Medical School operations and requests funding to complete hospital
- Texas has historically been at the bottom of mental health funding, facilities are in terrible shape
Hannah Mehta, Protect TX Fragile Kids
- Should improve waiting process, services actually represent significant cost savings for the state in preventing complicated care later in life
- Should look at ECI shortfall and consider continuing Money Follows the Person
- Concerned about Rider 22, trading short-term cost containment measures for long-term consequences is not an effective strategy
- Current managed care system already incentivizes blocking access to care
Amanda Fredriksen, AARP
- Requesting rider to better prepare Texas for a rapidly growing aging population, 65+ is fastest growing segment of TX population
- Could create something similar to the Behavioral Health Coordinating Council for aging; pulling agencies with funding for aging together
- One of the biggest concerns about nursing homes is staffing
Laura Guerra-Cardus, Children’s Defense Fund of Texas
- Pandemic has heightened struggles for children in TX
- Asking for agency staff by restoring funding for eligibility, 12 months of continuous Medicaid eligibility for children, and support for Medicaid expansion
George Lineal, Leading Age Texas
- Nursing homes and senior living have been disproportionately affected by pandemic
- Providers continue to face significant expenses due to COVID while revenues have fallen due to decreases in admissions
- Supplemental payments through QIPP have been a lifeline
- Need for staff is the biggest issue facing long-term care providers, should strengthen the Nursing Facility Direct Care Staff Rate Enhancement program, establish quality taskforce
Kevin Warren, Texas Healthcare Association
- Have a steady decline in occupancy rates due to COVID, local requirements have played a part
- Revenue is declining but current liabilities must be maintained and are growing
- Staffing has been the primary expense driver due to COVID, coupled with other expenses
- Should continue Medicaid add-on beyond public health emergency and into the 22-23 biennium
Donovan Dekowski, Regency Integrated Health Services
- Should consider continuing Medicaid add-on past end of public health emergency
- Should also consider a budget rider on maintaining payment rates similar to 2005
Cassie Mistretta, Senior Living Properties
- Asking that Medicaid add-on be extended beyond end of public health emergency
- Need funding and access to nursing schools to hire RNs
- Increased COVID expenses are $3 million annually
- Asks that a rider be created to maintain payments as methodology is examined
Christina Green, Children’s Advocacy Centers of Texas
- COVID has driven higher rates of mental health issues with children and leading to more in-home abuse, need to work to improve waiting times, children are being abused while waiting for basic mental health services
- Need $21.9 million for clinicians for children’s mental health services
- Howard – What percentage of children are abused in the home?
- Often someone they trust and someone in the home
- Howard – Are children waiting on the list while remaining in the home?
- Yes, many are reporting abuse starting at the onset of the pandemic
Julie Evans, Alliance for Children
- Impact of COVID on children is often overlooked, physical assault & abuse are much more common
Barbara Lundgren, Meals on Wheels Tarrant County
- Many seniors lost safety net of family & friends able to provide transport
- Programs saw challenges in delivering meals while maintain CDC guidelines
Andrew Homer, Texas CASA
- Appreciates addressing CVC funding shortfall
- Asking for increase in funding of $2.5 million annually, expecting to see an increase in children needing assistance due to COVID impact
Gloria Terry, Texas Council on Family Violence
- Have lack of capacity issues at family violence centers, continued to run during pandemic
Meera Riner, Nexion Health
- Speaking on behalf of Truman W. Smith, >120 bed high acuity long-term pediatric facility in Gladewater Texas
- Only facility of its kind in TX, treats newborns-teens for complex and chronic conditions
- Asking that reimbursement methodology take acuity and severity into account, similar to skilled nursing centers that are therapy-focused
- Would cost around $3 million GR for the biennium, $7 million total; would provide consistent means to hire trained staff and allow improvements to medical equipment
Kathryn Jacob, Safe Haven of Tarrant County
- Supports baseline $65.3 million domestic violence funding
- Requests addition of exceptional item funds for domestic violence totaling $13 million
Evelyn Delgado, Texas Women’s Healthcare Coalition
- Has taken years to stitch women’s health care back together after budget cuts of 2011
- Maternal Mortality & Morbidity Advisory Committee recommends expanding timeline of care for mothers
- Supports prioritizing funding for Family Planning Program and Breast & Cervical Cancer Services program
Kami Geoffray, Every Body Texas
- Supports priority funding for Family Planning Program, Healthy Texas Women, and Breast & Cervical Cancer Services Program
- Should revisit FPP funding in particular
Krista Stevens, Autism Speaks
- Texas should implement procedures and required funding to allow Medicaid eligible children to access treatment, including ABA
- Capriglione – Want to make sure agency keeps this available
Chris Masey, Autism Society of Texas
- Policy directives like ABA/IBA have not come to pass, disappointed to be speaking on need for this again; many other rulemaking areas have continued during the pandemic
- Should put a date certain of Sept. 1 2021
- Should rewrite rider 98 to actually address corrective action plan
- Telehealth has been wonderful, should add ABA & expand broadband access
Rany Thompson, Texas Association for Behavioral Analysis Public Policy Group
- Happy that rate hearing has been set for ABA
- HHS should listen to comments asking for increasing proposed rates
- Should direct HHS to implement ABA as soon as possible
Stacy Wilson, Children’s Hospital Association of Texas
- Up to 82% of Medicaid/CHIP enrollees are children, often with complex conditions; often can only get care in one of our hospitals, appreciates continuation of Medicaid funding
- Appreciative of work done on 1115 waiver extension
- Appreciate everything done on COVID from HHSC and DSHS
- Have seen an increased use of telemedicine in hospitals, flexible and allows parents & children to receive care when appropriate; CHAT hospitals have done a lot of training to ensure a good experience
- Asks that flexibilities continue & pay parity between in-person and telemedicine continue
John Hawkins, Texas Hospital Association
- Appreciates full funding for Medicaid client services & inclusion of Medicaid add-on payments
- Concerned about DSRIP drawn down, appreciates COVID support from HHS agencies
- Supports full funding of trauma services & SB 170 rural payments
Don McBeath, Texas Organization of Rural & Community Hospitals
- In a rural hospital crisis across the state; appropriations for rural hospital program did not match up last session by around $125 million
- Howard – What would the impact of Medicaid expansion be on rural hospitals
- Would be a positive for rural hospitals, cost of uninsured coverage is put on local taxpayers
Alex Bregman, Bregman Cares
- Need a competitive rate attached to ABA benefit
Steve Glazier, UT Health Harris County Psychiatric Center
- Provides overview of the Center and operations; asking for adequate funding to operate new Behavioral Sciences Center, full funding for bed space
Rachel Harracksingh, Texas Ambulance Association
- Speaking on COVID impact on ambulance providers, significantly increased costs due to need for PPE, decontamination, COVID protocols, etc.
- Would like legislature to consider 20% add-on for Medicaid payments
- Consider an ALS non-emergency rate
- Should consider waivers relaxing Medicaid PA on nonemergency transport, on telehealth to allow ambulance providers to bill for telehealth
Spotlight on Public Testimony
Joe Potts, Self
- Opposed to cut on expansion of community-based services, cuts funding for all slots over the next biennium; waiting list has been a continual problem
Mark Stoelje, San Antonio Clubhouse
- Clubhouses make sense for Texas, cost-effective holistic approach for people with mental illness; asking that legislature make no cuts to clubhouses this biennium
Dennis Borel, Coalition of Texans with Disabilities
- Attendant wages are the most critical issue for those in the community, workforce is collapsing
- Hep C medicine should be approved, will save money by using it earlier
- Should reinvest GR freed up by FMAP to draw down additional matching dollars
- Howard – Do you have a total of what the previous attendant wage increase meant?
- Already calculated these numbers in legislative report last year
- Howard – If we went to $9/hour it would $172 million GR increase in 2022 and $180 million Gr in 2023; that’s a challenge
- Community mental health care is the most effective and efficient care setting, if the individuals can’t stay in this program then they need to move to a facility and it is more expensive
Maureen Milligan, Teaching Hospitals of Texas
- COVID has had a severe impact on hospital performance
- Requests that legislature ensure trauma fund is fully funded, also strongly support investment in psychiatric facilities
- Should maintain Medicaid client access to community healthcare plans by eliminating Rider 22
Roberto Haddad, DHR Health
- Supports enacting provision allowing teaching hospitals to request an update to the Indirect Medicaid Education add-on once a biennium
Laurie Vanhoose, Texas Association of Health Plans
- Provides an overview of TAHP and managed care
- Report from TCCRI
- State cannot move to a contracting agency until managed care is fully adopted; should move all programs to managed care
- Extensive oversight at HHSC requiring thousands of deliverables, should develop a comprehensive real-time dashboard allowing public and HHSC to see important datapoints
- Concerned with Rider 22 and impact on stability of program
- Performance benchmarks should be based on national, tested standards focused on patient outcomes
- J Johnson – Who sets the reimbursement rates? You guys?
- Agency develops the FFS schedule and health plans negotiate those with providers
- Trying to move towards paying for quality rather than each single service delivered, providers could get incentives or higher rates for quality
- J Johnson – What network adequacy guidelines govern your networks?
- Federal and state guidelines exist, incl. time & distance, TDI also has standards
- Damages can be applied for inadequate networks
- No shortages for health plans except in areas with shortages of other types of providers as well
- 80% of physicians are in a Medicaid network
- Howard – 80% of physicians are in a network, but that doesn’t mean they take the patient though, right?
- HHSC does look at whether providers take clients, health plans do this as well
- There are standards for how quickly & closely a provider is
- Howard – I just know we’ve had issues over the years with Healthy Texas Women providers
- Women’s health is still FFS so their provider directories don’t have the same strict requirements; our networks have more scrutiny
- Since we are financially responsible for risk, if patients move to ERs it ends up costing us more, better to have care at the outset