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Below is the HillCo client report form the June 16 House Appropriations Subcommittee on Article II hearing.

The committee met to consider the following interim charge:
 
Monitor the administration of new state funding to expand behavioral health services in Texas. Make recommendations to improve coordination and prevent duplication of effort, including the behavioral health projects funded through the Medicaid 1115 waiver. Evaluate the methodology utilized by the state to fund the public mental health system in order to assess improvements in how mental health funds and associated performance targets are allocated throughout the state. Develop funding recommendations that emphasize equity in funding and performance expectations, improving outcomes, the attainment of performance targets, population needs, availability of local resources, and geographic diversity.
 
Christy Havel, Legislative Budget Board

  • For FY14 & 15, $3.3 billion was appropriated for mental health services
  • DSHS has over 95% of the Article II funds for mental health
  • Rep. Dawnna Dukes and Chairman John Zerwas both noted the significant investment represented by that appropriation

 
Sonja Gaines, Associate Commissioner for Mental Health Coordination, HHSC

  • The funding appropriated last session has been critical in implementing some of the new programs related to behavioral health
  • Locally driven collaboratives and initiatives are yielding the best results around the state
  • Health Community Collaboratives and YES waiver expansion were both created through new funding
  • Dukes asked about youth programs; African American youth are more likely to be sentenced when they should have been sent to some type of behavioral health program; asked about the Code Red initiative and Building Healthy Families
    • Not familiar with those programs yet; not trying to duplicate ongoing efforts so will try to get up to speed soon
  • Dukes asked about how the agency will pull in the recommendations handed down from the Building Healthy Families program
    • Need to work with other agencies such as TEA to figure out how to reach the children
  • Dukes noted the legislature may need to be more direct in working with school districts and TEA in getting information to HHSC agencies to increase coordination between the agencies
    • Kyle Janek, HHSC Commissioner noted that DFPS could be working a little better on preventative care
  • There needs to be a more cohesive effort to form a plan at the HHSC level as opposed to each agency having their own plan
  • Dukes brought up an issue she has heard about regarding the Impact system; money was appropriated to make those systems work better and work across agencies; the expected date for this to be completed is years away and that is too long; also heard that case files are not being completed all the way and information is missing that makes it more difficult to coordinate services
    • Janek noted that a lot of work has been piled on case workers; some of the work needs to be pulled back that does not necessarily affect their jobs; this will help them focus on the most important work
  • Access to mental health services in rural communities continues to be a problem
  • Need to assess the current state of behavioral healthcare in Texas; determine effectiveness and the need for innovation and redesign
  • Need to analyze current funding structures to eliminate barriers and potentially access additional available funds
  • Community collaboration is the best way to leverage dollars and see system improvements
  • Zerwas asked about veterans’ care
    • Janek replied that veterans are a hard population to serve because they do not ask for help very often; Gov. Perry also has asked that the agency develop a pilot project for a new treatment he had heard about in Irving; the creation of the Meadows Institute will be a significant aid in treatment of veterans

 
Lauren Lacefield Lewis, Assistant Commissioner for Mental Health and Substance Abuse

  • Almost 500,000 adults in Texas or 2.6% of the adult population are believed to have a severe or persistent mental illness
  • Over 9% of adults have an issue with chemical dependency; only 3% of those adults receive services for that dependency
  • Dukes asked about the impact of over medicating youth
    • It is a problem but there hasn’t been any new data recently
  • Lewis discussed substance abuse services provided through DSHS
  • The number of state funded psychiatric inpatient beds has decreased by about 30% over the last 10 years
  • Rep. Four Price asked about any new programs that may be coming up that will decrease the need for more beds
    • Outpatient competency restoration pilots have been successful so far
  • Discussed performance based incentives; ten percent of funding is held back to be given as an incentive; just over $17 million was released to LMHAs for performance based incentives

 
Sonja Gaines returned to discuss SB 58

  • The bill required HHSC to integrate behavioral health services through the state’s existing managed care infrastructure
  • A lot of work has been done over the last several months to educate MCOs and providers; ready to go live with the rollout very soon
  • An advisory committee will be providing formal recommendations by September
  • DSHS is directed to creating community collaboratives for persons who are homeless, contracts are anticipated for July 1;
  • Dukes asked if the homelessness initiative will help address veteran populations; what percentage of homeless in Texas are veterans
    • Not sure about that data
  • Dukes noted that in a program which rewards good outcomes it is important to focus on the good of the child and not just trying to get them out the door so they can be adopted
  • Zerwas asked about post-partum Medicaid coverage
    • Janek believes mothers are covered for 30 days post-partum
  • Dukes noted much more than that is needed to properly screen for post-partum depression; may be something to address through a waiver request

 
Lauren Lacefield Lewis returned to discuss new funding for mental health treatment

  • Last session DSHS received an additional $48.2 million to address the waiting list for community based services; the number has dropped from around 5,000 to around 700
  • DSHS was appropriated $43 million to go toward underserved children; almost 1,500 people were recognized as having the wrong level of services and were directed toward the appropriate services
  • Rep. Donna Howard asked about there being an adequate number of providers in the system
    • There have been challenges in recruiting new physicians to come into the program but the problem is getting better incrementally
  • DSHS received $4 million to increase capacity and reach of the current veterans’ mental health program; 11 new coordinators and 4 field clinicians have been brought on
  • Dukes asked if the wage for mental health workers is at a level that will help decrease turnover
    • There is work to be done in that regard, as well as looking at safety within the hospitals and hospital management

 
Lisa Kirsch, Deputy Medicaid Director for the 1115 Transformation Waiver, HHSC

  • Have two large pools of funds through the waiver
    • Uncompensated care pool – $17.6 billion over five years
    • DSRIP pool – $11.4 billion over five years
  • Trying to improve care for individuals, improve health for the population and lower care costs
  • Across the 20 regions, 300 performing providers submitted projects; Texas allocated 10% of initial DSRIP funds to community mental health centers
  • As of January DSRIP participants had earned over $2 billion for their participation in projects
  • There are around 1,500 active DSRIP projects in total
  • Rep. Four Price asked if all funds are now spoken for
    • Yes, there could be extra funding if some projects do not earn their full amount but all money is assumed to be spoken for
  • For years 2 and 3, projects are related to startup activities and infrastructure
  • Of 390 active behavioral health projects, 290 are performed by community health centers; around $937 million in all funds can be drawn down for the 390 projects
  • Behavioral health projects include increased staffing, partnering with law enforcement communities, primary care clinic expansion
  • The Meadows Foundation is performing an analysis on all of the behavioral health projects within DSRIP; preliminary analysis shows 146 projects target children and youth, more detailed analysis will be published in the July-August time period
  • DSRIP has been a great tool for leveraging state and local funds to draw down additional federal funds for behavioral health services
  • The waiver expires Sept. 30, 2016; will be working closely with stakeholders to develop the request for the waiver extension; there is lots of work to do in that regard; there is a very straightforward 3 year extension option that will simply continue the current program; renewing the waiver would be up to five years and allow CMS or HHSC to request changes be made in the program

 
Public Testimony
 
Scott Strang, COO, MHMRA of Harris County

  • Used last session’s additional funding to completely do away with the waiting list
  • Have 19 first round DSRIP projects that were approved and 7 additional projects in the 3 year round
  • Many mental health clients do not have access to primary care; attempting to help solve this problem through DSRIP projects

 
Sherry Blythe, Austin Travis County Integral Care

  • Have 11 projects in the county
  • Mobile crisis outreach team is one of the projects and has been successful in helping with emergency department and jail diversion

 
Christina Minter, Parkland Hospital

  • Parkland is the anchor entity for Region 9
  • Goals include improving access to care, improving coordination, improving outcomes
  • Behavioral health needs in RHP 9 include
    • Decreasing financial impact
    • Increasing available services
    • Integration of primary care and behavioral healthcare
  • Growth and enrollment in NorthSTAR has far exceeded the funding

 
Ron Stretcher, Criminal justice Director, Dallas County

  • Dallas County operates a DSRIP project focused on frequent behavioral health service users coming through the criminal justice system
  • Have served over 2,000 people through care coordination events
  • NorthSTAR needs more funding very badly

 
Stacy Wilson, Texas Hospital Association

  • Association members are experiencing a severe lack in crisis beds
  • The problem is more dire in rural areas

 
Katharine Ligon, Center for Public Policy Priorities

  • The state is moving in the right direction in allocation of funding
  • At least the same level of funding needs to be maintained for the next biennium