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The House Committees on Human Services and Public Health met in a joint hearing on November 1 to hear invited testimony from state health care agencies, city and county health departments, UTMB, and several health care advocacy groups and associations. The report below details these discussions.

Opening Comments

  • Rep. Wu – Many affected are going without paychecks & resources are stressed; Lives were “at the edge” before the storm and only got worse due to Harvey
  • Chair Raymond – Looking for flexibility from Congress with programs like SNAP

 

Charles Smith, Executive Commissioner HHSC

  • HHSC evacuated Corpus Christi SSLC to San Antonio SSLC, issued directives for facilities to comply with evacuation orders, deployed behavioral health specialists, temporarily closed HHSC leased offices
  • Additional leave was granted for affected employees and additional infrastructure was deployed for call response
  • Initial response included several waivers for SNAP
  • Rep. Collier – Regarding SNAP, you issued replacement benefits, was this additional money you had not issued or was this planned?
    • Smith – This was new money, worked with USDA To accelerate payments and also reissue some benefits that had already been expended
  • Collier – Read that people will need to reapply in their home county even when displaced?
    • This is D-SNAP, additional assistance for those affected by the storm only; Mostly intended for those who are not SNAP recipients
    • Clarified for recipients that reapplying in the home county was not needed
    • The only people turned away were those not eligible under Federal guidelines
  • SNAP households receiving benefits during August and September were issued supplemental benefits to bring them up to maximum allowable benefits for that period
  • DSNAP was implemented for many families returning to affected counties, OIG officers were on site to respond to concerns
  • Rep. Guerra – FEMA paid 75% of costs for this DSNAP program?
    • DSNAP is USDA-run and is 100% Federally funded; FEMA pays 75% of assistance grants
  • HHSC also administered FEMA grants and initial assistance payments for those whose property was affected by the hurricane; Eligibility and amounts are determined by FEMA, HHSC only works to administer the payments and is required to have a 25% match
  • Chair Price – Is there a cap on this?
    • No, based only on how much FEMA decides to pay out
  • HHSC was in constant contact with providers during the emergency, received temporary authority to suspend some of the standard regulations for nursing facilities, etc.
  • Price – Was there in any breakdown or delay in communication due to the organization of the SOC?
    • I didn’t see any breakdown, HHSC staff and DFPS staff are at the SOC and checked in everyday
    • Each nursing facility is required to have it’s own evacuation plan, most have contracts with private firms to help evacuate; HHSC staff would check in with facilities to ensure they were aware of weather and were following their own plans
    • SOC resources were deployed where there were gaps in facility plans, no issues were reported with how this worked
  • Administered behavioral health assistance grants, expecting roughly $12 million
  • Rep. Coleman – Regarding nursing facility evacuation, efforts during Rita saw many deaths during and due to evacuation; Hardening locations and avoiding evacuation could be more beneficial during certain types of storms
    • Ability to stage evacuation depends on the storm, in this instance the storm developed rapidly and a staged evacuation is difficult
  • Raymond – Intends to introduce a bill to add one more alert to Texas alert system, “Disaster Alert” could be added to rapidly spread info and encourage appropriate county decision on evacuation
  • Coleman – If evacuations are needed should be done with limited distance, can also build hardened infrastructure within reasonable distances for those in fragile condition
  • HHSC is also participating in the Governor’s Harvey Task Force on School Mental Health to help assess needs
  • Also implemented Medcaid/CHIP practices to help out of state workers access appropriate benefits; Similarly implemented WIC practices to help recipients access services
  • HHSC has also been actively communicating with members and issuing web updates
  • Coleman – Processed out of state benefits during Katrina as well, pre-planning this type of thing is helpful; Big disappointment is that it took far too long to put D-SNAP into place
  • Rep. Minjarez – Many that have relocated to San Antonio have experienced hurdles in getting new benefits, those who have lost or left EBT cards could not access benefits
    • HHSC did replace many cards, can definitely go back to better understand problems
  • Minjarez – Also had issues where money never came
  • Guerra – What type of coordination and communication is there for working with private individuals like Gallery Furniture or Wal-Mart who were sheltering individuals? List would be good
    • HHSC reaches out to those with an existing relationship, especially for things like WIC
  • Rep. Howard – Have heard of issues with reimbursement and unequal billing for disaster areas, providers could possibly be unable to bill for services for displaced individuals; What are you doing to ensure we know where displaced children are and that they are receiving services/those services can be billed for?
    • Received a waiver from CMS for displaced individuals to receive service outside of MCO catchment and that reimbursement was available for providers; Have not heard of specific complaints for people unable to receive services
    • For providers not receiving payments because clients have been displaced, this gets into provider arrangements with MCOs, but traditionally under Medicaid no payments are being made until services are being rendered
    • Can pull together claims data to provide insight into this issue
  • Howard – Would this be impacted by the glitch with the payment vendor not uploading data
    • This would be encounter data, important to remember that there is a data reporting delay
  • Rep. Burkett – Regarding HHSC working with private entities, would caution that we do not give the impression private entities cannot help without checking with the state
  • HHSC is expecting a $1.3 billion HHS impact in All Funds, majority in federal funds; $300 million AF/ $75 million GR in Other Needs Assistance through FEMA ($75 million GR), $70 million All Funds/~$$20 million GR for Medicaid and CHIP copay waivers
  • Coleman – Receiving a lot of calls and complaints regarding Medically Dependent Children Program, changes are causing eligibility issues
    • Can get details, MDCP was carved into STAR Kids in 2016 & HHSC worked with A&M to develop assessment tool to better fit children
  • Coleman – Wants to ensure Texans get the services they need and that changes do not kick people off of program when they are receiving needed services
    • There are also people entering program who would have been turned away under previous assessment
  • Raymond – Those previously on this program might be receiving care under a different program or through different methods, very unlikely that children are not receiving services at all

 

John Hellerstedt, Commissioner DSHS

  • Raymond highlights areas of interest found in Hellerstedt’s presentation; 1) Could see legislation to collectively authorize waivers instead of asking Governor individually, 2) LBB likely has authority to shift funds during a disaster, could see legislation to clarify
  • Hellerstedt – Texas did an incredible job responding to Harvey – no big failures, but there are some things that could be done to better future response
  • Would be good to have a tool or website to give access to state and federal actors to see large detail on individual facilities
  • Pre-planning things like waivers would be very helpful, there are many predictable factors in an emergency
  • Phased response for evacuations would be good in terms of getting medically fragile individuals out of an area
  • Surge capacity in general could be improved, though Texas’ systems are busy and moving people/staff all the time
  • A list of private organizations that want to help would be great, notes that it is difficult to integrate private actors into response plans after response has started
  • Anti-mosquito/Zyka response was successful and efficient
  • Collier – Concerned about gaps in services, are there things you noticed that would be better under DSHS purview?
    • Coordination was excellent and no major part of the response failed, transition was well planned out and things work fairly seamlessly
  • Rep. Oliverson – Was there any data gathering on how mosquito spraying might have affected pollinator species?
    • No data on pollinator species, but worked in coordination with people who raised bees and action was needed
  • Cortez – Where were the C-130s for spraying coming from?
    • Was a national response, ended up with 3 aircraft to do this

 

Hank Whitman, Commissioner DFPS

  • CPS reached out to all foster homes and kinship caregivers in June to ensure emergency procedures were up-to-date, all providers are required to have plans and respond to evacuation orders
  • Rep. Rose – Are these individual procedures?
    • Each home is required to keep and follow an emergency procedure
  • Cell communication was essential to keeping in touch with families and children, tower failure would have been an issue if it occurred
  • Caseworkers were deployed to shelters to provide interface for vulnerable children, very effective
  • Collier – How many RTCs are in Texas? Is there one in Fort Worth?
    • Can get this information to you
  • Collier – So children were placed in state, none were placed out of state?
    • Correct, none were placed out of the state due to the storm
  • All children are accounted for and safe, all RTCs and GROs are safe, all have returned to originating RTCs and GROs with the exception of those rebuilding due to damage
  • Roughly 100 DFPS staff were permanently displaced by Harvey
  • Emergency Coordinator position is coming back to DFPS from HHSC, will ensure that facilities have unified emergency procedures and follow plans

 

Giuseppi Colasurdo, President UT Health Science Center Houston

  • About $5 million in damage to Center during Harvey, about $7 million in business interruption
  • Primary rain and secondary injury from water release impacted vulnerable populations, especially during the night when staff and services are unavailable
  • Research and IT infrastructure is high up and safe, so Center was able to focus on community outreach
  • Oliverson – Do you have any concern with demolition efforts by volunteers contracting respiratory illnesses?
    • Clearly there environmental risks, there are many ways you can educate the community on how to do the demolition and how to rebuild safely
    • Problems arise with vulnerable populations trying to assist, could need in-patient care & typically see a few patients of this type after disasters
  • Oliverson – Heard that some residents or medical volunteers were turned away
    • There were too many volunteers this time, overflow can impede efforts to help
  • Price – Would be open to any suggestions that could improve response or preparation

 

Ben Raimer, Senior Vice President, Health Policy & Legislative Affairs UTMB Galveston

  • Emergency response plan meant that UTMB did not need to close operations centers and other facilities sent patients to UTMB; Shows effect of Legislature’s investment in recovery of UTMB after Ike, etc.
  • Definitely damaged during Harvey, but deductible is higher than damages incurred this time; Also due to recovery efforts after Ike
  • Worked with local entities and set up temporary clinics to help treat and prescribe
  • No significant health impacts have been noticed from clean up efforts
  • Suggests documenting all action and keeping FEMA documentation simple, persistence pays off in encouraging FEMA to provide assistance and mitigation
  • Mitigation pays for itself, building facilities back to be more resistant to disasters helps greatly
  • Oliverson – Are we doing enough to prepare for these events, could anything be done better in the curriculum to better respond?
    • Colasurdo – Programs are very competitive, emergency preparedness could be bolstered, but there are many things that need to be worked on in higher education

 

Stephen Williams, Director Houston Health Department

  • Large numbers of responders recovered people from the water and delivered people to service centers and shelters
  • Needed to send public works vehicles to staff homes to bring people to staff service centers and shelters
  • Worked extensively with private partners and HHS agencies to help provide SNAP/WIC assistance and ensure that care facilities, vaccinations, prescriptions, etc. were available; Would like to clarify role of LMHA better
  • Rose – How would you like to clarify role of LMHAs better?
    • Many people in shelters needed mental health services, likely a problem of capacity; Solution could be to integrate mental health teams and ensure someone is able to write prescriptions
  • Wu – What is the city doing to help with transportation issues; Many have lost vehicles or are displaced from typical transport routes
    • City has been attempting to coordinate services provided by governmental agencies and nonprofits
  • Wu – Have heard from many that they are waiting on government resources
    • Other groups are trying to help, coordination is the appropriate role for the city; Houston does not have the resources to fix this on its own

 

Derrick Neal, Director Victoria & DeWitt County Public Health Departments

  • Storm exacerbated housing problems within the counties, need to look at building codes and possibly update for disaster prone areas
  • Case management assistance would also be helpful
  • Collier – So a large part of your staff are single mothers? Is this a point of concern?
    • Not a point of concern, but it means that some staff will need to evacuate due to small children potentially
  • Oliverson – Asks for details on any respiratory disease rates, etc.
    • Did not have significant problems, medically vulnerable individuals were sent to areas that can accommodate
    • Williams – We did have to put people into isolation in Houston
  • Oliverson and Neal discuss rescue efforts of non-emergency personnel, many County personnel needed to perform tasks outside their mandate
  • Rep. Arevalo – Some of the individuals in San Antonio shelters did not have access to basic supplies for childcare, etc.
    • Displacement can complicate availability of resources and supplies
    • WIC enrollment experienced drops in affected areas, but spiked in other regions of the state

 

Isabel Menendez, Texas Medical Association

  • Government response from state agencies and legislators was excellent, has spurred FEMA action
  • Need to find ways to assist people in coming back to work in addition to basic assistance
  • Closure of businesses has likely driven employees becoming uninsured, will drive UC pool
  • Should consider legislation to allocate resources to help local communities rebuild; Should also encourage federal government to provide insurance assistance
  • Decentralization and inefficient communication hindered flow of information to frontline physicians
  • Response of Texas Medical Reserve Corps was not well-deployed in rural communities, should educate communities about it and encourage volunteers
  • Should also consider physician liability in volunteer situations

 

Jamie Dudensing, Texas Association of Health Plans

  • Medcaid program was exceptionally prepared for the disaster, much more so than previous disasters
  • Disaster plans are part of this, providers have them and those in STAR Kids have individualized plans
  • Medicaid plans are paying for CHIP copays to providers
  • Running free hotlines for a variety of public health areas
  • Service Coordinators helped to provide services for high needs patients, very efficient during Harvey
  • Current disaster plan does not acknowledge role of Plans, should be more integrated in emergency response
  • Plans need places for consumers to go, regular shelters will not work for patients with high needs & specialized technology shelters with nurses and physicians should be available
  • Raymond – What would you like done for expediting care claims?
    • Working with DSHS to address, searching for right role of managed care in disaster process
  • Price – Would it be better for you to be involved in the operational portion?
    • Our issues were mostly in communication and involvement, need to assess
  • Rep. Klick – Asks after personal disaster plans and if they helped
    • They were effective during Harvey, but still looking into it
  • Klick – What about wheelchairs, etc. that are lost
    • Largest cost is in replacing DME, will need to follow-up on lessons learned
  • Other costs were in transport evacuation and CHIP copays
  • Would like waivers of requirements to be accounted for in future audits
  • Cautions that there will be a long cost trend as a result

 

Kevin Warren, Texas Health Care Association

  • Saw issues with staff not knowing where they should be
  • Had decent lines of communication with state agencies and entities
  • Social media was used very well to issue updates and ask questions
  • Receiving facilities were very supportive
  • Significant challenges included access to dialysis machines and other specialized equipment, storm water blocked access and kept units away from need
  • Need to consider management of sheltering in place versus evacuation and facility status
  • Should look to giving priority to getting transportation running for critical patients, continuing waivers, expanding communication for local OEMs and local authorities for supply, expanding ability for responders from other states to help
  • Klick – What types of items did you have supply issues for?
    • Diapers, etc., mostly in moving material into affected areas

 

John Hawkins, Texas Hospital Association

  • Response was very effective, would like to be part of discussion for improvements
  • THA was very proactive in assisting members
  • Agrees that there were supply and service delays due to lack of communication lines with law enforcement, need to keep this in mind when planning for the future
  • Does not make sense that investor-owned or for-profit facilities cannot access Stafford Act funds
  • Was extremely difficult to get information statewide about the status of facilities
  • Dialysis equipment continues to be a major issue, moving services is challenging during a storm and without backup power

 

Closing Comments

  • Raymond – Hopefully taking things from this that can be worked on next session, encourages people to keep working with agencies and private sector in the interim
  • Coleman – Speaker gave County Affairs pretty robust charge to work on many of these same issues, County Affairs is looking forward to working closely with others