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The committee met to take up new and pending business. This report focuses only on the bills listed below.

HB 2304 – Price, Relating to the continuation and functions of the Health and Human Services Commission and the provision of health and human services in this state.

  • Committee substitute laid out
  • Consolidates administrative functions
  • Realigns other parts of the system along functional lines
  • Establishes a transition legislative oversight committee
  • Makes improvements in the Medicaid program for public/stakeholder input
  • Streamlines websites and hotlines
  • Removes outdated and unnecessary advisory committees
  • House committee substitute reflects the Senate engrossed version
    • Maintains DSHS and DFPS as independent agencies but streamlines DSHS purview
  • Goal is to make it easier for public to navigate what is now a broken system
  • Susan King asked about the fiscal note
    • Sarah Kirkle, Sunset, replied that there is still so much flexibility with how the transition will occur LBB was unable to estimate the fiscal note; HHSC estimates about $20 million in programmatic consolidation savings
    • Rep. Four Price noted the cost savings is not the driving factor of the consolidation it is the improvements to the system; although, cost savings can be anticipated down the road but not immediately
    • Kyle Janek, HHSC Exec. Commissioner agreed that this is about programmatic efficiencies and cost savings will be realized over time through attrition
  • King asked how they determined which agencies would be consolidated and which would stay independent
    • Mostly had to do with the responsibilities of the agencies
  • King asked how the Ombudsman will be used
    • Assume the Ombudsman will be used for all agencies
  • Naishtat asked how disruption of services will be minimized
    • The bill takes that concern into consideration; was specifically addressed by Governor’s Task Force report; slowing the consolidation down to address those concerns
  • Naishtat asked about contracting; how does the bill address that
    • Many of those concerns are being addressed with independent legislation; administrative services division would handle contracting for the agencies, that is addressed in this bill
    • Kirkle noted changes in the OIG bill will address some of those issues as well
  • Rose asked about NorthSTAR; concerned about waiting lists with new system
    • Janek replied that the integration of physical and behavioral health will provide immense benefits
    • Kirkle noted the primary recommendation is related to Medicaid clients; the state does not provide widespread coverage for indigent populations

 
Madelyn McClure, TexProtects

  • On the bill
  • Worried about the amendment from the Senate floor moving Nurse Family Partnership and other programs from DFPS into DFPS
  • DFPS does not deal in preventing child abuse
  • Home visiting programs better align with HHSC functions

 
Sherry Cuzamano, NAMI Dallas

  • Oppose
  • Concerned about the NorthSTAR provisions
  • Would like the necessary time to work on this
  • Want to participate in the redesign of the program

 
Roger Butler, Green Oaks Hospital

  • Oppose
  • Concerned about interruption of services

 
Alison Collazo, Self

  • Oppose
  • Works for Nurse Family Partnership
  • Concerned about moving that program into DFPS

 
Dusty Cornelius, Self

  • Oppose
  • Would like time for people who are building upon the strengths of the NorthSTAR program to finish their effort

 
Sam Strickland, Self

  • Oppose
  • Would like more time for stakeholders to discuss NorthSTAR issues and to rework the system already in place

 
Tom Collins, Green Oaks Hospital

  • Oppose
  • Discussed some of the programs in NorthSTAR that are working well
  • This bill will disenfranchise the indigent populations
  • Patients will end up in medical emergency rooms because they wont qualify for care in the new system
  • Cannot work out issues under the system being proposed

 
Susan McDowell, Lifeworks

  • Support
  • Leaving prevention and intervention services need to stay under DFPS, as it is in the committee substitute

 
John Dorheim, Self

  • Oppose
  • Open access and immediate service as is given in the NorthSTAR system is crucial to keepign people in North Texas healthy
  • Stakeholders want and need the system to continue
  • Would like until 2017 to present a plan that will continue the strengths of the system

 
Constance Smith, Self

  • Oppose
  • Need to restore current lost language regarding NorthSTAR and allow the existing counties to build a new integrated care model

 
Harrison Heiner, TSEU

  • Oppose
  • Concerned about eliminating advisory boards
  • Concerned that cost savings will be due to a reduction of an already understaffed workforce
  • Supports consolidation of the agencies’ administrative functions

 
Richard Singleton, Starry (Round Rock Nonprofit)

  • Support
  • It is vital that prevention and intervention services stay at DFPS

 
Paul Hunt, American Council of the Blind of Texas

  • Neutral
  • Want all services for the blind to be maintained and want all services transferred to a single agency
  • Suggest there be a DARS division within the consolidated agency
  • It is insulting for the blind to receive their services through a health agency
  • Complemented current DARS commissioner
  • Naishtat asked if the witness is suggesting that DARS needs to be transferred in full into HHSC along with its two subdivisions
    • Yes

 
Sheryl Hunt, American Council of the Blind of Texas

  • Neutral
  • Need to maintain DARS inside of HHSC as a separate division within the agency

 
Janie Metsinger, Mental Health America of Greater Dallas

  • Oppose
  • Mostly opposed to the dissolution of NorthSTAR
  • Discussion of the outpatient competency program
  • Price asked if it would be impossible for that to continue under the new proposal
    • The unbraiding of the funding is the main issue; people lose their Medicaid when they go to jail and come out as indigent
  • Price asked how other jail based competency programs are funded around the state
    • Not sure
  • Price would like to know if they would have to change as well if the structure changes

 
Deborah Moore, NAMI

  • Oppose
  • Worried about NorthSTAR going away
  • Need to know what will happen next when there is no more NorthSTAR as we know it

 
John Bracken, Montgomery County Youth Services

  • Support
  • Keeping prevention and early intervention services at DFPS is a good thing
  • Very easy for children to end up in the juvenile justice system without these programs
  • Having to get used to a new system would take focus away from providing essential services

 
Witness

  • Neutral
  • Concerned about the shifting of independent living programs

 
Marina Hench, Texas Association for Homecare and  Hospice

  • Support
  • Appreciate changes in committee substitute
  • Negotiated rulemaking should be considered for the consolidated agency

 
Dennis Borrel, Coalition for Texans with Disabilities

  • Would like for DARS to remain unconsolidated

 
Amy ­­­_____, Texas Centers for Independent Living

  • Agrees with Borrel
  • Recommend at least one public member of the transition oversight committee be involved with disability populations
  • Would like to make arrangements so that it would be possible for consumers to attend and take part in advisory committee meetings; difficult to do from a long distance

 
Ann Dunkelberg, CPPP

  • Concerned about the transition of the regulatory function
  • Overall, this is a large undertaking being done very rapidly; needs to be slowed down
  • Concerned about the HHSC Council having the capacity to undertake all of the issues they will be asked to

 
Bea Morehead, Texas Impact

  • Neutral
  • Texas Nonprofit Council and Interagency Coordinating Group have been reinstated into the bill and that was much needed

 
John Davidson, TPPF

  • Support
  • Concerned about extending the timeline too far being a hindrance to the bill accomplishing its goals
  • Concerned if the timeline is extended too far the consolidation will end up not happening

 
Louis Appel, Texas Medical Association, et al

  • Perinatal Advisory Council is a critical piece to promulgating HB 15 (83R) need to maintain it
  • Happy with the requirements for the composition of the Drug Utilization Review Board
  • Bill should strengthen stakeholder input piece

 
Jill Switzer, Mental Health America of Texas

  • Neutral
  • Opposed to the consolidation of prevention services in DFPS

 
Christine Gendron, Texas Network of Youth Services

  • Support
  • Support prevention and intervention services staying at DFPS

 
Rose noted there is no reason to dismantle a system that is working well in the community. NorthSTAR stakeholders continually praise the work product of the program.
 
Bill left pending
 
HB 2578 – Price, Relating to the efficiency and consolidation of powers and duties within the health and human services system.

  • Fixes two statutory barriers to consolidation of administrative functions that have been left unaddressed
  • Allows for a system-wide internal audit group
  • Requires information resource managers to report to deputy executive commissioners or the executive commissioner

 
Bill left pending
 
HB 3672 – Naishtat, Relating to expedited credentialing for certain licensed clinical social workers under the Medicaid managed care program.

  • Committee substitute laid out
  • Mental health provider shortage in Texas has increased the length of Medicaid waiting lists for mental health services
  • Legislation would establish expedited credentialing procedures for a licensed clinical social worker
  • Requires MCOs to determine an applicant’s eligibility for expedited credentialing; if eligible would be required to recognize the LCSW as a Medicaid provider

 
Karen Miller, Licensed Clinical Social Worker

  • Support
  • Would be very helpful to the health care system if these workers could be credentialed to get people help right away
  • Bill will facilitate people getting services

 
Will Francis, National Association of Social Workers

  • Support
  • Many therapists experience a long wait in the credentialing process
  • Expedited credentialing will make huge strides in reducing waiting lists

 
Bill left pending
 
HB 1093 – Guillen, Relating to transparency in the STAR Medicaid managed care rate-setting process.

  • Requires HHSC to clearly describe and demonstrate the methodology by which STAR payment rates are set
  • HHSC analysts have significant discretion in rate-setting
  • Rates vary by MCO and by region
  • Will be a committee substitute to include all Medicaid programs
  • Naishtat asked if a very similar bill has already been voted out
    • Yes, but not the same

 
Bill left pending