House Human Services met on February 28 to hear invited testimony only. This report covers discussions concerning the Texas Health and Human Services Commission and the Texas Behavioral Health Executive Council.
This report is intended to give you an overview and highlight 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.
Opening Comments
- Chair Frank – Welcomes new committee members including Ramos, Campos, and Manuel
Texas Health and Human Services Commission
Cecile Young, Executive Commissioner HHSC
- Overviews operations of the agency; provides the committee with the agency’s organizational chart
- Frank – Asks to overview big changes due to the legislature
- Are responsible for clients’ services; DSHS provides more broad public health rather than direct client services
- Regulatory programs were moved to HHSC
Trey Wood, Chief Financial Officer HHSC
- GAA Appropriations 20-23 have been higher historically due to Covid-19 funds
- Frank – Have an idea what the supplemental funds total for this time is?
- $2.9b in GR and $7b in all funds
- Client services 54% of funding including ECI, Medicaid, CHIP, etc.
- SNAP benefits flow through us, but are off budget
- Frank – SNAP do not flow through GR? Other off budget funds?
- Are federal funds; 1115 waiver uncompensated health pool
- Frank – What percentage of budget goes towards medical supplemental payments?
- Majority
- Majority of FTEs are in state/supported living centers, but makes up 1.8% of budget
- 3.3% of funding is administrative
- Frank – Asks about staffing; can get trends on real people employed
- Vacancy rate is high compared to normal at 15%; are only 3.3k FTEs
- Yes, can get information back to 2017
- Frank – What happens with money allocated to you for services not used? Like in mental health response being provided by police, not you; wonder if those funds should go to locals
- Beds can go offline; if funds are lapsed and goes back to GR
- Young – Made an effort to raise salaries to get beds back online starting this year
- Medicaid is the largest program service in the state; total spend has increased significantly due to Covid-19 and not being able to disenroll anyone from the program
- Increased number of clients has brought down per member per month average cost
- Frank – Is that due to more health people in the population?
- Yes
- 5.9m subscribed to Medicaid; 53% increase in caseload; highest ever been at one time
- Will begin unwinding/unenrolling due to federal legislation; have never attempted anything of this magnitude before and will take a majority of our resources
- Will have 14 months to finish that project
- Ramos – Will an individual’s coverage be terminated before they are allowed to renew?
- Stay covered before redetermination; if they do not respond to communications, will be disenrolled
- Ramos – 2m that could drop off?
- Estimated 2m will come off the rolls because they are not eligible; pool will be slightly over 4m
- Ramos – Need to think about how we can effectively communicate this to people; how many will be children?
- Will provide your offices with resources; cannot give numbers on that
- Frank – Were already doing redeterminations before this? Have the staff to do it?
- Have to do full redetermination every year
- Have an EI related to this project including hiring temporary staff and increased contractor costs like the one that handles 211 system
- Manuel – Any buffer for repayments?
- Would be no recoupment they would owe back to the state; will have an end date of coverage
- Shaheen – You need to be working on streamlining online processes in preparation for this as well as organizing legislative liaison
- Have been working on IT changes
- Overall 49% healthcare increase with Medicaid saw a 14% cost increase in the same time
- Frank – Would like to see stratified by type of client; contend that cost is low as many in that pool are healthy; if that is true, those costs are being transferred to those who have insurance
- Ramos – What are the requirements to qualify for Medicaid
- Stephanie Stephens, HHSC – Income eligibility different by group/family size; 100% of the federal poverty level is about 25k annually for a family of three; HHSC uses a slightly higher level than federal poverty level so more qualify
- Ramos – Wondering if that 14% of growth is due to additional resources for individuals at the federal level that make them ineligible
- 14% is cost growth
- Largest population in Medicaid is children 69% of total caseload and 30% of spend while the opposite is true for our aging population
Jordan Dixon, Chief Policy and Regulatory Officer HHSC
- The regulatory services transferred to HHSC are childcare, acute care, long-term care
- Have been focused on streamlining and consistency for providers/consumers
- Created operations support division to house administrative functions; has a centralized complaint and intake department
- In the cases of complaints of abuse in childcare, goes over to DFPS; hope to streamline this process
- Highlights the centralization of enforcement and determinations
- Budget is $160.5m for regulatory including GR and federal funds; 2.5k FTEs; 145k licensed professionals and 65k regulated operations
- Are third largest division in HHSC
- Frank – Asks about regulated operations
- Regulated operations include 25 different provider types
- Have one major system for long-term care in TULIP and have been integrating provider systems and have a child care licensing system
- Have four federal systems required to enter information into
- Ramos – What is the ratio of caseloads?
- Varies; can get that to you by department
- Take in licensee applications and if there is a complaint, they go on a registry
- Ramos – Most of this is response
- Depends on provider; acute care is complaint-based; there is also another layer of oversight for hospitals with accrediting
- Manuel – Asks about complaints; would be able to add temporary employees? 2.5k FTEs seems like a low number
- Are different levels of priority – which are in statute
- Have a backlog in long-term care; could move FTEs around in the agency, are focused on bringing salaries up to stop turnover issues
- Have 219 vacancies; training for long-term care is 3-9 months
- Spend $4m in turnover in long term care over the last few years; and costs a lot of time/resources to train
- Manuel – How much do you need to have competitive salaries? Base pay now for positions you cannot fill?
- EI 2 asking to bring salaries up to market rate for salary classification
- Wood – Around $38m in GR; will have additional all funds
- Investigator 6s have 30% turnover; their pay is $56k and market rate is $71k
- Are also struggling with nurses which is not
- Nurse 3s are another high turnover rate salary at 71k and market rate is 85k
- Frank – Where are a majority of FTEs located? Markets differ around the state
- Most staff are out in the regions; majority of staff live outside of metroplex
- Manuel – Are having more vacancies in rural areas? Natural disasters can affect this issue; notes Hurricane Harvey affected this in his district
- Can get that information to you
- Campos and Dixon discuss outreach to fill positions
- Campos – Have a state hospital in my district; need to do more on messaging
- Manuel – Able to do a different pay by regions?
- Wood – Yes; 78% of staff are not in Austin; have broad recruiting areas; telework has helped in this area
- Long-term care is the largest program in regulatory; nursing facilities being the highest regulated
- With 132k professional licenses
- Childcare regulation includes child placing agencies and group homes; daycares serve 1.2m children statewide
- Has been an increased number of those who are licensed for childcare
- Implementing SB 1896 from last session
- Healthcare regulation many facilities are based mostly on complaints
- Overviews providers’ due process
- Non-priority intakes have increased; has made it difficult to get through backlog
- Have been working on penalty matrixes and what due process looks like
- Noble – Concerned about the backlog; need to address
- Received more FTEs last session but they were not funded
- Cleared backlog for certain facilities, but number of complaints have increased
- Frank – If you did not have a backlog are you staffed for what comes in daily? Concerned about the federal requirements that may be contributing to backlog
- Were ordered to prioritize Covid-19 related investigations over everything but abuse/neglect
- Frank – Need legislative authority to change this practice? May be a willingness among the committee to consider this; issue could catch a ride, but filing deadline is March 10 so you should consider getting us something
- Will need to talk to legal, believe would need a statutory change
- Manuel – How long to close a case pre Covid versus now?
- Had less than 200 pre-Covid are not closed after 30 days and now have close to 10k
- Noble – Disappointed to hear about this; need to do something drastic
- Frank – May need to look for vehicles to add this on to; are members of this committee who are interested in this
- Manuel – Can you get us prioritization descriptions and backlog by provider?
- Yes
- Frank – Can you get that to us next week? Hope to hear some bills next week, but want to set this as a part of the plan next week
Texas Behavioral Health Executive Council
Darrel D. Spinks, Executive Director BHEC
- Was formed after back to back Sunset reviews to fix certain issues including anti-trust issues
- House the Boards of: Examiners of Marriage and Family Therapists, Examiners of Professional Counselors, Examiners of Psychologists, and Social Worker Examiners
- Frank – Anti-trust is a part of your responsibilities in statute? Want to see that anti-competitive piece in statute
- Will do; public member majority board, but pull from the boards themselves
- 80k licensees; anticipate continued growth in this population
- Thanks members for additional funding for salaries in the base bill and for support of the legislature
- Overall complaint process timeline is down and 60% resolved in 6 months or less
- Were licensing backlogs; now processing applications within 37 days
- Have moved applications online and will reduce licensing fees in September 2023
- Highlights efficiencies put in place between the boards under BHEC’s umbrella
- Since the Uvalde incident council members are making a concerted effort to make changes to increase mental health professionals in the state
- Are some things the boards do not want to change; council cannot substitute their recommendations on top of them
- Frank – Clarifies BHEC does not change law, enact rules
- Correct
- Hull – Noticed changes to informed consent language; if we are not gaining written informed consent is concerning
- Are talking about the LPC board
- Boards have geared themselves towards clinical practice; systems themselves have informed consent rules
- Respect informed consent gathered in a large organizational setting
- Okay with providers speaking with the client/patient to obtain informed consent as long as it is notated in records
- Rely on tradition in statute; asked Arc to conduct a study for public protection standards
- Will be able to know more about this in the future
- Have put together a behavioral health workforce study; includes student loan debt
- Have a number of bills pending including HB 2557 (Buckley) and SB 1100 (Paxton) concerning a licensed professional counselors compact; could possibly double the amount to deliver in Texas
- Also have HB 1167 (Romero) concerning allowing practice for those who are licensed from other states
- May see a social work compact coming down the pipes possibly next session
- Frank – Fascinated that we have put anti-competitive behavior in statute
- Noble – Do background checks for these out of state licensees?
- Yes
Committee Adjourned