The House Committee on Business & Industry interim report to the 88th Legislature covers 1115 waivers, charges related to the Texas border, early intervention programs, Rider 30, the foster are system, digital case management, and workforce challenges. For more information see the full report here.

Charge 1. Monitor the agencies and programs under the Committee’s jurisdiction and oversee the implementation of relevant legislation passed by the 87th Legislature, including HB 133, HB 2658, and HB 3041.

  • Continue to monitor the implementation and impact of Human Services-related legislation, especially upon the conclusion of the PHE.
  • Pass legislation similar to 87(R) House Bill 133, as it passed the House Human Services Committee, to extend Medicaid coverage for eligible women up to one year postpartum.
  • Continue monitoring implementation of Healthy Texas Women Plus, including barriers to enrollment.

Charge 2. Complete study of assigned charges related to the Texas border issued in June 2021.

  • Continue to monitor the impact of children, including unaccompanied minors crossing the Texas-Mexico border on DFPS programs.
  • Encourage better communication between state and federal agencies when referring allegations of abuse or neglect to the proper agency with jurisdiction.
  • Ensure allegations of abuse and neglect at GROs are investigated by the appropriate state or federal agency.
  • Consider legislation to allow child welfare providers operating under exempt status access to the central background check registry for individuals found by DFPS to have abused or neglected a child.

Charge 3. Evaluate current prevention and early intervention programs and make recommendations for improving the effectiveness of these programs in reducing child abuse and neglect.

  • Continue transitioning prevention services to community models to encourage flexibility in responses and building buy-in for local entities to improve outcomes for their families and children.
  • Consider expanding the candidacy definition for TFF services without a court order to include other populations who have voluntarily been in contact with DFPS
    • Example: Parents who voluntarily request services because they are at risk of relinquishment.
  • Utilize the remaining FFTA funds to support the transition of families receiving FBSS to FFPSA evidence-based programs.
  • Integrate the TFF pilot program into the roll-out of new CBC regions.
  • Increase the transparency of removals in FBSS stages. Without the oversight of a court, we run the risk of children being removed from their home without the due process of a full investigation.

Charge 4. Monitor implementation of SB1, Rider 30 (Health and Human Services Commission) and make recommendations for reducing the interest list for waiver services for Individuals with Intellectual Disabilities and reducing associated staffing shortages.

  • Monitor the implementation of the interest list questionnaire and online portal and look for ways to improve the accuracy and relevance of the information.
  • Continue to support the utilization of home and community-based services to help Texans avoid institutional settings and look for opportunities to expand those waiver services.
  • Examine the feasibility of requiring HHSC to transition the interest lists for Medicaid waiver service programs for individuals with intellectual and developmental disabilities from a “first come, first served” model to a model based on level of need and immediacy of need.
  • Ensure HHSC provides the Legislature with adequate data on the demand for slots for each Medicaid waiver service, including the current demand for emergency slots and the projected demand for future biennium.
  • Identify and support legislation to stabilize the community-based Medicaid programs and services, including the staffing shortage for direct care workers.
  • Direct HHSC to first assess financial eligibility of an individual when they reach the end of the interest list.

Charge 5. Evaluate further action needed to improve the safety and quality of the foster care system, including preventing children in foster care from being without a placement and increasing recruitment of foster families. Identify methods to strengthen Child Protective Services processes and services, focusing on efforts for family preservation and eliminating fatalities within the foster care system.

  • Monitor the implementation of CBC by DFPS and increase accountability methods to ensure its implementation in line with changes in state law.
  • Review the successes of SSCCs in CBC regions at limiting the level of CWOP in their regions and formulate best practices that could be replicated. Consider funding practices which have proven effective.
  • Ensure providers are utilizing STAR Health benefits and services that are already available to foster care youth (crisis intervention, mental health rehabilitation, care coordination, value added services, etc.).
  • Determine the efficacy of utilizing the Family First Prevention Services Act pilot program and prevention and early intervention programs to reduce CWOP in both CBC and Legacy regions.
  • Examine the number of central administrative staff and if a transfer of resources should occur to have additional local staff to alleviate overtime hours in CWOP.
  • Review the employee background check requirements implemented by DFPS at contracted facilities to ensure proper vetting of those working with foster youth.

Charge 6. Assess the quality and effectiveness of the DFPS IMPACT system for security, transparency, and accuracy. Review DFPS processes relating to the integrity of digital case management. Evaluate whether DFPS data collection adequately responds to child wellbeing indicators.

  • Continue to monitor the modernization of DFPS IMPACT including the interactions between the SSCCs and DFPS as Community-Based Care continues to roll out.
  • Ensure DFPS continues to harden their IT system.
  • Improve access to data for foster care providers.

Charge 7. Examine the longterm services and support system of care in Texas. Study workforce challenges for both institutional and community services. Assess opportunities to improve patient safety at senior living facilities. Consider mechanisms to promote a stable, sustainable, and quality-based long-term care system to address current and future needs of the state.

  • Promote CNA career advancement opportunities to support job retention.
  • Continue to study the challenges facing long term care facilities to hire and retain staff, including the results of the Rider 146 report once it is released.
  • Direct HHSC, or the or the HHSC Long-Term Care Ombudsman, to study the ownership of long-term care facilities across the state and develop policies or recommendations to increase transparency on the ownership of long-term care facilities across Texas.
  • Examine temporary COVID-era policies that were instituted to more easily hire and retain new staff (such as licensing reciprocity) and develop legislation to make those permanent.

Charge 8. Monitor federal decisions that may impact the delivery and financial stability of the state’s health programs, including: the Centers for Medicare and Medicaid Services’ rescission of its prior approval of the State’s 1115 Waiver, the state and federal negotiations of the Medicaid directed payment programs (including hospital finance methods), federal changes to the Medicaid Disproportionate Share Hospital Program and the exclusion of certain costs from the uncompensated care program authorized through the 1115 Waiver.

  • Due to the difficulties working with federal partners around implementation of HB 133, pursue legislative solutions outside of the federal waiver framework designed to increase affordable access to care.
  • Continue to monitor the 10-year extension to the 1115 Demonstration Waiver.