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The House Committee on Human Services met on June 28th to hear interim charges related to long-term services and supports, the implementation of HB 3041, and the state hospital system. A video archive of the hearing can be found here.

This report is intended to give you an overview and highlight of 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 remarks:

  • Chair Frank – Committee is not an appropriations committee, will be focusing on policy

 

Examine the long-term 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.

Michelle Dionne-Vahalik, Associate Commissioner of Regulatory Care, HHSC

  • Provides overview of long-term care regulation in Texas
  • 1,365 people oversee regulatory operations and licensing in Texas, along with assistance from CMS
  • Nursing facilities are all dually regulated, must follow CMS regulations and services
  • Assisted living facilities are only regulated by Texas Code, no federal regulation
  • Frank – If they don’t meet the requirements, let’s say someone gets sick, what is the enforcement mechanisms on the requirements?
    • If a complaint is filed, we will go out and investigate, if we find rules are broken, we will give a citation
  • Frank – So, it is only complaint driven?
    • There is an annual review on the nursing facility side, but we are only looking at a snapshot in time for
  • Noble – I am wondering where the requirement for a high school certificate comes in?
    • Actually, under review as we speak, CMS rule has
  • Noble – What about the age 18 requirement?
    • We are also looking at this, could potentially allow high school students without a diploma to work in these facilities
  • Dionne-Vahalik – Looking at increasing testing services for nurse aides, 4 months into a nurse aide program, the aide will have to test
  • Frank – Are these permanent changes or just for emergencies?
    • Online didactic and expansion of testing sites for nurse aides will both be permanent
  • Dionne-Vahalik – Filed a 1135 Waiver with CMS asking Texas to expand 4-month testing window, have not heard back
  • Rose – How many citations have been resolved?
    • For 2020, and the majority of 2021, the citations have been resolved, some still in motion for 2022, enforcement penalties possible
  • Rose – Are you staying we would need an additional 15K CNAs?
    • Survey identified a large group of temporary nurse aides who are not certified but under the waiver, approximately 10-15K needed with the addition of temporary aides
  • Klick – You mentioned some high school programs, do you know the numbers?
    • Will follow up with you
  • Frank – Where do those fines go? Into the agency?
    • Some result in penalties, penalties would go into general revenue, might fund some licensing services
  • Rose – Can you expand on high school programs?
    • Career in Technology program, has many health science programs within this, allows high schoolers to receive coursework that aligns with nurse aide training, usually has a practicum

 

Stephanie Stephens, State Medicaid Director, HHSC

  • Nursing facilities are a mandatory service in Medicaid, add on services can be added to required services
  • Medicaid covers about 49K nursing home residents, about 60% of Texans in nursing facilities
  • Frank – The 2.6B in annual expenditures, how much of that is base and how much is QIPP?
    • $2.6B is all base rate, QIPP is $1.1B as of year 5, $3.7B total
  • Stephens – Four CMS quality measures used in QIPP, two related to workforce development, measures related to infection control as well
  • Regarding QIPP, facilities must improve over their own baseline performance or meet a standard baseline, usually national average
  • Hull – For those that received an anti-psychotic medication, can you provide an overview? Wants to ensure they are not being pushed on patients
    • High statistic means low levels of administration, State has done a lot of work recently and seen strong improvements
  • Stephens – Most nursing facility services are provided in managed care
  • Working on implementing minimum performance standards for nursing facilities, instructed to adopt rules last Session, will have rules adopted by January
  • HB 1558 also instructed rules regarding staff to resident ratios, looking to implement into QIPP by September 2023
  • Frank – What is the difference in funding received for the best and worst nursing home, determined by QIPP standards?
    • With performance measures, homes can either meet measure specific to facility or a national benchmark, if a home improves within itself, it could still be below the national benchmark
  • Frank – So is there a significant difference in funds received?
    • We can follow up with this, really complicated data and need to compile

 

Patty Ducayet, State Long Term Care Ombudsman, HHSC

  • Independent office from HHSC, will make recommendations for improvements in HHSC
  • Made over 11k visits to long-term care facilities, monitoring care of residents
  • Last year, investigated over 1,200 complaints for long term facilities, 4,200 complaints for nursing facilities
  • Studies show high turn over rate is due to poor wages, lack of staffing, and poor work conditions, $24,200 is average salary of CNA
  • Recommends increase wages, especially for CNA staff, Texas is below the national average for CNA staffing
  • Recommends offering retention bonuses
  • Recommends establishing staffing ratios
  • 87% of LTC facilities have a 1- or 2-star rating from CMS
  • Need a more objective measure of our goal if we want more staff to care for residents
  • HHSC has only 19 surveyors to conduct inspections for all assisted living facilities, not enough staff
  • Finding ALF settings are more restrictive of resident rights than nursing facilities, need legislative direction here, ALFs following their own policies are generally found to be in compliance by HHSC
  • Provides statistics on annual voluntary nursing facility closures, average closures per year is 12
  • Looking to ownership of LTC facilities is important to understand quality, but can be tricky; private equity and real estate investors are involved in ownership of many LTC facilities
  • High rents and fees place constraints on operations and affect facility-level care, can see it in limited activities budgets, low staff, broken transport, broken HVAC, etc.
  • Need to pay attention to these health factors, have an effect on physical and mental health
  • Should publish a financial report of all Medicaid-certified facilities, analyze key measures of health as part of financial reports,
  • Should also publish more detailed ownership data and facility quality data
  • Chair Frank – Appreciate comments made, particularly on transparency issues
  • Chair Frank – Nursing homes are pretty similar across the state, have you seen a best practice of how much money should be spent on things, e.g. on personnel? Or is that what you’re asking for?
    • That is what I want via public reports
  • Chair Frank – Agree, there is a need for that; spoke to someone about private equity investors, pay office workers, but didn’t pay staff
  • Chair Frank – Without a free market, end up with Medicaid and all the little measures; don’t know what proper percentage of average $75k per patient is, but most should be going to patient care
  • Chair Frank – Want to reward good operators and squeeze out the bad, right now there is a disincentive, understaffed facilities make more money at the end of the year, is that fair? Trying to understand penalties and QIPP
    • This is where we’re also looking to build staffing into QIPP
  • Chair Frank – Would much rather measure outcomes than inputs
  • Noble – Trying to get a handle of who the parent companies are
    • Dionne-Vahalik, HHSC – Intense & complicated, possible to not be able to truly identify because of the corporate structures involved; HHSC does have a watchlist for facilities terminated due to enforcement action, can provide more details about policies regarding ownership structures
  • Noble – I don’t think we have a goal of making more red tape, but want to provide the best care we can
  • Chair Frank – Would like data about ownership structure, please provide to Committee

 

Elise Meyer, Leading Age Texas

  • Provides overview of Leading Age Texas, comprised of 200 facilities in Texas; over 30K Texans
  • Managed care organizations are having a more active role in low-income care senior facilities; often deal with homeless populations
  • Healthcare is not provided on site; advocating for a senior housing and services model and want managed care plans to collaborate with senior care facilities
  • Older Texans want services in the setting of their choosing, not necessarily full-time services
  • Recommends easing the licensing process for part-term services
  • Hiring challenges in all areas in facilities, not just direct care positions
  • US HHS projects Texas will have highest demand for nurses providing long term care support in 2030
  • Hourly wages in nursing homes are the lowest in all health care settings
  • Recommends increasing incentives for long term care sector such as student loan forgiveness
  • Suggests partnering with PTECH schools to offer CNA certifications
  • Encourages creating multigenerational programming in senior living facilities
  • Recommends identifying regulatory and cost barriers to employment
  • HHSC has ability to apply for federal funding that would assist nursing home residents
  • Providers need more streamlined reporting requirements
  • Chair Frank – Are you working on recommendations or are providers?
    • We are talking though it; because of federal oversight it is hard to make recommendations but there is room for improvement
  • Chair Frank recommends Leading Age makes their own concrete recommendations
  • Chair Frank – What is the difference between top and bottom in QUIP?
    • If providers don’t meet components, they don’t get paid for it
    • Providers typically could earn $25 per patient per day on top of base rate

 

Kevin Warren, Texas Health Care Association

  • Provides presentation of Texas patient numbers
  • Paid for study to determine recommended volume of RNs per patient day; found 4.1 in 2001
  • Pre-Covid found that TX needed additional 7,000 nurses
  • Need to ensure right amount of staffing based on acuity
  • Chair Frank – How much more do you get paid for a high acuity patient v a low acuity patient?
    • There are 34 levels of patients; the average Medicaid rate is $149 a day
  • Conducted surveys with Leading Age; found increasing staffing shortages
  • Since 2020, employment down by 9600
  • TX below national occupancy rate
  • Chair Frank – Is that because we built too many nursing homes?
    • That’s part of it
    • By not allowing visitors during Covid, fewer people wanting to be admitted
  • Since 2010, number of RNs increased by 42% but number of RNs working in long-term care decreased
  • Recommends expanding nursing faculty; need to help nurses get through pipelines faster
  • Must incentivize nurses into long-term care
  • From 2015-2020, payment increasing; facilities under financial pressure
  • Salaries increasing but Medicaid rate not
  • Texas has higher acuity patients in facilities
  • Staffing agencies became competitors of facilities
  • In 2021, asked AG to investigate agency competition
  • Travel nursing agency transparency study act conducted in Dakotas; looking to understand how agencies skewed salary expectations
  • Texas long-term facilities have low star ratings; due to understaffing
  • Used to be rated 49th in country for antipsychotics; now 10th
  • Developed workforce committee to examine issue
  • Held association workforce collaborative meeting in May to discuss
  • Looking at CMP grant development
  • Working with national affiliate to recruit
  • Recommends incentivizing nurse faculty, increasing number of nursing school graduates, and establishing student loan repayment systems
  • Suggests requiring staffing agencies to report and ensure they are in compliance
  • Klick – Is acuity in patients growing due to COVID?
    • Yes, less acute patients are staying home with families
    • Can’t admit acute patients without sufficient staff
  • Klick – Facilities would be great clinical sites for RN students
  • Klick – Are any of your providers incentivizing CBMs?
    • Yes; some are starting their own certificate programs
    • Meyer, Leading Age Texas – Without exposure to long-term care, nurses will think nursing homes are harder than hospitals
  • Chair Frank – Why is there a disparity in pay amongst nurse types? LVN was paid more in a nursing home setting, CNA was paid less, etc.
    • Meyer – LVNs have the most demand, so they have historically received higher pay
    • LVNs have more autonomy, providing greater care
  • Chair Frank – Have your concerns about IT and licensure been addressed?
    • Providers dealing with licensure issues; online system not working, part of the HHSC IT infrastructure
  • Chair Frank – Not a matter of waiting for MCAT?
    • No, Texas had almost had to go to a paper based process, system isn’t functioning correctly; Commissioner Young says they are working on IT issues
    • Also having issues with PEMS, since December over 100 Medicaid contracts have started and 4 have been completed, seems to go back to IT issues
    • Providers aren’t getting paid, still a problem; have asked HHSC to suspend PEMS until it’s fixed
  • Chair Frank calls Stephens from HHSC to respond
    • Stephanie Stephens, HHSC – Warren did send a letter to the agency about the system issues, part of the change of ownership process, expect to have a response this week
  • Chair Frank – Seems like if the problem is on our side there should be automatic renewals
    • Have automatically extended enrollment, will look at this
  • Chair Frank – Asks Warren for ownership breakdown of 1,200 homes, do you represent all of those? What is the breakdown of facility ownership, locally v. out of state v. small v. large?
    • I can get it for you
    • Many are private equity, wanted to clarify that
    • LTC is easily the most transparent of all professions, have had quality and ownership data published, licensure includes extensive info, etc.

 

Kathy Green, AARP Texas

  • Provides overview of AARP & LTSS; by 2050 1/5 of Texans will be over 65, current LTSS system doesn’t support this growing need, most want to stay in place, second most popular is assisted living
  • Highlights issues with infection control & staffing at nursing homes, Texas falls significantly below 45 minute recommended average care time per day
  • Consistent staffing is important, residents build relationships with staff
  • Nursing homes have received money from ARPA, but little transparency and current system allows for gamesmanship; money meant for resident care is going to corporation
  • Should consider moving funding to a blended rate, could incentivize MCOs to put people in least restrictive, least expensive setting
  • Should establish a direct care payment ratio
  • Should address incentives in the STAR+PLUS capitation rates, shouldn’t reward MCOs for placing people in nursing homes
  • Chair Frank – Have you looked at what other states have done?
    • Can get this info to you
    • Meyer – Are you talking about the gap?
  • Chair Frank – Yes, you mentioned a gap & what other states are doing in their program
    • Have a gap for the middle market, older Texans living on a fixed income, very few options aside from Medicaid and nursing homes, HCBS services also have a shortage
  • Chair Frank – Didn’t know if other states had come up with good programs
    • Some states don’t require separate licenses for HCBS services, should be able to have resources
  • Chair Frank – Top licenses should be able to provide lower licensed services
    • Green, AARP – Has presence in other states, can come back with info
    • Meyer – Many states have invested more in assisted living from Medicaid, but historically in Texas it has been private pay
    • Have providers who would love to expand, but can’t make it work on $60/day/patient

 

Rachel Hammond, Texas Association for Home Care & Hospice

  • Providers overview of TAHCH and home care
  • Can’t look at LTC in silos, need to look at it as a continuum of care as people age and move through care models
  • Home care and community services are somewhat overlooked
  • Texas was one of the early adopters of money following the person grants
  • Chari Frank – Do you have the bill number?
    • Was a long time ago, HHSC likely has this info
  • These grants have incentivized community care, but the services and supports for the services have eroded over the time and affected ability, seeing a workforce crisis
  • Rates, such as attendant rates, have not kept pace with cost, have seen very few increases & considering inflation decrease is significant
  • Could establish community care payment advisory committee to address LTC funding, HHSC needs to create viable and sustainable funding methodology
  • Regulatory waivers allowed providers to provide services safely, should continue some waivers where it makes sense
  • Also saw enhanced regulatory burden with infection controls, etc.; should align state requirements with federal requirements
  • HHSC should develop network and adequacy standards specific to services in the community and monitor workforce shortages
  • Should support coordination of care between MCOs & providers, currently costly & inefficient
  • Chair Frank – For your members money is flowing through MCOs?
    • Yes, large majority of services are provided through MCOs, very small amount of FFS
  • Chair Frank – Human Services is kind of an appropriations committee due to MCO model; Medicaid funding for LTC going through MCOs also?
    • Yes
  • Noble – Regarding regulatory waiver, are there mostly in law or in rules?
    • Many of these were in program or licensing rules
    • Would like to see some made permanent, some are no longer available and compound difficulties due to the workforce struggles; HHSC could assist with this
  • Noble – Would be all for this, encourage you to work together
  • Chair Frank – Does an MCO get paid the same, whether they send to you or a nursing home?
    • Don’t believe so
    • Stephens, HHSC – No, there are specific rates for nursing homes and other services, relates to testimony earlier on blended rates, study due in September
  • Chair Frank – Don’t want MCOs to have incentives to send people to the most restrictive environment, want to send them to the best environment
  • Rose – Why does it take so long to implement things we ask for?
    • There are a lot of Medicaid bills, not staffed to implement all of them at once
  • Chair Frank – Might have to think of other deadlines, everything seems due in September, October, and November
  • Rose – I need an update on 133 re: maternal care
    • Drafted an update after we submitted a waiver amendment, will confirm
  • Chair Frank – Good news is no one has been dropped of Medicaid, has gone beyond 6 months proposed; will change at some time
    • Correct, pregnant women’s Medicaid has been preserved up until now
  • Other TAHCH recommendations include: edits to EVV system allowing recognition of duplicates, claims data, etc.
  • Provides overview of private-duty nursing, is effectively a cost containment strategy, keeps children out of nursing homes, lower costs
  • Shrinking pool of nurses has created unprecedented inflation in rates, seeing shortages in home care similar to other areas, LVN rates have not kept up
  • Recommends funding grant program for loan repayment for nursing, should support LVN-RN bridge programs and educational programs, should recommend home health as viable clinical sites
  • Klick – We did clinical rotations with the public health authority doing home visits, would think a home care environment would be a great clinical site
    • Absolutely, can work with Board of Nursing to allow for supervised hands-on

 

Kendal Nelson, Texas Assisted Living Association

  • Provides overview of TALA, 99% funded by private pay
  • COVID supply chain shortages and workforce shortages have hit all sectors of industry, workforce problems extend beyond nurses
  • Working with HHSC to see where regulations stifle staffing options, e.g. 18 years old & high school diploma, relief could allow other high school students
  • Better outcomes for residents with workers happy in their roles
  • Over next decade, growing baby boomer population will not have the same resources
  • Regulations like transportation for residents to go to full-time jobs are burdensome, average resident is over 80 and does not want a full-time job
  • Often regulations do not recognize cost or effort needed to accommodate, e.g. OSHA barrier requirement due to COVID
  • Each new regulation comes with a price tag, at some point it is impossible for smaller facilities to operate
  • Diversity of care providers is crucial for the industry to operate
  • Assisted living saw relatively few COVID cases
  • TULIP has always been an issue for re-licensing, also affects LTC insurance; LTC companies aren’t paying on time until licensure issues are resolved
  • Chair Frank – What are the rates for assisted living low end versus top end?
    • Varies a lot, home with 4 residents has more flexibility to offer lower rates
    • Often offer a rate for rent, rates scale based on services

 

Chelsea Owens, Breckenridge Village of Tyler

  • Provides overview of BVT, ICFIDD facility
  • Highlights experience of residents at BVT
  • Medicaid reimbursement rate is $8.67 hourly for workers, private is >$16, need help to keep workforce; should look at ICFIDD reimbursement rates
  • Chair Frank – Is the rate max or what you’re getting reimbursed?
    • Reimbursed, BVT is licensed as 9 small ICFIDDs, rates based on level of care for resident
  • Chair Frank and Owens discuss rates at BVT
  • Klick – Isn’t it true that as an ICF, you need to provide clothing, etc.?
    • Correct, pay for medical care, clothing, food, counseling, etc.

 

Meera Riner, Coalition of Independent Nursing Home Providers

  • Need to incentivize staff for doing good so they are encouraged to come back
  • COVID led to a severe staffing crisis for nursing homes, workforce levels are at a 15-year low & recovery is lagging, studies showed existing deficit even before the pandemic
  • Nurses are leaving the profession, need to accentuate the things we are doing well; exhausted workforce, supply chain issues, financial issues, etc. all impact ability to provide care
  • Costs for transportation, food, supplies, etc. are increasing, also seeing surges in COVID cases
  • Important to support workforce, very knowledgeable in managing COVID, infection control has been difficult to manage, but currently open to visitation which has helped psychosocial wellbeing of residents
  • Trying to prioritize quality even with the difficulties, most nursing homes are good; TX outperforms other states on 11 of the 18 CDC measures, but bar for metrics keeps raising
  • Need to look at other states for metrics and reimbursements; contrary to popular belief Texas has improved in CDC’s 5-star quality measures program, staffing rating is very low, but somewhat beyond control due to staffing issues and gap in funding

 

Implementation of HB 3041, related to the implementation of the Family Preservation Services Pilot Program.

  • Chair Frank – Previously discussed implementation on HB 3041, was different than what I expect, but think this is resolved; today’s testimony will be more of an update on positive things done at DFPS

 

Jamie Masters, DFPS

  • Texas investigates lower rate of abuse & neglect reports, reflective of careful screening & only want to investigate when necessary
  • Children are removed at a rate of 2 per 2,000 children, lower than national average, should only be removing in the case of serious harm
  • Only 3% of children return to the system after exiting compared to 6% nationally; Texas maintains a lower percentage of children in long-term foster care
  • Highlights positive Texas statistics on child movement within the foster care system, kinship placements, Texas’ statistics on abuse and neglect are better than reported
  • Hull – Would you share numbers on PCSPs and children removed through those?
    • Heard committee message on PCSPs, in 2019 there were 13k children in PCSPs, as of March there were 534
  • Hull – Nothing else you are doing that is like a PCSP?
  • Chair Frank – How does that marry with the FBSS? Similar decrease in FBSS?
    • Will need to get back to you on comparative impact
    • Only remove when DFPS cannot ensure safety in the home
  • Hull – Do you know how many of those stayed at home, were they removed?
    • Green, DFPS – Can get this for you
  • Chair Frank – Also seeing a decrease in actual removals
    • Masters, DFPS – Yes, at a 10+ year low of children in care right now, doing a good job of assessing safety and valuing families
  • Link to DFPS presentation on HB 3041 presentation
  • Speaking on portions of HB 3041 that avoid foster placements, FPSS services may only be for children determined to be at imminent risk of foster entry, pregnant, or parenting foster youth
  • Pilots intended to provide DFPS with valuable insight in developing plan under HB 3041
  • HB 3041 allows establishment of pilot programs allowing DFPS to dispose of investigations by referring family to FPSS
  • Rider 48(b) provides $4.9m annually for pilot services
  • Strengthens due process rights for families and directs legal representation early in the process
  • Report due in advance of the 88th Session

 

Jerome Green, DFPS

  • Highlights investigation process on slide 7
  • Those cases at risk of imminent removal would be sent to family preservation pilot services
  • Chair Frank – On page, risk and safety assessment, these are kids that would be removed without the pilot program?
    • Yes, gives us an alternative
  • Chair Frank – So this is an option, court-ordered; had conversations previously that some issues can be fixed in the home
  • Framework directs DFPS to provide due process, work with court oversight, and have counsel appointed

 

Sasha Rasco, DFPS

  • Highlights slide 10, SSCCs have had contracts amended to provide FPSS pilot services
  • Will be looking at needs of families & how court orders match, will also be learning how process works and how the state can work with federal gov in drawing down Title IV-E funds
  • UTMB will be looking at qualitative data and conducting focus groups, will bring report to the legislature before session
  • Will be forming learning collaboratives with providers, regional entities, and courts
  • Chair Frank – How did you arrive at UTMB?
    • They have a violence prevention component, research branch that does this kind of work

 

Monitor the current status of the state hospital system, including the forensic bed waitlist.
Scott Schalchlin, Health and Specialty System

  • Overviews their psychiatric hospitals and services
  • Forensic commissions tend to be longer admissions and tend to not be able to draw down insurance/Medicare funds for these
  • Highlights workforce challenges, have lost 20% of workforce; have provided salary increases and other incentives
  • Klick – Did Census drop?
    • Yes; brought 700 hundred beds offline
  • Construction funded by the legislature:
  • Austin state hospital replacement opening November 2023
  • San Antonio state hospital replacement opening January 2024
  • Kerrville state hospital renovation opening September 2022
  • Rusk state hospital replacement opening May 2023
  • San Antonio new 40-bed-unit being completed
  • Completed the John S. Dunn Behavioral Health Center
  • Have been funded by the legislature to build a new hospital in Dallas; received a donation for an additional 100 bed pediatric unit
  • Waitlists for maximum security unit and non-maximum security have grown overtime
  • Looking for mid-level care to prevent
  • Frank – Hiring done out of where? Limited leadership in the communities
    • Locally; have centralized HR and CFOs
    • Have not heard the criticism on lack of leadership
  • Frank – Who cuts purchase orders
    • Have HHSC warehouses that hospitals order from
  • Neave – Asks about who is funding pediatric beds? For all minors under 18?
  • Rose – By Children’s Health Hospital, is a $200m gift
  • Rose discusses the work she has done for these state hospital beds; state needs to do better for these patients who have to sit in a jail when they need to be in the hospital
  • Noble – Asks about those on the wait list; other facilities available for these?
    • For maximum security, the state is it; for the other list, a majority are in jail
    • If on the waitlist have been arrested and competency issue was raised in court
  • Frank – Why taking beds offline if you cant staff, no one else can do that
  • Frank and Schalchlin discuss hospital policy regarding discussions with state reps
  • Hull – Have a breakdown on misdemeanors vs felonies?
    • Can get that to you, generally varies by county; two particular counties where half were maximum security and one county had minor crimes
  • Rose – Are talking about forensic beds; many on the list have criminal trespass charges, sometimes people sit in jail for a year and months because there is no bed for them
  • Noble – Are talking about the adult population only?
    • Yes
  • Frank – Going back to the capping of amount of beds-to-staff ratio; at what point at which we just say we need to get this staffed
    • Are recruiting all the time; has been difficult to hire nurses and direct care staff

 

Charles Reed, Dallas County Commissioner’s Court

  • Thanks the legislature for previous appropriations regarding state hospitals and HHSC
  • Due to lack of funding, have shifted costs to county property tax payers
  • Average non-maximum waitlist wait times have increased to about a year; oftentimes sit in jail and then are released without getting mental health service
  • Both maximum and non-maximum inmates on the waitlist, not one has been convicted of a crime
  • Costs Dallas County $470 per incompetent inmate per day; do not have adequate services
  • $5.5m per month over what we used to pay; is unsustainable
  • Understand workforce challenges, but cannot “pass the buck” on to anyone else
  • Should use ARPA Funds eligible for mental health uses to help with this situation
  • Klick – Anything doing for that population in jail when they get back into the community?
    • Have been using ARPA to supplement mental health authority and metro care
  • Klick – Some population may have other coverage to go to private facility?
    • Some do, but vast majority do not
  • Frank – If a person is qualified to go to the state hospital the state should pay for it
    • Do some outpatient competency restoration with local nonprofits
    • Determination on who goes to the state hospital
  • Rose – Once paperwork is processed, go in that order, but the waitlist comes into play
    • Would be happy to use HHSC’s unallocated funds to offset our costs
  • Frank – Do not want incentives to stay understaffed
  • Rose – HB 211 84(R) passed a bill where judges notify the attorneys when inmates return to the jail?
    • Do not have the exact numbers, know a number of cases where that did not happen
    • To be fair, there is no penalties for the judge in that bill
  • Rose – May have to make some changes
    • Ask you do not make it a financial penalty, the county would be on the hook still
  • Klick – Could mark on their court efficiencies record; do magistrates also do that?
    • Have an active case on bail practices, will ask how to answer that question and get back to you
  • Rose – This is a serious issue; will come back in the 88(R) to make some changes with the support of this committee
  • Rose – May need another hearing on this