The Joint Legislative Committee on Health & Human Services Transition Oversight met on September 12 to hear invited testimony from the Health and Human Services Commission and the Department of State Health Services regarding the progress of HHS transformation and any recommendations from the agencies moving forward.
This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. It is not a verbatim transcript of the hearing, 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.
Cecile Young, Health and Human Services Commission
Jordan Dixon, Health and Human Services Commission
- SB 1021 recommendations regarding DSHS continuing as separate agency within HHS system
- Stability is important for the current system, needs time to mature
- DSHS and HHSC leadership is committed to improving on issues
- Main issues are how decisions are made & if DSHS feels included, level of understanding admin staff have on DSHS’ business needs, and lack of clarity for processes & procedures
- Primary recommendation is to maintain current structure, formation of joint operations coordination committee between HHSC and DSHS
- Rep. Price – What is the current status of this coordination team? How are HHSC and DSHS working together currently?
- Dixon, HHSC – Chris Adams from HHSC has monthly meeting with DFPS and DSHS on facilities, IT meets monthly or quarterly, procurement has bimonthly meetings with DSHS
- A lot of work is being done, joint committee would focus on areas for specific improvements and starting with Support Services Agreements between admin services
- Rep. Price – This is different from the executive steering committee established by HB 5 for communication with DFPS; was anything established like this for DSHS?
- No, but we can consider this if legislature directs
- Rep. Price – Do you see any benefit to this?
- Purpose of committee is to develop recommendations that can be brought to HHSC and DSHS governance
- Steering committee was mostly as HHSC and DFPS are separate agencies; thinking of establishing similar committee between HHSC and DFPS to develop MOUs
- Having a kick-off in October and another meeting for this committee later in September
- HB 5 established DFPS as a separate agency, developed HB 5 steering committee and workgroups looking into how this should progress
- Identified a lack of formalized process between DFPS and HHSC, quality of communications is program-specific and often based on strength of personal relationships
- Sen. Nelson – Asks after priorities for agency improvement
- For both DSHS and DFPS, contracting is the biggest issue; addressing this through consulting & improvement plan
- Next priority down is IT
- Rep. Price – What is the status of contracting and enforcing remedies
- Young, HHSC – Had a series of issues in April, OIG, SAO, and internal audit looked at the HHSC process and brought in a consultant to help review
- Currently in week 7 of a 10 week review, hoping to have a report at the end of this that will help HHSC align process with law and good business practices
- Rep. Price – For contracts you already have in place, you have a policy of tailored remedies, correct?
- There are a number of things we can do if we feel that a vendor is not fulfilling their obligations
- Rep. Price – My office has heard that there is not only difficulty with contracts, but also vendors have difficulty navigating problems or obtaining sit down meetings with HHSC staff
- HHSC fully understands it cannot continue operations without vendors, trying to develop a contracting model that works with vendors
- There are various levels of maturity in process for contract management oversight, recently studied management for MCOs and in the process of maturing contract oversight for smaller issues
- HHSC staff discusses importance of structure surrounding vendor interactions, currently have policy surrounding these interactions
- Rep. Price – And this policy is relatively recent, I think it’s fair to say that some of the issues stem from before this effort
- Sen. Nelson – We specifically put into law that agencies cannot wall themselves off from communications with vendors; we will have a third round of contracting law next session
- Rep. Raymond – We have plenty of guidelines and direction on how to proceed with contracting, I think HHSC has identified and recognized issues in the process, would ask that you move forward; should not wait until next June to put corrections into place
- Rep. Raymond – Unless the process was so messed up that info received from proposals was so tainted, you shouldn’t wait and you should move forward
- SB 1021 required HHSC to identify and take steps to mitigate conflicts of interest, have taken steps to consolidate some regulatory services and ensure regulatory staff complete disclosure forms for conflicts
- Recommending Consumer Rights Intellectual Disability Unit is moved to Ombudsman Office as it is a consumer rights issue rather than regulatory
- Childcare Licensing has a policy on independence and impartiality, recommending revamping policy and applying it to all regulatory divisions
- Sen. Hinojosa – SSLCs are still under the jurisdiction of HHSC, there is a governance structure and we are still keeping track off compliance and issues around the state
- SSLCs and State Hospitals both report to Mike Maples, HHSC is keeping tracking of issues and complying with the DOJ settlement
- Rep. Raymond – I think we are doing more to comply with the DOJ settlement and ensuring SSLC residents are taken care of
- Sen. Nelson – Legislature injected a lot of money into SSLC and renovating facilities last session
- Sen. Hinojosa – We have made improvements, but some of the issues are more than money can correct like location issues, lack of proper specialties, decreasing populations, etc.; cost continues to increase, but there is no waiting list for SSLCs
- Rep. Raymond – The facilities in Austin and San Antonio are very old, these services will always be needed in some capacity; I think Sen. Schwertner suggested a more modern facility in San Marcos
- Sen. Schwertner – Texas has been released from a portion of the DOJ because of the progress at Austin SSLC, we are doing better, though there are more needed improvements
- SB 1021 had a direction to examine agency advisory
- SB 200 removed ~30 advisory committees from statute and allowed agency to reimplement through rule
- Examined 200 advisory committees, currently 52 advisory committees, including DSHS
- Gives an overview of some advisory committees that have been examined, i.e. peer support workgroup, etc.
- Recommendation is to do an in-depth analysis of how advisory committees report is in line with new structure from SB 200, e.g. ensuring Sonja Gaines would have sight into how IDD workgroup report as she has oversight in this area for HHSC
- In addition to the recommendations above, also looking at staff with innovative ideas and working on process to elevate staff to leadership positions
- Rep. Price – Seemed as if there were some communications issues, glad to see the renewed and continued effort to improve communication
John Hellerstedt, Department of State Health Services
- Conclusion of Sunset was that DSHS’ broad scope distracted it from its public health mission, DSHS has already benefited from transformation into a smaller, more focused agency
- DSHS and HHSC have identified issues that must be addressed, DSHS is committed to working with HHSC through Joint Operations Coordinating Committee
- DSHS believes DSHS should remain a separate agency under the HHS system
- Rep. Price – You had expressed some concern on the report regarding admin services issues, where are you with that?
- That was in response to HHSC’s survey, HHSC was very candid in its response & both agencies are confident issues can be addressed through continued clarity, transparency, and hard work
- Sen. Nelson – What are your biggest concerns and how would you address them?
- Biggest concerns would be addressed in joint committee, leadership needs to work together and ensure consistent approach from top down
- Sen. Nelson – Can we help you with this?
- Always open to dialogue with legislature, admin request in LAR could also help with this
- Rep. Price – Seems like some of the results of past discussions are just starting to take place, looking forward to future work
- Rep. Raymond – Is this the last meeting we are having this year?
- Rep. Price – Yes, next one will be in January