The committee met to receive an update regarding the impact of oil prices and production on state revenue and the budget and to consider the following interim charge:
 
Monitor the state's progress in coordinating behavioral health services and expenditures across state government, pursuant to Article IX Sec. 10.04. Identify ways state agencies that provide mental health services are collaborating and taking steps to eliminate redundancy, create efficiency, utilize best practices, ensure optimal service delivery, and demonstrate expenditures are coordinated and in furtherance of a behavioral health statewide strategic plan. Identify barriers that prevent the coordination of behavioral health services. Make recommendations to maximize use of state funding for mental health.
 
 
Impact of Oil Prices
 
Glenn Hegar, Comptroller

  • Severance taxes are split between public education, rainy day fund and transportation
  • When oil prices drop it affects the rainy day fund and transportation to a greater degree than education because the education money comes out first
  • As of today, state revenues are tracking with the certification revenue estimate
  • Texas has a much more diverse economy than it did in the 1980s but oil and gas still makes up 13% of the Texas economy
  • Sales tax revenues have averaged a 5% increase each year over the last 20 years
  • Texas has lost over 30,000 jobs in both the oil/gas and manufacturing industries but Texas unemployment is still better than the federal unemployment rate
  • The legislature left money in the bank last session and there is still a healthy balance in the rainy day fund, therefore the budget as set by the legislature will be fine
  • Chairman Jane Nelson asked if Texas is more protected today because of actions taken such as creation of the rainy day fund
    • Yes; the economy is more diverse and can absorb an impact to oil/gas; also, with money being put into the rainy day fund and the transportation fund, GR money is protected
  • Sen. Charles Schwertner asked if the state will see more of a contraction in economy and how appropriators should try to calibrate how much will be spent in the next two year cycle taking oil prices into consideration
    • There should always be concern over the economy; projections can only be made with deference to the information that is available at the time
  • Schwertner asked what percentage of the sales tax is derived from oil and gas industry
    • 5.9%
  • Sen. John Whitmire asked if steps have been taken to allow the rainy day fund investments to be more diversified
    • Yes, above a certain amount, funds can be invested in a broader array of investments
    • Phillip Ashley with the Comptroller’s Office noted money has been diversified and invested through the Texas Treasury Safekeeping Trust; dollars are invested slowly over a period of time
      • Primarily domestic fixed income funds
  • Sen. Kelly Hancock noted that with significant change in the market over the last few years, we should expect it to take some time for revenue estimators and similar professionals to get a better grasp of the economy
  • Sen. Royce West asked what cautions were provided to Texas from the rating agencies
    • Last session appropriators took some very positive steps on a few long-term liabilities such as transportation, ERS/TRS and water; Texas is better prepared to weather the storm than other states but needs to stay focused on remaining diverse and continuing to take care of long-term liabilities
  • West asked how oil/gas layoffs are impacting the economy
    • There were around 30,000 jobs lost in oil and gas yet the state grew by over 100,000 jobs
  • West noted he is seeing that oil prices will be staying low for an extended period of time; how long can that maintain before the ability of the state to do business is impacted
    • It is hard to put a number on that; there are an unbelievable amount of variables that go into projecting revenue
  • Sen. Chuy Hinojosa noted that despite diversity, oil/gas is still a huge part of the Texas economy; it is understandable that it is hard to predict revenue but it is important not to grossly underestimate revenues because of the impact that would have on state programs
    • With oil at $30/barrel the budget still works; there is an impact to the amount of GR that will be leftover and an impact to the rainy day fund and Fund 6 but at a certain point declining oil prices have less and less of an impact
  • Sen. Lois Kolkhorst asked where the employment gains are coming from
    • Leisure/hospitality and health care for the most part

 
Ursula Parks, Legislative Budget Board

  • The session was ended with a $4 billion balance
    • $600 million GR and the rest is GRD
  • If that balance is eliminated by any measure, there will be less tools for the legislature to use next session for situations like supplemental appropriations
  • One thing that needs to be considered is that property values may decrease which may require more from the state to fund public schools
    • Generally when the economy trends downward, public education enrollment increases; community college enrollment would likely increase as well
  • As the Texas economy trends downward, the state will likely see a better federal match for the Medicaid program although there is somewhat of a lag in that number
  • If the legislature decides to continue relying less on GRD balances for certification, that will put even more strains on budget flexibility
  • Kolkhorst asked when the next federal match update will come out
    • The current budget FMAP is around 56-57%  and every percentage point is worth about $300 million per year

 
Behavioral Health
 

  • Nelson noted the legislature significantly increased funding to mental health last session
  • In the current budget there is over $3 billion spent on mental health not including Medicaid recipients
  • There was a rider in the budget requiring all recipient agencies to work together to create a strategic plan to better coordinate mental health service delivery, identify redundancies and encourage agencies to use best practices
  • West noted he believes more resources need to be put toward law enforcement training as it relates to mental health
  • Kolkhorst asked if the $3 billion includes waiver money that flows to counties directly
    • No it does not
  • Nelson noted there was a newspaper article that mentioned Texas spends only $900 million on mental health care
    • LBB staff noted that article only counted money spent on programs from the primary mental health agency of the states
  • Whitmire noted many mental health patients are picked up in Houston and taken to the county jail every night; they stay for a few days and are releases just to be picked up again; this is an issue that has been around for a while and nothing is happening despite the money being spent on mental health care; mental health is all encompassing and involved in every corner of state systems and programs
  • Schwertner noted there does need to be a much higher degree of coordination to ensure those individuals are being treated appropriately and timely in the right setting
  • Sen. Robert Nichols noted wait lists in his district have gone down significantly, patients are getting more treatment and in some programs the additional funding is working well; need to determine where improvement is still needed

 
Ursula Parks, Legislative Budget Board

  • Texas funds behavioral health programs across a wide range of entities and programs
  • Texas takes a more decentralized approach when compared to many other states
  • Over the last two sessions the legislature has significantly increased funding toward behavioral health programs in a variety of ways
  • Last session the legislature increased funding in crisis services, HCBS, community programs at TJJD and other programs

 
Mike Deal, Legislative Budget Board

  • Agencies from 5 different Articles receive behavioral health funding; over 15 agencies
  • Behavioral Health Coordinating Council was established last session
    • Required to develop a 5 years strategic plan
      • Must include inventory of current services, number of people receiving services and a delivery plan
    • Required to provide a description of all expenditures from each agency
  • Medicaid spending could not be identified because of managed care integration but it is expected that spending will be incorporated into the strategic plan
  • Schwertner noted he has been unhappy that particular number can’t be identified; there are Medicaid claims data out there that can be used to find this number
    • Parks noted it is the HHSC that holds that data and LBB cannot just go in and get it; believe HHSC will provide an estimate on that number today
  • Federal funds drawn down through the 1115 waiver and DSRIP pool do not show up in behavioral health funding numbers either
    • Nelson noted this is important in understanding money outside of the budget flowing to mental health services
  • Sen. Larry Taylor asked about mental health dollars spent in Article XIII
    • Those dollars are spent on peer assistance for substance abuse
  • Nichols asked if funding intended for planning for state hospitals is included in behavioral health funding
    • No
  • Schwertner noted the Health & Human Services Committee is charged with studying that issue

 
Sonja Gaines, Associate Commissioner for Mental Health Services, HHSC

  • The investment in mental health is much appreciated across the entire array of agencies and entities who were able to expand services
  • Developed a catalogue of what exists across the state for mental health services so that duplication can be avoided
  • Whitmire discussed the need for a crisis mental health intervention program so that law enforcement can be avoided
  • Do not yet have numbers for what is spent in Medicaid for behavioral health services; because it is a capitated system the numbers have to be teased out including services and pharmaceuticals that the state pays for; want the number to be accurate
  • Kolkhorst noted there are codes that can be looked at; it may be a symptom of a larger problem if those numbers can’t be determined in a timely manner; may be a problem with the managed care overseers; this is a signal of how little clarity there is in the managed care system; our systems may not be capable of overseeing that program to the degree legislators would like them to
  • Other members expressed disappointment that these numbers are taking so long to come up with
  • Schwertner asked if the information is available or if MCOs are withholding information
    • Yes it is available and not being withheld
  • Schwertner asked if the problem then is just that the numbers have to be crunched
    • Yes
  • When the strategic plan is developed there will be an inventory of all mental health programs in the state, how many people are being served and how much is being spent on those services; have received 100% participation from all agencies involved including agencies not named in the budget rider such as TEA
  • Have identified specific goals and target areas that need to be addressed through surveys that have been completed by local entities and public stakeholders
  • Have been working very closely with LBB throughout the process to ensure all the deliverables will meet their expectations
  • Service delivery, homeless populations, workforce shortage and other areas will be the major focus
  • Have explored statewide data and how the agencies can do a better job of sharing data across agencies
    • Nelson noted sharing information needs to include local entities as well
  • Nelson asked who is looking at the DSRIP projects and evaluating what is working and not working
    • There are 460 behavioral health projects; HHSC has an office solely devoted to managing that initiative
  • Sen. Brian Birdwell asked if there is command authority or just support/coordinating authority at the council; want to ensure the council isn’t being held accountable when the authority doesn’t allow them to take command
    • The rider requires that everything must come through the council; expenditures have to be approved through the LBB; the state agencies have been very cooperative and collaborative in breaking down some of these barriers
  • Bettencourt asked if any legislation is needed for this to work better
    • Not at this point; there has been very good coordination so far

 
April Zamora, Texas Department of Criminal Justice

  • Population served is primarily the incarcerated population and those on probation and parole
  • Incarcerated populations receive mental health care while they are in the system and they receive a 10 day supply of medication when they are released; they also see a mental health care professional within one week of being released
  • When an individual comes to a jail, a records search is done to see if they have touched the mental health system at any time in the past
  • Worked very closely with the Texas Veterans Commission to start a reentry dorm
  • Need to strategically continue to capitalize on existing programs and resources
  • Nelson asked if there is any information that isn’t received that would help on intake
    • Don’t believe so
  • Nelson noted she understand there is an 11% recidivism rate for populations who finish their programs
    • In order to enroll in programs people must be high criminal risk and high clinical needs
  • Nelson asked how many people have high clinical needs and do not finish the program
    • Within the criminal justice population, those on parole have a condition requiring them to participate in mental health treatment
    • Have developed a program for people to step down into once the high frequency treatment is completed

 
Texas Juvenile Justice Department

  • Youth receive comprehensive evaluations and a decision is made on which facility best suits them
  • Whitmire asked what percentage of the juveniles have mental health issues
    • 50% have been diagnosed with mental health issues
  • Nelson asked how TJJD determines whether children need mental health services
    • Upon intake, a series of assessments are done to determine specific needs including substance abuse treatment, mental health treatment, etc.
  • Working on more specialized ways of treating youth more effectively
  • SB 630 from the 84th session helped a lot toward solving problems in rural and less populated areas

 
Sean Hanna, Texas Veterans Commission

  • Provide direct services, award grants to programs that serve veterans and connect veterans to services
  • Military Veteran Peer Network is a collaborative program between TVC and TDCJ; delivered through LMHAs primarily
    • Targeting veterans with a traumatic military experience

 
Dr. Andy Keller, Meadows Mental Health Policy Institute

  • The legislature has built quite a system for crisis management over the last decade; incrementally making progress but there is a lot still to be done
  • The crisis system in Texas is better than that of many other states
  • The legislature has also shored up the mental health safety net which is a big step
  • Targeted strategies to individual populations work very well and the legislature has adopted that approach; should continue along those lines
  • There are a large number of individuals with behavioral health conditions that are living in poverty; Texas does not have the capacity to build out the system to serve those people
  • Texas services focus on serious and persistent mental illness and the focus needs to be shifted to also focus on individuals who have not reached that point yet
  • Youth services also need expansion; generally the system waits until a person is arrested before mental health services are provided
  • Kolkhorst asked if LMHAs are capable of doing the work that is needed
    • They all have programs that can be scaled up and improved with guidance
  • Kolkhorst noted the remoteness of rural Texas is frustrating and sometimes Sheriffs have a hard time getting help from LMHAs; there is a response lag time which is a huge area that we could improve on
  • Most metropolitan counties have a large number of places where a person can be dropped off to be taken to the county jail and very few locations to drop a person off to get them into a mental health facility

 
Lee Johnson, Texas Council of Community Centers

  • About 300 1115 projects are community projects related to mental health; included in those projects are some great examples of what can be done to help super-utilizers of mental health services
  • DSRIP projects have the ability to leverage state dollars and local funds and that has a huge impact on the ability of the programs
  • Looking to local programs can offer insight into what works and what can work across the state; community problem solving has a lot of great opportunities

 
Linda Frost, Hogg Foundation for Mental Health

  • Focusing on three recommendations
    • Services should be provided with a premise that recovery is possible; there is a pathway for everyone to address their concerns
    • Programmatic and financial silos need to be eliminated; an office for mental health that would promote accountability surrounding mental health services would improve the system
    • Integrations of services at the service provision level is important
  • Peer support specialists could also have a tremendous impact and are not a high cost solution
  • There are economical prevention and intervention methods that should be explored

 
Public Testimony
 
Dan Johnson, Behavioral Health Advocacy of Texas

  • Many MCOs have not appropriately outlined the credentialing process for community organizations who are statutorily allowed to provide mental health services through SB 58

 
Jesse McCrum, Austin Clubhouse

  • Testified to the benefits of Austin Clubhouse
  • Bettencourt asked what the clubhouse did best that he was lacking
    • Relationships that he couldn’t have made elsewhere

 
Tracy Spinner, Comprehensive Health for Austin ISD

  • There are many children across the state who have mental health needs
  • Mental health calls to AISD police department are constantly increasing
  • Discussed a pilot in which a full-time licensed psychologist was placed on Crockett HS campus
  • Would like more funding for campus-based services such as this

 
Craig Shapiro, Crockett High School Principal

  • The program described at Crockett HS had many good outcomes including a decrease in school suspensions and class disruptions
  • Student performance outcomes improved as well
  • Need to fund more of these types of programs

 
Will Francis, National Association of Social Workers

  • The classification for licensed clinical social workers is durable medical equipment
  • This is a huge problem for pulling information and determining who these clinical social workers are
  • This also poses a problem in interpreting rules
  • Social workers currently receive 70% of the Medicare reimbursement rate in Texas

 
Elizabeth Portman, Vida Clinic

  • Operate the campus-based mental health centers at Crocket, Bowie and Anderson HS in Austin ISD
  • Discussed the referral process for the mental health centers
  • Schwertner asked if everything is done with parental notification/permission
    • Yes

 
Bill Kelly, Mental Health America of Greater Houston

  • Provide direct services to veterans and services to children in schools
  • Working on an integrated mental health care model
  • 1 in 5 people suffer from a mental health disorder at some point in their lives
  • Texas needs to do more work on jail diversion

 
Greg Haensch, National Alliance on Mental Illness

  • Have seen unprecedented improvements in the mental health service area in the last few years thanks to legislative investment
  • The system is reducing unmet need and more people are receiving services

 
Josette Saxton, Texans Care for Children

  • The state can do a better job of helping schools learn from each other with programs such as what is going on at Crockett HS
  • Having TEA at the table with the Behavioral Health Coordinating Council will help tremendously

 
Amy Granbury, Association of Substance Abuse Programs

  • A lot of what is put into mental health funding does not make it to substance use disorder