Below is the HillCo client report from the August 13 Sunset Advisory Commission meeting.

The following report focuses only on discussion of commission decisions for the following agencies: Department of Assistive and Rehabilitative Services, Department of Family and Protective Services, Department of State Health Services and Department of Aging and Disability Services.

  • Chair Nelson received 51 modifications to the Sunset Staff recommendation by the deadline of August 6th and thanked the committee for their hard work

 
DARS ADOPTEDLink to DARS Staff Report with Decision Material

  • DARS Lacks Case Oversight to Control Spending and Ensure Effective Delivery of Services.
    • Modification: to begin immediately without statute requirements
  • DARS Lacks Mechanisms for Effectively Integrating, Directing, and Overseeing Its Programs
    • Modification: For SARS to do an evaluation to move the Deaf and Hard of Hearing programs to Centers for Independent Living
    • Modification: For DARS to report on their progress every 6 months to the legislature
    • Modification: Put the Comprehensive Rehab Program in statute
    • Modification: Put the Children’s Autism Program in statute
    • Nelson – we don’t have a strategy for this program; we serve very few children
    • Luce – CMS has a current law for states to put their autism strategy in their state plan
    • Modification: Recycle and reuse of DME – need to ask HHSC and DARS why they say they cannot do this

 
DFPS ADOPTEDLink to DFPS Staff Report with Decision Material

  • Efforts to Reduce Turnover of CPS Caseworkers Fail to Address Key Reasons Many Staff Leave
    • Modification: consolidate the workforce under one workforce officer
    • Require CPS to submit an annual business planning process
  • A Crisis Culture Affects CPS’ Ability to Focus on Day-to-Day Management  Activities Needed to Successfully Perform Its Difficult Work
    • Require DFPS to submit a business report by October of this year to reflect the implementation of Sunset and Steven’s Group recommendations
    • Incorporate Steven’s group report focusing on retention, process and policy
      • Mentoring
      • Strengthening career management
      • Streamline case work
      • Use technology that allows for more time spent with the children and their families
    • Reoccurring 6 month performance measurements and metrics to gauge CPS progress
    • DFPS needs to create on statewide policy unit to eliminate disparities
  • DFPS Faces Significant Challenges and Risks in Its Efforts to Reform the State’s Foster Care System
    • The workforce officer oversees surveys and relay results back to the leadership so the staff feels like they have a voice
    • Expand connection to faith based communities to build wrap around services
  • DFPS Should Elevate the Importance of Its Prevention and  Early Intervention Efforts and Better Use Existing Data to Evaluate Program Effectiveness
    • Modification: make prevention and early intervention their own division that reports directly to the Commissioner

 
DSHS ADOPTEDLink to DSHS Staff Report with Decision Material

  • Resolving the Current Crisis in the State Mental Health Hospital System Requires Action, Starting Now
    • Nelson Modifications:
      • Increase local involvement in hiring for state schools
      • Expand contracted beds
      • Ensure purchase outcomes from contracts
      • Streamline the system
  • DSHS Has Struggled to Deliver Integrated, Outcomes-Focused Community Mental Health and Substance Abuse Services
    • Dutton Modification: The agency needs to review if the money being spent in mental health is truly being used to help mental health care
    • Schwertner Amendment: DSHS needs to review current allocation of mental health funding to make sure it is allocated in areas of prevalence
  • The Unmanageable Scope of DSHS’ Regulatory Functions Reduces Needed Focus on Protecting Public Health
    • Price laid out workgroup Modifications:
      • Perfusionists, physicists, respiratory care specialists and radiologic techs moved under the Medical Board
      • Respiratory care specialists and radiologic techs will have their own licensing function
      • Perfusionists, physicists will have an advisory board
      • 11 programs will be deregulated
      • The rest will transfer over to Texas Department of Licensing Regulation in 2 phases, one in 2016 and the second in 2018
    • Burkett voiced her concern about deregulating dyslexia therapists
  • The State Has a Continuing Need for the Texas Health Care Information Collection Program
    • Schwertner Modification: transfer all data to the EQRO public database for easier use
    • Schwertner Modification: replace the certifying data process with a data validation process with the facilities
    • Schwertner Modification: ensure that the liability of data does not fall to the doctor if there is an improper disclosure at THCIC
    • DSHS to establish a single registry for births, deaths, marriages and divorces

 
DADS ADOPTEDLink to DADS Staff Report with Decision Material

  • Despite Declining Enrollment, Skyrocketing Costs, and Questionable Quality of Care, Texas Continues to Operate 13 SSLCs.
    • Hinojosa:  The reality is that we need both SSLCs and community based centers
      • He recommends that we do not change this staff recommendation
      • There are no waiting lists at SSLCs, but waiting lists for community based services
    • Luce: DADS has the ability to hire an independent contractor for oversight at the SSLCs and during the closure process
    • Schwertner: We need to ensure that we close the Austin State School right and ensure successful transitions into the community
    • Raymond: Shutting these schools down will be a delicate situation – recommends increasing reimbursement rates so communities can provide good living conditions
      • Could build a Center of Excellence in Central Texas
      • No one takes this closure lightly
      • Wants to use the Austin assets to only be used to help the IDD population in the communities, nothing else
    • Hinojosa: clarifying – All funds from the sale of the any SSLCs will go to the treatment for the IDD population
      • Want this to be called the “restructuring commission”
      • Will use the Austin experience to move forward and help to ensure that the IDD population is getting the best care
      • Does not agree with the Staff that there should be a set number of SSLC closures
    • Schwertner: We need a targeted solution that we take away from the Austin closure with the right amount of care and a look into reimbursement rates
  • DADS Lacks Effective Means for Ensuring Its Clients Receive Adequate Care in Day Habilitation Facilities
    • Gonzales noted that the federal guidelines will be changing this fall – we should monitor to align with the Feds
    • Schwertner Modification: DADS needs to adopt rules in a timely manner, by December 2016
  • Few Long-Term Care Providers Face Enforcement Action for Violations
    • Schwertner Modification: DADS needs to adopt rules in a timely manner, by December 2016
    • Dutton:  DADS must license group homes
    • Luce: how can they find them when they are not registered now?
    • Jon Weizenbaum, DADS
      • DFPS has a listing of child care homes, but there are no inspections or licenses
    • Dutton: I just want to know where these homes are
    • Weizenbaum will try to determine the cost to the stat to license these facilities
    • Luce: does this occur more in Houston due to lack of zoning laws?
    • Burkett: Last session I carried a bill for the listing of these facilities and it has been very difficult
    • Schwertner new recommendation: We ned to implement a three strikes rule for nursing facility bad actors that revokes the facility’s license – for facilities that have 3 or more level 4 deficiencies on different days in a 24 month period
      • Hinojosa: We need stricter enforcement but is concerned about subjectivity in a 3 strike rule – it that flexibility away from the agency
      • Level 4 are the worst violations, and this speaks to repeat offenders
    • Raymond: believes that this issue should be a bill, and that he is willing to work with the agency and stakeholders to clean it up and he would be happy to carry it in the House with Schwertner in the senate
    • Campbell: a level 4 offense is measurable and is not up to someone’s discretion
    • Dutton: concerned with arbitrary standards – what happens to the people when the nursing home is shut down?
    • Rules should be interpreted across the state the same at all facilities

 
The next Sunset Meeting will be November 12 and 13.