Both the Senate Committee on Health & Human Services as well as the House Committee on human Services have published their interim reports. See belo for highlights from the reports.
House Committee on Human Services
Interim Charge I – Behavioral Health – Examine Crisis Resources for individuals with co-occurring mental illness and intellectual/developmental disabilities. Identify strategies to serve individuals with complex behavioral and medical needs in the community.
Recommendations:
- For purposes of uniformity and transparency across all state programs, including crisis services, HHSC should study the benefits and feasibility of developing and utilizing standard definitions for the terms “Developmental Disability” and “Related Condition”.
- HHSC should expand awareness and the use of trauma-informed care for persons with I/DD.
- LAs and LMHAs should whenever feasible integrate training and education for personnel providing intake services, assessments, service coordination and crisis services.
Interim Charge II – Foster Care Redesign – Monitor the implementation of Foster Care Redesign. Evaluate its impact on the child welfare system in areas of the state where redesign is underway, including transition from the legacy system, foster family retention and recruitment, placement stability, permanency, and child safety.
Recommendations:
- The state should remain committed to redesigning the paid foster care service delivery system, but the FCR rollout should be temporarily delayed pending further evaluation of available data, additional PPP input, and possible legislative direction.
- The PPP should play a primary role in developing data-based refinements to the FCR model prior to each subsequent rollout.
- Prior to each subsequent rollout, DFPS should ensure that all tasks and related FTEs to be transferred from DFPS to an SSCC are clearly identified, agreed upon and fully funded, including fringe expenses for transferred FTEs
- DFPS should work with the PPP to develop future FCR catchment areas to ensure existing community-based systems and provider bases are preserved and their potential maximized.
- DFPS should dedicate an appropriate number of personnel within the agency’s ombudsman division specifically assigned to address provider and consumer complaints, including allegations of abuse, within the paid foster care system.
- DFPS should continue the use of independent, third-party evaluation of FCR rollout until implementation is complete in one non-metropolitan catchment area and one large metropolitan catchment area.
- DFPS should set aside a portion of Federal Adoption Incentive dollars each budget cycle to be reinvested in sustaining adoptions by increasing the number of post-adoptive parent liaisons within each service region, focusing on those areas not currently served by a liaison.
Interim Charge III – SB 7 (83R) – Monitor and evaluate implementation of SB 7 (83R), including agency preparations for the statewide rollout of STAR+PLUS.
Recommendations:
- It is the committee’s opinion that implementation of S.B. 7 should continue as planned using the timeline cited by HHSC and included with this report.
- This committee should continue to closely monitor the various managed care carve-ins required by S.B.7, and any resulting impact to service delivery.
- HHSC should require participating STAR+PLUS MCOs to adhere to network adequacy standards that to the greatest extent possible align with Medicare Advantage standards.
- HHSC should implement a single portal for provider claims submission and work with providers to decrease unnecessary paper-based claims.
- HHSC should work to increase its efforts to solicit and consider relevant stakeholder input as specifically called for in S.B. 7.
Interim Charge IV – Foster Care/Higher Education – Former foster youth have the benefit of free tuition and fees if they enroll in higher education, yet very few take advantage of this opportunity. Consider new strategies to support these youth and make recommendations to enroll and retain more foster youth in higher education. (Joint charge with the House Committee on Higher Education)
Recommendations:
- THECB should implement a mechanism in the state’s common application for higher education for students to self-identify as former foster care youth so that institutions of higher education can inform them of their right to the exemption.
- The collaborative model between DFPS, TEA and other stakeholders for the K-12 foster youth population should be broadened to include postsecondary education stakeholders, including the THECB.
- DFPS should work collaboratively with stakeholders to implement a training program specifically designed to assist foster parents in navigating the state’s public higher education system.
- Colleges and universities should develop volunteer mentorship programs using former foster youths to support incoming students participating in the tuition and fee waiver program.
- DFPS and the THECB should collaborate to create a mechanism for tracking the outcomes of current and former foster youth who utilize the tuition and fee waiver.
Interim Charge V – Implementation of 83rd Legislation – Conduct legislative oversight and monitoring of the agencies and programs under the committee’s jurisdiction, including implementation of the Balancing Incentives Program and relevant legislation passed by the 83rd Legislature. In conducting this oversight, the committee should:
- consider any reforms to state agencies to make them more responsive to Texas taxpayers and citizens;
- identify issues regarding the agency or its governance that may be appropriate to investigate, improve, remedy, or eliminate;
- determine whether an agency is operating in a transparent and efficient manner; and
- identify opportunities to streamline programs and services while maintaining the mission of the agency and its programs.
Recommendations:
- The committee supports the recommended due process and transparency reforms impacting the HHSC Office of Inspector General unanimously adopted by the Sunset Commission at its December 10, 2014 public meeting.
Senate Committee on Health and Human Services
Interim Charge I – Child Protective Services – Review the Department of Family and Protective Services’ efforts to reduce child fatalities. Review the process by which the Department of Family and Protective Services collects and uses data to evaluate agency performance and improve outcomes for children in the Child Protective Services system. Make recommendations to ensure the process effectively uses data to strategically improve caseworker performance, and identify and improve upon deficiencies within the system and improve overall outcomes for children and reduce child fatalities.
The Committee concluded that they fully supported and endorsed the recommendations adopted by the Sunset Advisory Commission at their August 13 decision meeting, which aimed to improve child safety and caseworker retention, and strengthen the overall management structure of the agency.
Noted in the Interim Report to the 84th, on August 13, 2014, the Sunset Advisory Commission adopted all of Sunset’s recommendations, in addition to several member modifications that will:
- Statutorily require CPS to develop an annual business plan that will be reported to the Legislature;
- Require DFPS to implement appropriate changes identified in the Stephen Group Operational Review with an immediate focus on changes related to retaining caseworkers, process changes that will improve the computerized casework system and facilitate structured decision making, and streamlining policy to refocus team members on spending time with children and families;
- Require DFPS to report CPS performance measures to the Sunset Advisory Commission every six months, including staff turnover rates and recidivism into the CPS system;
- Direct CPS to expand its connection to the faith-based community, beyond adoption and permanency, to fill gaps in contracted services; and
- Elevate the Prevention and Early Intervention programs within CPS to a separate division that reports directly to the Commissioner.
Interim Charge II – Mental Health and Substance Abuse – Monitor the implementation of programs that were created or expanded by the 83rd Legislature to improve mental health and substance abuse services and assess these efforts' contribution to improved outcomes such as reduced recidivism in state hospitals, diversion from emergency rooms and county jails, and access to permanent supportive housing. Identify and address gaps in the current mental health and substance abuse system and make recommendations to better coordinate services across agencies and programs.
Recommendations:
Structural reform
- Mental health and substance abuse programs should be elevated from their current status as a division within the Department of State Health Services to a more highly visible position within the Health and Human Services Enterprise that will ensure adequate leadership and accountability
Early Intervention and Identification
- Expand Mental Health First Aid to include additional school personnel
Mental Health Workforce
- Create a loan repayment program for mental health professionals
- Promote the use of Certified Peer Specialists
Diversion from Higher Cost Settings
- Ensure crisis stabilization services are available in all areas of the state to avoid more costly and restrictive treatment settings such as Emergency Rooms and county jails
- Carefully evaluate the Harris County Jail Diversion Pilot Program to determine if expansion is warranted
Collaboration
- Encourage jails to allow Mobile Crisis Outreach Teams into their facilities
- Create a centralized online source of information about behavioral health prevention, treatment, and recovery for patients, families, providers and advocates
Integration
- Encourage integration of substance abuse and mental health services by providing grants for the co-location of providers
Interim Charge III – Women’s Health – Build on previous legislative achievements in women's healthcare by examining women's access to preventative health care, pregnancy services, and post-partum care, and exploring ways to expand access and improve quality, particularly in rural and underserved areas of the state. Monitor the implementation of women's health programs in Texas. Assess these programs' impact on outcomes such as improving access to preventative services, reducing unplanned pregnancies, and achieving cost savings. Recommend ways to better coordinate the various programs in a manner that increases the number of women served, ensures adequate provider capacity statewide, and maximizes efficiencies to the state.
Recommendations:
- Consolidate women's health programs at one state agency
- Reduce gaps in family planning coverage
- Add-on payment for LARCs
Interim Charge IV – Alternatives to the Affordable Care Act – Identify cost-effective alternatives to Medicaid and the Affordable Care Act to better connect low income individuals to health care services through private market-based solutions, including Medicaid block grants and waivers. Recommendations should strive to encourage cost sharing, promote personal responsibility, reduce uncompensated care costs, contain increasing health care costs, improve access to care, address access to emergency department care issues in rural areas, promote the use of existing private coverage or employee sponsored coverage, reduce non-emergency use of emergency departments, and reduce the need for federal approval to the state Medicaid plan.
Recommendations:
- Texas should encourage congressional action to operate Medicaid as a block grant program and should simultaneously continue to pursue a waiver from the Centers for Medicare and Medicaid Services (CMS) to allow the state increased flexibility in the operation of our Medicaid program
- Support successful programs and entities that have local buy-in and include local funding sources
Interim Charge V – Temporary Assistance for Needy Families – Evaluate the Temporary Assistance for Needy Families (TANF) program structure. Make recommendations to improve the program's operations and ensure the program achieves outcomes that allow TANF recipients to find employment and achieve self-sufficiency. Recommendations should seek to ensure Texas is using the most effective work-related requirements and drug testing protocols.
Recommendations:
- Require Drug Screening for adult TANF applicants
- Remove exemption from work requirements for adults in child-only cases who have been disqualified from TANF for non-compliance or reaching lifetime benefit limits
- Require the Personal Responsibility Agreement (PRA) signed by adults in child only cases, where applicable, to include a requirement to fulfill work requirements and to attend parenting classes, if referred
Interim Charge VI – Prescription Drug Abuse – Evaluate the current state of prescription drug abuse and strategies for reducing prescription drug abuse in Texas. Make recommendations on how these policies can be improved or modified to enhance the State of Texas' handling of services, treatments and education related to prescription drug abuse and to reduce the overall prevalence of prescription drug abuse.
Recommendations:
- Transfer the PAT system and associated appropriations from DPS to the Texas State Board of Pharmacy (TSBP)
- Give TSBP authority to join the national Prescription Monitoring Program (PMP) InterConnect
- Enhance usability of the PAT system by enabling the TSBP to make the following changes:
- Create push notifications to notify current PAT users when certain criteria for a patient is met that may indicate doctor shopping, such as obtaining and filling prescriptions from multiple providers;
- Allow data to be integrated into electronic health records; and
- Automatically notify pharmacies via PAT if a physician's prescriptive identity has been compromised.
- Automatically register providers in PAT upon receipt or renewal of their Controlled Substance Registration permit to encourage use
- Align the Controlled Substance Registration permit for advanced practice registered nurses and physicians' assistants with license renewal, similar to the aligning of these requirements for physicians in House Bill 1803, 83rd Regular Session
- Enhance services, education, and outreach to communities and providers in order to reduce the prevalence of and treat the symptoms of NAS
Interim Charge VII – Implementation of 83rd Legislation – Monitor the implementation of legislation addressed by the Senate Committee on Health and Human Services, 83rd Legislature, Regular Session, and make recommendations for any legislation needed to improve, enhance, and/or complete implementation, including but not limited to:
- Monitor implementation of initiatives aimed at improving the quality and efficiency of Medicaid long-term care services and supports, including the redesign of services for individuals with intellectual and developmental disabilities
- Monitor implementation of initiatives aimed at reducing fraud, waste, and abuse in Texas Medicaid and other health and human services programs
- Dental Board Reforms: Monitor implementation of initiatives aimed at improving the State Board of Dental Examiners' ability to protect public safety, including strengthening the Board's authority and enforcement powers, improving the complaint review and resolution processes, and increasing staffing to improve the Board's ability to respond to complaints and potential fraudulent activity. Determine whether there are additional changes necessary to ensure that the Board is able to regulate the practice of dentistry and ensure public safety
- Cancer Prevention and Research Institute: Monitor implementation of initiatives aimed at restructuring the governance structure, eliminating conflicts of interest, and increasing transparency at the Cancer Prevention and Research Institute of Texas (CPRIT)
Recommendations:
Senate Bill 7
- HHSC should carefully and continuously monitor the adequacy of the acute care provider network for the IDD population in STAR+PLUS and focus on developing that network in all areas of the state
- HHSC should continue and enhance communications with consumers, families, providers, and advocates impacted by the expansion of managed care for the IDD population to proactively identify and address issues
Senate Bill 8
- HHSC should continue to carefully monitor the performance of MTOs contracting with the agency to provide services in MTP to ensure clients receive timely access to transportation and to ensure transportation providers are appropriately staffed during peak hours of demand for services
- Continue to improve the regulation of the EMS industry to reduce the incidence of fraud, waste and abuse.
- Enact whistleblower protections for EMS personnel who report violations to the state oversight agencies;
- Require prior written approval from a governmental authority in the area in which an EMS provider plans to operate prior to expansion of an existing EMS provider's service area; and
- Direct DSHS to determine the potential benefits of regulating non-medical stretcher and wheelchair transportation in Texas as a means to reduce fraud and contain costs.
Dental Board Reform (HB 3201) – The Texas State Board of Dental Examiners should:
- Clarify its existing statutory authority to regulate the activities of non-dentists which impact the practice of dentistry, and identify potential statutory changes necessary to effectively prohibit undue influence on dental practices;
- Continue to improve transparency in their rule-making process; and
- Continue to utilize the increased Full-Time Equivalent employees (FTEs) appropriated by the 83rd Legislature to further reduce the average time that cases are open and the number of unresolved complaints.
Cancer Prevention and Research Institute of Texas (SB 149) – CPRIT should:
- Continue to operate the agency and the Oversight Committee in a transparent way and allow for ongoing public input; and
- Begin developing a plan to transition the Institute to a fully self-sufficient entity by their Sunset date of 2021, as envisioned when the agency was created.
