texas council legislative retreat
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Political Landscape:
Texas House Races
Political Landscape:
Texas House Races
(cont.)
Major Changes in the Legislature
• New presiding officer in the Senate
(Lt. Governor)
• 8 new Senators
• 25 new Representatives
• New Chairs: Finance, HHS, HAC,
Public Health
• Straus likely to remain Speaker
• More conservative 84th Legislature –
Tea Party is alive and well in Texas
Political
Landscape:
Significant Changes
in Leadership
• 140 Days Every Odd Year
• Specials Called by Gov.
• 181 + Governor, Lt. Gov.
• Must Pass – Budget Bill
• 6,378 Bills Filed in 2013
• TXC Tracked 659 Bills
Texas Legislature 101
During the 140-day session,
the average legislative
office handles :
• 6,000 + bills
• 6,000 + telephone calls
• 5,000 + drop-in visitors
• 8,000 + letters
• 15,000 + emails
• 600 + invitations
Legislative Session
Dynamics
Secure local matching fundsLeverage resources to enhance servicesAcquire grants and giftsEducate the publicFacilitate local planning, identify service gapsDevelop and manage provider networkCoordinate with local partners & volunteersCollaborate with other stakeholdersRespond to disasters & emerging community needs
11
Community Leadership Role(Beyond Traditional Service Delivery)
12
City County Other (e.g., Hospital Distict)Total Local Taxing Authority
Investment
FY 2009 $2,858,986 $50,450,717 $5,069,887 $58,379,590
FY 2010 $4,775,123 $51,915,530 $7,122,817 $63,813,470
FY 2011 $5,377,085 $48,392,672 $15,088,323 $68,975,503
FY 2012 $5,925,356 $51,860,573 $11,167,093 $68,953,022
FY 2013 $5,312,970 $53,806,917 $11,057,638 $70,177,525
$-
$10,000,000
$20,000,000
$30,000,000
$40,000,000
$50,000,000
$60,000,000
$70,000,000
$80,000,000
Local Taxing Authority Investment
NOTE: Local Taxing Authority chart includes fund investment made over the course of 5 years (FY 2009 – FY 2013) to Community Centers. These figures include funds for both Mental Health and Intellectual Disability Services, but the majority of funds from local taxing authorities are directed to mental health services.
(TDCJ) Mental
Health & Criminal
Justice Data
2008 vs. 2014
% of Criminal Justice Offenders w/CARE Match 2008 2014
Prison 27% 34%
Probation 12% 15%
Parole 27% 29%
% of Criminal Justice Offenders w/ ‘Big 3’ 2008 2014
Prison 7% 11%
Probation 4% 6%
Parole 7% 10%
Senate Bill 7
System Redesign
for Medicaid Acute and
Long-term Services
and Support to
Persons with
Intellectual and
Developmental
Disabilities
Attendant/Habilitation Services
become part of the
Medicaid State Plan
under the
Community First Choice option
Attendant
Assistance with activities of daily
living provided to an individual
because of a physical, cognitive
or behavioral limitation related to
disability or chronic health
condition.
Habilitation
Assistance provided to an
individual acquiring, retaining or
improving:
(1) skills related to activities of
daily living; and
(2) social and adaptive skills
necessary to live and fully
participate in the community.
IDD system redesign includes the promotion of independent service
coordination, ombudsman services and the prevention of
inappropriate institutionalization.
DADS to contract with LIDDA for the independent service coordination function in
the new program designed to provide basic attendant and habilitation services.
Local Intellectual and Developmental Disability Authorities—in conducting the
Service Coordination function—will not also provide the new attendant care and
habilitation services.
This requirement does not impact the Local Authority Service Coordination/Local
Safety Net Role as a limited provider of HCS and Texas Home Living waiver
services.
Jail Diversion Program ($10 million/biennium)Establish jail diversion pilot program to be implemented by the Harris County Judge• Pilot target: serve at least 200 frequent
recidivists/year with serious mental illness• Dollar for dollar match with county• Contract executed December 2013• Services started July 2014
Jail-Based Competency Restoration ($3 million/biennium)Pilot to provide mental health services and legal education to individuals found incompetent to stand trial in a jail-based setting• Rules in process of being adopted• Projected to start August 1, 2014 in Dallas
State Budget
(FY 2014-15):
Select Mental
Health & Criminal
Justice
• Sunset Commission Review
• State Budget
• 1115 Transformation Waiver
Renewal/Extension
• HB 3793 Recommendations
• Mental Health First Aid
• Veterans Mental Health
• “Texas Solution” or “Texas Way”
• Revisit System Redesign [SB 7 &
SB 58]
• Re-instatement of Benefits
• Criminal Justice Issues
• Guardianship
• Assisted Outpatient Treatment
• MH Code Updates
84th Legislative
Session:
Public Policy
Priorities (Select)
Sunset Review
Decisions
(DSHS Select)
(DSHS) Issue 1 • streamline hiring practices in state hospitals
• expand contracting with local communities for inpatient psychiatric beds, including input from H.B. 3793 Advisory Panel.
(DSHS) Issue 2 • new process for allocating state hospital beds among
local regions; review methods for allocating regional mental health funding, all related costs and other factors; determine prevalence of mental illness in regional populations
• improve performance measures and payment mechanisms across all DSHS contractors of behavioral health services.
• formalize behavioral health advisory bodies, establish enterprise-wide behavioral health advisory committee
Sunset Review
Decisions
(DADS Select)
(DADS) Issue 1 • close the Austin SSLC by August 2017, all net proceeds
from the sale or lease of the Austin SSLC dedicated for services
• establish an SSLC Restructuring Commission to right-size the number of SSLCs required for the level of need in Texas, report to Legislature by December 1, 2016
• close any SSLCs recommended by the Restructuring Commission by 2025
• submit a plan to improve the quality of care in all SSLCs to the Legislature by December 31, 2014
Sunset Review
Decisions
(DADS Select)
(DADS) Issue 2Recommendations:• expand crisis intervention teams to supports to people with
IDD in the community. • add a reimbursement level that incentivizes small specialized
group homes for people with high medical needs.• Establish the array of services an SSLC can provide to
community clients and the fees for those services
(DADS) Issue 3Recommendation:• create an advisory committee to address the redesign and
potential licensure or certification of all day habilitation facilities, with recommendations to the 85th Legislature.
Sunset Staff
Report
(HHSC Select)
Sunset Staff Recommendations:
Change in Statute 1.1 Consolidate the five HHS system agencies into one with divisions established• Governor appoints executive commissioner, with
Senate confirmation
• Establish divisions along functional lines as basic organizational framework
• Replace agency advisory councils with executive council comprising executive commissioner and division heads
• Form transition legislative oversight committee and develop transition plan
• Continue the basic functions in the single, reconstituted agency for 12 years.
Sunset Staff
Report
(HHSC Select)
Sunset Staff Recommendations (Issue 9): Management Action • Transition services in Dallas area from NorthSTAR to
updated model
Change in Appropriations • Transition NorthSTAR funds to DSHS behavioral
health funding strategies
Change in Statute • State to assist with maintenance of Medicaid
eligibility statewide
• Ensure behavioral health services integrated into managed care organizations statewide
State
Budget:
DADS LAR
FY 2016-17
Exceptional Item #1: Maintain waiver caseload growth ($112.0 million – All Funds)
• Annualize appropriations for approximately 1,775 non-entitlement Medicaid waiver clients
• Allow DADS to continue to continue services to people receiving assistance as of August 31, 2015
• Does not create new slots
Exceptional Item #2: Maintain current service levels ($55.4 million – All Funds)
• Increase in client acuity and costs are expected to trigger a need for additional funding
• Funds are tied to entitlement programs where DADS has little discretion regarding service provision
State
Budget:
DADS LAR
FY 2016-17
Exceptional Item # 3: Reduce community waiver program interest lists by expanding community options ($725.7 million – All Funds); and,
Exceptional Item #4: Promoting Independence slots ($85.1 million – All Funds)
• Increase of 15,780 slots for community-based services
• Full interest list funding for STAR+PLUS CBA waiver and DBMD
• 20% of people on interests lists for HCS, MDCP, TxHmL, CLASS
Distribution of proposed Promoting Independence Slots:• 500 people moving from large ICFs and SSLCs• 216 children aging out of foster care • 400 people at imminent risk of admission to ICF-
IIDs • 120 people with IDD moving from s tate hospitals • 25 DFPS children transitioning from general
operations facilities Total: 1,261
State
Budget:
DADS LAR
FY 2016-17
Exceptional Item #5: Enhance community IDD services for people with complex medical and/or mental health issues ($58.3 million)
• expand crisis respite and behavioral intervention programs
• target services for people with medical or psychological needs
• increase ICF and HCS rates to encourage active treatment of these issues
• provide more intensive service coordination for SSLC residents transitioning to community
Exceptional Item #6: Comply with federal PASRR requirements ($117.7 million)
• create 1,300 HCS and 200 TxHmL slots to be used by people moving or diverted from a nursing facility
• provide range of specialized services and intensive service coordination
State
Budget:
DADS LAR
FY 2016-17
Exceptional Item #7: Protect “vulnerable” Texans ($41.8 million – All Funds)
• hire additional staff in DADS guardianship program
• increase number of assisted living facility ombudsmen
• increase HCS funding limit for dental expenses from $,1000 to $2,000 per person per year
Exceptional Item #7: Maintain/improve SSLC operations ($112 million – All Funds)
• make necessary life safety repairs and renovations at SSLCs
• finance a 10-year replacement plan for vehicles • finance a possible reclassification of Qualified
Intellectual Disability Providers
Exceptional Item #9: Enhance ADRC Structure through the addition of veterans resource specialists ($2.2 million – General Revenue)
State
Budget:
DARS LAR
FY 2016-17
Exceptional Item #1: Maintain Caseload in ECI ($25.9 million – All Funds)
DARS has used more IDEA Part C funds than projected, resulting in less IDEA Part C funding available to maintain base funding levels and to serve eligible children
Exceptional Item #2: Fund forecasted caseload growth in ECI ($24.6 million – All Funds)
Caseload expected to grow to approximately 28,600 children served monthly in FY2016 and 30,100 children in FY2017
State Budget:
DSHS LARFY 2016-17
(4a.) Behavioral Health: Prevention Expansion ($27.8 Million) • Serve an additional 596,284 youths and their families through the expansion of
substance abuse Your Prevention programs into new counties
• Broaden the Speak Your Mind public awareness campaign to include the state’s three prevention priorities of alcohol, marijuana, and prescription drugs
• Extend online interactive behavioral health risk factor awareness training to elementary educators
State Budget:
DSHS LARFY2016-17 (Select)
(5a.) Crisis Services Expansion and Enhancement - $36.8 Million • Build on efforts by the 80th and 83rd Legislatures to support an array of crisis services
• Ensure a facility-based crisis option in all 37 Local Mental Health Authorities and NorthSTAR catchment areas
• Develop crisis sites in 57 counties (10 LMHAs) without beds or a facility-based option
• Enhance crisis service sites: expedited access and transport, coordinated medical care, and substance abuse services
(5b.) Mental Health Surge: Nursing Facilities - $39 Million • Enhance referral for individuals with mental illness or an intellectual or developmental
disability to suitable long-term support and other services
• Coordinate with DADS, HHSA and other partners to ensure standardized screening for potential clients and that there is “no wrong door” into services
• Deliver mental health targeted case management and psychosocial rehabilitation services for nearly 10,000 individuals in nursing homes
• Provide housing and relocation assistance for at risk individuals and nursing home residents ready for movement into the community
State Budget:
DSHS LARFY2016-17 (Select)
(5d.) Expansion and Development of Recovery-Focused Clubhouses ($2.5 Million)
• Allow more individuals with mental health issues access to accredited Clubhouses
• Support existing Clubhouses to expand infrastructure, staffing, days, and service hours in order to increase capacity
• Develop new or early-stage Clubhouses in areas without robust options, requiring a local match of 25%
• Ensure quality of services by requiring Clubhouses to become nationally accredited and meet contract performance measures
• Require Clubhouses to meet a sustainability plan to ensure lasting impact to communities
(5e.) CMBHS and other IT Improvements ($7.6 Million)• Make improvements to the CMBHS electronic records system• Make technical upgrades to allow third party billing, to streamline
processes, and to eliminate dependence on outsourcing and legacy outdated systems
• Automate invoicing and client services tracking for the Home and Community Based Services – Adult MH Program
• Create a Mental Health Crisis mobile application for use by emergency responders, emergency rooms, and other organizations to identify available resources and bed space
State Budget:
DSHS LARFY2016-17 (Select)
(6a.) Ten Year Plan (Rider 83) Preliminary Assessment ($40.0 Million) • Procure an additional 150 beds over the biennium: 50 beds in FY 2016
and 100 additional beds in FY 2017 • Purchase private psychiatric hospital beds throughout the state in
locations where services are needed • Address interim needs pending implementation of the Ten-Year State
Hospital Plan required by DSHS Rider 83 of the FY 2014-2015 General Appropriations Act
State Budget:
DSHS LARFY2016-17 (Select)
Exceptional Item 6b: Expand Medical Residency Program in State Hospitals and Community Centers ($1.2 Million)
• Purchase an additional four FTE residency slots each year, for a total of 19
• Offer rotations in both State Hospitals and Community MH Centers
Exceptional Item 6c: Supported Decision-Making Program ($2.5 Million) • Create a supported decision-making program to facilitate the
discharge of certain long-term state hospital patients to more appropriate community-based facilities
• Provide housing decision-making assistance for 100 state hospital patients who no longer need impatient MH services but cannot be discharged to the community due to lack of support
• Train supported decision-makers to ensure individuals smoothly transition into appropriate community-based services
State Budget:
TDCJ LARFY2016-17 (Select)
Exception Item #8: Texas Correctional Office on Offenders with Mental and Medical Impairments (TCOOMMI) ($6 Million)
• Expand jail diversion services in metro areas to divert an additional 1,250 offenders with special needs from state jails and prisons.
• Expand caseloads that serve offenders with high criminogenicrisk factors and clinical care needs through contracts with LMHAs
• Goal: serve an additional 1,400 offenders
State Budget:
Supreme Court of Texas LARFY2016-17 (Select)
Exceptional Item #5: Justice for Veterans Initiative ($4 Million) • In conjunction with the Texas Veterans Commission (TVC),
the Supreme Court of Texas will create Justice for Veterans initiative to provide funding for Veterans Courts and direct legal assistance to Veterans and their families.
• The TVC will contribute $1.5 million, for a combined $5.5 million that will be awarded via grants to organizations that assist Veterans and their families with legal needs.
Medicaid 1115
Transformation Waiver
Changing Communities in Texas
1115 Project Update
Prevent unnecessary use of services through the development and
implementation of a Mental Health Officer Task Force
Metric Target YTD Outcomes
Provide services to at least 325
unduplicated individuals325 1,253
1,000 service contacts with individuals in
mental health crisis1,000 1,481
Decrease arrest rate of people in a mental
health crisis
85 or
less7 arrests
(Example)Tropical Texas Behavioral Health
General Legislative Considerations:
Texas Council Principles
• Strong Communities
• Local Control
• Public Accountability
• Proven Performance
• Personal Independence
Promote legislative direction that
adheres to established principles and
stop legislative direction that violates
established principles.
General Legislative Considerations:
Adherence to Established Principles
Legislative Priority: Promote & Protect
• Legislative Appropriations:– Do No Harm
– Promote Value of Continued Investment in Community-based Services
Organized and effective grassroots
Presence in the Media
Legislative Champions
Key Partners
Mental health and substance use disorders impact every community
People with intellectual disabilities can and do live successfully in the community with varying levels of support
Understand the gap between need and available resources
Encourage people to tell their own success stories
Effective Legislative
Strategy:
84th Legislative Session
Key Dates:• Tuesday, November 4, 2014
(Election Day) • Monday, November 10, 2014
(prefilling of legislation begins)
• Tuesday, January 13, 2015 (first day)
Lee Johnson
Deputy Director
Texas Council of Community Centers
ljohnson@txcouncil.com
www.txcouncil.com
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