Continuing Legal Education This session qualifies for 1.5 hours of CLE credit. Course Title: 34th Annual Texas Council Conference Course Number: 174051119 Date: June 19-21, 2019

Texas Council Annual Conference June 21, 2019 Danette Castle, Executive Director Lee Johnson, Deputy Director Texas Council of Community Centers

Chief Executive Officer Danette Castle dcastle@txcouncil.com Board of Directors Gladdie Fowler, Chair gladdiefowler@gmail.com Chief Executive Officer Danette Castle dcastle@txcouncil.com Deputy Director Lee Johnson ljohnson@txcouncil.com Chief Fiscal Officer Jay Snyder jsnyder@txcouncil.com Office Manager Tara Brown tbrown@txcouncil.com Director of Communication, Education and Training Maria Rios mrios@txcouncil.com Healthcare Policy Director Erin Lawler elawler@txcouncil.com Director of IDD Services Isabel Casas icasas@txcouncil.com Communication Specialist Jackie Wang jwang@txcouncil.com Director of Children’s Mental Health Services Leela Rice lrice@txcouncil.com Director of Recovery Based Services Janet Paleo jpaleo@txcouncil.com Director of Adult Behavioral Health Jolene Rasmussen jrasmussen@txcouncil.com Legal Counsel (contracted)

Community Mental Health Act of 1963 Texas MHMR Act of 1965 Federal funding for Community MH Centers Community-based service philosophy Emphasized natural support systems, new medications, regionalized relationship with state facilities Catalyst for state legislation and funding Authorized local taxing authorities (counties, cities, hospital districts, school districts) to create local governmental entity appoint local governing board develop community alternatives to treatment in large residential facilities Established local, state and federal partnership to create a community based system for people with mental illness and intellectual disabilities Created the Texas Department of MHMR The Community Center system of Texas was launched as a result of two pieces of legislation, the federal Community MH Act of 1963 (specifically referred to as the Intellectual Disability and Community Mental Health Facilities Construction Act) and its Texas companion, the Texas MHMR Act of 1965. Of note, the 1963 Act, which turned 50 on October 31, 2013, was the last piece of legislation President John F. Kennedy signed before his death on November 22, 1963. In President Kennedy’s “Special Message to Congress” setting the stage for passage of the Act, he called on “Governments at every level—Federal, State and local—private foundations and individuals citizens to all face up to their responsibilities” relating to people with mental illness and intellectual disabilities, citing the tragedy of our failure as a nation to recognize the circumstances of individuals and families of individuals facing these conditions. Outlining three major objectives, To seek out the causes of mental illness and intellectual disability and eradicate them, “noting an ounce of prevention is worth a pound of cure” To strengthen the underlying resources of knowledge and, above all, of skilled manpower necessary to mount and sustain professionals and paraprofessionals who work in this field; and To strengthen and improve the programs and facilities serving people with mental illness and intellectual disabilities. …the Act called on communities and states to leverage local and state funds in order to take advantage of available federal funds for developing Community Centers. As directed by the federal government, the Texas legislature focused on two eligible populations, people with mental illness and people with intellectual disabilities. The Texas Act of 1965 gave communities the authority to design regions that made most sense at the local level and expressly called on them to create alternatives to institutional placements. This decision rested on the premise that local communities will have more ownership and be more willing to invest if they have authority over who they’ll partner with in this endeavor. The federal government bailed on us before adequate gains could be made…but over the years

Community Centers of Texas 1 ACCESS 2 Andrews Center Behavioral Healthcare System 3 Austin Travis County Integral Care 4 Betty Hardwick Center 5 Bluebonnet Trails Community Services 6 Border Region Behavioral Health Center 7 MHMR Authority of Brazos Valley 8 Burke 9 Camino Real Community Services 10 The Center for Health Care Services 11 Center for Life Resources 12 Central Counties Services 13 Central Plains Center 14 Coastal Plains Community Center 15 MHMR Services for the Concho Valley 16 Metrocare Services 17 Denton County MHMR Center 18 Emergence Health Network 19 Gulf Bend Center 20 Gulf Coast Center 21 The Harris Center for Mental Health & IDD 22 Heart of Texas Region MHMR Center 23 Helen Farabee Centers 24 Hill Country Mental Health & Developmental Disabilities Centers 25 Lakes Regional Community Center 26 LifePath Systems 27 StarCare Specialty Health System 28 Behavioral Health Center of Nueces County 29 Pecan Valley Centers for Behavioral & Developmental Healthcare 30 PermiaCare 31 Community Healthcore 32 Spindletop Center 33 MHMR Tarrant 34 Texana Center 35 Texas Panhandle Centers 36 Texoma Community Center 37 Tri-County Behavioral Healthcare 38 Tropical Texas Behavioral Health 39 West Texas Centers UPDATED 2018-06

85th session there were 95 Rs to 55 Ds Began on January 8th Ended on May 27th 140 days in odd number years 28 Million people Growth of the state budget this session: We went from a state budget of $216 B (FY 18-19) to $250 B + $9 B supplemental (FY2020-21)... House 85th session there were 95 Rs to 55 Ds 86th session there were 83 Rs to 67 Ds Senate 85th session there were 20 Rs to 11 Ds 86th session there were 19 Rs to 12 Ds

Statewide Republicans were held to single digit victories by the Democrats

The Big Three Biggest story at the beginning of the session was: New House Speaker Dennis Bonnen, R (Angleton) First open race for House Speaker in 25 years. He’s been serving in the House since 96

What is Intellectual Disability? Intellectual disability is a condition characterized by significant limitations in reasoning, learning, problem-solving, and practical and social skills. Formerly described by the term “mental retardation” (now considered disrespectful), intellectual disability is often evident at birth or in early childhood and must have occurred before age 18. Causes include trauma and genetic conditions, such as Down syndrome. People with intellectual disabilities face higher rates of abuse, neglect, and exploitation than the general population and people with other disabilities. Shift to discuss major public policy priorities for the Texas Council during the 86th legislative session… First was IDD services

86th Legislative Session: IDD Services Priorities SB 7 (2011) Protective Provisions Delay IDD LTSS into Managed Care Comprehensive Service Provider Requirements for IDD Services LIDDA Targeted Case Management Provider Rates: Uphill battle, not in HHSC Legislative Appropriations Request Transition of IDD Waiver services to managed Care: Pilot program required before transition. TxHmL Delayed until 2027 HCS Delayed until 2031 Provider Rates: Rider 44. Rate Increases: Intermediate Care Facilities and Certain Waiver Providers. $10,018,488 in General Revenue and $15,454,404 in Federal Funds in fiscal year 2020 and $10,966,874 in General Revenue and $17,878,140 in Federal Funds in fiscal year 2021 in Strategy A.3.1, Home and Community-based Services (HCS), to increase the factor for HCS providers from 4.4 percent to 7.0 percent for facility-based services and to provide a rate increase with the intent that the additional funds be spent for the benefit of direct care staff, including direct care staff wages; Rough edges, no new $ for TxHmL

86th Legislative Session: Mental Health Services Priorities Outpatient Treatment Capacity for Adults and Children Locally Purchased Inpatient Bed Capacity Criminal Justice / Mental Health Interface School Safety / Mental Health Interface Substance Use Disorder Services State Hospital System Redesign

Catalysts for Action (Select) SB 58: BH Integration Advisory Committee (2014) Rider Directed BH Strategic Plan (2015) Rider Directed CCBHC Grant (2015) 1115 Waiver Transition Plan (2019) HB 2196: Integrated Care Study (2009) Patient Protection & Affordable Care Act (2010) 1115 Waiver (2011) SB 58: MH Rehab and TCM into Managed Care (2013) Mental Health Parity Act (1996) U.S. Surgeon General (1999) Rider Directed: SUD Treatment Medicaid Benefit (2009) HB 2303: Expanded Center Scope (2009) Over the years our system has been leading the way on significant change.

Amend/Extend 1115 Waiver Amendment AMH 1115 Waiver Amendment CMHC DSRIP Waiver Pool Funds Tailor STAR+PLUS: CCBHC as a Class of Providers and Directed Payments Access to STAR+PLUS Benefits for a Targeted SMI Population Integrated Care Capacity-Building Initiative (Estimated 14% of current DSRIP Funding Pool) Amend/Extend 1115 Waiver Amendment 1115 Waiver Pool Funds Access to CCBHC as a Class of Providers and Directed Payments based on diagnosis Access to Private Insurance Benefits based on income (Current 1115 Waiver Funding) Substantial conversation with membership during the session Texas Council given latitude to make decisions based on evolving legislative strategy Describe the slide Describe Rider combined Going it on our own Leadership believed and we agreed, that legislative direction was not necessary. The question was always, would the agency act… What’s the rush… another session in 2021 before DSRIP is totally gone… Maintain flexibility by not having specific direction from the legislature to negotiate with the Feds…

State Hospital System Total HHSC Request: $784M Total Funded: $445M ASH Requested: $282M Funded: $165M SASH Requested: $323M Funded: $190M Rusk Requested: $90M Funded: $90M

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IDD Waiver Programs Program Requested Received CLASS 719 240 DBMD 8 HCS 2,375 1,320 MDCP 235 60 STAR+PLUS HCBS 397 TxHmL 905 TOTAL 4,639 1,628 IDD Waiver Programs

Total bills filed: 7798 total bills tracked: 1546 Of total tracked bills, 242 passed. (16%)

End of Session Report https://www.txcouncil-intranet.com/wp-content/uploads/2019/06/Comprehensive-End-of-Session-Report.pdf