Texas Council Update Presented to: IDD DiRectors’ Consortium, September 10, 2015 Presented by: Erin E. Lawler, J.D., M.s. Director of IDD Services

Staff and other updates from Texas Council -Change to IDD Director position -Upcoming changes to Director of Recovery Based Services position -Local Authority Workgroup (LAW) new members

Legislative Updates

Consolidation of HHS Agencies Sunset Consolidation of HHS Agencies

IDD Bills of Note

HB 3523: Medicaid long-term care services and supports revisits provisions from Senate Bill 7 (83rd Session) -- IDD System Redesign strengthens the role of the IDD System Redesign Advisory Committee postpones the deadline for implementation of any pilot programs established to improve service delivery from September 1, 2016 to September 1, 2017 adjusts the timelines related to the transition of certain IDD waiver programs into managed care (next slide)

HB 3523 (continued)

SB 1385: administrative penalties on providers in certain Medicaid waiver programs Highlights: authorizes DADS to assess and collect an administrative penalty against a Medicaid provider who participates in the HCS waiver program or the TxHmL waiver program for a violation of a law or rule relating to the program. prohibits DADS from imposing a payment hold against or otherwise withholding contract payments from the provider for the same violation of a law or rule requires the executive commissioner of HHSC, after consulting with appropriate stakeholders, to develop and adopt rules regarding the imposition of the administrative penalties amount not to exceed $5,000 for each violation

SB 1664: ABLE Program Highlights: allows individuals with significant disabilities to maintain an ABLE savings account to cover qualified expenses, including education, housing, transportation, employment training and support, health care, assistive technology and personal support services eligible individuals with disabilities (with an age of onset before age 26) will be able to save their earned income and plan for the future without losing their eligibility for Medicaid instructs the Comptroller to set up ABLE accounts through the Texas Prepaid Higher Education Tuition

Budget Update

DADS Care Management Initiative 24-hour nursing and behavioral health hotlines Support consultative model for addressing complex behavioral needs of people recently transitioned from SSLCs Crisis Respite and Behavior Intervention DADS Sunset Bill would create teams in unserved areas Defines team as specially trained to provide services to people with IDD and behavioral health needs at risk of institutionalization *Money Follows the Person (MFP) 8 Support Teams for IDD/Complex Needs Enhanced community coordination Focused on people transitioning from SSLCS and NFs

Update on Crisis Respite and Behavior Intervention Programs DADS Sunset bill failed, but $18.6 million still appropriated toward this initiative for the biennium in state budget DADS currently working on implementation plan: Considering using a Needs and Capacity Assessment Considering distributing: $6 million in FY 2016 $12 million in FY 2017

Other Initiatives and Implementations

Senate Bill 7: IDD System Redesign DADS recently released a report on the role of LIDDAs as service providers.  The report is posted on the DADS website. The report includes data from FY2006—FY2014 and illustrates the following: Since FY 2006, the number of individuals serviced by a private provider substantially increased; Generally, the types of services provided by LIDDAs and private providers are similar; All CAP increases approved by DADS between FY 2006—FY 2014 were due to individual choice. HHSC posted a Request for Information (RFI) related to the IDD pilot(s) to test managed care strategies based on capitation on July 20, 2015. Request for Proposals to follow.

Community First Choice (CFC) Congratulations on implementing on June 1, 2015! Opportunities and challenges Personal story

Three initiatives DADS Care Management Initiative – expected “go live” October 1, 2015 24-hour nursing and behavioral health hotlines Support consultative model for addressing complex behavioral needs of people recently transitioned from SSLCs Crisis Intervention Teams – expected implementation this year State budget includes funds to create new teams and expand existing resources to unserved areas *Money Follows the Person (MFP) – ongoing 8 Support Teams for IDD/Complex Needs Enhanced community coordination Focused on people transitioning from SSLCS and NFs

*Money Follows the Person (MFP) Proposal: $19 million for 3 years Enhanced services for people with IDD and complex medical/behavioral health needs transitioning from SSLCs and NFs Objective 1: medical, behavioral, and psychiatric support teams $11 million over 3 years Objective 2: enhanced community coordination $7.5 million over 3 years

Objective 1: Eight Support Teams Medical, Behavioral, and Psychiatric Support Teams Eight (8) medical, psychiatric, and behavioral support teams serving all 254 counties of Texas, including all 39 LIDDAs and community waiver providers within a designated region. The teams provide the following support services: Education. Educational activities and materials, such as webinars, videos, and other correspondence, focused on increasing the expertise of LIDDA and providers in serving this population, will be provided at least quarterly. Technical Assistance. Technical assistance will be available upon request from LIDDAs and program providers on specific conditions, with examples of best practices and evidence-based services for individuals with significant challenges. Case and Peer Review. Case and peer review support will be provided to service planning teams that need assistance providing effective care for an individual.

Region Covered LIDDA Service Areas LIDDA HUB 1 Concho Valley, Emergence, Permian Basin, West Texas Emergence 2 Central Plains, StarCare, Texas Panhandle StarCare 3 Betty Hardwick, Center for Life Resources, Helen Farabee, Pecan Valley, Tarrant Tarrant 4 ACCESS, Andrews, Burke, Community Healthcore, Metrocare, Denton, Lakes, LifePath, Spindletop, Texoma Metrocare 5 ATCIC, Bluebonnet, Brazos Valley, Central Counties, Heart of Texas ATCIC 6 Alamo COG, Camino Real, Gulf Bend, Hill Country Hill Country 7 Border Region, Coastal Plains, Nueces County, Tropical Texas Nueces County 8 Gulf Coast, Harris, Texana, Tri-County Texana

Objective 2: Enhanced community coordination Enhance current Local Authority responsibilities: service planning and continuity (pre- and post-relocation), crisis and critical care help to access behavioral and/or medical supports, to ensure uniquely designed supports through person-centered process, and to increase responsibility to ensure services are delivered as planned and intervene as needed to adapt care to meet individual needs.

Outreach

Disability-themed issue of the Texas Bar Journal Commemorating the 25th anniversary of the signing of the Americans with Disabilities Act (ADA) Texas Bar Journal: official publication of the State Bar of Texas Only legal publication mailed to every member of the Texas Bar. Monthly publication with a circulation of 102,000 readers.

Summary Major initiatives to improve long-terms services and supports for people with IDD in Texas continue. Congratulate yourselves for your hard work in the face of much change! Questions: elawler@txcouncil.com.