1. Texas Council Update Presented to: IDD Directors’ Consortium
January 10, 2017
Presented by: Erin E. Lawler, J.D., M.S.
Director of IDD Services
Texas Council of Community Centers

2. Texas Legislative Session
January 10, 2017:
Texas Legislative Session
Begins

3. Key Dates - 85th Texas Legislative Session
Bill pre-filing begins:  Nov 14, 2016
 1st day of session:  Jan 10, 2017
 Adjournment:  May 29, 2017
 Deadline for governor to sign or veto:  June 18, 2017
 Effective date (91st day after adjournment):  Aug 28, 2017

4. To reach Erin during session
(call/text)

5. HHSC: Legislative Appropriations Request
Overview. HHSC, which now oversees IDD client services formerly housed in DADS and DARS, released its Legislative Appropriations Request (LAR) in September HHSC requested $81.6 billion for FY This includes:
$75.6 billion in base funding
$6 billion in Exceptional Items.
Transformation. With the consolidation, HHSC’s financial and appropriations outlook is substantially different from previous biennia.

6. Base Strategy Request Summary: IDD
Base spending
(Est Bud. 2017)
Baseline request
(BL BL 2019)
Biennial change: amount / %
HCS Waiver (A.3.1)
$2,291.8m
$2,441.5m
$149.7m / 7%
TxHmL Waiver (A.3.4)
$222.7m
$187.3.m
($35.4m) / -16%
Non-Medicaid IDD Community Services (F.1.3)
$86.8m -
Intake, Access, and Eligibility (Local Authority) (I.2.1.1)
$309.6m
$312.4m
$2.7m / 1%

7. IDD Crisis Services / Base Budget
FY2016
FY2017
Biennial Total
$6 million
$12 million
$18 million
FY 2018
FY 2019
$9 million
$9 million =

8. IDD Exceptional Items GR = General Revenue
AF = All Funds (includes federal funds)

9. EI 3: Waiver Slots ($29.9m GR/ $70.2m AF)
Waiver Slots. Per Legislative Budget Board instructions, HHSC’s base budget request includes funding to maintain HCS and TxHmL waiver program service levels at the average of the FY biennium. Exceptional Item 3 would fund the gap between the biennial average service level and the end-of-biennium service level.
HCS end-of-biennium service level was higher than biennial average due to ramp-up.
TxHmL end-of-biennium service level was lower than biennial average; due to higher than anticipated costs after implementation of Community First Choice in TxHmL, intake for TxHmL was suspended during the FY2016-FY2017 biennium.

10. EI 7: MFP ($13.0m GR/$13.0m AF)
Continuation of Money Follows the Person Initiatives. Through Exceptional Item 7, HHCS requests funds to sustain Enhanced Community Coordination (ECC) services and Transition Support Teams (previously known as the Medical, Behavioral, and Psychiatric Support Teams or “hubs”) when the Money Follows the Person grant funding ends after FY 2017 ($13.0m GR/$13.0m AF).

11. EI 14: Promoting Independence ($50.3 GR/$114.5 AF)
Promoting Independence. If Exceptional Item 14 is funded, HHSC would continue to transition and divert individuals to HCS waiver placements, rather than institutional care, through the Promoting Independence program. For the first time, MDCP slots would also be available under Promoting Independence to children at risk of nursing facility admission.

12. Exceptional Item 14: Promoting Independence (continued)
Promoting Independence Groups
Number / Slot Type
Individuals transitioning from SSLCs
400 / HCS
Individuals transitioning from large-medium ICFs-IID
100 / HCS
Children aging out of foster care at DFPS
236 / HCS
Individuals in crisis and/or at imminent risk of institutionalization
Individuals with IDD moving from state hospitals
120 / HCS
Children in transition from DFPS general residential operations facilities
40 / HCS
Individuals with IDD transitioning from nursing facilities
700 / HCS
Individuals with IDD diverted from admission to a nursing facility
600 / HCS
NEW: Children at imminent risk of nursing facility admission
550 / MDCP

13. EI 15: Reducing Community Program Interest Lists ($346. 3m GR/$803
EI 15: Reducing Community Program Interest Lists ($346.3m GR/$803.4m AF)
Full interest list funding for:
Deaf Blind Multiple Disabilities (DBMD)
Medically Dependent Children’s Program (MDCP): Supplemental Security Income (SSI)
CRS
Independent Living Services
Mental Health
• 20 percent of estimated number of eligible individuals on interests lists for:
Community Living Assistance and Support Services (CLASS)
Home and Community-based Services (HCS)
MDCP: Medical Assistance Only
Texas Home Living (TxHmL)
10 percent of interest lists for Non-Medicaid Services (Title XX)
This item also provides FTEs to ensure slots are enrolled on a timely basis and provide adequate regulatory and contract oversight.

14. Exceptional Items 38 and 39: Wage Enhancements
Wage Enhancements for Community Direct Care Workers. HHSC requested two Exceptional Items related to enhancing wages for direct care workers. Exceptional Items 38 and 39 would raise the minimum wage for attendants from $8.00/hour to $8.50/hour and increase wage enhancement through the Attendant Compensation Rate Enhancement program.

15. Exceptional Item 40: HCBS Settings Compliance
Funds for HCBS Settings Compliance. In Exceptional Item 40, HHSC request $30.6m GR / $70m AF to assist community providers to come into compliance with the federal Home and Community-Based Services settings regulations. Funds might include rate increases, additional services added to service arrays, and increased state oversight.

16. IDD Legislative Advocacy: Focus Area Briefs
Adopted by the Texas Council Board of Directors on October 29, 2016:
IDD Services One-Pager
ECI Policy Brief
Both documents are available for your use on the Legislative Documents page of the Texas Council website:

17. Congratulations, Haley Turner
Congratulations, Haley Turner! Deputy Associate Commissioner of IDD Services, HHSC
In December 2016, Haley (formerly of ATCIC) accepted the position of Deputy Associate Commissioner of IDD Services, HHSC.
Haley works in the IDD and Behavioral Health Services Cross Division Office.

18. Texas Council Focus Areas for LIDDA-HHSC Relations (Preliminary)
1. Contract processes
opportunities for meaningful feedback on the performance contract
timely distribution of quarterly allocations
timely reimbursement for PASRR Specialized Services 
2. Money Follows the Person funding (ECC and Transition Support Teams)
3.  Direct Service Targets
4. Communication
improve usefulness of the Local IDD Authority COMNet
increase efficiencies in Program Enrollments
develop CFC subject matter expertise
5. Case management monitoring function / administrative burden of case notes

19. General Revenue Service Targets
Local IDD Authorities are still in an unofficial “hold harmless” period; no financial penalties will be assessed for service targets not met.
As usual, HHSC is requiring Corrective Action Plans (CAPs) from Centers who did not meet targets.
Texas Council continues to work with HHSC leadership on reasonable targets to funding.
Not attempting to adjust funding.

20. FY 2015 General Revenue Recoupment
December 2016: HHSC indicated seven (7) Local IDD Authorities will be subject to recoupment of lapsed 2015 General Revenue funds (total: $411,000).
Recoupments are likely to occur in 2017.
Texas Council staff analyzed Report IIIs related to lapses funds. If you have questions, contact me.

21. IDD Managed Care Pilot / SB 7 Advisory Committee
IDD Managed Care Pilot RFP released January 3, 2017
Pilot procurement schedule:
Proposals Due: February 16, 2017
Award Announcement: April 10, 2017
Anticipated Contract Effective Date: May 5, 2017
IDD System Redesign Advisory Committee (SB 7 Committee) 2016 report published online November 2016:

22. HMN Support (Maybe) Coming to HCS
New Services to be added in High Medical Needs Support, High Medical Needs Support Registered Nursing, and High Medical Needs Licensed Vocational Nursing may be added as new services to the HCS Waiver Program in 2017.
Available to Individuals with High Needs. These services will provide additional support for eligible individuals who have medical needs that exceed the service specification for existing HCS services and require additional support in order to remain in a community setting.
LON Bump. The same rule amendments will include DADS current practice of increasing a Level of Need (LON) 1, 5, or 8 to the next LON due to an individual’s high medical needs if the individual meets certain criteria, including requiring 181 minutes or more per week of face-to-face nursing services.
Status. Implementation is delayed. Stakeholders provided feedback in multiple venues, including at the Medical Care Advisory Committee, encouraging HHSC to revise relevant rules to expand eligibility to include, not only those individuals who receive 181 or more minutes per week of face-to-face nursing, but also those who receive a commensurate number of minutes of delegated nursing tasks. This feedback, and the cost associated with expanding eligibility in this way, is currently under review by the agency.

23. Provider Reimbursement for Installation of Sprinkler Systems in 4-bed HCS Group Homes
DADS processed all reimbursement requests from March 1, 2016 round and funds remain available.
Second round of reimbursement requests will commence soon.
Providers may be reimbursed up to 50% of installation costs, not to exceed $10,000 per home, for installations made after September 1, 2012.

24. DOL Overtime Regulations: Temporarily Blocked
Changes blocked. Changes to Department of Labor overtime rules scheduled to go into effect December 1, 2016 have been temporarily blocked. 
Effect of rules. Overtime rules would increase the salary threshold under which employees qualify for overtime pay to $47,476 a year, extending overtime eligibility to an estimated 4 million American workers. 
Response to Texas lawsuit. November 22, 2016: a federal judge granted a temporary injunction, barring the rules from going into effect. The judge's action was in response to a lawsuit filed by Texas and Nevada on behalf of 21 states, claiming the overtime rules amounted to federal overreach and posed an undue burden on employers. 
Fate uncertain. The ultimate fate of the rules is uncertain at this time.

25. HCBS Settings Regulations / Day Habilitation
Texas Council and LIDDA representatives participated in a series of stakeholder workgroups to discuss strategies to bring Texas day habilitation sites into compliance with HCBS rules.
Texas Council feedback emphasized:
Need for gradual, measured approach to transition
Encouraged HHSC to examine Ohio’s initial approved Statewide Transition Plan, which extends transition of adult day activities into 2024
HHSC leadership is currently considering feedback in order to present several options to the Executive Commissioner.

26. IDD Direct Service Workers Curriculum
Overview. In anticipation of possible carve-in of TxHml (2018) and HCS (2021) into managed care, the LAW is developing a recommended curriculum for IDD Direct Service Workers (DSWs).
Goal. The goal of this project is to identify standardized curriculum that constitutes the minimum information, knowledge and understanding a direct service worker (DSW) must satisfy in order to meet credentialing requirements to provide services for people with intellectual and developmental disabilities (IDD).

27. IDD Direct Service Workers Curriculum
Guiding Principles. LAW members determined IDD DSW training should be:
• Achievable in a reasonable timeframe (requiring a reasonable number of training hours),
• Affordable,
• Available statewide,
•High quality, and
• Tailored to address distinct needs and capabilities of people with IDD.

28. IDD Direct Service Workers Curriculum
LAW members evaluated twelve (12) core competencies identified and defined by the Centers for Medicare and Medicaid Services (CMS) and the Direct Service Workforce Center. Of the twelve core competencies, the five determined most critical to IDD DSWs are:
(1) Person-Centered Practices: The DSW provides person-centered services to support participant’s preferences, strengths, interests and goals, and participates in multidisciplinary teams, with participant approval.
(2) Crisis Prevention and Intervention: The DSW identifies potential risks, crisis situations, and/or behaviors, and uses appropriate procedures to de-escalate the situation and minimize potential for danger, using strategies specific to the environment and as outlined in the participant’s plan.

29. IDD Direct Service Workers Curriculum
(3) Communication: The DSW recognizes communication as a core function of support, and uses person first language and effective communication skills to establish a supportive and collaborative relationship with the participant and his or her family.
(4) Safety: The DSW understands ways to support a participant to be safe and adhere to procedures necessary to maintain a safe environment, in order to reduce risks and be prepared for emergencies.
(5) Health and Wellness: The DSW assists the participant and supports the development of skills to maintain health and wellness in all areas of his or her life.

30. IDD Direct Service Workers Curriculum
Recommendation. The curriculum for IDD DSWs in Texas should encompass an introductory course on IDD, followed by five courses, each designed to fulfill one of the five core competencies. All courses must be accredited by the National Alliance of Direct Support Professionals (NADSP).
Status. Recommendation is being refined for eventual review by other stakeholders and HHSC.

31. Determinations of Intellectual Disability
Several efforts are underway at the state level to enhance the quality of Determinations of Intellectual Disability (DIDs).
Best Practice Guidelines. HHSC worked closed with select members of the IDD Directors’ Consortium to create the DID: Best Practice Guidelines.
HHSC created a dedicated mailbox for questions related to the DID Best Practice Guidelines at
HHSC also hosted a webinar to review the DID Best Practice Guidelines. An archived version of the webinar is available at:

32. Determinations of Intellectual Disability, continued
Teleconference Series. The DID Workgroup of the IDD Consortium partnered with HHSC to implement a series of teleconferences for authorized providers (AP) to:
(a) provide training on the DID rules and DID Best Practice Guidelines;
(b) expand clinical expertise through case discussions; and
(c) facilitate networking among APs in the state.
HHSC is gathering contact information of APs and will soon publicize the first teleconference.
Thank you to Dr. Maria Quintero-Conk of Tri-County Behavioral Healthcare for her leadership!

33. 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 change (and much more change to come)!
Questions: