Texas Council Legislative Retreat. November 7, 2014

Transcription

1 Texas Council Legislative Retreat November 7, 2014

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3 Political Landscape: Statewide Races Election Day Tuesday, November 4 th

4 Political Landscape: Texas Senate Races

5 Political Landscape: Texas House Races

6 Political Landscape: Texas House Races (cont.)

7 Political Landscape: Significant Changes in Leadership 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 84 th Legislature Tea Party is alive and well in Texas

8 Texas Legislature Days Every Odd Year Specials Called by Gov Governor, Lt. Gov. Must Pass Budget Bill 6,378 Bills Filed in 2013 TXC Tracked 659 Bills

9 Legislative Session Dynamics 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, s invitations

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11 Community Leadership Role (Beyond Traditional Service Delivery) Secure local matching funds Leverage resources to enhance services Acquire grants and gifts Educate the public Facilitate local planning, identify service gaps Develop and manage provider network Coordinate with local partners & volunteers Collaborate with other stakeholders Respond to disasters & emerging community needs 11

12 $80,000,000 Local Taxing Authority Investment $70,000,000 $60,000,000 $50,000,000 $40,000,000 $30,000,000 $20,000,000 $10,000,000 $- 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 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. 12

13 Texas Population Community Services Funding

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17 (TDCJ) Mental Health & Criminal Justice Data

18 (TDCJ) Mental Health & Criminal Justice Data 2008 vs % of Criminal Justice Offenders w/care Match Prison 27% 34% Probation 12% 15% Parole 27% 29% % of Criminal Justice Offenders w/ Big Prison 7% 11% Probation 4% 6% Parole 7% 10%

19 Senate Bill 7 System Redesign for Medicaid Acute and Long-term Services and Support to Persons with Intellectual and Developmental Disabilities

20 Attendant Attendant/Habilitation Services become part of the Medicaid State Plan under the Community First Choice option 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.

21 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.

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23 Historic Mental Health & Substance Use Funding Source: Center for Public Policy Priorities (CPPP)

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25 State Budget (FY ): Select Mental Health & Criminal Justice 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

26 Mental Health System Data

27 84 th Legislative Session: Public Policy Priorities (Select) 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

28 Public Policy Issues (Select) Sunset Review

29 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 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

30 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

31 Sunset Review Decisions (DADS Select) (DADS) Issue 2 Recommendations: 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 3 Recommendation: create an advisory committee to address the redesign and potential licensure or certification of all day habilitation facilities, with recommendations to the 85th Legislature.

32 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.

33 Sunset Staff Report (HHSC Select)

34 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

35 Public Policy Priorities (Select) State Budget FY

36 State Budget: Exceptional Item Summary DADS LAR FY

37 State Budget: DADS LAR FY 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

38 State Budget: DADS LAR FY 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

39 State Budget: DADS LAR FY 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

40 State Budget: DADS LAR FY 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)

41 State Budget: DARS LAR FY 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

42 State Budget: Exceptional Item Summary DSHS LAR FY

43 State Budget: DSHS LAR FY

44 State Budget: DSHS LAR FY

45 State Budget: DSHS LAR FY (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

46 State Budget: DSHS LAR FY (Select)

47 State Budget: DSHS LAR FY (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

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49 State Budget: DSHS LAR FY (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

50 State Budget: DSHS LAR FY (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 General Appropriations Act

51 State Budget: DSHS LAR FY (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

52 State Budget: TDCJ LAR FY (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 criminogenic risk factors and clinical care needs through contracts with LMHAs Goal: serve an additional 1,400 offenders

53 State Budget: Supreme Court of Texas LAR FY (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.

54 Medicaid 1115 Transformation Waiver Changing Communities in Texas

55 Public Policy Priorities (Select) 1115 Waiver Renewal

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57 (Example)Tropical Texas Behavioral Health 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 individuals 325 1,253 1,000 service contacts with individuals in mental health crisis 1,000 1,481 Decrease arrest rate of people in a mental health crisis 85 or less 7 arrests

58 HB 3793 Advisory Panel Recommendations

59 HB 3793 Recommendations: Capacity

60 HB 3793 Recommendations: Access

61 General Legislative Considerations: Texas Council Principles Strong Communities Local Control Public Accountability Proven Performance Personal Independence

62 General Legislative Considerations: Adherence to Established Principles Promote legislative direction that adheres to established principles and stop legislative direction that violates established principles.

63 Legislative Priority: Promote & Protect Legislative Appropriations: Do No Harm Promote Value of Continued Investment in Community-based Services

64 Effective Legislative Strategy: 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

65 Media Outreach

66 Key Partnerships

67 84 th Legislative Session Key Dates: Tuesday, November 4, 2014 (Election Day) Monday, November 10, 2014 (prefilling of legislation begins) Tuesday, January 13, 2015 (first day)

68 Lee Johnson Deputy Director Texas Council of Community Centers