Legislative Alerts
Meeting Notes for October 14, 2011
10:00 a.m. – 3:30 p.m.
Reliant Park / Medical Center Room 600
One Reliant Park, Houston, TX 77054
Public Council Members Present:
Frank McCamant, Chair, Austin
Anna Hundley, Vice Chair, Dallas
Pamela Rollins, Dallas
Stephanie Sokolosky, Lubbock
Glenn Roque-Jackson, Dallas
Tammy Lemoine, Center
Public Council Members Absent:
Callie Matthews, Ft. Worth
Ex-Officio Council Members Present:
Jeff Kaufmann, Department of Aging and Disability Services (DADS)
Barbara Kaatz, Texas Education Agency (TEA)
Marc Mullins, Department of Assistive and Rehabilitative Services (DARS)
Terry Beattie, Health and Human Services Commission (HHSC)
Ex-Officio Council Members Absent:
Barbara Fountain, Department of State Health Services (DSHS)
Bridget Crawford, Department of Family and Protective Services (DFPS)
Others Present:
Cindy Swain, TEA
Alice Antilley, DADS
Jennifer Kaut, DARS
Sobha J. Georme, Parent
Cynthia Singleton, Texas Autism Council Houston Regional Advisory Committee Chair
Lone Star Lend Program: Evelyn Perez,
Justyna Chevallier, Faiza Sheikh, Kari Rote, Megan Karlsen
Michael Watkins, UT Houston Medical School
Lucy Walker, Texas Council for Developmental Disabilities
Ivy Zwicker, Autism Treatment Center
I. Call to Order, Welcome & Introductions
Meeting was called to order at 10:00 a.m. Members and guests introduced
themselves.
II. Approval of Minutes of July 29, 2011
Minutes of the July 29, 2011 Texas Council on Autism meeting were approved
without change.
III. Public Testimony
Cynthia Singleton discussed issues related to adolescents with autism and the
impact of hormones.
IV. Items from the Chair
Texas Council on Autism approved final version of its 2011 Annual Report.
V. Legislature Session – Bills related to Autism
Staff reviewed bills passed by the 82nd Texas Legislature which affect services to
individuals with autism including the 2012-13 General Appropriations Act
Descriptions of the bills discussed are included in the Autism and the 82nd Texas
Legislature section of the Texas Council on Autism 2011 Annual Report.
VI. Medicaid Services
DADS staff explained that HHSC staff are studying two areas of legislative
authority related to improving Medicaid services. Senate Bill 7, 82nd Legislature,
Regular Session, 2011 requires that HHSC pursue a Medicaid Reform Waiver that
would allow Texas to implement reforms to eligibility, benefits, and long-term care
services and implement copayments. HHSC is also directed to seek a modification
to the Federal Medical Assistance Percentage (FMAP) formula, including seeking
additional federal funding for Medicaid services for illegal immigrants.
Section 1115 of the Social Security Act provides the federal government broad
authority to authorize experimental, pilot, or demonstration projects likely to
assist in promoting the objectives of the Medicaid statute. Flexibility under Section
1115 is sufficiently broad to allow states to test substantially new ideas of policy
merit.
VII. The Lone Star LEND
Staff of The Lone Star LEND provided the Council an overview of its program. The
Lone Star LEND is a collaborative effort between University of Texas Health
Science Center at Houston, University of Houston, Texas Women’s University,
University of Houston Clear Lake and Baylor College of Medicine.
Its purpose is to improve global service delivery, including increased identification and diagnosis of autistic spectrum and other neurodevelopmental disabilities (ASD/ND), to children with ASD/ND in the core disciplines by providing training across the entire state through a distance learning initiative and an annual conference.
VIII. DARS Division for Rehabilitation Services (DRS) Pilot Program
Jennifer Kaut, DARS Division for Rehabilitation Services (DRS) provided an overview of the DRS effort to improve vocational rehabilitation programs for individuals with ASD. DRS established five statewide autism teams with a total of 15 regional specialists, in addition to five central office program specialists. The main goals of this team for 2012 will be to 1) support the development of autism specialist counselors, and 2) target one or two Community Rehabilitation Providers in each region to be trained as autism specialists.
She also provided an overview of the partnership between Texas State University Clinic for Autism Research, Evaluation and Support (CARES) and DRS which provides behavioral services to consumers whose behavior is an impediment to their employment.
IX. Texas State Plan for Individuals with Autism Spectrum Disorders 2010-14 (State Plan)
Council reviewed the current goals and action items of the State Plan including the importance of adult and early intervention services. Specifically discussed were ways to support the work of the DARS DRS Pilot Program with CARES, Lone Star LEND, TARRC initiatives related to adult services, and the Texas Statewide Leadership for Autism project to promote the use of evidence-based practices for children and adolescents with autism spectrum disorders (Model Sites For Evidence-Based Practices grant received by TEA from the National Professional Development Center on Autism Spectrum Disorders (NPDC-ASD).
The Chair requested that agency and appointed Council members work together to incorporate these items into an updated version of the State Plan implementation schedule. Review and discussion of the updates will be discussed at the Council’s December 1, 2011 meeting.
X. Agency Reports
The DADS representative provided updates the Texas Autism Research and Resource Center (TARRC) and announced that an informal request for proposals for development of a "Community Assessment & Planning Toolkit" for autism services is on track to be released in November. The toolkit would include resources designed to help communities work together more effectively to provide improved and expanded services for individuals and families affected by autism.
The DARS representative provided an update on the DARS Autism Program and its six contractors. DARS will consider making a presentation at the 2012 Texas Autism Research Conference to include analysis of the program’s outcomes.
The TEA representative reported that, in response to Senate Bill 1788, TEA has posted on its website a model form for an individualized education program. She also shared the TEA organization chart, updated September 1, 2011 following significant reductions in staff.
XI. Future Meetings/Assignments
The next Council meeting will be in Austin on December 1, 2011.
XII. Adjourn
The meeting was adjourned at 3:30 p.m.
Tuesday, August 23, 2011 PPAT ALERT
Summary of August 22, 2011 Meeting re: Implementation of Cost Containment Measures & Request for Comment
The details associated with the 90th percentile reductions required by the 2011 Texas Legislature's cost containment measures were presented at the DADS stakeholder meeting today, August 22. The meeting focused on a review of the materials included in the attachment***.
In reviewing the materials please know that DADS reported that as of August 22, 2011 approximately 2,200 consumers (10%) in HCS will be affected by the service limits. In CLASS about 2/3 of the persons served will be affected by the reductions which includes reductions of some services to the 90th percentile and reductions of Specialized Therapies to the 75th Percentile.
A. Overview of Information Shared
1. Rule Development, Related Hearings & Effective Date: DADS intends to present the proposed rules to implement this mandate to the Medical Care Advisory Committee (MCAC) on September 8, 2011 and to the DADS Agency Council on September 14, 2011. Opportunities for public comment will be afforded at each of these meetings as well as through the Texas Register comment process. A public hearing is also being planned for mid to late October. Target date for implementation is December 1, 2011. Note: With the exception of the reductions to requisition fees in certain programs, according to DADS the rules/new service limits will be in effect through August 31, 2013.
2. Communication to Providers and Consumers/Families: DADS intends to send letters to providers by September 1, 2011. [Each provider will receive a list of the consumers they serve who will be impacted by the reduction in services, copies of the letters sent to families/consumers and the Instructional Guide which was not distributed. See below for more information on the Instructional Guide.] Regardless of whether their current service plans will be affected by the mandate, ALL consumers or LARs will receive a letter regarding the new service limits. The letters will be sent approximately one week after the letter to providers have been sent.
3. Provider Responsibilities/DADS Expectations: DADS expects (and urges) providers to explain the process to families and consumers. Providers are also required to notify each consumer's service coordinator if changes are needed. See the last paragraph to question #7 on page 10 of the attached document for further details.
4. Exceptions and Related Information: It was stressed that these reductions are to be viewed as soft caps and that exceptions will be granted on an individual basis if justified by the service planning team with evidence that exceeding the new service limit is necessary to protect the individual's health and welfare.
DADS indicated that because the services to be limited are currently being provided, it anticipates that most (if not ALL) consumers subject to the new service limits (or their respective LAR) will urge their provider to submit an exception request. Note: Although not stated in the current DRAFT Provider Letter, providers can inform DADS that they will not be submitting an exception if the current level of service is no longer needed and the consumer’s health and welfare can be protected at the new service limit.
Other important comments and/or components of the process include the following:
§ It is possible that someone’s current condition or access to third party resources could result in a reduced need for the service. In these situations, submission of an exception request would not be necessary.
§ For any new enrollments, transfers, or revisions above the new service limit, providers will have to submit an exception.
§ Should a person be denied an exception and elect to go through the fair hearing process, previously authorized services are to be provided until the outcome of the hearing. Providers will be paid until a determination is made.
§ Persons who have recently had their service plans subjected to Utilization Review and are over the new service limit caps will have to go through the exception process.
§ There will be a 'payment exception process' to allow payment over the limit while an exception is being considered. In the event the new service limit is close to or over the limit upon denial an additional approved exception request will be required for services for the remainder of the plan year above the new service limit.
5. Instructional Guide: As previously stated, the Instructional Guide was not distributed at the meeting. The Guide (which will accompany the letter sent to each provider) will include specific probing questions to help providers adequately justify services.
6. Point of Contact: To ease the process in responding to this mandate, a single point of contact (for the purpose of providing technical support) at DADS will be assigned to each provider.
7. Training: DADS has not planned any training on the new process, but may consider conducting a webinar or scan calls (by program) following distribution of the letters. We will keep you posted.
B. Request for Comments
DADS has asked each provider and advocacy organization to collect comments from their respective memberships on the DRAFT materials attached. That said, PLEASE review the documents carefully and provide the PPAT Office any comments you have no later than Wednesday, August 24, 2011 at 5:00 p.m. Example: If you believe the letters to providers and those to families and consumers are not clear, offer some alternative language.
***Attachment: Please note that the document is 32 pages and provides information related to the cost containment measures that will be implemented in HCS, CLASS, CBA and MDCP. To ease your review of these pages the following is offered:
§ Page 2: Presents the timeline for implementation including (but not limited to) rule development, various public hearings, when letters to providers, families and consumers will be sent.
§ Page 3: Method for Developing Service Limits
§ Pages 4 - 8: New Service Limits for All Programs Affected (HCS service limits are on page 7)
§ Pages 9 - 10: Preliminary FAQs
§ Pages 11 - 27: Provider & Consumer/Family Letters (HCS DRAFT letters are on pages 24 - 27)
§ Page 28; Criteria for Granting an Exception
§ Page 29: Language to be submitted to CMS for waiver amendment approval
§ Pages 30 - 32: Implementation of the Service Limits Cost Reduction Plans
Questions? Please call the PPAT Office at 512.452.8188
Thursday, March 24, 2011
PPAT ALERT
GREAT NEWS! YOUR VOICES BEEN HEARD!
Update on Activities of the Senate Finance Subcommittee on Medicaid
While the news yesterday from the House Appropriations Committee on the committee substitute for HB 1 was disappointing, it appears the Senate (or at least the Medicaid Subcommittee of Senate Finance) has heard you! Today this subcommittee adopted (5 ayes, 2 nays) many funding requests requested by DADS that place providers in a significantly better position when the House and Senate bills are debated in the conference committee that will be appointed once both chambers pass their respective budget bills. Of course, these recommendations MUST also be adopted by the full Senate Finance Committee.
Special Notes:
1. Senators Whitmire and Zaffirini voted 'no'.
2. Senators Hinojosa, Eltife, Deuell, Nelson and Williams voted 'yes'.
3. Senators Eltife and Hinojosa indicated that their support for moving the process forward (i.e., to the full Senate Finance Committee) does not mean they will vote in favor of the budget. Specifically, Senator Eltife stated that if no more than $4.5 billion of the Rainy Day Fund and no new revenue was identified for inclusion in the budget that he would not vote for its passage.
4. Senator Deuell made similar comments to those of Senators Hinojosa and Eltife stating the legislature needs to find other sources of revenue such as a tax on gasoline, use of Rainy Day Fund, etc., revenue sources he said many in his very conservative district have told him they support.
5. Senator Williams had no comments.
6. HHSC stated that if there are holes left in priority areas of the budget, for example attendant care wages that were left pended and which could be left below minimum wage, it would re-evaluate the full budget and move money around from other provider rates to cover the holes as necessary.
7. Concerning caseloads, DADS is examining whether all persons currently receiving services has been fully funded. Caseload growth was pended.
Greta Rimel from HHSC stated that if there are holes left in priority areas of the budget, for example attendant care wages that could be left below minimum wage, HHSC will re-evaluate the full budget and move money around to cover the holes as necessary.
While this is very good news, it is important to remember that we still have a long way to go before this is over. In other words, anything can happen.
We can thus not let up on calls and visits! The minute legislators quit hearing from you, the easier it becomes for decisions to be made to move dollars from the services you operate to other services.
So celebrate briefly, then resume your advocacy efforts!
Further details will be forthcoming. This is a preliminary analysis.
Questions? Contact the PPAT Office at 512.452.8188.
Wednesday, March 23, 2011
PPAT ALERT
House Appropriations Committee (HAC) Votes Out Committee Substitute HB 1
The House Appropriations Committee voted on the committee substitute for HB 1 this morning. The committee substitute did NOT include any funds to address the rate reductions in the ICF or community-based waiver programs (which includes HCS); i.e., DADS Exceptional Items # 1 and #2.
As expected, the bill was voted out favorably and will now go to the House Floor for a vote. See member votes below. Chairman Pitts stated that the full House will consider HB 4 and HB 275 (the supplemental appropriations bill and the Rainy Day Fund bill) on Wednesday or Thursday of next week and HB 1 on Thursday or Friday.
Remember: This is not over yet. The Senate has yet to consider its bill with the Senate Finance Committee not having yet even considered its version of the appropriations bill. Given the differences in the two bills, a conference committee will be appointed to debate these differences. All to say, the Legislature's work is not yet done and neither is our's and there remains time for changes.
This means that you, your staff, families, etc. MUST keep the pressure on by continuing to make calls and visits and writing letters.
Votes: 18 Ayes; 7 Nays; 2 Absent
Ayes:
Pitts
Aycock
Button
Chisum
Crownover
Darby
Gooden
S. King
Margo
D. Miller
G. Morrison
Otto
D. Patrick
Riddle
Schwertner
Shelton
Torres
Zerwas
Nays:
Turner
Giddings
Hochberg
Johnson
Martinez
McClendon
Villarreal
Absent:
Dukes
Eiland
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