Texas 2003 | advancingstates.org

<H3>Texas</H3>   <H4>Task Force</H4> In September 1999, the governor issued an executive order requiring the Health and Human Services Commission (HHSC) to conduct a comprehensive review of all services and support systems available to people with disabilities in Texas. To include stakeholder involvement, the HHSC created the Promoting Independence Advisory Board (PIAB). The PIAB provided guidance to the HHSC in the evaluation of a system of community-based services and supports for people with disabilities. The board included providers, people with disabilities and their representatives, and state agency officials. In response to the executive order, HHSC developed the Promoting Independence Plan and released the first version to the governor and Legislature in 2001. A new stakeholder task force, the Interagency Task Force on Care Settings for Persons with Disabilities, replaced the previous board. However, many of the same members were kept on the new group in an effort to maintain continuity. The group released a revised version of its plan on Dec. 2, 2002. The plan is located online at <A HREF=\"http://www.hhsc.state.tx.us/tpip/tpip_report.html\">http://www.hhsc.state.tx.us/tpip/tpip_report.html</A>   <H4>The Plan</H4> The Promoting Independence Plan contains recommendations related to the system of long-term care services and supports for the populations affected by the Olmstead decision. The recommendations include: <UL> <LI>Expanding all waiver programs. </LI> <LI>Increasing outreach to inform people with disabilities about community options. </LI> <LI>Providing permanency planning to develop community placements for children. </LI> <LI>Moving nursing facility residents into the community. </LI> <LI>Providing temporary rent subsidies for consumers who are awaiting federal housing assistance. </LI> <LI>Making available one-time grants to families who need to make a home modification to care for children with disabilities. </LI> <LI>Providing funding for non-medical transportation for people who are making the transitioning into the community.</LI></UL> The plan also coordinates the efforts of the multiple agencies that provide long-term care services within the state. The two largest agencies are the Department of Human Services and the Department of Mental Health and Mental Retardation. The Texas Department of Human Services is using a multi-phase approach to identify and assess individuals to whom Olmstead applies. Phase one of the plan was implemented and effective Dec. 1, 2000. Phase one activities involved informing nursing home residents about community-based alternative programs, training agency staff, promoting community awareness about choice and community options, collecting baseline data about nursing home residents who are seeking to make the transition into the community, and developing permanency planning for community placements for children in facilities. Phase two is being implemented over a two-year period beginning from September 2001 to September 2003. The department will hire and train relocation specialists, develop an identification process and assessment instrument, track data from the relocation specialists, and conduct community awareness activities. Phase three will divert people from institutionalization by placing additional staff in hospitals and rehabilitation centers for preadmission and admission screening. The state views its response to Olmstead as an ongoing process. With the completion of the Promoting Independence Plan, the state intends to continue moving forward in its efforts to identify individuals who are living in institutions but who are desirous of community-based services, helping these individuals make the transition into the community, reducing the waiting lists, and coordinating all long-term care services and supports to improve services to citizens of the state with disabilities. The state expects its plan to evolve over time in response to funding, stakeholder input, agency-related initiatives, and continued growth and demand for community services and supports for people with disabilities. Implementation Steps <UL> <LI>Funding and capacity issues implementation steps:</LI> <UL> <LI>HHSC will address Olmstead related issues through their agency planning activities and through their budget development activities. </LI> <LI>HHSC will work with the Legislative Budget Board and the Governor's Office of Budget, Planning and Policy to encourage further investment in community-based services. </LI> <LI>HHSC will request funding for continuation and expansion of the family-based alternatives project. </LI> <LI>Requires legislative direction and appropriations. </LI> <LI>HHSC will assist those individuals who make the transition from institutional care into the community with a \"money follow the individual\" mechanism, when funding is not cost neutral and the cost of community care must be supplemented in order for the service to be provided in the community.</LI> <LI>Requires legislative direction. </LI> <LI>HHSC would assist in the redirection of institutional money appropriated to follow the individual into the community, if the individual chooses. The state would monitor the effects of any decision to implement the redirection of funds to allow the money to follow the individual for his or her choice of services and to assess the effects on providers, individuals and state general revenue.</LI> <LI>Requires legislative direction. </LI> <LI>HHSC would implement changes to allow HHSC to use funds appropriated for long-term care waiver slots for: a) the establishment, maintenance, and development of capacity to expedite utilization of long-term care waiver slots; b) the provision of wraparound services that are specifically associated with such slots and that relate to transitional services, access to immediate housing, and transportation services; c) the development of family-based alternatives for children leaving institutions, and d) the development of capacity in community waiver services.</LI> <LI>HHSC will include an inflation adjustment related to LTC Medicaid providers.</LI> <LI>Requires legislative direction and appropriations. </LI> <LI>HHSC would assist appropriate agencies in the implementation of funding appropriated for transition providers who voluntarily downsize their facilities. The funding would be used for specific increased per capita costs incurred as individuals with disabilities and/or families exercise their right to choose to live in community settings.</LI> <LI>Requires legislative direction. </LI> <LI>HHSC would assist agencies to implement a sliding fee for institutional and community services and support programs of children under age 22 and adults with legal guardians, to the extent allowed by federal regulation. HHSC would ensure that the sliding fee scale be developed with input from families, advocates and other interested stakeholders.</LI></UL> <LI>Housing issues implementation steps:</LI> <UL> <LI>HHSC has requested funding for promoting independence supports in housing and transportation assistance. </LI> <LI>HHSC, upon request, will assist in the provision of staff training related to disability issues. The training should be developed with input from appropriate stakeholders. </LI> <LI>HHSC will assist in enhancing the stock of accessible, affordable integrated housing in Texas, and will work to remove the existing barriers to accessible housing. </LI> <LI>HHSC will work to give technical assistance to local public housing authorities so that they may apply for and prioritize accessible, affordable integrated housing for people with disabilities. </LI></UL> <LI>Workforce Issues Implementation Steps:</LI> <UL> <LI>HHSC will assist to assure optimal work opportunities for people with disabilities. </LI> <LI>HHSC will work to review and identify workforce issues and concerns. </LI> <LI>HHSC will coordinate a forum with providers on implementing the Olmstead decision and the implications to members of labor unions and other workers in relation to helping individuals make the transition from institutions to the community. </LI> <LI>HHSC requested legislative consideration for Medicaid rate increases as indicated by current rate methodology and cost reviews. </LI> <LI>HHSC will explore and develop employee recruitment and retention incentives for all providers of long-term care services.</LI></UL> <LI>Children's issues implementation steps:</LI> <UL> <LI>HHSC has implemented permanency planning as provided by law. </LI> <LI>HHSC will study existing agency data collection mechanisms. </LI> <LI>Requires legislative direction and appropriations. </LI> <LI>HHSC would work to target 20 percent of newly appropriated HCS/MRLA waiver slots (FY 2004 and FY 2005), for children placed on the waiver waiting or interest list as a result of permanency planning efforts and for those children living in institutions within the Family-Based Alternatives Project.</LI> <LI>Requires legislative direction and appropriations. </LI> <LI>HHSC would work to study and implement the use of appropriate waiver slots for children, particularly those placed in licensed institutions for children with physical and cognitive disabilities.</LI> <LI>Requires legislative direction and appropriations. </LI> <LI>HHSC would assist in the permanency planning function being removed from the ICF/MR provider. </LI> <LI>HHSC will work to coordinate services for individuals who are making the transition from nursing facilities, including addressing those individuals from birth to age 2.</LI></UL> <LI>Other implementation steps:</LI> <UL> <LI>HHSC will work with appropriate agencies to review and provide input into all workgroup recommendations. </LI> <LI>HHSC will have mechanisms for public input throughout the state. </LI> <LI>HHSC will review all policies and procedures and rules regarding services to individuals that would assist them in making the transition from institutions. </LI> <LI>HHSC will ensure that any information and referral assistance systems is linked to the existing 211 efforts. </LI> <LI>HHSC will include a definition of individuals at imminent risk of institutionalization. </LI> <LI>HHSC will develop a subcommittee to review all materials and processes that inform individuals of community-based alternatives. </LI> <LI>HHSC will invite the Texas Hospital Association to participate in discussions about effective discharge planning from a hospital setting into the community. </LI> <LI>HHSC will invite the Texas Board of Nurse Examiners to participate in discussions about the nurse practice act and nurse-delegated tasks in a community setting. </LI> <LI>HHSC will evaluate the rule related to nurse delegation of tasks in an independent living environment.</LI></UL> <LI>Access Issues</LI> <UL> <LI>Local Access Plans</LI> <UL> <LI>HHSC will work with agencies to develop a system of access to services that will be local, user friendly, and provide the information necessary to consumers, family members, volunteers and advocates to reduce the fragmentation of the current system of services.  </LI> <LI>HHSC will complete the work of the Texas Long-Term Care (TLC) Access Review Committee to review local plans and develop a state response to requests for assistance. </LI></UL> <LI>Consumer Assessment and Navigation Services</LI> <UL> <LI>HHSC and HHS agencies will study the current case management system and the possible development of specialists who can navigate the network of services on behalf of the consumer and his or her family, in order to reduce the fragmentation of services. </LI> <LI>HHSC will ensure that the system of access will incorporate development of the information and referral network and potential use of the 211 telephone number. </LI> <LI>HHSC will continue work on a single functional assessment and the consolidated waiver pilot project and will move forward with implementation if data indicates a successful system change. </LI></UL> <LI>Training and Information</LI> <UL> <LI>HHSC will coordinate with appropriate agencies to develop and implement training in the history, intent and scope of the Promoting Independence Initiative, development of community supports for people in transition from institutions to the community, contact information of service providers, and initiation of community-based services. </LI> <LI>HHSC will take the lead in developing one comprehensive information packet and video that can be used in all institutional settings to educate residents, families and guardians about all available community services; using stakeholder focus groups for input regarding content, format, etc. </LI></UL> <LI>Technology</LI> <UL> <LI>HHSC will study the infrastructure issues between agencies related to varying computer systems, databases and tracking of consumers.  </LI> <LI>HHSC will continue the work in standardization and consistency in data systems across agencies. </LI> <LI>HHSC will continue the work of the technical architecture committee to assist in the development of a single data center where various agency service tracking systems can be consolidated and data can be easily shared. </LI> <LI>HHSC will continue evaluation of products that will allow the current agency systems to share data. </LI></UL> </UL> </UL> On December 1 of each even-numbered year, HHSC will use the information gleaned from task force meetings, reports and continued public comment to revise the Texas Promoting Independence Plan. The biennial revision allows the state's efforts to stay vibrant and effective in meeting the changing needs of individuals with disabilities. The commission will continue to seek public input into its plan.   <H4>Implementation</H4> Legislation There was no 2002 legislation related to the Olmstead decision. During the 2001 session, several laws were enacted related to the Promoting Independence initiative. Senate Bill 368 directed the Department of Protective and Regulatory Services to develop a permanency plan for each child in an institution for whom the department has been appointed permanent managing conservator. It also directed the state to contract with various organizations to develop and implement a system under which a child may receive necessary services in a family-based alternative. House Bill 966 required the study of costs of institutional care and the ability to move funding with the consumer as the individual moves into the community. Lawsuits For an update on lawsuits in Texas and other states, see Status Report: Litigation Concerning Medicaid Services for Persons with Developmental and Other Disabilities by Gary A. Smith at <A HREF=\"http://www.hsri.org/index.asp?id=news\">http://www.hsri.org/index.asp?id=news</A> Next Steps The state of Texas received a $1.385 million Nursing Facility Transitions, Independent Living Partnership Grant. The money is being used to expand upon successful outreach activities to identify people with disabilities of all ages in nursing facilities who are seeking to make the transition into the community with appropriate services and supports.