Texas Council

Legislative

Retreat

November 7, 2014

Political Landscape:

Statewide Races

Election Day Tuesday,

November 4th

Political Landscape:

Texas Senate Races

Political Landscape:

Texas House Races

Political Landscape:

Texas House Races

(cont.)

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 84th Legislature –

Tea Party is alive and well in Texas

Political

Landscape:

Significant Changes

in Leadership

• 140 Days Every Odd Year

• Specials Called by Gov.

• 181 + Governor, Lt. Gov.

• Must Pass – Budget Bill

• 6,378 Bills Filed in 2013

• TXC Tracked 659 Bills

Texas Legislature 101

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

• 15,000 + emails

• 600 + invitations

Legislative Session

Dynamics

10

Secure local matching fundsLeverage resources to enhance servicesAcquire grants and giftsEducate the publicFacilitate local planning, identify service gapsDevelop and manage provider networkCoordinate with local partners & volunteersCollaborate with other stakeholdersRespond to disasters & emerging community needs

11

Community Leadership Role(Beyond Traditional Service Delivery)

12

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

$-

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

$70,000,000

$80,000,000

Local Taxing Authority Investment

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.

Texas

Population

Community Services

Funding

(TDCJ) Mental

Health & Criminal

Justice Data

(TDCJ) Mental

Health & Criminal

Justice Data

2008 vs. 2014

% of Criminal Justice Offenders w/CARE Match 2008 2014

Prison 27% 34%

Probation 12% 15%

Parole 27% 29%

% of Criminal Justice Offenders w/ ‘Big 3’ 2008 2014

Prison 7% 11%

Probation 4% 6%

Parole 7% 10%

Senate Bill 7

System Redesign

for Medicaid Acute and

Long-term Services

and Support to

Persons with

Intellectual and

Developmental

Disabilities

Attendant/Habilitation Services

become part of the

Medicaid State Plan

under the

Community First Choice option

Attendant

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.

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.

Source: Center for Public Policy

Priorities (CPPP)

Historic Mental Health & Substance Use Funding

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

State Budget

(FY 2014-15):

Select Mental

Health & Criminal

Justice

Mental Health

System Data

• 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

84th Legislative

Session:

Public Policy

Priorities (Select)

Public Policy

Issues (Select)

Sunset Review

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. 3793 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

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

Sunset Review

Decisions

(DADS Select)

(DADS) Issue 2Recommendations:• 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 3Recommendation:• create an advisory committee to address the redesign and

potential licensure or certification of all day habilitation facilities, with recommendations to the 85th Legislature.

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.

Sunset Staff

Report

(HHSC Select)

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

Public Policy

Priorities

(Select)

State Budget

FY 2016-17

State

Budget:

DADS LAR

FY 2016-17

Exceptional Item Summary

State

Budget:

DADS LAR

FY 2016-17

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

State

Budget:

DADS LAR

FY 2016-17

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

State

Budget:

DADS LAR

FY 2016-17

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

State

Budget:

DADS LAR

FY 2016-17

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)

State

Budget:

DARS LAR

FY 2016-17

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

State Budget:

DSHS LARFY 2016-17

Exceptional Item Summary

State Budget:

DSHS LARFY 2016-17

State Budget:

DSHS LARFY 2016-17

State Budget:

DSHS LARFY 2016-17

(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

State Budget:

DSHS LARFY2016-17 (Select)

State Budget:

DSHS LARFY2016-17 (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

State Budget:

DSHS LARFY2016-17 (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

State Budget:

DSHS LARFY2016-17 (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 2014-2015 General Appropriations Act

State Budget:

DSHS LARFY2016-17 (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

State Budget:

TDCJ LARFY2016-17 (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 criminogenicrisk factors and clinical care needs through contracts with LMHAs

• Goal: serve an additional 1,400 offenders

State Budget:

Supreme Court of Texas LARFY2016-17 (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.

Medicaid 1115

Transformation Waiver

Changing Communities in Texas

Public Policy

Priorities

(Select)

1115 Waiver

Renewal

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 individuals325 1,253

1,000 service contacts with individuals in

mental health crisis1,000 1,481

Decrease arrest rate of people in a mental

health crisis

85 or

less7 arrests

(Example)Tropical Texas Behavioral Health

HB 3793 Advisory

Panel

Recommendations

HB 3793

Recommendations:

Capacity

HB 3793

Recommendations:

Access

General Legislative Considerations:

Texas Council Principles

• Strong Communities

• Local Control

• Public Accountability

• Proven Performance

• Personal Independence

Promote legislative direction that

adheres to established principles and

stop legislative direction that violates

established principles.

General Legislative Considerations:

Adherence to Established Principles

Legislative Priority: Promote & Protect

• Legislative Appropriations:– Do No Harm

– Promote Value of Continued Investment in Community-based Services

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

Effective Legislative

Strategy:

Media Outreach

Key Partnerships

84th Legislative Session

Key Dates:• Tuesday, November 4, 2014

(Election Day) • Monday, November 10, 2014

(prefilling of legislation begins)

• Tuesday, January 13, 2015 (first day)

Lee Johnson

Deputy Director

Texas Council of Community Centers

ljohnson@txcouncil.com

www.txcouncil.com