The Health and Human Services Commission’s major Promoting Independence accomplishments during fiscal year 2009 include the following activities:
The Legislature approved a two-year budget of $44.8 billion for Medicaid, which accounts for 29 percent of the state’s total budget. The program provides health coverage for one out of every three children in Texas, pays for more than half of all births, and covers 44 percent of all nursing home care provided in the state. Children make up about two-thirds of the state’s Medicaid caseload. However, services to individuals who are aging and/or have disabilities account for two-thirds of the program’s costs.
The Legislature maintained all current Medicaid services, client categories and provider rates. Major legislative decisions about the state’s Medicaid program include:
HHSC’s major Promoting Independence accomplishments during FY 2010 include the following activities:
Family-based Alternatives: EveryChild, Inc. is contracted to develop and implement a system of family-based alternatives so children have the option to leave institutional care and live in families. The project primarily serves children residing in facilities in and around the metropolitan areas of Houston, San Antonio, Austin-Temple, Dallas, and Longview.
Permanency Planning: HHSC continues to collect information for the Permanency Planning Reports and to inform the Legislature of the progress of this deinstitutionalization effort. While the total number of children in institutions, as defined by S.B. 368, which includes Home and Community-based Services (HCS) supervised living and residential support, has declined very slightly in the past eight years, there has been a significant shift in the distribution patterns. Sizable numbers of children are moving back to their families, to family-based alternatives, or to other smaller, less restrictive environments.
The data shows an overall decrease in the number of individuals moving to families or smaller settings in the mid year 2009 to mid year 2010 period, including state mental retardation facilities and targeted DFPS licensed facilities, which had increased slightly in the previous report period. In total, the number of children living in all DADS non-HCS facilities, which include community Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR), nursing facilities, and state mental retardation facilities, has declined by 36 percent in the past seven and one-half years, and is down 2 percent in the past year. Meanwhile, the number of children in all targeted DFPS facilities and all non-HCS DADS facilities combined has declined by 2 percent in the past year, and 28 percent since August 2002. Significant long-term declines have been seen in the populations of children in large ICFs/MR, which are down by 85 percent since August 2002, and nursing facilities, which are down by 58 percent in the same time period.
Consumer Direction Workgroup: HHSC continues to lead the Consumer Direction Workgroup (CDW). Acting on recommendations from the first biennial report to the Legislature, the CDW supported significant expansion of the Consumer Directed Services (CDS) option and is preparing for expansion of the Service Responsibility Option (SRO) into all long-term services and supports. The CDW assisted in education and outreach through improvement in web-based resources and participating in Town Hall meetings; and improved the function of the workgroup through a new member orientation program and the election of a member to serve as the vice-chair. The CDW prepared its second biennial report to the Legislature. The report presents 16 specific recommendations adopted by the workgroup. These recommendations are intended to make consumer direction an option available to more Texans to help make their lives more independent and meaningful. The CDW continues to identify issues that represent barriers to consumer direction and provides guidance to state agencies to help remove or lessen these barriers.
The Long-Term Care Partnership is a joint effort between private long-term care insurers and Texas state agencies. The partnership encourages people to plan for their long-term care needs, by purchasing Long-Term Care Insurance instead of relying on Medicaid. Through the Partnership program, the state offers individuals who purchase partnership qualified policies access to Medicaid without the need to impoverish themselves should additional long-term care coverage be needed, beyond what the policy provides. Individuals receive resource protection at the time of Medicaid eligibility and estate recovery in the amount of benefits paid under the policy.
The Deficit Reduction Act of 2005 authorized all states to establish Long-Term Care Partnership programs. The 80th Texas Legislature passed S.B. 22 (80th Legislature, Regular Session, 2007) which requires the Health and Human Services Commission (HHSC), the Texas Department of Insurance (TDI) and the Department of Ageing and Disability Services (DADS) to coordinate efforts to implement a Partnership in Texas. Requirements include training for insurance agents and education for consumers, inflation protection depending on consumer’s age, and reciprocity between partnership states who do not opt out of reciprocity. Approximately 35 states have or are developing LTC Partnership programs so far. TDI adopted rules that allow Long Term Care Partnership Policies to be sold in Texas in March of 2009.
In February of 2010 HHSC launched the Own Your Future Texas Long Term Care (LTC) Awareness Campaign to educate Texans about LTC and the importance of planning for their future LTC needs. The Own Your Future Texas campaign includes:
A mailing to approximately 1.4 million households in the targeted demographic population, conducted in collaboration with the U.S. Department of Health and Human Services federal Own Your Future campaign.
A LTC planning kit designed to serve a user-friendly planning tool to help individuals assess their future LTC needs and begin planning for the costs.
A website www.ownyourfuturetexas.org to provide detailed information and resources on LTC planning and options, including interactive features such as online need assessment worksheets and calculators.
Online banner ads on targeted websites.
Public service announcements aired on a network of radio stations around the state.
Community outreach to help educate community organizations and assist them in providing community-based education outreach about LTC and LTC planning.
Medical Transportation Services: Medical Transportation Program (MTP) is administered by the Texas Health and Human Services Commission. MTP is responsible for arranging transportation services for Texas Medicaid clients, Children with Special Health Care Needs Services clients, and eligible cancer patients in 8 counties in the Texas valley (i.e., Transportation for Indigent Cancer Patients).
Transportation services centers (call centers) are responsible for authorizing services for clients. Centers are located in Austin, San Antonio, McAllen, and Grand Prairie. In addition, contract specialists are located throughout the state and are responsible for monitoring transportation service providers. These monitoring activities are designed to ensure that services are provided to clients appropriately.
In compliance with Rider 55 (Article II, Health and Human Services Commission, S.B. 1, 81st Legislature, Regular Session, 2009), MTP is developing a full-risk broker model for the provision of transportation services in a portion of the state. In the rest of the state, MTP continues to subcontract and directly provide transportation services through 15 transportation service area providers.
For increased efficiencies in provider reimbursement and reporting, MTP is working to integrate its claims processing function with a contracted vendor. The provider enrollment function is also being transferred to a contracted vendor to streamline the enrollment process and reduce administrative burden to providers. MTP received approval on the Advanced Planning Document from the Centers for Medicare and Medicaid Services for the development and installation of a new transportation automation system.
To respond to high call volume in the transportation services center, MTP increased its telecommunication lines from 529 to 621. MTP is also using workforce optimization software to assist in determining staffing patterns.
MTP implemented recommendations according to its business process review, which has strengthened operations and processes.