March 15, 2013
Presented in response to a request for comments and suggestions regarding CSSB 7 by Senator Nelson:
Sec. 533.0335 related to the Comprehensive Assessment And Resource Allocation Process: This section limits use of the tool to waiver services only.
Recommendation: Add intent that the end result should be a single comprehensive assessment for all ICF, waiver and CFC recipients.
Recommendation: Add language about how to handle the assessment for the CFC service that is not based on a medical model and timeline to ensure that it is chosen/developed prior to implementation. The assessment used at implementation may need to be an intermediary measure until a comprehensive tool is adopted; but it still needs to be valid, reliable and not based on a medical model.
Recommendation: Add language to reflect that the comprehensive assessment process should be coordinated by IDD local authorities per Section 533.0355 (b) 3 for individuals with intellectual and developmental disabilities. In this manner, the enhanced assessment process will compliment and inform the HCS Person Directed Planning process.
Recommendation: The HCS Person Directed Planning process and tool developed with substantial stakeholder input should be included in the future of the IDD system. As part of the ongoing implementation of Sec. 48 Rider provision (2009), stakeholders have developed and refined a PDP process and tool that should be expanded to the other programs in the system (including SSLCs).
Recommendation: Add language to reflect intent for the Department/Commission to consult with the Advisory committee in the development and implementation of the comprehensive assessment instrument. CSSB 7 expects that consultation only with respect to developing the resource allocation process.
STAR Kids stakeholder input eliminated – Sec 534.152 – this section deleted a subsection re: stakeholder input. Not sure if that’s now expected from the new advisory committee, or just dropped.
Recommendation: Add an advisory process specific to STAR Kids. The STAR Kids transition is a BIG issue that needs its own stakeholder process. Recommend a broad stakeholder advisory committee specific to the transitions of SSI kids with complex needs.
IDD Advisory Committee & CFC Option: Although Section 534.053 states that the Advisory Committee will advise HHSC and DADS on the redesign of the IDD system under this chapter, there is no reference to its involvement in the development and implementation of the CFC Option under Section 534.152 or in Section 1.04 related to the final report that is due to the legislature not later than June 1, 2016 regarding the CFC Option.
Recommendation: Add language regarding the role of the Advisory Committee in the implementation of CFC.
Advisory Committee Composition: Sec. 534.053 (a) (3) (E) specifies that the committee shall include a representative from NorthStar.
Question: What is the relevance of NorthStar to this committee?
Recommendation: If the intention is to include mental health providers, identify mental health providers. Membership of the IDD stakeholder advisory committee should be limited to actual IDD stakeholders.
Advisory Committee Travel: Not addressed.
Recommendation: In order to ensure meaningful participation by self-advocates and families, reimbursement for travel expenses for self-advocates and families of persons with disabilities appointed to that Committee should be authorized by the bill and via contingency rider.
Sec. 534.202. Transition Of ICF/IID And Medicaid Waiver Recipients To Managed Care Program: Subsection (f) requires that before transitioning the provision of Medicaid program benefits for children, an MCO providing services under the managed care program delivery model must demonstrate to the satisfaction of the commission that the MCO’s network of providers has experience and expertise in the provision of services to children with IDD.
Recommendation: The above required IDD experience should apply regardless of the person’s age. There should also be a requirement that the MCOs have demonstrated experience providing management of care for persons with IDD.
Recommendation: Network adequacy standards need to be strengthened. There is little confidence in the accuracy of network provider lists in the current system. An independent (not affiliated with HHSC or DADS) ombudsperson should be authorized to routinely deploy “mystery shoppers”, by region, to contact listed providers’ offices to verify that they are a member of the network and that they are accepting new patients. This was identified by AARP as Promising Best Practice and would help to mend consumer confidence.
Secs 534.201 and 534.202 related to Transition Of Recipients of Texas Home Living (TxHmL) ICF-IID and Medicaid Waiver Program Recipients To Managed Care: At various forums it has been stated that current programs and services would not change or go away.
Recommendation: The language in the bill does not track these assertions. If the intent is not to eliminate services for current participants, the bill should provide explicitly that the intent of the bill is for the current array of services to be maintained in the future either through a managed care model, the current waiver(s), or a new waiver program for that purpose.
Recommendation: The decisions for transferring services to managed care or maintaining in an existing or new waiver should be delegated to the legislature by specific language. This and the previous recommendation will reassure families that it is not the intent of the bill to “take away” critical services for their family members.
Eliminate Choice of Health Plan for “Certain Persons”
Section 2.01 – 533.025 (f) – (h) allow the commission to study and implement auto enrollment for “certain populations” into a managed care plan.
Recommendation: Remove. It seems that this would remove “certain” persons’ ability to choose the plan with the individuals’ traditional significant health providers.
Independent Ombudsperson – The last time the state introduced managed care to a new population an independent organization was created to assist Texans with health care access and health education, and to ensure their rights in a managed care system.
Recommendation: Include a provision that requires an independent (not affiliated with HHSC/DADS and MCOs) ombudsperson to operate a toll-free helpline to assist people with cognitive disabilities with health care access and health education, and to ensure their rights in a managed care system. This entity should also be authorized to routinely deploy “mystery shoppers”, by region, to contact listed providers’ offices to verify that they are a member of the network and that they are accepting new patients.
Pilot Projects – There is no reference to how pilot providers will be monitored to ensure health and safety or reference to rules to which they must adhere.
Questions: There are substantial concerns about the “flexibility” that will be provided to pilot providers. Monitoring and accountability, including a sanctioning process, to ensure health and safety are vital to achieving the goals of SB 7. What rules and regulations will they be operating under? Will local oversight be provided? Are we taking a step backward by allowing a person to only have a provider in their life?
Recommendation: Add language to reflect intent for local IDD authorities to continue their role and responsibilities for individuals with intellectual and developmental disabilities as provided by Health and Safety Code Sec. 533.0355. (FYI – that includes access, intake, eligibility functions, enrollment and initial person centered assessment, safety net, service coordination function, and monitoring.)
Parent Premiums –SB 7 would require parents to pay a premium for long term services and support provided to a child. Under federal law a co-pay cannot be charged for institutional services. SB 7 would thus expect a co-pay from parents for only services in community based waivers and other community long term services programs. Families stated that it would be unfair to have premiums for parents whose children use community-based long term services and supports unless premiums are also applied to institutional services.
Recommendation: Make parent premiums contingent on equitable application across programs.
Section 544.054 – Annual Report – Now Dec 1 each year, previously Sept 1.
Recommendation: Return the reporting back to September rather than December. Legislators and stakeholder should have ample opportunity to understand the scope of the reports. In the event that substantial change occurs between September and December, agencies can turn in supplemental reports.
Provider Base Expansion – Home care providers are aggressively seeking to exclude providers without HCSSA licensure from providing the new CFC service. Self-advocates and families have been clear that they want providers with demonstrated experience providing services specific to people with IDD.
Recommendation: Affirmatively state that the intent is to expand the provider base and deem both licensed and certified DADS providers with demonstrated experience working with people with IDD as eligible CFC providers. And identify CLASS, HCS and TxHmL providers as significant traditional providers for the purposes of LTSS managed care for people with IDD.
Habilitation – Resource regarding the difference between habilitation and rehabilitation at: https://tcddstaging.missc.net/public-policy/public-policy-input/public-input-provided-in-2012/public-input-to-the-texas-department-of-insurance-nov-21-2012/