Yesterday, Amy Kantoff, TACIL Executive Director, attended a House of Representatives Human Services Committee hearing regarding Senate Bill 7. Its implementation will have a direct impact on the well-being of nearly 100,000 Texans with disabilities, their families, and providers — so the hearing provided a great opportunity to hear about the intent of the legislation, the plan for how it will be carried out, and how stakeholder concerns are being addressed.
About SB 7.
SB 7 changes how medical and long-term services and supports will be provided through Medicaid and Medicaid waivers. Medicaid managed care (STAR, STAR+PLUS) is being expanded. The idea is to provide better services to more people, improve information and access and enhance person-centered planning and self-direction. You can find a summary of all HHSC Medicaid Managed Care Initiatives here.
Agency Testimony.
First, HHSC and DADS (HHSC Deputy Commissioner Chris Traylor and DADS Commissioner Jon Weisenbaum) provided testimony regarding details about the bill and its implementation.
Gary Jessee (HHSC Deputy Director, Medicaid / CHIP) also spoke to questions regarding enrollment and ensuring consumer awareness of upcoming changes.
Committee members asked questions with regard to network adequacy and consumer access, particularly RE: consumers with intellectual / developmental disabilities. They shared concerns the public expressed (below) about the aggressive timeline for implementation.
Public Testimony.
The hearing room was standing-room-only for most of the day – testimony was provided by a wide array of individuals and organizations that shared support for the initiative as well as concerns about its implementation.
- Organizations such as TCDD, CTD, ADAPT (including the Personal Attendant Coalition, an ADAPT project), DRT, the ARC of Texas
- Associations such as the Texas Healthcare Association, Private Providers Association of Texas, the Texas Chapter of the National Association of Social Workers
- Providers, such as nursing home and intermediate care facilities, and attendants
- Parents, grandparents, and other citizens
Testimony included comments regarding:
- Support for the initiative as it is intended to provide better services, information and access to more people while reducing costs and waiting lists
- Support for functional assessments based on the needs of the consumer
- The importance of the attendant! We all know about issues with low attendant rates / wages – need to raise the minimum rates for attendants. They are the providers who spot decubiti, nutrition issues, hygiene issues…they provide services that help keep the consumer from requiring services such as acute care, hospitalization
- People don’t know these changes are coming, or if they have received information, they are confused. The messages need to be made more clear. (Dennis Borel of CTD suggested HHSC consider doing something like the Between Two Ferns comedy episode featuring President Obama. Personally, I think this is a great idea.)
- Consider a less-aggressive timeline, and phasing, to ensure successful, not-rushed-into implementation and communication about changes. (This was echoed by many.) Develop an outreach and education strategy involving stakeholders
- Transportation. How will transportation issues be managed? This was also echoed by many. (Judy Telge travelled from Corpus to Austin to speak to this concern; she shared information about CILs with the Committee and the audience, as well as concerns about secondary providers: those who provide transportation and housing services.)
- Judy also spoke to nursing home relocation services: let’s dialog to ensure that those people who don’t want to be in nursing homes can get out. There are tensions between managed-care-organization and relo staff (medical vs. consumer control model)
- Mental health needs of the I/DD population. Few people who work with I/DD consumers are familiar with mental health issues, and few people who work in mental health are familiar with I/DD needs. Behavioral services are typically ordered for compliance. Often, mental health conditions are not diagnosed but instead symptoms are attributed to the disability. Trauma-informed care is needed
- Availability of providers overall for the I/DD population
Next Steps:
- Committee Chairman Rep. Raymond asked that HHSC organize a meeting in mid-May for stakeholders.
- A hearing regarding I/DD redesign will be held in Austin April 15. I plan to be there.
- Information sessions are being held in Houston, Beaumont, Laredo, McAllen, and Brownsville in the coming weeks. Presentations are also available online that DADS and HHSC created to provide information for consumers as well as providers.
I encourage you to share this information with your staff. I hope that you will take advantage of the opportunity to become more acquainted and involved. Feel free to provide your input or ask questions at any time.
Amy Kantoff
Executive Director
TACIL | Texas Association of Centers for Independent Living
7101 Easy Wind Drive # 3114 | Austin, TX 78752
512.374.0730