HHSC Submits Exceptional Items to Senate Finance Committee

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Learn about the exceptional items that may be of interest to people with disabilities and their families.

In September, the Health and Human Services Commission’s (HHSC) Legislative Appropriations Request (LAR) included requests for 64 exceptional items (see TCDD’s Summary of HHSC LAR). Exceptional items are priorities the agency considered of great importance in addition to the base budget. At a Senate Finance Committee (SFC) hearing on January 30, HHSC submitted an LAR with just 22 exceptional items. Funding for interest list reduction, community attendant wages, and Intensive Behavioral Intervention for children with autism were among the original exceptional items that were not included in HHSC’s LAR submitted on January 30.

Below are the exceptional items submitted by HHSC that may be of interest to people with developmental disabilities and their families.

Maintain Waiver/State Supported Living Centers (Exceptional Item 13)
$108M GR, $256M AF

The introduced 2017 Senate budget did not include funds:

  • for HCS, CLASS, TxHmL, and DBMD waiver services that the 2015 Texas Legislature said it paid for, and
  • the mid-biennium rate adjustment HHSC automatically approves. In September the SSLC daily rate increased 11.2% to $856.70 per day.

If not funded some people receiving waiver services at the end of the biennium will lose their waiver services on August 31, 2017.

This is the first time in the recent past that SSLC increases have not been included in either the base or the entitlement exceptional item, thus, SSLCs will have to develop a more aggressive cost reduction plan.

Day Habilitation Compliance (Exceptional Item 7, formerly Exceptional Item 40)
$30.6M GR, $70M AF

There is no change to this item, however, HHSC staff acknowledge the item does not meet the need they thought it would in September. Stakeholders are concerned that the plan to date would not address the needs of people with complex needs and funding at this level would likely result in a significant number of people with complex support needs moving into more expensive, less integrated settings.

This item was intended to bring Texas into compliance with the Centers for Medicare and Medicaid Services (CMS) Home and Community-based Services (HCBS) Settings Rule. The agency’s primary proposed strategy is to assist waiver providers with rate increases and anticipates additional services (community integration), and increased contract oversight.

Maintain ECI Caseloads (Exceptional Item 6)
$19.8M AF

Federal Individuals with Disabilities Education Act (IDEA) Part C regulations require all children determined eligible for Early Childhood Intervention (ECI) to be served. To reduce state funding for the program, the Texas Legislature already narrowed ECI eligibility criteria in Fiscal Year 2012. Although IDEA Part C funding has remained relatively level, the ECI program has historically seen growth in the number of children served. Several providers have already exited the program and the federal Office of Special Education Programs report they were notified by HHSC that there are potentially 11 more providers expected to withdraw from Texas’ ECI program.

Even if the additional funding is appropriated, HHSC projections anticipate 0.5% fewer children will be served in 2018. ECI program modification may be under consideration.

Transition to Community — formerly Promoting Independence (Exceptional Item 15)
$49.2M GR, $114.5M AF

This item provides the following new Promoting Independence services to persons who would otherwise be entitled to more expensive institutional services. [This was Exceptional Item 14 in the September HHSC LAR for roughly the same amount, but it no longer includes Medically Dependent Children’s Program (MDCP) services for 550 children at risk of entering a nursing facility].

The number of people who will receive Promoting Independence services
Promoting Independence Groups Number of People
HCS for People Moving from SSLCs 400
HCS for People Moving from Large ICFs 100
HCS for Youth Aging out of Foster Care 236
HCS for Persons at Imminent Risk of Entering an ICF 400
HCS for People with IDD Moving from State Hospitals 120
HCS for Children Moving from a general residence operations (GRO) facility (DFPS) 40
HCS for People with IDD moving from nursing facilities 700
HCS for People with IDD at risk of entering a nursing facility 600

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