Summary of DADS Exceptional Items Request

84th Legislative Session

The following are the decisions adopted by the 84th Texas Legislature in House Bill (HB) 1 above the base budget for the Department of Aging and Disability Services (DADS).

Exceptional Items

  1. Restore Baseline Funding
    DADS requested $21.1 million in General Revenue (GR)[1. General Revenue Funds are state funds. The general revenue fund receives money from the sales tax, the motor vehicle sales and rental taxes, the franchise tax, insurance premium taxes, and various other taxes and fees.] and $44.9 million in All Funds (AF)[2. All Funds are the combination of state general revenue funds, federal funds and other revenue.]. The base budget maintained Targeted Case Management (TCM), provided by local intellectual and developmental disability authorities (LIDDA), at Fiscal Year (FY) 2014 and FY 2015 funding levels, however, the caseload for FY 2016–17 is expected to increase significantly as a result of implementation of both the Community First Choice (CFC) program and the current Preadmission Screening and Resident Review (PASRR) process. This request also would have funded Data Center Consolidation and the 2% salary increase approved by the 83rd Texas Legislature for FY 2015:

    1. Adopted $14.9 million to address targeted case management.

    2. Adopted $2.27 million for Data Center Consolidation.

    3. Adopted 2% salary increase as a technical correction with no cost to the bill.

  2. Cost Trends
    Client-related increases in costs and acuity will require a need for about $22.4 million in GR over the next biennium. These funds are for DADS entitlement programs (Primary Home Care, Community Attendant Services and Nursing Facilities); the agency has little discretion in paying for these services. Costs have increased by 1% to 2% in some programs. Adopted $23.7 million.

  3. Interest List Reduction
    This comprehensive request would have funded medical and community-based DADS waiver services for an additional 15,780 people. Services were projected to cost about $305.9 million in GR. This amount would fully fund the STAR+PLUS waiver and Deaf-Blind Multiple Disability (DBMD) interest lists, fund services for 20% of those waiting for Home and Community-based Services (HCS), Medically Dependent Children Program (MDCP), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), and Title XX services, and would reduce interest lists for In Home and Family Support (IHFS) and LIDDA Community services by 10% from FY 2014–15 levels. Adopted $51 million to reduce interest lists.

    The number of people additional funds requests would provide medical and community-based DADS waiver services for and the number of people HB 1 will provide these services for.
    Waiver DADS Request 20% Reduction HB 1
    HCS 6,792 2,134
    CLASS 4,151 752
    DBMD 21 50
    MDCP 1,282 104
    TxHmL 1,040 no data
    STAR+Plus 1,646 1,235
  4. Promoting Independence
    The Promoting Independence Initiative makes community waiver services available to people who are otherwise entitled to institutional services. DADS requested $32 million in GR for waiver services for 1,362 people to move to the least restrictive setting to meet their needs. Adopted $29.7 million of the $32 million request.

    The number of people additional funds requests would provide community waiver services for and the number of people HB 1 will provide these services for.
    Promoting Independence Groups Number of People Requested HB 1
    HCS for people Moving from large and medium Intermediate Care Facilities (ICFs) — including State Supported Living Centers (SSLCs) 500 500
    Children Aging out of Foster Care 216 2016
    Persons at Imminent Risk of Entering an ICF 400 400
    Individuals with Intellectual and Developmental Disabilities (IDD) Moving from State Hospitals 120 120
    Children Transitioning from a general residence operations (GRO) facility (DFPS) 25 25
    STAR+Plus for people at Imminent Risk of Nursing Facility Admission 100 no data

    Should address the full request as sufficient funds were allocated to Health and Human Services Commission (HHSC) to address the need for STAR+Plus for people at imminent risk of nursing facility admission.

  5. Enhanced Community Services for Persons w/IDD and Complex Needs
    DADS requested $36.9 million in GR to support people with complex needs:

    1. Behavior Intervention and Crisis Respite Services ($27.5M GR). Adopted $18.3 million.

    2. An add-on rate of $75.76 per day will be piloted to assist ICF and HCS providers to serve people with complex medical support needs (FY 2016 150 ICF; FY 2017 175 ICF, 175 HCS) ($5.9M). Adopted.

    3. Enhanced transition services for people leaving SSLCs ($3.5M). Adopted.

  6. PASRR Compliance
    To bring Texas into compliance with federal PASRR requirements for persons with IDD entering or seeking admission to a Nursing Facility, DADS requested $40.4 million in GR for the FY 2016–17 biennium. Half of this request would be used to provide community services and is offset by the lower number of persons expected to be in Nursing Facilities. Adopted $43.8 million.

  7. Protecting Vulnerable Texans
    DADS is requesting funds, about $21.2 million in GR and $41.8 million in AF, to improve the safety of people receiving DADS services:

    1. Additional contracted assisted living facility ombudsmen ($1.9M GR/AF). Adopted.

    2. Expand the Lifespan Respite Care Program ($2M GR/AF). NOT Funded.

    3. Raise the HCS dental cap from $1,000 to $2,000 per person per year ($8.3M GR, $19.2M AF). $2.9 million, or an increase to about $1,750 per person.

    4. Assist HCS group homes to install sprinkler systems ($5.9MGR, $13.8MAF). $3 million to reimburse providers of 4-bed group homes up to 50% of the cost of sprinklers to meet new life safety requirements.

    5. Regulatory oversight of home health providers ($1.4M GR, $3M AF). Adopted.

  8. Maintenance/Improving SSLC Operations
    DADS requested $8.2 million in GR and $109 million in AF, including $94 million in bond proceeds, to make life/safety repairs and renovations at the 13 SSLCs. This included funds for the 10–year vehicle replacement plan and a reclassification of Qualified Intellectual Disabilities Professionals (QIDP) position in order to raise their salaries. It also would have expanded an outcomes-based Quality Improvement Program for the 3,310 people living in SSLCs as they transition into an integrated community setting. $9.6 million for capital improvements only.

  9. Specialized Resource Navigation for Veterans
    DADS is requesting $2.2 million in GR and AF to support a Veterans Resource Navigation Specialist at each of Texas’ 22 Aging and Disability Resource Centers to streamline access to programs and benefits. NOT Adopted.

Additional Items

Attendant Wages

Attendant wages are addressed in the HHSC budget. HHSC requested $121.6 million to raise community attendant wages by 5%. Adopted $38.1 million:

  • $7.5 million attendant care rate enhancement (ACRE)

  • Would raise the floor to $8 per hour

Enhanced Managed Care Ombudsman

Contingency funding for Senate Bill (SB)1475 that would require an ombuds system for all persons receiving services under any managed care in order to reduce the need for internal appeals at the managed care company and fair hearing levels. SB 1475 Failed to Pass; Not funded.

Enhanced Services for Persons with IDD

The Community First Choice program does not include transportation and respite, services that are included in habilitation, the equivalent service in the waivers typically used by people with developmental disabilities. This item allows HHSC rate setting to build transportation and respite into the CFC rate. Adopted $12.3 million.

Children with Special Health Care Needs (CSHCN)

The Children with Special Health Care Needs waiting list is addressed in the Department of State Health Services budget. The Department of State Health Services (DSHS) requested $11 million GR to provide services to more than 500 children eligible and waiting for services. Adopted $5 million for services for 186 people.

Provider Rates

Contingent on a system of accountability that requires providers to expend 90% of the rate increase on services:

  • $6.8 million for HCS provider rate increase, and

  • $5.2 million for a 2.2% community ICF provider rate increase.

  • $6.8 million for HCS provider rate increase, and

  • $5.2 million for a 2.2% community ICF provider rate increase.