77th Legislative Summary
Outcome
of the 77th Texas Legislature
After 140 days of deliberations, at midnight on May 28, 2001, the 77th Texas Legislative Session ended. A total of 6,206 bills and concurrent and joint resolutions were filed. Of these bills, only 1,934 (998 HBs, 13 HJRs, 250 HCRs, 612 SBs, 7 SJRs, and 54 SCRs) actually passed both chambers and were sent to the Governor for signature. (An unprecedented 82 bills of the 1,934 forwarded to the Governor for approval, were vetoed). In comparison to the 76th Session, the 77th Session resulted in 34 more bills being filed and 296 more bills passed.
Note: Of the 6,206 bills that were filed, PPAT monitored the status of 149 of them, having identified such as being relevant to the industry. Of these 149 bills, 59 were passed by both the House and Senate and forwarded to the Governor for signature. The Governor signed 56 of these into law and vetoed three of them.
A summary of key bills pertinent to the mental retardation service system that were signed by the Governor can be found on PPAT’s website under Key Bills Passed. Information regarding other bills relevant to the health and human services system that passed are noted under Other Bills Passed of this same website. A summary of the appropriations relevant to the health and human services system is provided below.
General
Appropriations Bill
The state’s budget, as
jointly passed by both the House and the Senate, calls for $114 billion in
expenditures over the upcoming biennium. Of
these funds, approximately $61.7 billion are from General Revenue (GR), $4.5
billion is General Revenue-dedicated, and $47.5 billion is from federal and
other funds. Of these allocations,
the health and human services system received a 17% increase ($29.9 billion to
$35 billion) in spending.
Note: While the Comptroller confirmed that the GR funds appropriated by the Legislature balance with the GR funds expected to be available to support the state’s budget for FYs 02-03, she commented that “this balance, however, masks underlying discrepancies that could make the budget next session a challenge.” The Comptroller noted the following as cautions for the 78th Legislature:
* The appropriations base for GR for the subsequent biennium (2004-05) will be at least $1.4 billion more than the $61.7 billion because Senate Bill 1 includes funding for only one year of teacher health insurance at $1.25 billion and delays the last Medicaid premium payment of $150 million.
* The 2002-03 budget relies on a projected $2.9 billion surplus from this biennium as part of the revenue base used to fund the $61.7 billion in appropriations and an additional $800 million is funded by one-time measures that cannot be repeated next biennium.
While this does not
necessarily mean that there will be a $5 billion shortfall next biennium, it
implies that legislators will be faced with significant budget challenges in the
78th Session.
Concerning funding for TDMHMR, the preliminary analysis indicates that the agency was appropriated approximately $3.8 billion in all funds to operate during FYs 02-03. Of these dollars, the following is of importance:
* $144.5 million in additional GR funding were appropriated to fund about 1/3 of the services on the department’s initial LAR Exceptional Items List. Items either fully or partially funded include: Restoration of Current Service Levels for both MH and MR; Maintenance of State School and Hospital Services, Upgrade Salaries for Direct Contact Staff at State Schools, Rate Adjustments for HCS Providers, Promoting Independence to include funding for new services for those on the Waiting List, and Critical Life Safety Code Repairs at State Facilities.
* $27.3
million in GR ($68.5 in all funds) were appropriated to fund the department’s
request for expansion of HCS. The
$27.3 million represents only about 50% of the amount the department requested
in its LAR Exceptional Items List. The
funds, which will be used to comply with the Promoting Independence Initiative
(Texas’ response to the Olmstead decision), will provide services to
approximately 918 persons over the upcoming biennium.
Of these 918 persons…
571 are
persons currently residing in state schools who have either requested community
placement or who are projected to request placement in the community.
Of this figure, 295 are persons who have requested community
placement and must receive the placement by Feb. 2002, and 276 are
persons who reside in state schools and are anticipated, over the biennium, to
request movement to the community. Both
HCS and ICF/MR settings are being explored for these persons.
347
are persons who currently reside in community-based ICFs/MR (14 bed and
larger) who have either indicated their preference to move to a smaller living
arrangement (either ICF/MR or HCS) or who, over the biennium, are projected to
request alternate placement. Of this figure, 227 have already requested
placement and are targeted for placement within the first year of the biennium
and 120 are projected to request and receive placement during FY’02.
Waiver services are the only option being explored for these persons.
This includes both HCS and the Consolidated Waiver pilot.
* Approximately $2.5 million in GR ($6 million in all funds) were received to support rate adjustments for HCS/MRLA providers. This will provide a rate adjustment of less than 1% for each year of the biennium (1.2% for the entire biennium).
* No funds were allocated to support rate adjustments for ICF/MR providers. SB 1839, however, was passed which calls for the establishment of a Quality Assurance Fee, applicable to both private and community MHMR Center ICF/MR providers, to support rate adjustments for ICF/MR providers. The bill provides that any excess dollars generated from the fee, but not used/deemed needed for ICF/MR may be used to augment rates for HCS/MRLA. See Key Bills Passed under this website for details on SB 1839.
* No funds were appropriated for Equity Funding.
*
The department received approximately 48.81% of the funds it requested to
provide salary upgrades for direct
are staff at its state facilities and 10.4% of the funds it requested for rate
adjustments for community providers.
* The department did not receive any funds it requested for the mid-range waiver. See TDMHMR Rider #61 for more information.
Concerning
funding for TDHS, the following should be noted…
Preliminary estimations indicate that for FY’02 expansion funds were received to serve approximately:
* 5,469 persons on the waiting list for services through the Community-based Alternatives (CBA) waiver. Currently, this program serves 23,593 persons.
* 730 persons on the waiting list for services through the Community Living Assistance and Support Services (CLASS) program. Currently, this program serves approximately 1,146 persons.
* 48 persons waiting for services through the Deaf-blind with Multiple Disabilities program. Currently about 97 persons are served through this program.
* 245 persons waiting for services through the Medically Dependent Children program (MDCP). This program currently serves about 826 children.
Critical Appropriations Riders By Agency…
HHSC
Rider #16 related to TDMHMR Feasibility Study: To maximize the number of HCS/MRLA consumers served, HHSC shall examine the cost effectiveness and feasibility of allowing HCS/MRLA consumers to receive services in a 5-bed residence at the current applicable per-consumer level of need rate.
Rider #19 related to Medicaid Cost Containment Consultants: HHSC is authorized to contract with a consultant during FYs 02-03 for the purpose of identifying cost-containment or savings options for the Medicaid program.
Rider #52 related to Alternative Service Delivery Options for Court Committed Clients: From funds appropriated, the Commissioner of HHSC shall examine whether the Mexia State School and/or any other Intermediate Care Facility (ICF/MR) are appropriate settings for a consumer with mental retardation who has been referred through the criminal justice system. This includes: a) In the event the commission finds the Mexia State School or other ICF/MR facility are appropriate settings, the commission shall seek an appropriate waiver from the federal government for Medicaid-eligible clients who reside at the Mexia State School or other ICF/MR facilities who have been referred from the criminal justice system, b) In the event the commission finds the Mexia State School or other ICF/MR facilities are not appropriate settings for these clients, the commission shall develop a suitable alternative, and c) The commission shall make its conclusions known to the Governor and the Legislative Budget Board by February 1, 2002.
TDHS
Rider #45 related to Contingency Appropriation for HB 154 regarding the Personal Needs Allowance for Residents of Certain LTC Programs: Dollars were appropriated to TDHS to implement the provisions of HB 154 in the event the bill passed and was signed by the Governor. The bill calls for a personal needs allowance of not less than $60.00 a month and is applicable to residents residing in nursing homes, ICFs/MR, personal care facilities, or other similar long term care programs that receive medical assistance. See Key Bills Passed under this webpage for more details on HB 154.
TDMHMR
Rider #13
related to HCS: Requires
TDMHMR to ensure the cost effectiveness of the HCS program by limiting the
average annual HCS expenditures per client to 80% of the average annual per
client ICF/MR expenditure. Expenditures
for individual clients may exceed this cap as long as the overall average
expenditure for HCS remains below 80% of the annual average.
In order to increase the number of clients served, the overall average
monthly expenditure per client shall not exceed $3,511 per month in FYs 02 –
03. TDMHMR must report to the LBB
and Governor by October 1 of each year on the measures taken to decrease the
average cost per person and to increase the number of clients served in the HCS
program.
Rider #16 related to Enhanced Equity: Requires MHMR to use any funds appropriated for expanding or improving services in either Strategies A.1.2 (MH) or C.1.2 (MR) and for addressing the HCS waiting list as noted in Strategy C.1.4 in accordance with the Equity formula.
Rider #17 related to State School Funding: Requires TDMHMR to implement a single funding methodology for state schools which funds all state schools equitably and at a level which is adequate to maintain compliance with applicable federal regulations.
Rider #18 related to Reports on Local Authorities: Requires TDMHMR to keep the Legislature and the Governor informed of the effects of delegating to a local MHA or MRA the responsibility of planning, coordination, and oversight of mental health and/or mental retardation services in that area.
Rider #34 related to Pilot Project for Persons with Developmental Disabilities: Requires TDMHMR to develop a pilot project in Midland County which will identify 16 persons who have required long term care settings in the past and/or are still in need of and eligible for placement in long term Medicaid group homes. These persons or their legally authorized representatives will be provided the opportunity to direct their own level of care, such that their service plans would include only necessary and requested services. The intent of the pilot is to demonstrate that provision of only necessary and requested services in a manner prescribed by persons with DD will produce less dependent, more productive citizens in a most cost-efficient model. A full cost/benefit analysis to demonstrate the effects of the model is due by July 1, 2003.
Rider #54 related to Residential Providers: Requires that persons seeking residential services for a person with MR have a choice of available providers. To ensure this choice, TDMHMR must inform persons seeking residential services of all service options available, including large and small congregate settings and waiver services.
Rider #55 related to Placement Options: A person with MR or his/her legally authorized representative (LAR) seeking residential services must receive a clear explanation of programs and services for which the person is determined to be eligible, including state schools, community ICFs/MR, 1915 ( c ) waiver services or other services. The programs and services that are explained are to be documented in the person’s record and acknowledged in writing by the person or the LAR. If the chosen programs or services are not available, the person or the LAR must be given assistance in gaining access to alternative services and the selected waiting lists.
TDMHMR must keep a central list of the number of openings available for each type of residential service and must honor the program and service preferences of the person or LAR to the maximum extent openings are available in a residential program or service for which the person meets program criteria.
Rider #61 related to HCS Mid-range Waiver: TDMHMR in conjunction with HHSC is authorized to seek approval from HCFA for an HCS mid-range waiver to provide services and supports to persons with MR who do not require out-of-home residential support. Services and supports in the waiver would be capped at $25,000.00 per year. The LBB and the Governor must approve implementation of the waiver prior to expenditure of any funds on waiver placements.
Rider #62 related to Provision of Information about All Care Alternatives: Requires TDMHMR to comply with the requirements of 533.038 of the Health and Safety Code by specifically providing to a person with MR who is seeking residential services or that person’s LAR, information regarding the full continuum of care alternatives that are available, as well as information regarding spaces available in all the care alternatives.
Rider #65 related to Cost Comparison Report: Requires TDMHMR to develop a report for the Legislature analyzing state and federally funded residential and non-residential services for persons with MR for which it is the Medicaid operating agency. The report must include 1) an analysis of the difference between the annual average cost to the state per person for persons residing in state-operated and non-state operated ICFs/MR, and 2) an analysis of the difference between the average annual cost to the state per person participating in the HCS, HCS-O, and MRLA waivers.
Concerning the costs to the state per person residing in an ICF/MR, TDMHMR must include all costs such as SWICAP, DICAP, maintenance and construction costs, employee benefit costs, and other federally allowable administrative, medical, and overhead costs. Concerning the cost to the state per person in state-operated ICF/MR facilities, non-state operated ICF/MR facilities, and the HCS, HCS-O, and MRLA waivers, TDMHMR must include all Medicaid costs that are not included in the reimbursement rate for those programs.
Rider #66 related to Plan for Care of Dually Diagnosed Persons: Requires TDMHMR to develop a plan to enhance the well-being and care of citizens who are dually diagnosed with MR and MI. The plan must include all relevant agency divisions and consider the following as options to improve care: adding HCS placements, developing a new system of care for these clients, working with the federal government and contracting of services. TDMHMR must also make preparations for implementation of this plan as well as provide a mid-year progress report on plan development. The plan must be completed and all relevant reports provided to the LBB and the Governor by May 1, 2002.
Rider #70 related to Alternative Service Delivery Options for Court-committed Clients: From funds appropriated, HHSC is to examine whether Mexia State School and any other ICF/MR are appropriate settings for a consumer with MR who has been referred through the criminal justice system. This includes a) if the examination shows that ICFs/MR are appropriate settings, HHSC is to seek a waiver for Medicaid-eligible clients who reside at Mexia or any other ICF/MR who have been referred from the criminal justice system, b) If they are not appropriate settings, HHSC must develop suitable alternative, and c) HHSC is to report its conclusions to the LBB and the Governor by February 1, 2002.
Rider #70 related to Friendship Opportunities for Persons with MR (Contingency Appropriations): Contingent upon receipt of additional Social Services Block Grant federal funds by the state, TDMHMR may allocate $100,000.00 in fiscal year 2002 and $100,000.00 in fiscal year 2003 to contract with nonprofit entities that offer statewide programs that serve persons with MR; facilitate community integrated employment; coordinate one-on-one friendships between students with MR and other students in middle school, high school, and college; coordinate one-on-one friendships between community volunteers and persons with MR; and coordinate one-on-one friendships for persons with MR over the Internet.
Special Provisions Related To All Health and Human Services Agencies
Section 2:
Night Shift and Weekend Differential
a.
Clinical and Support Personnel.
TDMHMR and TDH are authorized to pay an additional night shift salary
differential not to exceed 15 percent of the monthly pay rate to personnel who
work the 3 p.m. to 11 p.m. or the 11:00 p.m. to 7 a.m. shift or its equivalent.
A weekend shift salary differential not to exceed 5 percent of the
monthly pay rate may be paid to
persons who work weekend shifts. The
evening or night shift salary differential may be paid in addition to the
weekend shift salary differential for persons working weekend, evening, or night
shifts.
b.
Data Processing Personnel. TDH,
TDHS, TDMHMR, TDPRS, and the Health and Human Services Consolidated Print Shop
may pay an evening or night shift salary differential not to exceed 15 percent
of the monthly pay rate to personnel in data processing or printing operations
who work the 3:00 p.m. to 11:00 p.m. shift or 11:00 p.m. to 7:00 a.m. shift, or
their equivalents. A weekend shift
salary differential not to exceed 5 percent of the monthly pay rate may be paid
to persons who work weekend shifts. The
evening or night shift salary differential may be paid in addition to the
weekend shift salary differential for persons working weekend, evening, or night
shifts.
Section 16.
Consolidated Waiver Pilot Project Authorization.
From funds appropriated in Article II for Medicaid waivers that serve
people with disabilities, HHSC is authorized to utilize up to $6,529,345 in
Interagency Contracts and $9,562,207 in matching federal funds for the biennium
to develop and implement a pilot waiver program that would consolidate waiver
services provided to eligible clients. Waiver
programs affected under this provision include the Community Based Alternatives,
Community Living Assistance and Support Services, and Medically Dependent
Children’s program at TDHS and the HCS waiver at TDMHMR.
Section 17.
Functional Assessment for Disability Services.
HHSC is authorized to continue implementation of the provisions of House
Bill 663, Seventy-fifth Legislature, requiring the development of a single
functional assessment for all disability services.
The health and human services agencies that provide long-term care
programs based on a determination of disability as an eligibility criterion
shall contribute, from amounts appropriated in this Article, a total of $125,000
to HHSC for development of the assessment tool.
HHSC shall determine the amounts to be contributed by each agency.
This page was last updated on 02/22/06