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Minutes — Committee of the Whole Meeting, November 2, 2010

(As approved by the Committee May 5, 2011)

Attendance

Council Members Present

Council Members Absent

Staff Members Present

Guests Present

Call to Order

The Committee of the Whole of the Texas Council for Developmental Disabilities convened on Tuesday, November 2, 2010, in the Salon C&D Room of the Marriott Austin South, 4414 South IH-35 Austin, TX 78744. Council Chair Brenda Coleman-Beattie called the meeting to order at 10:02 AM.

Introductions

Committee members, staff and guests were introduced.

Route to Success

Graham Mulholland, Executive Director of the Pennsylvania DD Council, provided a presentation on the Pennsylvania Council’s process for developing the 5-year state plan. The Route to Success model uses five overlapping concepts to promote systems change: improve knowledge base; select clear social strategies; create stakeholder will; support policy entrepreneurs; and use unexpected events.

  • The first concept of improving the knowledge base identifies the problem and conducts research into trends, current best practices and potential solutions.
  • The second concept of selecting social strategies establishes goals and methods for achieving those goals.
  • The third concept of creating stakeholder will identifies interest, potential collaborators, sense of urgency, etc.
  • The fourth concept describes the process of finding leadership who can create policy change that is the key to sustainability.
  • The fifth concept is about Councils being prepared to seize unexpected opportunities and/or to address unpredictable negative events that may occur.

Mulholland recommends applying each of these concepts to each identified issue area and provided examples of how his council has used this process. He also recommended analyzing past work to look at what has worked and what hasn’t and provided questions to consider about new ideas. Mulholland and Planning Coordinator Joanna Cordry discussed how this model may apply to the issue areas designated by the Council.

Council members expressed appreciation for the model’s systemic approach of identifying “next steps” needed to achieve desired outcomes, and indicated that they would like to explore use of the model after state plan goals are identified. Members also indicated an interest in adapting “generic” services and activities in most communities so that people with developmental disabilities can be more fully included.

Goal Areas for TCDD FY 2012-2016 State Plan

Cordry guided the discussion on possible areas of focus for the TCDD 2012-2016 State Plan. She presented 12 issue areas that the Council has focused on through grant projects and public policy activities. Council members then discussed areas of personal interest and consideration and broke into small groups for further discussion and ranking by priority. Seven issue areas were listed as top priority by the small groups. The issue areas include:

  • Employment, Income and Assets
  • Education
  • Building Community Capacity
  • Leadership Development
  • Transportation
  • Developing Community Supports that might help decrease non-desired SSLC admissions
  • Health and Healthcare

Staff members were asked to research successes and barriers to success for previous TCDD efforts in these areas and present that information at the next Council meeting. Council members will continue to develop goals, objectives and activities for these issue areas prior to the submission of the next five-year state plan in August 2011.

MOTION: To approve the seven listed issue areas for the FY 2012 – 2016 TCDD State Plan.

MADE BY: Rick Tisch

SECOND: Mate Delgado

The motion passed with opposition by John Morris, Deneesa Rasmussen and Brenda Coleman-Beattie.

Recess

Chair Coleman-Beattie recessed the meeting at 4:09 PM for continuation Thursday morning.

Attendance: Wednesday, November 3, 2010

Council Members Present

Council Members Absent

Staff Members Present

Guests Present

Reconvene

The Committee of the Whole of the Texas Council for Developmental Disabilities reconvened on Thursday, November 3, 2010, in the Salon C&D Room of the Marriott Austin South, 4414 South IH-35. Austin, TX 78744. Council Chair Brenda Coleman-Beattie called the meeting to order at 8:35 AM.

Introductions

Committee members, staff and guests were introduced.

Chair’s Remarks

Coleman-Beattie provided brief comments on the following:

  • Excused absences for these meetings.
  • Several Council members recently toured Austin State Supported Living Center (SSLC).
  • Expected remarks by Chris Adams, DADS Assistant Commissioner for SSLCs.
  • Coleman-Beattie recently authorized an increase for the extension grant award to Texas A&M Research Foundation by $1100, however, that the increase and extension of the project were declined due to the project manager’s resignation.
  • The updated Memorandum of Understanding between TCDD and Texas Education Agency has been signed.
  • Council Member Kris Bissmeyer recently provided testimony to the Senate Finance Committee on Medicaid Waiver Services on behalf of the Council.
  • Coleman-Beattie expects to be absent from part of the February 2011 Council and Committee meetings due to conflicts with the Central Texas African American Family Support Conference.
  • Council member Marcia Dwyer has asked to be removed from the Audit Committee which creates a vacancy; volunteers were requested to contact Coleman-Beattie or TCDD staff.
  • Members to the Nominating Committee will be selected during these meetings.
  • Executive Director Webb recognized Grants Management Director Patrice LeBlanc and Planning Coordinator Joanna Cordry for ten years of service to TCDD. Coleman-Beattie added her appreciation and gratitude for their efforts on behalf of the Council.
  • Council member Joe Rivas noted that the recent documentary video about his life by students from the University of North Texas is available for viewing on YouTube and is also linked from his Facebook page.
  • Webb provided information regarding fact sheets that are available for Council members on the Council’s budget and allowable activities as well as the recent Council action to support Advocacy, Inc. on a call for a moratorium on new admissions to state supported living centers. TCDD has received inquiries on both topics during the last quarter.
  • Council member Kristen Cox provided comments about her tours of State Supported Living Centers.
  • Webb noted that TCDD will have a student intern from the University of Texas School of Social Work who will begin work in January. Laura Poskochil will work with planning and public policy activities.
  • Former Council Chair Linda Parrish received a National Meritorious Service award for more than 30 years of service to people with disabilities from the Association on University Centers on Disabilities.
  • In response to an inquiry from a Council member on DD funds awarded to projects based out of state, Webb queried other DD Councils and found that other councils also award funds to out-of-state organizations when viewed as the best vendor. TCDD has awarded 3-5% of its funds to out-of-state entities each of the past three years.

Public Comments

No public comments were offered.

Review of Key Agenda Items

Public Policy Committee Chair Rick Tisch and Project Development Committee Vice-Chair Dana Perry reviewed key topics of discussion for their committees.

Presentations

Grants Management Specialist Sonya Hosey introduced Susan Murphree, Advocacy, Inc. who provided an overview of the Texas Community Integration Project. TCDD provided funds for this project from 2000 to 2009 with up to $270,000 per year to assist individuals with disabilities to transition from institutions into community settings and to provide technical support and training to build informal and formal community supports. Murphree discussed the training provided to individuals with disabilities and their families, care providers, case workers and members of the community. The project assisted on average 100 persons per year to transition from nursing facilities, intermediate-care facilities and state supported living centers to community settings.

At the invitation of Council Chair Brenda Coleman-Beattie, DADS Associate Commissioner of State Supported Living Centers Chris Adams spoke to members about the department’s response to the Department of Justice investigation and findings reflected in monitoring reports of the state supported living centers. Adams noted that reports of follow-up visits and compliance reviews are posted on the DADS website. DADS is working with the independent monitors to implement lasting improvements but that it is a long-term effort.

2010 Biennial Report Recommendations

Public Policy Director Lello facilitated a discussion on proposed recommendations for the FY 2010 Biennial Disability Report. Lello also provided a draft outline of the report to members. The report will be delivered to the Governor, Lt. Governor, and Speaker of the House by December 1, 2010, as required by law. Chair Coleman-Beattie asked that members receive a copy of the final document for review and any further comments prior to submission. Ms. Lello indicated that Council members would receive a copy via e-mail just around the Thanksgiving holiday, and that there most likely would be a quick turn-around response time. Many of the report recommendations continue the theme of the Council’s 2008 report since many issues have not changed significantly.

Council members asked to focus the primary recommendation on the goal of rebalancing the funding of system services in favor of community services and increased funding for those services. However, there was recognition of the State’s current and anticipated fiscal challenges. When additional funding is available, the Council supports rebalancing the allocation of resources to community-based services as a priority. Members provided input on the draft recommendations and asked that wording be revised in various instances to reflect the current environment. Staff agreed to provide a draft copy of the report to members for final comments prior to submission.

MOTION: To approve the recommendations of the 2010 Biennial Disability Report.

MADE BY: Kristen Cox

SECOND: Hunter Adkins

The motion passed unanimously. (Below as approved.)

Adjourn

Chair Coleman-Beattie adjourned the Committee of the Whole at 10:39 AM.

Roger A. Webb, Secretary to the Council
Date

Attachments

2010 Biennial Disability Report Recommendations

Background

In 2008, the Texas Council for Developmental Disabilities contracted with Human Services Research Institute (HSRI) to conduct a Gaps Analysis of the Texas service system for people with developmental disabilities. This research provided the foundation for recommendations made by TCDD in its 2008 Biennial Disability Report. This external analysis evaluated Texas’ performance with three performance benchmarks and found that:

  • People with developmental disabilities in Texas do not have access to services with reasonable promptness;
  • Many people with developmental disabilities do not receive services within the least restrictive setting appropriate to their needs; and
  • The state’s service system for people with developmental disabilities is not operated in a manner that promotes efficiency and economy.

In 2008, TCDD concluded that the Legislature had four policy options to consider in response to this policy dilemma:

  1. Do nothing and keep the current investment patterns and service array in place, which will continue the inefficient use of resources, the community service system will not easily meet local service needs and the interest lists for waiver services will continue to grow.
  2. Increase funding significantly, but maintain the current system of organizing and delivering services. This approach may help marginally, but would perpetuate present inefficiencies, even if most of the new money were to be directed at community systems. Additionally, fewer people will be served than might otherwise be served in a more efficient system.
  3. Keep funding relatively level, but de-emphasize the use of Intermediate Care Facility (ICF/MR) services in favor of Home and Community-Based Services (HCBS). Under this approach, there may be a marginal impact on unmet service demand, but the state may achieve greater cost efficiencies.
  4. Increase funding significantly and de-emphasize the use of ICF/MR services in favor of HCBS. This is the most forward-looking option that would provide a pathway toward increased efficiency while providing needed funds to strengthen the community system and address unmet service demand.

The 81st Texas Legislature increased funding for community services, but maintained the current system of delivering services. As a result, the gaps in the Texas service system that were previously identified in 2008 still remain. It is important to note that the 81st Legislature did, however, make significant improvements to the developmental disabilities services system in Texas and the proposed 2010 Biennial Report Recommendations take that into account.

Draft Recommendations

Strengthening Existing Community Services

  1. Enroll an average of 4,604 additional individuals each year in HCBS waivers for individuals with ID/DD, increasing the 2006 capacity of 13,999 to approximately 64,085 individuals by 2018 in order to meet the service demand in our state.
  2. Provide sufficient funds to ensure that the Community Safety Net of community support services has the capacity to meet the needs of all individuals with intellectual and development disabilities (ID/DD) in the community. Including:
    1. Build capacity and fund the community mental health and substance abuse supports network to deter unnecessary placements in hospitals, criminal justice systems, and nursing facilities.
    2. Build capacity and fund the community infrastructure to support individuals with significant behavioral and/or medical needs in order to reduce reliance on institutional settings for specialized services and support.
  3. Ensure that individuals are able to receive adequate amounts of needed services, based on their functional needs.
    1. Amend the eligibility requirements and service array of Medicaid waiver programs to serve individuals who have cognitive/emotional-behavioral/psychosocial disabilities with or without accompanying physical disabilities.
    2. Update the assessment of needs by replacing the Inventory for Client and Agency Planning (ICAP) tool with more current protocols such as the Supports Intensity Scale (SIS).
  4. Expand home-based services as the primary tool for addressing service demand, including expanding the Texas Home Living (TxHmL) HCBS “supports” waiver to include a broader array of services and a more robust level of services.
  5. Expand efforts to provide community respite alternatives.
  6. Make necessary program changes to allow participants increased control over their individual service budget. Expand options for Self-Directed Services (CDS, SRO) in Medicaid and non-Medicaid programs (including waivers) that provide long-term services and supports including fee-for-service and managed care programs (STAR+Plus). Extend self-directed options to additional services beyond personal assistant services and respite services.
  7. Develop specialized services and supports to allow individuals with developmental disabilities to age in place following the loss of a family caregiver.
  8. Address insufficiencies in provider reimbursements that impact the availability and quality of community support services. Specifically:
    1. Increase rates and expand rate enhancements for community service providers to ensure that providers can recruit, train, and retain quality direct care staff and compete with other employers in the workplace.
    2. Create a hierarchical structure of reimbursement rates that recognizes case mix, complexity of care, family supports, and individual needs.
    3. Adjust reimbursement mechanisms to provide incentives for providers to expand community supports and to implement innovative approaches in service delivery to improve quality and cost effectiveness.
    4. Use existing cost data as a basis for increases in payment rates for community agencies to catch up with underlying changes in the cost of doing business in Texas.
    5. Implement low-cost or no-cost workplace improvements to increase retention of direct care workers.
    6. Initiate a comprehensive study of community wages and benefits in 2011 and target for completion during 2012.
  9. Explore quality-improvement strategies such as using self-advocates to provide peer support to consumers to increase safety, prevent abuse and neglect, and improve awareness of community living options.
  10. Expand services and community living options for youth with disabilities transitioning from education settings to
    post-education activities.

Serving People in the Most Integrated Setting

  1. Reduce the number of people served at state supported living centers. During the 2010-2018 period, the SSLC population should be reduced to not more than 1,465 individuals for Texas to simply meet the projected nationwide averages.
  2. Cease admissions of children to state supported living centers. Continue and expand efforts to accommodate all children under the age of 22 who are in state supported living centers and seek community placement utilizing mechanisms such as in-home support services for children living at home with families and “Money Follows the Person” to provide opportunities for children to leave institutional settings in favor of HCBS alternatives.
  3. Further develop the “Money Follows the Person” initiatives to accommodate a stronger transition of people living in ICFs/MR who prefer to receive services in the most integrated setting.
  4. Modify the Community Living Options Information Process (CLOIP) to ensure that residents of state supported living centers who express interest in community living arrangements receive appropriate education about, and are able to access community options. Specifically:
    1. Improve the required documentation of mandated discussions with residents regarding their options for community supports and services, and include documentation concerning supports and services needed to successfully transition to a community setting, efforts to secure those services, and documentation of the reasons for not providing community living arrangements when requested.
    2. Revise procedures to require local Mental Retardation Authorities to provide choice options to residents in community ICFs/MR and fully reimburse local authority costs to for those activities.
    3. Expand “transition assistance services” for participants in all HCBS waivers, including the HCS waiver program.
  5. Expand and promote opportunities for ICFs/MR providers to transition to supporting individuals in the most integrated setting.

Projection of Future Long Term Care Needs

  1. Build expertise among service providers to assist individuals with developmental disabilities who are aging and their family caregivers in actively planning for their future long-term care needs.
  2. Direct HHSC and its Departments (DADS, DARS, DFPS, DSHS) to develop the infrastructure to collect and share common information about individuals receiving services across access and intake systems at the state and local level.
  3. Periodically review and use data on the types of services selected by individuals with disabilities when they are offered Medicaid waiver supports to more efficiently fund future long-term supports based on consumer needs.

10-Year Plan for Rebalancing the Long-Term Services and Supports System

  1. Develop and implement a comprehensive plan Continue and formalize the redesign of LTSS for people with ID/DD with executive and legislative branch sponsorship to reduce the institutional bias in long-term services and support systems by 2018 and redirect funds to community services infrastructure.
  2. Pursue redesign through a collaborative process that engages people with intellectual and developmental disabilities and other appropriate stakeholders as primary constituents of the system.