Texas’ Fourteen Year Journey to Rebalance its LTSS system

Marc S. Gold

Texas Department of Aging & Disability Services

Houston, TX

September 30, 2013

One Voice Collaborative Conference

Olmstead to BIP: Rebalancing

1985: First 1915 (c) waiver1999: Texas embraces Olmstead: Promoting Independence Initiative2001: Creates “Money Follows the Person” (MFP): 45,000 relocated2003: Consolidation of Health and Human Services system2006: Aging and Disability Resource Centers2007 – National MFP Demonstration1998-2012: Expansion of LTSS managed care2012: Balancing Incentive Program (BIP)

PII: Early Enhancements

Creation of MFP and Promoting Independence Priority Populations.Development of relocation specialists statewide system.Creation of “Transition Assistance Services” which allow a one-time expenditure from waiver cost cap to set-up a new household.Creation of regional “Community Transition Teams”.Implementation of “Project Access” housing vouchers: dedicated housing vouchers for individuals relocating from institutional settings.

PII: Early Enhancements

Consumer-directed Services.Expansion of Centers for Independent Living.Increased support for individuals residing in State Hospitals with three or more admissions within 120 days.Family-Based Alternatives.

Barriers to Relocation

Long-term institutionalization Information/knowledge of options housing Co-occurring behavioral health issues Lack of a statewide provider base to serve individuals with complex needs Stabilized direct services workforce Service providers/transportation in rural areas Service array flexibility

Barriers to Relocation

Health and welfare concerns Family/guardian resistance Coordination of services/SSI address change Personal fears Provider liability Loss of community supports

MFP Demo: The Next Step

Demonstration: took state to the next level in enhancing the

community-based infrastructure; increased interagency cooperation across

health and human services enterprise; and significantly increased awareness of

behavioral health issues as a LTSS and began a major collaboration between the behavioral health agency and managed care and the long-term services and supports agency.

MFP Demo: Selected Projects

Over 30 projects funded through the Demonstration to enhance the community-based infrastructure; examples:

Voluntary closure of private ICF/IID. Behavioral Health pilot. Quality Management reporting office. Program wide “data mart”. Direct service worker initiatives. Dedicated specialists to work with individuals

with IDD in publicly operated ICFs. Customized employment pilot.

MFP Demo: Selected Projects

Over 30 projects funded through the Demonstration to enhance the community-based infrastructure; examples:

Specialized trainings. PASRR Webinars. Realistic Job Previews. Positive Behavioral Management

Workshops. Automated contract monitoring instruments.

MFP Demo: ADRC Enhancement

Started “no wrong door” efforts.Refinanced first three ADRCs once ACL start-up funding was no longer available.Expanded ADRC system from three sites to fourteen.Funded staff to be “housing navigators.Funded staff to be “local contact agency”.Funded staff to perform “options counseling” and to create statewide standard.

MFP Demo and Housing

811 Infrastructure Grant.United States Housing and Urban Development (HUD award of $12 million in 811vouchers (385).Regional CMS – Regional HUD – Texas Department of Aging and Disability Services’ housing initiative with public housing authorities: thus far it has created more than 140 dedicated section 8 vouchers.

MFP Statistics 45,071 individuals have relocated from Texas Medicaid-certified institutions

NF: 33,421 ICF/IID: 11,650

More than 9,000 individuals remain active in the community.

49 percent: 0-64 years of age 51 percent: 65 and older

14 percent: 85 and old 21 persons 100 years of age or older

MFP Residential Placements

37 percent living with a family member 26 percent living in assisted living 34 percent living alone

BIP: Data Follows the Person

$301.5 million award.External Stakeholders and Executive and Legislative Involvement and Leadership.Official oversight:

MFP Demonstration – BIP Advisory Committee;

ADRC Advisory Committee; and Promoting Independence Advisory

Committee.

BIP: Work Plan Strategy

Supports TX’ overall goals and strategic planning in relation to upcoming legislative session (January – May 2013).

Pre-legislative proposals: significant ongoing movement to an integrated and comprehensive managed care system to serve all individuals with disabilities regardless of age.

Movement to integrated IT systems and single-portals to access services.

Partners and Scope of BIP

Health and Human Services Commission: umbrella agency; Medicaid agency; operates managed care programs.

Department of State Health Services: behavioral health (BH) operating agency.

Department of Aging and Disability Services: LTSS operating agency.

Department of Family and Protective Services: Child Protective Services/Adult Protective Services.

Department of Assistive and Rehabilitative Services: vocational rehabilitation; sensory disabilities.

All individuals with disabilities who are eligible for Medicaid LTSS regardless of age.

Fee-for-Service and Managed Care.

BIP Award Allocation

NWD: Data Follows the Person

Heavy emphasis on “data follows the person”: providing infrastructure to support individuals going to one place, giving high-level information once, and having system data available.

Expand ADRC system statewide. Expansion of TX’ front door web-based portal:

Your Texas Benefits (YTB). Development of an interactive Children’s with

Special Needs website. Development of interoperability of

financial/functional eligibility systems.

BIP: Guiding Principles Contracting for several IT projects: initial

analyses of system and development Principles:

to build a system for the next decade that will be flexible to respond to ever-changing legislative and federal policy direction .

Consistent process across TX. Transparency and real-time visibility of

data across the enterprise. Leverage existing systems. Use most advanced technologies that can

be easily adapted and amended. Secure privacy and confidentiality.

IT System Features

Single front-door portal which is self-service or with assistance (ADRC). Data warehousing. Messaging/reminders. Mutual storage and sharing of data (demographic and assessment) across enterprise.Integrity of data (ongoing quality improvement of system).

Beyond BIP: Transformative

Greater cooperation across health and human services system – true “enterprise” systemLooking at whole person and reducing “silo” mentality: impacting every aspect of service delivery.Exploring new technologies to support efforts into the next decade.Emphasis on overall quality of system/services to ensure an individual can remain in the community as long as possible. Developing extensive data base to make more precise evidence-based policy decisions.More productive experience for the individual and more efficient usage of staff support.Supporting goals of a comprehensive MC system.

BIP: Project Interdependencies

BIP: Vision Statewide portal for easy access into the

health and human services system to provide transparency of all eligibility functions and data.

Statewide ADRC to become the lead “NWD” and to provide information, assistance in filling out eligibility forms and options counseling.

Integrated IT support. Comprehensive assessment data. Managed care delivery system to support the

individual holistically across the acute and LTSS system regardless of “diagnosis” or service need.

Contact Information

Marc S. Gold, TX Department of Aging and Disability ServicesSpecial Advisor for PolicyOffice of the Commissioner 512.438.2260marc.gold@dads.state.tx.uswww.dads.state.tx.us/business/pi/index.html

Website Information

Balancing Incentive Program:http://www.dads.state.tx.us/providers/pi/bip/Your Texas Benefits: https://www.yourtexasbenefits.com/ssp/SSPHome/ssphome.jspAging and Disability Resource Centers:http://www.dads.state.tx.us/services/adrc/Promoting Independence Initiative:http://www.dads.state.tx.us/providers/pi/Money Follows the Person:http://www.dads.state.tx.us/providers/pi/mfp_demonstration/index.html