Transcript Joint Budget Hearing - Health and Human Services Commission

Joint Budget Hearing
FY 2012-2013
Legislative Appropriations Request
September 15, 2010
Health and Human Services Commission
“The mission of the health and human service agencies in
Texas is to develop and administer an accessible, effective,
and efficient health and human services delivery system
that is beneficial and responsive to the people of Texas.”
Page 2
FY 2010-11 Actions and Accomplishments
Eligibility and Enrollment Improvements:




Increased Eligibility Determination Staffing
Improved Timeliness for Processing Applications
Improved Error Rates
Successful Implementation of Initial TIERS Rollout in Austin, Lubbock
and El Paso Regions in FY 2010
Medicaid and CHIP:




Implementation of STAR+Plus in the D/FW area – February 2011
Rebased Hospital Rates pursuant to Rider 68 - October 2010
Reviewing HHS impact of Federal Health Care Reform
Implementation of Non-Emergency Medical Transportation Broker
Model - Spring 2011
Enterprise Progress and Improvements:
 HHS Staff Participating on Comptroller’s Project ONE
Page 3
Health and Human Services Commission (HHSC)
LAR Policy Guidance and Resulting Actions
•
•
Instructions allowed GR-Entitlement growth for Medicaid and CHIP caseloads
and maintaining FY 2011 Eligibility Determination staff levels. Requested
Entitlement GR increased $4.6 billion over the 2010-11 biennium.
Non-Entitlement GR for the base request was submitted lower than allowed
because of the HHSC’s acknowledgement of FY 2010-11 one-time funding and
the assumption of FY 2013 savings from the decommissioning of SAVERR.
Biennial Comparison of General Revenue
($ in billions)
FY 2012-13 Base
Request
FY 2010-11 Total
GR Exempt
$
GR Non-Exempt
13.1
$
0.9
17.8
Biennial
Difference
$
0.9
4.6
(0.0)
Total, GR
$
14.0
$
8.6
$
4.6
Total, All Funds
$
41.8
$
47.3
$
5.5
Page 4
FY 2012-13 Base Request Assumptions
• Medicaid
 Average monthly caseloads are projected to increase from 3.73 million in
FY 2011 to 3.88 million in FY 2012 and 3.99 million in FY 2013.
 Costs for hospitals, physicians, and other providers are maintained at FY 2011
levels for the 2012-2013 biennium which continues the 1 percent rate reduction.
• Children’s Health Insurance Program (CHIP)
 Average monthly caseloads for CHIP are projected to increase from 581,599 in
FY 2011 to 593,836 in FY 2012 and to 611,418 in FY 2013.
 Costs for hospitals, physicians, and other providers are maintained at FY 2011
levels for the 2012-2013 biennium which continues the 1 percent rate reduction.
• Temporary Assistance for Needy Families (TANF)
 Recent trends of increasing TANF caseloads continues through the next
biennium. The FY 2010 average monthly caseload of 123,338 is projected to
increase to a monthly caseload of 136,507 by FY 2013.
 Monthly and annual TANF cash amounts would be reduced due to base
limitations of TANF State MOE and TANF federal funds. Reductions for
monthly grant awards would be 16 percent for regular TANF and 50 percent for
two parent TANF families.
Page 5
Medicaid Caseload by Group
Fiscal Years 2000 - 2013
4,500,000
2013 Total Caseload
3,986,452
4,000,000
2010 Total Caseload
3,341,658
3,500,000
Total Caseload
Recipient Months
3,000,000
2,500,000
Non-Disabled Children
2,000,000
1,500,000
Aged and Disability
Related Clients
1,000,000
TANF Adults/Pregnant Women
500,000
0
2000
Total
2001
2002
2003
Aged and Disability-Related
2004
2005
2006
2007
2008
TANF Adults and Pregnant Women
Page 6
2009
2010
2011
2012
2013
Non-Disabled Children Ages 0-18
Children’s Health Insurance Program (CHIP)
Caseloads, September 2001 – August 2010
Mar 2009 - present: Increasing
caseload, reaching pre-2003
policy change levels.
550,000
August 2010:
522,696
Fall 2003: Policy changes include addition of three month
507,259
510,757
500,000
waiting period and income disregards elimination (beginning
November 2003). Approximate decline of 40,000 due to policy
changes.
491,069
463,199
450,000
Sept 2004: Assets test
implemented. Approximate
caseload decline of 34,000 due to
policy change.
429,066
Sept 2007: New eligibility
criteria, including a 12-month
term of coverage. The 12-month
impact is seen in the caseload
beginning March 2008
400,000
Sept 2008 - Jan 2009: Slight
declines in enrollment as caseload
stablizes after impact of recent
policy changes.
355,528
350,000
Jan 2004: Change from twelve
to six month eligibility.
Approximate decline of 78,000
due to change.
326,557
327,379
300,000
291,530
Winter-Spring 2006: New business rules aimed at
verification of information put into effect and adjusted.
250,000
Sep-01
Sep-02
Sep-03
Sep-04
Sep-05
Page 7
Sep-06
Sep-07
Sep-08
Sep-09
TANF Recipients, Fiscal Years 2003 – 2013
400,000
372,786
350,000
364,030
September 2003: Full family sanctions take
effect, which have a large impact on the TANF
population. Approximately 71,000 recipients
are removed from TANF program in first
month.
300,000
FY 2005: The Deficit Reduction
act of 2005 goes into effect.
251,339
250,000
200,000
196,341
History
Foreca st
161,005
150,000
138,016
138,793
119,197
100,000
Page 8
119,585
127,790
132,020
135,287
FY 2010-2011 Budget Issues in the LAR
• Net Supplemental Funding Need - $1.1 billion GR
 $1.094 million GR for Medicaid costs and caseloads (yet to be adjusted for
recent FMAP extension).
 The HHSC impact of the FMAP extension would reduce this need by an
estimated $660 million GR. Other HHS agencies impact could also be used to
further reduce the supplemental funding need.
 $46.2 million GR for CHIP costs and caseloads
 Assumes FY 2011 TANF need would be covered by a Medicaid transfer based
upon April 2010 letter submission.
• Federal Funding and Other Issues
 Extended lengths of time for review of state plan amendments and waivers
that would provide additional federal reimbursement.
 Federal deferrals and disallowances have increased federal cash flow issues.
Page 9
Key LAR Federal Fund Assumptions
• FY 2010-11 ARRA
 August 2010 enactment of the extension (January 2011 – June 2011) of the
temporary increase in federal match is not reflected in the FY 2010-11 Base
funding.
 FY 2012-13 includes approximately $3.0 billion GR to fund the return to a nonARRA federal FMAP rate.
• Health Care Reform (HCR)
 In the LAR, FY 2010-13 reflects the HCR impact on increased federal
recapture of the State’s supplemental drug rebates beginning January 2010.
 Since HCR enactment, HHSC has prepared updated impacts of this policy as
additional federal information is provided. FY 2010-11 assumes the first
estimated impact which was available in June 2010 which was $18.9 million in
lost state share of supplemental rebate revenue for the biennium.
 The most recent estimate for FY 2010-11 would increase that biennial loss of
state share to $25.2 million.
 As CMS continues to provide guidance on this policy decision, no rebates have
been recaptured yet.
Page 10
Key LAR Federal Fund Assumptions
• Federally-Required Perinate Changes for Clients Under 185% FPL
 Beginning with FY 2011, Perinate moms and their newborns under 185% FPL
will be funded in Medicaid.
 Prenatal services would continue to be covered by CHIP until delivery.
• Pending Amendment for Qualified Alien Coverage
 The LAR assumes that as of May 2010, federal CHIP match is available for
Medicaid coverage for Qualified Aliens.
 The SPA has not been approved at this time and recent CMS guidance issued
in July 2010 could alter the funding assumptions.
Page 11
HHSC FY 2012-2013 Key Issues
• CHIP and Medicaid Services
 Preparing for Health Care Reform
 Successful Implementation of any Medicaid Managed Care
Expansion
• Eligibility and Enrollment
 Completion of Rollout of TIERS
 Maintaining the staffing & improvements gained during FY 2010-11
• Addressing HHS IT Security Concerns
• Maintaining Sufficient Support to Implement FY 2012-13 Work
Effort
• Adequate and Safe Work Environment for HHS Employees and
Customers
 Maintaining local office space, utilities, and services.
Page 12
HHSC LAR Summary Request
GOAL
Goal A
Goal B
Goal C
Goal D
Goal E
Goal F
Goal G
Goal H
Other
Other
HHS Enterprise Oversight & Policy
Medicaid
CHIP Services
Encourage Self Sufficiency
Program Support
Information Technology Projects
Office of Inspector General
Enterprise Exceptional Items
Savings-Revenue Gain Insurance Tax
Savings-DADS LTC*
Total, Agency Request
FY 2010-2011
Expend/Budgeted
$
1,943.0
36,378.5
2,218.2
661.5
303.8
183.1
99.0
41,787.2
Method of Financing:
General Revenue
$
General Revenue - Dedicated
State Revenue Gain Insurance Tax
GR Savings to DADS LTC*
Subtotal, GR $
14,011.7
14,011.7
Federal Funds
Federal Savings to DADS LTC*
Subtotal, Federal
Other Funds
Subtotal, HHSC Method of Finance
Total, LAR Method of Financing
$
$
$
$
$
27,085.1
27,085.1
690.5
41,787.2
41,787.2
FY 2012-2013
Base Request
$
$
$
$
$
$
$
$
$
2,010.5
42,066.5
2,299.1
345.5
321.7
141.2
98.4
47,283.0
18,611.1
18,611.1
28,006.9
28,006.9
665.0
47,283.0
47,283.0
FY 2012-2013
Exceptional Items
$
273.7
3,837.0
135.5
58.6
-
FY 2012-2013
Total Request
$
4.4
690.7
(238.0)
(1,329.4)
3,432.5 $
2,284.2 $
45,903.5
2,434.7
404.1
321.7
141.2
102.8
690.7
(238.0)
(1,329.4)
50,715.5 $
341.1
9,525.0
216.4
(257.4)
17.9
(41.9)
3.9
690.7
(238.0)
(1,329.4)
8,928.3
2,210.8 $
0.0 $
(238.0)
(524.5)
1,448.4 $
20,822.0 $
0.0 $
(238.0)
(524.5)
20,059.6 $
6,810.3
0.0
(238.0)
(524.5)
6,047.9
2,789.1
(805.0)
1,984.1
3,432.5
3,432.5
30,796.0
(805.0)
29,991.0
665.0
50,715.5
50,715.5
3,710.9
(805.0)
2,905.9
(25.5)
8,928.3
8,928.3
`
$
$
$
$
$
$
$
$
Biennial
Change
$
$
$
$
$
$
$
$
* Estimates of managed care expansions are derived from current services estimates of caseload and costs for both DADS and HHSC.
Assumptions of lower costs or caseloads would decrease savings.
Page 13
Comparison of Selected Measures
Estimated
FY 2010
Measure Name
Average Medicaid Acute Care Recipient Months per Month
Budgeted
FY 2011
Base Request
FY 2012
Base Request
FY 2013
3,346,903
3,732,835
3,884,015
3,986,452
32,186,170
35,695,662
36,942,856
37,786,590
$239.68
$246.54
$250.46
$252.05
$71.70
$75.38
$75.84
$75.56
Average CHIP Programs Recipient Months per Month
569,818
581,599
593,836
611,418
Average CHIP Programs Benefit Cost without Prescription Benefit
$139.35
$137.82
$135.65
$135.52
Average CHIP Programs Benefit Cost with Prescription Benefit
$160.00
$159.78
$157.86
$157.74
Average Number of TANF Recipients per Month
117,162
123,527
126,491
129,621
6,176
6,562
6,719
6,886
Average Monthly Grant: TANF
$70.23
$72.52
$58.69
$60.67
Average Monthly Grant: State 2-Parent Cash Assistance
$64.02
$69.18
$34.77
$34.49
Number Served by Family Violence Programs/Shelters
80,942
80,942
81,000
81,000
98
100
100
100
Number of Medicaid Prescriptions Incurred
Average Medicaid Acute Cost per Recipient Month
Average Cost per Medicaid Prescription
Average Number of State 2-Parent Cash Assistance Recipients
Number of Participating Family Violence Programs/Shelters
Page 14
10% GR Biennial Base Reduction
Supplemental Schedule
•
Capital

•



•
$1.1 million
Reduces grants to Guardianship Programs, Community Resource Coordination
groups, Office for the Elimination of Health Disparities and Medicaid initiatives
- $1.1 million
Eliminates Faith and Community-Based Grants - $0.1 million
TANF Cash Assistance (Basic and State Programs)

•
$22.1 million
Medicaid and CHIP Reduced Scope and Service Levels - $5.3 million
Reduction and Conversion of IT and TIERS Contractors - $10.8 million
Reduced Scope and Services Minimal
Impact - $3.5 million & Significant Impact - $2.5 million
Grants

$12.0 million
Salary Savings by reducing 202 positions in FY 2011 and another
43.6 positions in FY 2013. Will attempt through attrition - $5.8 million
Travel and Other Operating - $5.7 million
Infrastructure Delays - $0.5 million
Contracted Services



•
Deferral of Projects - $6.9 million and One-Time Adjustments - $2.3 million
Administrative & Program Operations

•
$9.2 million
$13.1 million
Reduces grants awards by approximately 6.5 percent on top of base reductions
and jeopardizes portion of federal TANF grant to State for failure to maintain
MOE requirement
Eliminate Frew Rewards to Managed Care Organizations
Total GR
$26.0 million
$83.5 million
Page 15
Exceptional Item Summary
Total Exceptional Items
•
$1.4 billion GR & $3.4 billion AF
HHSC Current Services
$1.56 billion GR & $3.68 billion AF
 Medicaid, CHIP, TANF, Frew Strategic Initiatives, and Cost Annualization
 DIR Data Center (HHS System Request)
•
HHSC Service Improvements
$135.1 million GR & $256.3 million AF
 Eligibility Improvements
 Salary Increases for Staff Retention & Additional Staff for Caseload Growth
 Food Bank Collaboration Expansion & Local Office Improvements





Additional Family Violence Funding and Services
2-1-1 TIRN Funding
Additional Office of Inspector General (OIG) Staffing
MEPD Asset Verification System
Autism Resource and Research Center
Page 16
Exceptional Item Summary
•
Managed Care Expansion
($600.6) million GR & ($1.2) billion AF
 Cost and Savings of Managed Care Expansion assumes Department of
Aging and Disability (DADS) and HHSC current services funding for costs
and caseloads.
 Net Savings represent HHSC increased STAR+PLUS Costs offset by Long
Term Care (LTC) Savings at DADS and the Premium Insurance Tax
Revenue Gain to State. The revenue gain would offset the need for GR
and is reflected as a savings.
 Implementation is assumed September 1, 2011 for STAR Expansion in
Contiguous Counties and Vendor Drug capitation. March 2012 is assumed
as implementation for all other initiatives.
 Federal approval would be required for the rates.
 Impact to Administration and other services have yet to be estimated.
Page 17
Biennial Summary of Managed Care
Expansions
2012-13 Biennial Impact of Managed Care Expansion Exceptional Items
$ in millions
Mangaged Care Exceptional Item
# Initiative
13
14
15
16
17
18
Capitate Medicaid in Urban &
Contiguous Counties
Expand Medicaid Managed Care
in South Texas
Expand Medicaid Exclusive
Provider Organization Model
Capitate Medicaid Dental
Services
STAR+Plus Hospital Carve-In
Captitate Medicaid & CHIP
Vendor Drug Programs
HHSC
Cost/(Savings)
Insurance Tax
Revenue Gain
GR
GR
AF
$ 80.7 $ 204.3 $
AF
(19.4) $
(19.4) $
DADS LTC Savings
GR
(96.1) $
179.1
452.5
(40.7)
(40.7)
(428.4)
(20.2)
(51.8)
(41.0)
(41.0)
-
(53.0)
(127.4)
(48.6)
(48.6)
(19.4)
(49.3)
(9.5)
(5.3)
(35.1)
(78.8)
Total $ 161.8 $ 393.3 $
(238.0) $
Page 18
AF
Net Impact
GR
(243.6) $
(1,085.9)
(34.7) $
AF
(58.6)
(290.0)
(674.0)
-
(61.2)
(92.8)
-
-
(101.6)
(176.0)
(9.5)
-
-
(28.9)
(58.8)
(78.8)
-
-
(84.1)
(113.9)
(238.0) $
(524.5) $ (1,329.4) $
(600.6) $ (1,174.1)
HHS System Exceptional Items
•
HHS System Exceptional Items $351.2 million GR & $671.9 million AF
 HHSC Community Expansion
 Technology Improvements
• IT Security
• Address Systems at Certain State Facilities
 Health Initiatives
• Acquired Brain Injury Waiver
• Veteran’s Health Initiative
 HHSC Disproportionality and Disparities Initiative
 HHS Targeted Staff Retention and Recruitment
• Salary Increases for Nurses and Assistants at Certain State Facilities
• Salary Increases for DADS LTC Eligibility Staff
Page 19
Exceptional Items
Reference
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
LISTING of
EXCEPTIONAL ITEMS
BIENNIAL TOTAL
GR/GRD
All Funds
Maintain Medicaid Cost Trends for Current Services
Maintain CHIP Cost Trends for Current Services
Maintain TANF Grant Amounts for Current Services
Maintain Funding for Frew Strategic Initiatives Current Services
Annualize Costs and Maintain Current Services
Maintain IT Services for HHS Provided by DIR Data Center Services
Improve Security in IT Systems
Implement MEPD Asset Verification System
Expand Food Bank Collaboration Pilot Statewide
Increase Retention of Eligibility Staff
Increase Eligibility Resources for Caseload Growth
Implement Eligibility Customer Flow Management System
Capitate Medicaid in Urban & Contiguous Counties (Savings)
Expand Medicaid Managed Care in South Texas STARStep (Savings)
Expand Medicaid Exclusive Provider Organization Model (Savings)
Page 20
$
1,341.9 $
41.8
54.1
91.4
19.8
13.7
10.9
2.3
2.2
52.9
66.4
1.0
(34.7)
(290.0)
(61.2)
3,341.7
140.7
54.1
96.9
26.3
18.8
16.1
4.6
4.5
102.5
128.7
2.0
(58.6)
(674.0)
(92.8)
FY12
FTEs
FY 13
FTEs
3.1
3.1
958.0
1,547.0
Exceptional Items
Continued
LISTING of
EXCEPTIONAL ITEMS
16
Capitate dental services for Medicaid (Savings)
17
BIENNIAL TOTAL
GR/GRD
All Funds
(101.6)
(176.0)
STAR+Plus Hospital Carve-In (Savings)
(28.9)
(58.8)
18
Capitate Medicaid and CHIP Vendor Drug Programs (Savings)
(84.1)
(113.9)
19
Improve Staffing and Supports for the Office of Inspector General
2.4
4.4
20
Increase Family Violence Services Funding
4.5
4.5
21
Establish Texas Autism Research and Resource Center
1.6
22
Increase State Assistance to 2-1-1 Information Centers
Increase Capacity of HHS-Funded Community Services (Reduce
Waiting and Interest Lists)
23
24
25
Support a Veteran's Health Initiative
Enhance Technological Supports of State Hospitals & State Supported
Living Centers
26
Implement Acquired Brain Injury Waiver
27
28
Implement Disproportionality and Disparities Initiative
Increase Retention and Recruitment of Targeted HHS Staff
Total, Exceptional Items $
Cost Items $
Savings Items $
Page 21
FY12
FTEs
FY 13
FTEs
35.0
35.0
1.6
4.2
4.2
1.7
3.5
2.1
2.1
265.4
543.5
62.4
125.5
14.9
14.9
3.1
3.1
8.8
12.4
1.2
2.6
4.1
8.1
2.2
47.7
3.1
79.3
9.5
9.5
1,448.4 $ 3,432.5
2,049.0 $ 4,606.6
(600.6) $ (1,174.1)
1,081.4
1,737.5
Appendix
• Summary of Exceptional Item Requests
Page 22
Description of HHSC Exceptional Items
1.
MAINTAIN MEDICAID COST TRENDS FOR CURRENT SERVICES
$1,341.9 GR / $3,341.7 AF
This request represents cost and utilization increases forecasted for FY 2012-13 in the Medicaid program
that are not allowed in the base request. Caseload growth is assumed to be in the base request at FY 2011
cost levels and FMAP rates of 60.55 percent for FY 2012 and 60.55 percent for FY 2013. The one percent
provider reduction imposed in FY 2011 is assumed to be continued through FY 2012-13.
2.
MAINTAIN CHIP COST TRENDS FOR CURRENT SERVICES
$41.8 GR / $140.7 AF
This request represents cost and utilization increases forecasted for FY 2012-13 in the CHIP program that
are not allowed in the base request. Caseload growth is assumed to be in the base request at FY 2011
cost levels and FMAP rates of 72.39 percent for FY 2012 and 72.39 percent for FY 2013. The one percent
provider reduction imposed in FY 2011 is assumed to be continued through FY 2012-13.
3.
MAINTAIN TANF CASH GRANT AMOUNTS FOR CURRENT SERVICES
$54.1 GR /$54.1 AF
This request would continue funding the monthly cash grant awards at current amounts for the basic and
two-parent family programs at the projected caseload levels assumed in the base request. The limitations of
the FY 2012-13 base funding held constant the FY 2010-11 federal TANF funds and state GR funds. The
requested state general revenue for the basic program could also be TANF federal funds, if available.
Page 23
Description of HHSC Exceptional Items
Continued
4.
MAINTAIN FREW STRATEGIC INITIATIVES FUNDING
$91.4 GR /$96.9 AF
This funding request would complete and continue those Frew Strategic Initiatives initiated during the
current biennium that are not related to rates which are in the FY 2011 Medicaid cost trends in the base
request. This funding would complete two initiatives during FY 2012 and provide on-going funding for
continuing the courier service for TH Steps lab testing, physician and dentist loan repayment program,
mobile dental units, health home and developmental calendars. No Strategic Initiative funding from the
original $150 million is available for FY 2012-13.
5. ANNUALIZE AND MAINTAIN CURRENT OPERATING LEVELS FOR HHSC POGRAMS &
SERVICES
$19.8 GR / $26.3 AF
During the 2010-11 biennium, HHSC acquired office space for which there is not 24 months of expenditures
in the FY 2012-13 base request funding. This request would fund $17.8 million GR and $24.3 million All
Funds for the balance of those facility costs as well as $1.0 million GR and $2.0 million AF for increased
transaction costs associated with the Electronic Benefit Card due to SNAP caseload growth. .
6.
MAINTAIN IT SERVICES FOR HHS PROVIDED BY DIR DATA CENTER SERVICES
$13.7 GR / $18.8 AF
This request would provide funding to all five HHS agencies in support of Data Center Services
consolidation managed by the Department of Information Resources (DIR). Funding of $4.4 million GR and
$7.3 million All Funds would cover increased billings from DIR for HHSC, DARS, and DSHS) as well as
$9.4 million GR and $11.5 million All Funds internal agency costs (DADS, DFPS, DSHS, and HHSC) to
transform and remediate existing systems to be supported by DIR.
Page 24
Description of HHSC Exceptional Items
Continued
7.
IMPROVE SECURITY FOR HHS IT SYSTEMS
$10.9 GR / $16.1 AF
This project would use technology to find and protect client confidential data and would put the HHS
agencies in compliance with state and federal law and policy. The agencies can be fined significant
penalties for failure to comply with these protection policies. Additionally, this request includes Winters
building data center power infrastructure and physical security upgrades.
8.
IMPLEMENT MEPD ASSET VERIFICATION SYSTEM
$2.3 GR / $4.6 AF
This request funds the development of an Asset Verification System for the Medicaid Eligibility for the
Elderly and People with Disabilities (MEPD) Program. Development of this system is mandated by the
Supplemental Appropriations Act of 2008 which added section 1940 to the Social Security Act (Sec.
1940.[42 U. S. C, 1396w]). This system would be used to verify applicants’ assets by electronically
matching client provided information with information obtained from financial institutions.
9.
EXPAND FOOD BANK COLLABORATION PILOT STATEWIDE
$2.2 GR / $4.5 AF
This request would allow statewide expansion of the Food Bank Collaboration Pilot implemented during FY
2010. USDA approved an HHSC waiver request for the Community Partner Interviewer (CPI)
demonstration project enabling HHSC to expand application assistance services provided through a
strategic public partnership with Texas Food Bank Network (TFBN) which includes the SNAP eligibility
interview process.
Page 25
Description of HHSC Exceptional Items
Continued
10. INCREASE RETENTION OF ELIGIBILITY STAFF
$52.9 GR / $102.5 AF
This request would provide funding to increase retention of Office of Eligibility Services (OES) regional field
office staff by providing a salary increase and performance incentives. A 10 percent salary increase would
be allocated for clerks, workers, supervisors and program managers totals $28.6 million GR and $59.5
million all funds. There would also be $24.3 million general revenue and $43.0 million all funds for
performance incentives for OES staff as recommended by a State Auditor’s Report.
11. INCREASE ELIGIBILITY RESOURCES FOR CASELOAD AND WORKLOAD GROWTH
$66.4 GR / $128.7 AF
This request for funding would support additional direct eligibility staff associated with the caseload
forecasts assumed in the base for Medicaid, TANF, SNAP and CHIP- 958.0 FTES in fiscal year 2012 and
1,547.0 FTEs in fiscal year 2013.
12. IMPLEMENT OES CUSTOMER FLOW MANAGEMENT SYSTEM
$1.0 GR / $2.0 AF
This request would allow for the Office of Eligibility Services’ (OES) statewide expansion of a customer flow
management system for certain regional field offices that house three or more eligibility units. This system
would help improve client services, decrease client waiting time, and increase customer flow efficiency.
The system would also help provide reports to help OES managers track the customer flow within an office
to identify processes that need to be improved.
13. CAPITATE MEDICAID SERVICES IN URBAN AND CONTINGUOUS COUNTIES
($34.7) GR / ($58.6) AF
This request represents the net fiscal impact to implement Medicaid capitated managed care services in
certain contiguous counties to the managed care service delivery areas of Lubbock, San Antonio, Austin,
Houston, Corpus Christi and El Paso by September 2011 as well as STAR+Plus in the two remaining urban
Page 26
Description of HHSC Exceptional Items
Continued
counties of Lubbock and El Paso by March 2012. Managed care programs would include STAR and
STAR+Plus where these programs currently exist. Assuming full funding of current services at DADS and
HHSC, the estimate reflects the biennial impact of improved utilization management in the affected service
areas, long-term savings of client services at DADS ($96.1 million GR and $243.6 million all funds), and the
revenue gain in Insurance Premium Tax to the State Treasury ($19.4 million general revenue). Thus, all of
the identified savings cannot be reduced from HHSC. Administrative impacts have not yet been calculated.
14. EXPAND MEDICAID MANAGED CARE IN SOUTH TEXAS
($290.0) GR / ($674.0) AF
This request represents the net fiscal impact to implement Medicaid capitated managed care services in
South Texas by March 2012. Managed care services would include STAR and STAR+Plus in 10 counties
in South Texas. Assuming full funding of current services at DADS and HHSC, the estimate reflects the
biennial impact of improved utilization management in the affected service areas, long-term savings of
client services at DADS ($428.4 million general revenue and $1,085.9 million All Funds) and the revenue
gain in Insurance Premium Tax to the State Treasury ($40.7 million general revenue). Thus, all of the
identified savings cannot be reduced from HHSC. Administrative impacts have not yet been calculated.
This action would also require a statutory change in order to implement managed care programs in Hidalgo,
Cameron and Maverick counties.
15. REPLACE PCCM SERVICES WITH MANAGED CARE (EPO AND STAR+PLUS)
($61.2) GR / ($92.8) AF
This request represents the net financial impact incurred by HHSC replacing Medicaid PCCM service
delivery with EPO to provide managed care services to include all Acute Care services for all Adults (Aged
and Disability-Related, as well as current HMO) in 164 counties with a capitated EPO model by March
2012. Assuming full funding of current services at HHSC, the estimate reflects the revenue gain in
Insurance Premium tax to the State Treasury ($50.0 million general revenue) Thus, all of the identified
savings cannot be reduced from HHSC. Administrative impacts have not yet been calculated.
Page 27
Description of HHSC Exceptional Items
Continued
16. CAPITATE MEDICAID DENTAL SERVICES
($101.6) GR / ($176.0) AF
This funding request the net impact incurred by HHSC to capitate children’s dental services through a DMO
or HMO dental carve-in by March 2012. The biennial estimate also reflects the revenue gain in Insurance
Premium Tax to the State Treasury ($48.6 million general revenue) so all of the identified savings cannot
be reduced from HHSC. Administrative impacts have not yet been calculated.
17. CARVE-IN HOSPITAL COSTS IN STAR+PLUS
($28.9) GR / ($58.8) AF
The funding represents the net impact to HHSC by including in-patient hospital costs in the capitation rates
for STAR+Plus by March 2012. Currently, these costs are excluded from the capitation and paid fee-forservice for STAR+PLUS members. The biennial estimate reflects the revenue gain in Insurance Premium
tax to the State Treasury ($9.5 million general revenue) so all of the identified savings cannot be reduced
from HHSC. Administrative impacts have not yet been calculated.
18. CAPITATE MEDICAID AND CHIP VENDOR DRUGS
($84.1) GR / ($113.9) AF
This request represents the net financial impact incurred by HHSC to provide capitation managed care
services for prescription drugs by September 2011. The biennial estimate reflects lost vendor drug
supplemental rebates by the State as well as the revenue gain in Insurance Premium tax to the State
Treasury ($78.7 million general revenue) so all of the identified savings cannot be reduced from HHSC.
Administrative impacts have not yet been calculated. It is assumed that the rate paid to managed care
organizations would be reduced for their collection of supplemental rebates.
Page 28
Description of HHSC Exceptional Items
Continued
19. IMPROVE STAFFING AND SUPPORTS FOR THE OFFICE OF INSPECTOR GENERAL (OIG)
$2.4 GR / $4.4 AF
This funding request would increase the staff for the OIG by 35 positions each year, adding investigators
and support positions to address the increasing workload of the Office and reduce backlog. Most of the
requested staff would be in General Investigations to conduct recipient fraud investigations, establish
overpayment claims, and research data matches in HHS programs and within federally mandated
timeframes Four positions would support Internal Affairs to investigate alleged criminal activity including
abuse, neglect, sexual assault, and exploitation of client/residents within State Supported Living Centers
(SSLC). The general revenue amount also includes the general revenue share that would be billed to other
HHS agencies but would eventually be Interagency Contracts in HHSC’s method of finance
20. INCREASE FAMILY VIOLENCE SERVICES FUNDING
$4.5 GR/ $4.5 AF
This request would enhance family violence services for existing service providers to expand services in
four areas: economic stability (including but not limited to transitional housing, job training and educational
support), legal services (to address complex issues such as custody, immigration, and protective orders),
primary prevention and Domestic Violence Fatality Review. Funding would also allow for new providers
and initiatives to implement evidence-based primary prevention models and Domestic Violence Fatality
Review efforts across Texas.
21. ESTABLISH TEXAS AUTISM RESEARCH AND RESOURCE CENTER
$1.6 GR / $1.6 AF
Senate Bill 1574, 81st Legislature Regular Session 2009, requires HHSC to establish and administer an
autism spectrum disorders resource center to coordinate resources for individuals with autism and other
pervasive developmental disorders and their families. Funding would enable HHSC (through a contract
with DADS) to begin to provide some of the training and development activities that are central to the
mandates required of the center. It would also support further development and on-going implementation of
the web-based resource tools, as well as the development of some of the coordination and support
activities described in legislation.
Page 29
Description of HHSC Exceptional Items
Continued
22. INCRESE STATE ASSISTANCE TO 2-1-1 INFORMATION CENTERS
$1.7 GR/ $3.5 AF
The requested funding would increase support of 2-1-1 Area Information Centers (AICs). Included in the
request are funds to implement telephony improvements to increase call capacity needed for daily
increased call volumes and especially during natural disasters. The AICs would also be able to increase
their staffing to better achieve targeted service levels. Due to increasing call volume, an increasing number
of AICS are not meeting the monthly service level of 80 percent of calls answered within 60 seconds.
Additionally, two FTEs are needed to support the HHSC expanding 2-1-1 workload in the areas of contract
management and routine administrative (clerical) duties.
23. INCREASE CAPACITY OF HHS-FUNDED COUMMUNITY SERVICES
$265.4 GR / $543.5 AF
This exceptional item would request funding to increase capacity of HHS community services as part of a
continue the effort to reduce and/or eliminate programs with waiting or interest lists at the Department of
Aging and Disability Services (DADS), the Department of Assistive and Rehabilitative Services (DARS) and
the Department of State Health Services (DSHS). The biennial cost has been reduced for the assumed
impact of Medicaid managed care expansions.
24. SUPPORT A HHS VETERAN’S HEATLH INITIATIVE
$14.9 GR / $14.9 AF
This funding request would address HHS efforts to fill some of the gaps and enhance veterans’ services at
HHSC, DADS, and DSHS. The initiative includes contracting with Local Mental Health Authorities to
develop veterans resource networks, contracting with 2-1-1 providers to expand the Texas Military Family
Access Project, contracting with local government entities with high concentration of veterans and service
members to expand the military-focused CRCG, and supporting Aging and Disability Resource Centers that
assists veterans.
Page 30
Description of HHSC Exceptional Items
Continued
25. ENHANCE TECHNOLOGICAL SUPPORTS OF STATE HOSPITALS AND STATE-SUPPORTED
LIVING CENTERS
$8.8 GR / $12.4 AF
This request represents all enterprise IT funding supporting existing initiatives supporting both State
Hospitals and State Supported Living Centers, such as integrated enhanced reporting initiatives to allow an
increase in the efficiency of real time reporting of clinical information to make patient treatment and care
decisions, implementation of failover infrastructure of software suites to support pharmacy and medication
administration applications, client trust fund (CTF) application upgrade (which does not meet software
requirements for the Data Center Services (DCS) contract), and the consumable inventory management
system (MIMS) upgrades.
26. IMPLEMENT AN ACQUIRED BRAIN INJURY WAIVER
$1.2 GR / $2.6 AF
This request would fund the development and implementation of a Medicaid waiver to provide support and
respite services to individuals who have acquired a brain injury. The waiver would require federal approval
and is assumed to be implemented during fiscal year 2013. Initially 100 slots would be funded with
expansion to 200 slots by fiscal year 2015. Acute costs would be funded at HHSC and long-term costs
would be funded at DADS.
27. IMPLEMENT AN HHS DISPROPORTIONALITY AND DISPARITIES INITATIVE
$2.2 GR / $3.1 AF
This funding would facilitate cross systems disproportionality and disparities work at a state and regional
level including working with communities and other stakeholders. Training for HHS employees and
managers would build a foundation for understanding culture, ethnicity and race, enhancing the
competency of staff to ensure equitable outcomes for all clients served.
Page 31
Description of HHSC Exceptional Items
Continued
28. INCREASE RETENTION AND RECRUITMENT OF TARGETED HHS STAFF
$47.7 GR / $79.3 AF
This funding would provide salary increases to medical personnel at DADS and DSHS working in the statesupported living centers and state hospitals to address high turnover in nurses, mental retardation
assistants and nursing assistants. There is also a salary increase for DADS long-term care eligibility
workers.
Page 32