Texas’ Fourteen
Year Journey to
Rebalance its LTSS
system
Marc S. Gold
Texas Department of Aging & Disability
Services
Hou...
Olmstead to BIP: Rebalancing
1985: First 1915 (c) waiver
1999: Texas embraces Olmstead: Promoting
Independence Initiativ...
PII: Early Enhancements
Creation of MFP and Promoting Independence
Priority Populations.
Development of relocation speci...
PII: Early Enhancements
Consumer-directed Services.
Expansion of Centers for Independent Living.
Increased support for ...
Barriers to Relocation
 Long-term institutionalization
 Information/knowledge of options housing
 Co-occurring behavior...
Barriers to Relocation
 Health and welfare concerns
 Family/guardian resistance
 Coordination of services/SSI address c...
MFP Demo: The Next Step
Demonstration:
 took state to the next level in enhancing the
community-based infrastructure;
 ...
MFP Demo: Selected Projects
Over 30 projects funded through the
Demonstration to enhance the community-based
infrastructu...
MFP Demo: Selected Projects
Over 30 projects funded through the
Demonstration to enhance the community-based
infrastructu...
MFP Demo: ADRC Enhancement
Started “no wrong door” efforts.
Refinanced first three ADRCs once ACL start-up
funding was n...
MFP Demo and Housing
811 Infrastructure Grant.
United States Housing and Urban Development
(HUD award of $12 million in ...
MFP Statistics
 45,071 individuals have relocated
from Texas Medicaid-certified institutions
 NF: 33,421
 ICF/IID: 11,6...
MFP Residential Placements
37 percent living with a family member
26 percent living in assisted living
34 percent livin...
BIP: Data Follows the Person
$301.5 million award.
External Stakeholders and Executive and
Legislative Involvement and L...
BIP: Work Plan Strategy
 Supports TX’ overall goals and strategic
planning in relation to upcoming legislative
session (J...
Partners and Scope of BIP
 Health and Human Services Commission: umbrella
agency; Medicaid agency; operates managed care
...
BIP Award Allocation
NWD: Data Follows the Person
 Heavy emphasis on “data follows the person”:
providing infrastructure to support individual...
BIP: Guiding Principles
 Contracting for several IT projects: initial
analyses of system and development
 Principles:
 ...
IT System Features
 Single front-door portal which is self-service or
with assistance (ADRC).
 Data warehousing.
 Messa...
Beyond BIP: Transformative
 Greater cooperation across health and human
services system – true “enterprise” system
Looki...
BIP: Project Interdependencies
BIP: Vision
 Statewide portal for easy access into the
health and human services system to provide
transparency of all el...
Contact Information
Marc S. Gold, TX Department of
Aging and Disability Services
Special Advisor for Policy
Office of the ...
Website Information
Balancing Incentive Program:
http://www.dads.state.tx.us/providers/pi/bi
p/
Your Texas Benefits:
https...
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Texas' Fourteen Year Journey to Rebalance Its LTSS System

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Texas' Fourteen Year Journey to Rebalance Its LTSS System

  1. 1. 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
  2. 2. Olmstead to BIP: Rebalancing 1985: First 1915 (c) waiver 1999: Texas embraces Olmstead: Promoting Independence Initiative 2001: Creates “Money Follows the Person” (MFP): 45,000 relocated 2003: Consolidation of Health and Human Services system 2006: Aging and Disability Resource Centers 2007 – National MFP Demonstration 1998-2012: Expansion of LTSS managed care 2012: Balancing Incentive Program (BIP)
  3. 3. 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.
  4. 4. 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.
  5. 5. 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
  6. 6. Barriers to Relocation  Health and welfare concerns  Family/guardian resistance  Coordination of services/SSI address change  Personal fears  Provider liability  Loss of community supports
  7. 7. 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.
  8. 8. 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.
  9. 9. 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.
  10. 10. 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.
  11. 11. 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.
  12. 12. 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
  13. 13. MFP Residential Placements 37 percent living with a family member 26 percent living in assisted living 34 percent living alone
  14. 14. 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.
  15. 15. 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.
  16. 16. 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.
  17. 17. BIP Award Allocation
  18. 18. 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.
  19. 19. 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.
  20. 20. 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).
  21. 21. Beyond BIP: Transformative  Greater cooperation across health and human services system – true “enterprise” system Looking 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.
  22. 22. BIP: Project Interdependencies
  23. 23. 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.
  24. 24. Contact Information Marc S. Gold, TX Department of Aging and Disability Services Special Advisor for Policy Office of the Commissioner 512.438.2260 marc.gold@dads.state.tx.us www.dads.state.tx.us/business/pi/ind ex.html
  25. 25. Website Information Balancing Incentive Program: http://www.dads.state.tx.us/providers/pi/bi p/ Your Texas Benefits: https://www.yourtexasbenefits.com/ssp/S SPHome/ssphome.jsp Aging 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/m fp_demonstration/index.html

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