SB 7 Recommendations for Continuing Improvement

April 16, 2013

These recommendations are provided by the following organizations, recognizing the efforts and improvements that were made prior to the bill being received in the House.

  • Disability Rights Texas
  • Texas Council for Developmental Disabilities
  • EveryChild, Inc.
  • The Arc of Texas

Definitions

  1. Regarding Section 534.001 and the definition of habilitation, we recommend adding “and instrumental activities of daily living” to 5 (A) following the word “living.” See the revised definition below.

(5) “Habilitation services” includes assistance provided to an individual with acquiring, retaining, or improving:

(A) Skills related to the activities of daily living and instrumental activities of daily living; and

(B) The social and adaptive skills necessary to enable the individual to live and fully participate in the community.

Rationale: Instrumental activities of daily living, and not just activities of daily living, include many tasks that can be the focus of skill development for individuals, for example, money management.

Employment and Consumer Direction

  1. Regarding employment goals for Acute and Long Term Supports and Services Section 534.051, we recommend adding the following additional goals:
    • promote and expand consumer direction for all long term services and supports;
    • ensure accessible, affordable transportation necessary to promote community participation
  2. Regarding employment goals for Managed Care Strategy Proposals; Pilot Program Service Providers Section 534.104 (c) (7), we recommend adding,
    • “including consumer directed supported employment” after the words “supported employment”

Rationale: It is important to specify a goal for consumer directed employment in addition to the goal for gainful employment, employment assistance and supported employment that would increase and prioritize a focus on implementation of consumer directed employment related services by the state agencies.

Basic Attendant and Habilitation Services Section 534.152

  1. Regarding providers for the provision of basic attendant and habilitation services, we support including current IDD providers of these services as significant traditional providers. We support expanding the provider base by including new IDD providers, including qualified Home and Community Support Services Agencies (HCSSAs), that demonstrate capacity to provide such services. For those Significant Traditional Providers that provide quality basic attendant and habilitation services, we recommend they not be excluded after the first 3 years “without good cause.”

Rationale: Competition and quality go hand in hand. Qualifications would need to be carefully established and, once the standards are clear and approved, both quality and access may be improved with additional provider options. We support not requiring providers of this service to be HCSSA licensed, but rather that HCSSA licensed and certified IDD providers should be allowed.

Housing

  1. Regarding Flexible, Low-cost Housing Options Section 533.03551 (a) (1) we recommend deleting “that comprise a continuum of integration varying from most to least restrictive.” The revision would read as follows: (a) (1) a selection of community-based options that permits individuals to select the most integrated and the least restrictive setting appropriate to the individuals needs and preferences.

Rationale: Since language in (a) reflects the need to adopt or amend rules, and since that language is directed at the Executive Commissioner, it appears that the intention is to amend community based waivers to “allow a continuum of integration” that would increase options for “most restrictive” living arrangements in the waivers, contrary to the intention of all the waivers to be an alternative to (and not to perpetuate) “most restrictive” settings. If implemented as written, this could roll back the progress Texas has made on Promoting Independence initiatives since 2001. In addition, “most restrictive” is not defined so it is left to the imagination as to what effect this would have.

Transition to Managed Care Section 534.202

  1. We support choice and options for individuals currently in DD waiver programs and their optional transition into managed care. We recommend the following in (h), replace “at a later time” with “after the first year” so that individuals, by their choices, can evaluate and access the service delivery model that best meets their needs, at least during the first year.

Rationale: To lock-in individuals who chose to try managed care over their legacy, traditional DD waiver program in which they are already enrolled will have a chilling effect on individuals trying the new model. It will also not allow flexibility which may, if people choose to return to their original waiver program in the first year, help inform the State about what is and is not working in the managed care arena if an evaluation is required related to reasons for opting to return to one’s original waiver. Flexibility would provide the state time to evaluate why people return to their original program and make adjustments to managed care so that more people will chose to try and/or return to managed care.

Automatic Enrollment in Managed Care Expansion Section 2.01

  1. We have concerns regarding automatic enrollment, both as relates to the feasibility and advisability. We cannot support rushing to enrollment over education and choice for managed care participants.

Rationale: In the health care and insurance market place, individuals who understand and engage in choice will be more engaged in their health and health care outcomes. Rather than studying automatic enrollment, we suggest investing in supports for future and current participants of managed care to build capacity for making informed choices at enrollment and getting advocacy supports to navigate and effectively access the services and supports they need.

Traumatic Brain Injury

  1. Section 534.051 – We recommend adding a new (13) “ensure the availability of services appropriate for individuals with traumatic brain injury.”
  2. Section 534.052 Implementation of System Redesign – We recommend adding, after the word “disabilities,” “including individuals with traumatic brain injury.”
  3. Section 534.053 Intellectual and Developmental Disability System Redesign Advisory Committee – We recommend adding in (1) after “disability advocacy organizations” “and one individual or advocate for individuals with traumatic brain injury.”

For more information, please contact: