Thank you for the opportunity to provide input on DARS’ LAR for fiscal years 2014-2015. I am a parent of an almost five-year old with Down Syndrome. I have also been appointed as a parent member to the Children’s Policy Council (established by HB 1478 of the 77th Legislature), the Task Force for Children with Special Needs (established by SB 1824 of the 81st Legislature), and the Early Childhood Intervention Advisory Committee. Not only am I living this as a parent, but I’m also involved in attempting to change things to provide better services to children like my son.
I think there are a number of areas where DARS can provide leadership via this LAR:
- Sustainability and ECI
- Access to services
- Integration of planning
- Senate Bill Seven
- Stakeholder Input
Sustainability and ECI:
Thanks to a combination in loss of Federal stimulus funds as well as budget reductions from the 2011 Legislature, ECI has had to make some significant changes including implementing a family cost share, making eligibility to services more stringent, and having contractors directly bill Medicaid. These are all band aid solutions that allowed ECI to survive the current challenges. They do not take advantage of the opportunity the current climate represents to rethink ECI and how it can be both effective and sustainable in the future. DARS, through this LAR, can at least educate the state’s decision makers about the importance of doing this.
Access to Services:
In the most recent draft of DARS’ strategic plan (shared with the ECI Advisory Committee during its April 11, 2012 meeting) it is evident that the need for services is significantly larger than DARS’ ability to meet that demand. It is likely that the Legislature does not understand the scope of this disparity. Again, the LAR can be a tool that DARS can u se to educate the Legislature. While it probably won’t reverse the funding trend, at least the Legislature will be making a highly informed decision.
Integration of Planning:
It is important that future planning with regards to health care, Medicaid, and the improvement of services for individuals with special needs must be integrated. Often, these planning efforts are disconnected or driven by whim and this ensures that they will fail. Committees can draft reports, they can develop plans, but if they are not integrated and supported by the state agency strategic plan and the Legislative Appropriation Request then they are doomed to failure.
Senate Bill Seven:
Senate Bill 7, passed by the 2011 Legislature in special session, serves as an example of increasing government waste and inefficiency while attempting to reduce it. The bill seeks to reduce Medicaid and health care issues impacting children with disabilities to a handful of outcome measures in order to simplify an enormously complex problem. In so doing, it requires no less than 14 different reports, studies, and assessments and sets up new government entities that will require ongoing funding diverted from areas that could be providing direct services to children with disabilities.
Each of the reports that SB7 requires (some are for the Legislature, some for the Governor, most are for both) will require staff time to collect data, analyze data, compile reports, brief agency officials, and prepare agency officials for Legislative testimony. Each of these reports will lead to situations where state agencies will seek new streams of information from health care providers in order to satisfy the needs of the reports for data. The combination of all of these efforts will mean that more resources are being devoted to collecting, analyzing, and reporting data rather than providing services to children with special needs. While the Legislature’s desire for knowledge is admirable, I question how influential this data will ultimately be in the decision-making process.
SB7 also requires a number of studies by HHSC and its enterprises. These are described in sections 1.02 (patient centered medical homes, external quality reviews, payment incentives), 1.09 (physicians incentives), 1.12 (performance incentives based upon outcome and process measures), 3.01 (outcome measures of quality and efficiency), 6.05 (preventable events for hospitals/long-term care facilities), 6.07 (data by facility), and 6.08 (study on incentives and recognition of health care quality). While the intent behind these studies is admirable, they will result in health care providers spending more time and resources on these and less on direct services and it is unclear that these studies will uncover any information that is not already known.
DARS should educate the Legislature, via the LAR, about the hidden costs and ripple effects that this kind of micromanaging has.
Stakeholder Input:
I appreciate DARS soliciting stakeholder input on the LAR. Often, stakeholder input is solicited towards the end of planning instead of at the beginning. I would like to encourage DARS to continue soliciting stakeholder input at the beginning and during the planning process, rather than just with the final product.
Thank you again for the opportunity to provide feedback to DARS’ 2014-2015 LAR. If you have any questions I may be reached at:
214-334-4754
Respectfully;
John M. Cissik
Jcissik's Blog 