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Yesterday I attended the Early Childhood Intervention (ECI) Advisory Committee meeting in Austin. These meetings are always informative and important because ECI has experienced huge, fundamental changes over the last four years and it is not done. Over the last four years, ECI has narrowed its eligibility which has changed the population of children receiving ECI services, it has required ECI providers to directly bill Medicaid and insurance companies to get reimbursed for services which has required them to develop new skill sets, and it has begun requiring families to pick up some of the costs of the ECI services which has some far-reaching effects.

I’m going to use this post to talk about several things:
• Senate Bill 1060
• Annual performance report data
• Senate Bill 7

Senate Bill 1060
Senate bill 1060 requires the Department of Assistive and Rehabilitative Services (DARS) to study the cost effectiveness of the family cost share system in ECI. Now, the bill is a little more than a study. The bill directs DARS to study the cost-effectiveness of the system and also to evaluate the changes necessary to improve the cost-effectiveness of the family cost share part of ECI. DARS will also implement those changes if they improve the cost-effectiveness and if they don’t hurt access to the services. This will all be done by December 1, 2014. So part of the meeting yesterday dealt with the fact that this study is going to begin soon.

The family cost share idea sounds really good on the surface. Those families that are able to pay for the services should. However, when families are asked to do either pay out-of-pocket or to use their insurance to cover ECI services, it introduces something unexpected – competition. Those families with the means may begin going to private providers for speech therapy, occupational therapy, and physical therapy as opposed to an ECI provider. This has a number of interesting potential impacts. First, private providers aren’t providing services in the child’s natural environment which is a huge advantage that traditional ECI has. Second, private providers are “fixing” the delay as opposed to coaching the family to help the family be successful, which is another huge advantage that traditional ECI has. Finally, if this happens on a large enough scale it is unclear if traditional providers can adjust to this change.

Annual Performance Report (APR) data
DARS is required to submit an APR to the federal government each year as a condition to renew the federal funding for ECI. There are a lot of measures in this report and I’m usually the one that does the most arguing over the statistics and their meaning. Anticipating this, DARS reported on the data at a meeting that was earlier than usual. While there are a lot of measures, the focus is usually around the impact of ECI on children and the impact on families.

The data looking at the impact of ECI on children shows that more children than ever make improvements as a result of the ECI program, but we’re losing ground in terms of how many of these children are reaching an age-appropriate level as a result of the ECI intervention. The DARS staff felt there were two major reasons for this. First, the quality of the data is improving. In other words, this might be a more accurate reflection. I’ve actually heard that the data is improving for several years now. At some point we have to quit using this one.

Second, because eligibility was narrowed this changes the children in the program so that they have more complex needs. I asked the staff when the eligibility was narrowed, because this actually happened two and a half years ago – in other words, last year to this year might be looking at apples to apples. The staff felt that there was a transition period during which you had children under the old eligibility requirements comingled with the new requirements, so you are looking at different populations. The chair of the committee had a great suggestion about running the historical data incorporating the current eligibility requirements to see where we are compared to where we were.

The family outcome data is based upon a survey and shows overwhelmingly that ECI is a valuable service for families. The challenge with this is always that there are approximately 25,000 children in ECI and the data is based upon something like 600 surveys, which is about 2.5% of the population. I don’t have any issues (and am glad) that the surveys are extremely positive about the impact of ECI on families, I just always wonder how representative the sample is of the entire population. The DARS staff assured me that this was a representative sample size.

Senate Bill 7
Senate bill 7 passed in the last legislative session and is slowly moving individuals with intellectual and developmental disabilities away from the Medicaid waivers and to managed care. This impacts ECI because SB7 establishes Star Kids, which is the form of managed care for children. At the meeting yesterday we had a presentation from the Health and Human Services Commission (HHSC) staffer that is coordinating this. And she got an earful. Essentially HHSC will develop the broad guidelines, services, etc. and will then request that managed care organizations submit proposals on piloting this program. During what was meant as a high-level presentation on Star Kids, parents and one school district staffer submitted feedback about SB7 and Star Kids:
• Managed care organizations are used to treating medical problems. For example, if you break your leg it is generally treated in a certain way and generally takes a certain amount of time to heal. If it’s bad enough, based upon an assessment, you may require some physical therapy to become stronger/regain your balance/etc. All this is measurable. People with IDD don’t necessarily have medical conditions. They are complex, have changing needs, and this model won’t work with them – they aren’t being treated.
• Managed care organizations that ultimately end up providing these services are clearly not doing this out of the goodness of their heart, they are seeking to make money. There’s nothing wrong with this, unless it’s your loved one who isn’t receiving services in the interest of the company’s profit.
• Any managed care organization(s) selected should have experience working with people with IDD.
• It needs to be recognized that if there are a handful of managed care organizations providing services in Texas ultimately, each will be offering slightly different services and have slightly different ways of doing things which parents and caregivers aren’t going to understand.
• Finally, there was a discussion about why didn’t SB7 and Star Kids think about the services the children are receiving in the school system? This actually has some implications. Some kids in this population may be receiving speech therapy, physical therapy, occupational therapy, have an assistant, communication/mobility aides, transition, even specialized nutrition through the school system. How does this link up with the services that Star Kids provides? What about case management? What about transition?

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The system that provides services to individuals with Intellectual and Development Disabilities (IDD) is currently in a state of transition in Texas. With the passing of Senate Bill 7 in the last legislative session, the state is redesigning the system that provides waiver services to individuals with IDD and eventually moving those services to managed care. From conversations that the advocacy groups are having with some of these managed care companies, it’s already clear that there is going to be a large and painful learning curve for them with regards to how Texas operates and with regards to the needs of individuals with IDD.

I’m going to be the Chair of the Arc of Texas’ government affairs committee. When I spoke with the Arc’s leadership about this, I laid out my personal concerns moving into the next two years. As you can see from the list below, there is a lot going on right now:
1. Recap of the Legislative session. What happened, how will this impact families and individuals with IDD?
2. Keeping up with the implementation of SB7. The Devil is in the details.
3. Since SB7 is now a fact, how is managed care working in other states? What can we learn from the experience of other states and how can we apply it to take advantage of what works well and how can we avoid the problems?
4. Keeping up with the state supported living centers and the implementation of the Department of Justice agreement.
5. I’m thinking there was also a Department of Justice settlement about nursing homes…
6. In the spring, the Office of Civil Rights put out a dear colleague letter that potentially radically changes the landscape of kindergarten-university athletics for people with disabilities. This may greatly expand the access of individuals with disabilities to athletics in public schools and may also have some unintended long-term consequences to the Special Olympics.
7. If anyone could point me to some places to begin getting up to speed on education and transition issues I’d really appreciate that.
8. Finally, there are a lot of unintended consequences to legislation. For example, ECI as we know it is going to change over the next few years. By requiring families to pay more of the cost, and by having ECI bill insurance, the result is that families that can will begin going to private providers for ECI services. The current ECI providers are slow to adapt to these changes and may not survive… It would be good to be able to think through and anticipate some of these things.
9. Remaining flexible so we can respond to unanticipated topics as they come up…

For obvious reasons, the big issue is the implementation of SB 7. The question comes up about how to stay informed and how to have an impact on the process. There are a number of ways:

First, realize that much of the details of the implementation of SB7 will be handled by state policymakers and by the managed care organizations. However, there are advisory committees that have been set up to advise the state in these matters. The membership of those committees, along with contact information, can be found:
IDD System Redesign Committee: http://www.hhsc.state.tx.us/about_hhsc/AdvisoryCommittees/iddsrac.shtml
STAR Kids Advisory Committee: http://www.hhsc.state.tx.us/about_hhsc/AdvisoryCommittees/STAR-kac.shtml
State Managed Care Advisory Committee: http://www.hhsc.state.tx.us/about_hhsc/AdvisoryCommittees/smmcac.shtml

Second, your Legislators should be accountable to you about this. The major committees in the Senate and House that handle this are linked below:
Senate: Health and Human Services http://www.capitol.state.tx.us/Committees/MembershipCmte.aspx?LegSess=83R&CmteCode=C610
House: Human Services http://www.capitol.state.tx.us/Committees/MembershipCmte.aspx?LegSess=83R&CmteCode=C310

You should contact the membership of both and let them know what you think.

Finally, advocacy groups need your feedback so they understand what your needs are and how they can best be impactful in this time of profound change. The Arc of Texas is currently conducting a survey to get an idea of people’s needs and how they can address them via advocacy and policy efforts. This survey can be found at: http://www.thearcoftexas.org/site/Survey?SURVEY_ID=2602&ACTION_REQUIRED=URI_ACTION_USER_REQUESTS&AddInterest=1044

It’s important to get involved and be heard. As I tell many people, it’s better to drive the bus than have it dropped on you!

In August, the Health and Human Services Commission of Texas published a report on their website. This report is an external quality review that was performed on STAR+PLUS home and community-based services. This is an extremely important and timely report because of the passage of Senate Bill 7 in the 2013 Texas Legislature, which will gradually shift the waiver services for individuals with Intellectual and Developmental Disabilities (IDD) over to managed care (i.e. STAR+PLUS). First, the full report can be accessed at: http://www.hhsc.state.tx.us/reports/2013/EQRO-STAR-PLUS-Waiver.pdf

This report was developed via a combination of surveying individual service plans (ISPs), telephone surveys, and face-to-face interviews. For the telephone surveys and face-to-face interviews, individuals whose ISP was studied were contacted. Of the 1207 people eligible, 202 returned surveys. Of those 202, 23 people from the Harris County area were interviewed in the face-to-face interviews.

The results are interesting:
• Almost 93% receive services at home.
• Almost 68% of members live with their families, almost 20% live alone, 10% live in an assisted living facility.
• The most used services are personal assistant services (95%), emergency response services (90%), and respite care (57%). The least used services are minor home modification (2.6%), meals (almost 4%), and dental services (4%).
• 28% of the members have some college education, a degree, or more than a college degree. 42% have a high school education or lower.
• 91% of the respondents have a caregiver that helps them with daily activities. 16% of those caregivers are unpaid family volunteers.
• The top five reasons for needing a caregiver include health, assistance looking after themselves, assistance with nutrition, assistance getting around, and assistance with daily activities.
• Almost 80% of the respondents identify their health as being fair or poor. Only 6.5% identified excellent or very good for their health.
• 67% of the respondents have moderate-to-high depressive sympotomatology.

The survey also looks at the service coordinators and the ISP:
• 84% of the respondents were satisfied or very satisfied with the help they received from their service coordinator in the past six months.
• Almost three quarters of respondents were included in the decision-making process of their ISP, were included in decisions about services, felt their ISP was respondent to their needs, and felt that their plan included services that were important to them.

In the face-to-face interviews, participants were asked about positive and negative experiences. The following negative experiences were reported by 31-45% of those people interviewed: poor communications, delays in care/services, poor phone experience, red tape, poor quality transportation, poor quality dental care, and poor communication with doctors.

Each service coordinator reported caseloads of 200-500 cases, per coordinator.

The study makes a number of recommendations:
• There should be more stringent standards regarding the frequency and methods of contact between service coordinators and members.
• There should be a reduction in caseloads of service coordinators (which will also allow for more frequent contact).
• Existing protocols for contracting with home health care, transportation, and other types of vendors should be evaluated to ensure high-quality service.
• There should be a vendor certification process to assist with quality.

The population studied includes Medicaid and some Medicare-eligible individuals. They may or may not have IDD. This is, however, very interesting as it may help map out potential concerns for the implementation of SB7. Concerns include service coordinator caseloads, depression, communications, delays in care/services, red tape, and some quality control issues.

On June 29th, I finished the first group of Down with Fitness classes. These are fitness classes geared towards children with Down Syndrome. These classes have been running for five Saturdays in a row, for about an hour, at the gymnasium at St. Gabriel’s Catholic Church in McKinney, TX.

We’ve had anywhere between three and eight kids at each of these, ranging in age from three years old all the way to nine years old. Each class also included parents and siblings to help and to participate along with their kids. The idea behind the class is to get the kids moving, work on motor skills and basic fitness, and show the parents that creative and fun fitness activity is possible with their kids (and that their kids would enjoy it).

Each of these classes was organized in a similar manner, though things have been progressively becoming more challenging for the kids. We begin each class with mobility exercises, though we’re not calling them that. In the pictures you see us walking like T-Rex’s and walking like little kitty cats.

Walking like a T-Rex

Walking like a T-Rex

Walking like  cats Walking like cats[/caption]After that, we hop like kangaroos, frogs, or bunny rabbits and then play a fast game of tag.tag

tag2</aThis all serves as a great warm up and gives the kids a chance to develop their muscles as well.

After the mobility exercises we progress to hula hoops. A large number of exercises are done with the hula hoops. These include stepping in and out of the hoops (and the hoops are held at different heights to make this more challenging), putting the hoops around a body part (put them around your arm, leg, etc.), and lifting the hoops to certain heights (lift it overhead, lift it to your shoulders, etc.). hopping

walking through the hoops

walking through the hoops

around the waist

around the waist

lift the hoops

lift the hoops

After those exercises, the hoops are put on the ground to make an obstacle course. First the kids would walk through them, then hop through them, then the hoops would be spread out to make the exercises more difficult. After that, mini-hurdles are used for zig sagging around and for walking over. Finally, the kids throw bean bags into the hoops.hurdles1

zig zags

zig zags

The next activity involves tunnels, kids love crawling through tunnels. After the kids have crawled through the tunnels for awhile, the ball is introduced and the kids push/throw the ball through the tunnel as they crawl through.tunnels

Finally, some type of ball-related activities are introduced. During these classes we have used basketballs, footballs, Frisbees, soccerballs, and on this session we’re using little hockey sticks to hit balls into goals. hockey1

hockey2 After all of that, the session ends with some free play to help the kids wind down.

I wasn’t sure what offering this class would be like, but it has been a lot of fun and very rewarding. I’m going to start this up again in August, run it four 4-5 weeks, take a break due to little kids’ baseball, then start up again in November.

Individuals with Down Syndrome, especially as they age, tend to be characterized with obesity, health-related problems from that obesity, poor fitness, a reduced physical work capacity, as well as hyperflexibility and low muscle tone.  In the latest issue of Exercise and Sport Sciences Reviews, Fernhall et al discuss the cardio-vascular impacts of Down Syndrome and the impact of exercise training on this.

 

The authors begin by discussing the low work capacity (i.e. maximal oxygen consumption) of individuals with Down Syndrome (DS):

·      Individuals in their 20’s with DS have a maximal oxygen consumption equivalent to a 60-year old without DS.

·      Maximal heart rates in people with DS are typically 25-30 beats/minute below that of people without DS.

 

What causes these?  The authors note that this is not due to congenital heart disease due to the fact that the studies examining this exclude people with congenital heart disease.  Traditionally this has been thought to be due to a lack of understanding/comprehension and a lack of motivation on the part of people with DS.  However, the authors report that with training individuals with DS can take a maximal oxygen test on a treadmill and produce consistent results, so understanding and motivation are not issues. 

 

Other possibilities are a lack of physical activity or obesity.  Interestingly, the authors report that while the DS population is sedentary it is not more so than the general population.  Based upon the authors’ research, 8-10 hours of week of training still result in unusually low work capacities.

 

In the non-DS population, as we age we tend to accumulate more body mass.  As this happens our work capacity declines.  In the DS population, as they age they also accumulate more body mass but their work capacity remains constant.  According to the authors, maximal oxygen consumption remains in the mid twenties (ml/kg/min) for people with DS between the ages of 9 and 45; whereas for the non-disabled population (on average) it changes from about 45 ml/kg/min to about 35 ml/kg/min over that same age range. 

 

All of this combined suggests that understanding, motivation, obesity, and activity level are not the culprits of the reduced work capacity seen in individuals with DS.  While this is oversimplifying the discussion somewhat, essentially the authors report that a combination of the brain’s control over heart rate and a reduced production of catecholamines (for example, epinephrine) are the likely culprits behind this reduced work capacity.    In other words, due to the brain’s regulation a person with DS has a lower heart rate, which has an impact over their ability to supply oxygen to their body, which reduces their ability to perform long, strenuous exercise.

 

The authors report that exercise helps with this.  I wrote an article a number of years ago about exercise and Down Syndrome, and at the time (and even today) there was little research on this.  The good news is that exercise helps individuals with DS just like it helps individuals without DS.  The challenge is that parents, siblings, caregivers, and individuals working with someone with DS need to be cognizant of these limitations because they impact motivation and require creative ways to address the fitness of a person with DS. 

 

Fernhall, B., Mendonca, G.V., and Baynard, T.  (2013).  Reduced work capacity in individuals with Down Syndrome: A consequence of autonomic dysfunction?  Exercise and Sport Sciences Reviews, 41(3), 138-147.

 

 

The Texas Comptroller has certified that the funds are available for the appropriations bills that came out of the 2013 Legislature. There is mixed news for people with intellectual and developmental disabilities and their families.
With regards to the Department of Assistive and Rehabilitative Services (DARS) and Early Childhood Intervention, there is good news and bad news for Early Childhood Intervention (ECI):
 ECI is seeing an almost 18% increase in its funding, from ~$270 million for the current biennium to ~$318 million for the upcoming one. Both respite and the administrative oversight of ECI are being funded at the same amounts as in the current biennium. In addition, the Legislature wants to see the number of hours of services per child per month to increase from an average of 2 hours to an average of 2.9 hours.
 The bad news is that the ECI appropriation has a rider. The rider says that anyone receiving ECI services who has a family income greater than 400% of the federal poverty level must pay 100% of the cost of the services.
It’s great that ECI funding is expanding and that the Legislature wants to see more hours of services per month per child. It will be interesting to hear DARS’ forecasts on how this will impact the number of children served. The rider is concerning and has significant long-term implications for both providers and the people that will be receiving ECI services. This will mean that some families will opt not to receive the services because they cannot afford it and others may be driven to private providers, which means that current ECI providers will have to learn how to be competitive with private providers.
With regards to the Department of Aging and Disability Services (DADS) and their long term services and supports appropriation, there is mixed news that reflects the shift to managed care that is being driven by Senate Bill 7. First, some programs are seeing a reduction in funding:
 Primary home care (~42% reduction): Provides non-skilled personal care services. Reduction is due to STAR+PLUS and this service will eventually be eliminated.
 Day Activity and Health Services (~67% reduction): Another casualty to STAR+PLUS.
 Community-Based Alternatives (~22% reduction): due to STAR+PLUS.
 ID Community Services (~7% reduction): Administrative expenses are being transferred elsewhere and some of the individuals receiving services are being transferred to the Texas Home Living Waiver.
 Promoting Independence Services (~5% reduction): Another casualty due to STAR+PLUS.
 Hospice (~5% reduction)
There are a number of programs seeing an increase in funding, including several waiver programs that are seeing a large increase in funding:
 Community Attendant Services (11% increase): Seems to be balancing out the reduction in primary home care.
 Home Community-Based Services (HCS) (15% increase)
 CLASS (10% increase)
 Deaf Blind Multiple Disabilities (38% increase)
 Medically Dependent Children (6% increase)
 Texas Home Living Waiver (63% increase)
 Nursing Facility Payments (4% increase)
 Medicare Skilled Nursing Facility (6.5% increase)
 Balancing Incentive Program: 14.7 million
 State Supported Living Centers (~2% increase)
It should be noted that none of the bills that sought to establish realignment committees for the State Supported Living Centers (SSLC), closure of the SSLCs, or bills of rights for people with intellectual and developmental disabilities passed. There are no riders directing DADS to close SSLCs, or explore closing SSLCs, only a rider to develop a ten year plan for the SSLCs.
The expansion of the waiver programs is great news. But the reality is that managed care is coming as a result of Senate Bill 7, so we’re going to be in uncharted territory soon. The fact that the Legislature will not move on the SSLCs is interesting.

Senate Bill 7, which shifts the Medicaid waiver services for individuals with intellectual and developmental disabilities over to managed care organizations, has passed the Senate is has passed the House as of May 21. However, while in the House one of the representatives amended the bill in a major way. Representative Turner amended the bill by eliminating the redesign advisory committee, which would have been the mechanism for stakeholder input into what they new system will look like. Below is a copy of the letter that I sent to my representative about this as well as Representative Raymond, who oversees the House Human Services committee. Feel free to cut and paste and share with your elected leaders.

“I hope that this finds you both well.

As you are both aware, the House has been voting on SB7. Yesterday Representative Turner amended the bill by striking the IDD redesign advisory committee. This is a huge concern and without that committee I as a parent am unable to support this bill.

As you both know from my previous communications and visits with you, I feel that stakeholder input is absolutely critical to the long-term success of this bill for the state and for the people that will be receiving services. Without that stakeholder input, the state does now know what this population needs or how it experiences services. Without this input, the state does not know if managed care organizations are providing the services and the environment that this population needs. The redesign advisory committee provided an accountable mechanism to providing and receiving stakeholder input. Sweeping this into another committee that is not designed for this purpose is criminal.

Many parents like myself and many advocacy groups supported SB7 only because of the presence of that advisory committee. If that has been eliminated, then I can no longer support that bill and I strongly urge that Representatives Sanford and Raymond both withdraw their support of the bill.

Thank you for your time.”

Senate Bill 1361 is being heard by the Senate Health and Human Services Committee on Tuesday, April 23rd.  This is a bill that seeks to establish a bill of rights for persons receiving long-term services and supports under Medicaid programs.  As we seem to be moving inexorably towards managed care, this is a short, four-page bill that establishes some important principles especially for individuals with intellectual and developmental disabilities (see the text here: http://www.legis.state.tx.us/tlodocs/83R/billtext/pdf/SB01361I.pdf#navpanes=0 ). 

If passed, this legislation puts the following principles into state law:

  • Individuals have the right to live as independently as possible
  • Individuals have the right to control their own lives
  • Individuals have the right to receive services and supports to secure and retain employment
  • Individuals have the right to be able to self-advocate or receive that help from family or guardians
  • Individuals have the right to be involved in system redesign
  • Individuals have the right to receive services and supports that address individualized needs, that close the gaps that exist in current services and supports, that are part of a quality management process, that are overseen by qualified staff with decision making powers, and that are accessible and transparent.
  • Individuals have the right to select their own qualified provider
  • Individuals have the right to have access to both institutional and home/community-based services and supports
  • Individuals have the right to retain existing health care coordinators and physicians
  • Individuals have the right to periodically change health care providers, coordinators, and managed care programs
  • Individuals have the right to be fully informed about their rights and obligations
  • Individuals have the right to have access to grievance procedures

 I realize this is a philosophical document.  However, if passed it provides the foundation behind any system changes to long-term services and supports.  Many people are concerned about their loved ones being swallowed up by soulless managed care programs that are more concerned about efficiency and bottom line than in the people they care for, legislation like this would help to reassure guardians and family members that the state has some compassion and interest in taking care of this vulnerable population.

To contact members of the Senate Health and Human Services committee, click here for a list of members: http://www.legis.state.tx.us/Committees/MembershipCmte.aspx?LegSess=83R&CmteCode=C610 .

I’ll be conducting a fitness program for children with Down Syndrome beginning in June.  It’s going to run on Saturdays from 2 until 3 at St. Gabriel’s Catholic Church in McKinney, TX.  St. Gabriel’s is graciously letting me use their gymnasium for this program.  Thanks to their generosity, this program is being offered at no charge to families of children with Down Syndrome.

I have several goals with this program.  First, to get these kids moving and active.  I don’t think kids in general respond well to structured exercise programs (for example, do three sets of ten crunches) so we’ll be approaching this through movement activities and games that they should find fun.  Second, I’d like to convince family members that their kids can enjoy movement and that it is not difficult to incorporate this into their lives.  Finally, it’s a great opportunity to socialize everyone and get past some of the scare factor that can be associated with working with special needs individuals.

The program information, along with a registration flier, can be found at: program information

There are several important bills that have on the state supported living centers (SSLC’s) that have been filed in the Legislature this session.  All of these bills have been filed and referred to committee, but all the bills are just sitting there waiting for a committee hearing.  These bills deal with the following topics:

  • Creating a SSLC realignment commission
  • Evaluating the SSLC system
  • Developing criteria for the closure or consolidation of the SSLCs

 

Creating a SSLC realignment commission:

In the Senate, SB 729 by Rodriguez seeks to create a SSLC realignment commission. In the house it is HB 3528 by Klick.  These bills would establish a realignment commission to evaluate and make recommendations regarding the operation and management of the SSLCs, would make recommendations on the consolidation or closure of SSLCs based upon criteria established in the bill, and oversee the implementation of its recommendations.  Members would be appointed by the Governor.

 

Evaluating the SSLC system:

In the Senate, SB 1045 by Rodriguez and in the House HB 3312 by Collier seek to direct the Health and Human Services Commission to contract with an outside entity to evaluate the SSLC system.  This evaluation would include examining the proximity of SSLCs to community service providers, administrative costs of operating SSLCs, availability of employment opportunities for SSLC employees should a SSLC close down, conditions of both the SSLCs and community service providers, capacities of other SSLCs and community service providers should a given SSLC be closed, examining whether specialized services and programs at a given SSLC can be conducted in the community, support needs of residents in a SSLC and whether those are available in the community, etc.  In other words, these bills seek to give decision makers the information that they need to make unemotional decisions about the future of the SSLCs.

 

Developing SSLC closure criteria:

In the Senate, SB 1766 by Rodriguez and HB 3527 by Klick in the House seek to direct the Health and Human Services Commission to develop a formula-based approach to determining when a SSLC should be closed or consolidated with another SSLC.   These bills also include instructions on how to consolidate the SSLCs provided that seven of the thirteen are closed down.

 

All three of these bills are important.  The realignment commission develops an independent group to make the decisions.  The evaluation bills provide the information that is needed to make objective decisions about this emotional topic.  The criteria allows the comparison of apples to apples.  None of these bills requires that SSLCs be closed or consolidated, but they do lay the groundwork for this to occur and could perhaps incentivize and improvement in services and supports.

None of these bills are currently scheduled to be heard in their committees.  If this is something that you feel strongly about, contact the members of both committee about this.  To find the members of the committees, click on the following:

Senate Health and Human Services Committee membership: http://www.capitol.state.tx.us/Committees/MembershipCmte.aspx?LegSess=83R&CmteCode=C610

House Human Services Committee membership: http://www.capitol.state.tx.us/Committees/MembershipCmte.aspx?LegSess=83R&CmteCode=C310