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Tag Archives: LAR

The Department of Aging and Disability Services has published its Legislative Appropriations Request (LAR) for the 2016/2017 biennium. The full report can be found here: .

The LAR is the important first step in the state’s budgeting process. This represents the agency’s priorities and wish list. The Legislature will factor some of this in when determining the agency’s budget. This is important because these dollars, while large, represent services to people with intellectual and developmental disabilities. The table below shows what was budgeted for the 2014 and 2015 biennium compared to what the agency is asking for in the 2016/2017 biennium. Keep in mind that Texas budgets according to two year cycles, so 2014/2015 represents the combined budget of both years as does 2016/2017. The column at the end shows you the change. A positive number means that the agency is asking for more, a negative number indicates they are asking for less, and a zero means essentially no change.

The breakdown of the LAR can be found here: dadslar

As requested by DADS, there are major changes to the funding of community based alternatives, primary home care, and SSLC capital repairs/renovations. DADS is requesting increases in hospice, guardianship, community attendant services, CLASS, DBMD, regulation, administration, and IT program support.

In addition to the LAR, DADS is also requesting several exceptional items. Frequently the LAR requests by strategy represents no change to services. In other words, this is the cost for the status quo. The exceptional items represents new things the agency would like to do.

The first exception item is funding to maintain the current caseload for many of the waiver programs (HCS, CLASS, DBMD, MDCP, Texas Home Living Waiver, non-Medicaid services, and PACE). This exceptional item is asking for approximately 111 million dollars over the biennium. In their justification, DADs mentions that the current biennium (FY 2014 and 2015) had the funding to expand waiver slots, particularly in HCS, but a failure to continue funding those into the next biennium (i.e. a failure to grant this exception item) will result in people losing care.

The third exception item deals with funding to reduce waiver interest lists. If funded, this exception item would add 15,145 slots for community-based services and cost approximately 724 million dollars over the biennium. It would fully fund the STAR+PLUS community-based alternatives, the deaf-blind multiple disability lists, would serve about 20% of the people on the interest lists for HCS, MDCP, TxHmL, and CLASS. For In Home and Family Support and IDD Community services, it would serve about 10% of the people on those interest lists.

The fourth exceptional item deals with promoting independence for individuals with intellectual and developmental disabilities (IDD). This represents a little over 85 million dollars to either move people from facilities or keep people from having to go there. If funded, it would move 500 individuals from large or medium-sized intermediate care facilities, 216 children aging out of foster care, 400 crisis slots for individuals for individuals at imminent risk of entering a large/intermediate care facility, 120 individuals with IDD in the state hospitals, and 25 for children transitioning from a general residence facility.

The fifth exceptional items seeks to enhance community IDD services for individuals with complex medical and/or behavioral needs. This is an exceptional item that is meant to address things that the Sunset Commission noted. DADS is requesting approximately 57 million dollars over the biennium to the fund new crisis respite and behavioral intervention programs, and increase the ICF and HCS rates to encourage treatment.

The seventh exceptional item relates to protecting vulnerable Texans. This item requests approximately 41 million dollars over the biennium to hire new guardianship supervisors, expand the Lifespan Respite Care program, increase the HCS cap on dental expenses to $2000 per individual per year, to provide assistance to small HCS facilities for required fire sprinkler systems, and would increase regulatory tools.

The either exception item deals with the state supported living centers. This one asks for approximately 112 million over the biennium to finance repairs and renovations, to finance a replacement plan for vehicles, and to reclassify some positions.


The Texas Department of Assistive and Rehabilitative Services (DARS) has released their Legislative Appropriations Request (LAR). The full document can be found here: . This document represents the agency’s budget request for fiscal years 2016 and 2017 (taken together these are a biennium). This is the first step in the budget process, where the agency identifies what it needs and what special requests that it has. This will be matched in the beginning of the Legislative session in the spring of 2015 with a document by the Legislative Budget Board, which will be their view of what the agency needs. The agency will then spend the spring testifying before the Texas Legislature to secure its appropriations.

This is an extremely important document because there may very well be more significant changes on the horizon for the Early Childhood Intervention (ECI) program. Reading through the document, DARS tells us that in fiscal year (FY) 2013, ECI served approximately 25,000 children per month. In their LAR, they are projecting to serve a little over 22,800 by FY2017. This represents an almost 9 percent decrease. During this time, the average monthly number of hours of service per child per month is projected to increase from 2.61 hours/month to 2.93.

In their LAR, DARS is projecting that ECI will essentially maintain its budget in FY 2016, but will see a reduction of more than 15% during FY2017. In other words, in their baseline budget request DARS is telling us that they are projecting a decrease in funding and are projecting that they will need to serve fewer Texans between the ages of birth and three years old.

As a result of this, DARS is making two special requests for funding in their LAR on behalf of the ECI program. The first is a request of over $25,000,000 over the biennium just to maintain the projected FY2015 case levels. From page 189 of the LAR: “Federal IDEA Part C funding available to fund the ECI system in Texas has remained flat in recent history. However, ECI program costs associated with federal
requirements and not reimbursed by Medicaid has resulted in the agency using more federal IDEA Part C funding for allowable program expenses than projected. As DARS uses more IDEA Part C funding in fiscal years 2014-2016 to support ECI program costs, the result is less IDEA Part C funding available to maintain base funding levels and serve eligible children in fiscal year 2017. Funding for this exceptional item is to maintain the number of children served in fiscal year 2016 in fiscal year 2017 in the ECI

What does this mean? It means that Texas has consistently underfunded the ECI program, relying on a finite amount of Federal funding instead. That funding is running out, creating a shortfall. If that shortfall is not covered, Texas will have to provide ECI services to fewer children.

The second special request is an additional $25,000,000 over the biennium to increase monthly caseload to over 30,000 by FY2017. DARS is projecting that even with their more stringent eligibility criteria the number of young Texans who qualify for ECI is going to increase pretty dramatically by FY17.

My take on the bottom line, DARS needs an almost fifty million additional dollars over the biennium to continue to offer services to young Texans who qualify under the current eligibility criteria. If they can’t get that through the Legislature, there will be another difficult round of system changes that involve a combination of more stringent eligibility criteria (so fewer children are being served) combined with more family cost share.

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:



John M. Cissik