Self-Evaluation Report - Sunset Advisory Commission

464 Pages·2013·11.54 MB·English

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TABLE OF CONTENTS

Page

I. Agency Contact Information ............................................................................................... 1

II. Key Functions and Performance ......................................................................................... 3

III. History and Major Events.................................................................................................. 21

IV. Policymaking Structure ..................................................................................................... 27

V. Funding ............................................................................................................................. 53

VI. Organization ...................................................................................................................... 67

VII. Guide to Agency Programs

Health and Human Services System Support
Introduction .................................................................................................................. 81
Executive Commissioner and Chief Deputy Commissioner ......................................... 82
System Support Services .............................................................................................. 83
Financial Services .......................................................................................................... 86
Chief Counsel ................................................................................................................ 91
Internal Audit ................................................................................................................ 97
Procurement and Contracting Services ........................................................................ 98
Office of the Ombudsman ............................................................................................ 99
Information Technology ............................................................................................. 102

Office of Social Services
Introduction ................................................................................................................ 105
Supplemental Nutrition Assistance Program Client Benefits..................................... 108
Temporary Assistance for Needy Families Client Benefits ......................................... 119
Medicaid and Children’s Health Insurance Program (CHIP) Client Benefits .............. 128
Eligibility Operations .................................................................................................. 140
Community Access and Services ................................................................................ 157

Medicaid/CHIP Division
Introduction ................................................................................................................ 171
1115 Healthcare Waiver and Cost Containment........................................................ 178
Policy Development .................................................................................................... 186
Medicaid Health Information Technology ................................................................. 193
Vendor Drug Program ................................................................................................ 201
Program Operations and Contract Management Oversight ...................................... 213
Table of Contents i HHSC
Project Management .................................................................................................. 235
Operations Coordination ............................................................................................ 241
Medical Transportation Program ............................................................................... 247
Frew Coordination ...................................................................................................... 257

Health Policy and Clinical Services
Introduction ................................................................................................................ 267
Office for Program Coordination for Children and Youth ......................................... 270
Office of Acquired Brain Injury ................................................................................... 287
Informal Dispute Resolution....................................................................................... 295
Office of e-Health Coordination ................................................................................. 301
Office of the Medical Director .................................................................................... 308
Healthcare Quality Analytics, Research Coordination, and Support ......................... 313

Office of the Inspector General ..................................................................................... 319

Texas Office for the Prevention of Developmental Disabilities ................................... 335

Interagency Task Force for Children with Special Needs .............................................. 357

VIII. Statutory Authority and Recent Legislation .................................................................... 365

IX. Policy Issues

Health and Human Services System
Issue 1: Are there additional avenues to further integrate the HHS System? .............. 411
Issue 2: Should all Medicaid-related programs be administered by one department
within the HHS System? ................................................................................................. 413
Issue 3: Should programs supporting individuals with IDD be administered by one
department within the HHS System? ............................................................................. 416
Issue 4: Are there opportunities to address gaps in waiver coordination through the
HHS System? ................................................................................................................... 417
Issue 5: Should separate agencies have oversight of State Hospitals and State Supported
Living Centers?. ............................................................................................................... 419

Health and Human Services Commission
Issue 1: Should eligibility criteria for Medicaid Buy-In Denials based on mental illness be
revised? ........................................................................................................................... 423
Issue 2: Should managed care organizations assist with Medicaid eligibility maintenance
and continuity of care? ................................................................................................... 426
Issue 3: How can the provider enrollment process be strengthened? ......................... 428
Issue 4: Do gaps exist in managed care delivery and HHSC’s relationship with managed
care organizations? ......................................................................................................... 431
Issue 5: Should the State revise its approach to obtaining durable medical
Table of Contents ii HHSC
equipment? ..................................................................................................................... 433
Issue 6: Is the health information exchange providing beneficial outcomes? .............. 435
Issue 7: Does a more effective method exist to operate the Texas Women’s Health

Program? ........................................................................................................................ 437

X. Other Contacts ................................................................................................................ 439

XI. Additional Information ................................................................................................... 449
Complaint Data ............................................................................................................... 450
HUB Data ......................................................................................................................... 451
EEO Data ......................................................................................................................... 455

XII. Agency Comments .......................................................................................................... 459

Table of Contents iii HHSC
HEALTH AND HUMAN SERVICES COMMISSION
SELF-EVALUATION REPORT

I. AGENCY CONTACT INFORMATION

Health and Human Services Commission
Exhibit 1: Agency Contacts

Telephone &
Name Address E-mail Address
Fax Numbers

4900 N. Lamar 512/424-6502
Executive Kyle Janek, M.D. [email protected]
Blvd.
512/424-6587
Commissioner
Austin, TX
78751-2316
Brown-Heatly
Building

4900 N. Lamar 512/487-3395 [email protected]
HHS Sunset Kelly Garcia
Blvd.
512/424-6587
Liaison
Austin, TX
78751-2316
Brown-Heatly
Building

I. Agency Contact Information 1 HHSC
I. Agency Contact Information 2 HHSC
II. KEY FUNCTIONS AND PERFORMANCE
A. Provide an overview of your agency’s mission, objectives, and key functions.

Mission
The Texas Health and Human Services (HHS) System includes five entities: Health and Human
Services Commission (HHSC); Department of Aging and Disability Services (DADS); Department
of Assistive and Rehabilitative Services (DARS); Department of Family and Protective Services
(DFPS); and Department of State Health Services (DSHS). Together these agencies administer
more than 200 programs, ranging from Medicaid and Child Protective Services, to regulatory
and licensing functions. Their collective mission is to develop and administer an accessible,
effective, and efficient health and human services delivery system that is beneficial and
responsive to the people of Texas.

Within this structure, HHSC provides System oversight and administers programs, primarily
focused on Medicaid and the hildren’s Health Insurance Program (CHIP). As an agency,
HHS’s mission is to maintain and improve the Health and Human Services System in Texas, and
to administer its programs in accordance with the highest standards of customer service and
accountability for the effective use of funds.

Objectives
HHSC has a broad range of objectives and goals related to HHS System oversight and delivery of
Medicaid, HIP, and other programs, which are detailed in state and federal law/ The agency’s
main objectives include the following.
HHS Oversight and Policy. Improve the Health and Human Services System’s business
operations to maximize federal funds; improve efficiency in system operations; improve
accountability and coordination throughout the System; and ensure the timely and accurate
provision of eligibility determination services for all.
HHS Consolidated System Support Services. Improve System operations through the
coordination and consolidation of administrative services.
HHS Medicaid Support. Improve service quality by serving as the single state Medicaid
agency, coordinating Medicaid-related programs administered by other agencies and
determining program eligibility. Provide policy direction and management of the State’s
Medicaid program, maximizing use of federal dollars.
Medicaid Health Services. Administer programs that provide medically necessary health
care in the most appropriate, accessible, and cost-effective setting.
CHIP Services. Ensure health insurance coverage for eligible children in Texas.
Special Services for Children. !ddress the specific health and dental needs of Texas’
children before associated problems become chronic and irreversible.
II. Key Functions and Performance 3 HHSC
Assistance Services. Provide appropriate support services that address the employment,
financial, and nutritional needs of eligible individuals.
Other Support Services. Promote safety, self-sufficiency, and long-term independence for
those living with domestic violence or other adverse circumstances.
Inspector General. Improve health and human services programs and operations by
protecting them against fraud, waste, and abuse.

Key Functions
As the lead agency in the HHS System, HHSC serves a dual role − providing System oversight and
support, and developing policies, determining eligibility, and implementing health and human
services programs. To fulfill these two main objectives, the agency performs the following key
functions.

HHS System Oversight
Unified Policy Decisions. To ensure a cohesive approach in maximizing federal funds and
enhancing client focus across the HHS System, the Executive Commissioner adopts all formal
policies and rules. The Executive Commissioner also provides strategic guidance across the HHS
System as well as oversees the day-to-day agency operations within HHSC. Under the Executive
Commissioner’s direction, HHSC provides budget and fiscal policies, such as rate setting and
forecasting across the HHS System.

In addition, HHSC coordinates policies, initiatives, and services across the HHS System for child
and youth programs, acquired brain injury, and elimination of health disparities.

HHSC also coordinates compliance and reporting requirements including policy, program, legal
requests for information, and budget activities across HHSC and within the HHS System for
cross-agency issues such as the Frew v. Janek lawsuit regarding Medicaid for clients age 20 and
younger.

Streamlined Business Operations. To ensure consistency and accountability across the HHS
System, HHSC coordinates human resource policies, contract procurement and management,
ombudsman complaints monitoring, legal and IT services, and initiatives such as e-health
opportunities across the HHS System.

Consolidated Support Services. To maximize System efficiencies, HHSC provides facilities
management.

Eligibility Determination
Within the framework of state and federal regulations, HHSC determines eligibility for health
and human services programs, including children’s and adult Medicaid programs, Supplemental
Nutritional Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and
CHIP.
II. Key Functions and Performance 4 HHSC
In addition to these main functions, HHSC also collaborates with DADS on the Medicaid
Eligibility for Elderly and People with Disabilities program. In this program, HHSC determines
the financial eligibility and DADS determines the physical need.

Medicaid Service Delivery
HHSC is the single state agency for Medicaid in Texas. To ensure clients receive efficient and
cost-effective medically necessary services, HHSC implements the federal-state Medicaid
program. Largely administered through contracts with multiple managed care organizations,
HHSC oversees this process and other delivery systems, such as fee-for-service.

Specific functions unique to this program area include: developing client benefits policies and
ways to maximize federal funds; maintaining the Medicaid State Plan, rules, and
communications with the Centers for Medicare & Medicaid Services; and coordinating
Medicaid long-term care services with DADS.

HHSC also operates the Texas Medicaid Medical Transportation Program, which provides free
transportation or travel reimbursement to Medicaid clients for medical and dental
appointments.

Other Social Services
Community-based Support
HHSC provides targeted services that enable clients to become more self-sufficient, healthier,
and fiscally responsible. Through contracts with faith and community based organizations,
HHSC provides services such as emergency shelter and support to victims of domestic violence,
marriage and relationship education to eligible clients, and medical assistance and social
services to eligible refugees.

Emergency Assistance
HHS System agencies work through the HHS System Emergency Council to respond to the
demands of a particular emergency or disaster. Given the size of the state and the complexity
of health and human service delivery, especially in a disaster situation, coordination ensures a
prompt and effective response.

HHSC works with the Texas Division of Emergency Management and the federal government to
determine emergency eligibility for SNAP, TANF, and Medicaid benefits to qualified clients.
HHSC works with the agencies inside the HHS System, as well as outside partners, such as the
Red Cross and Salvation Army, to coordinate essential supplies. HHSC also provides long-term,
case management services to eligible recipients impacted by natural disasters and participates
in post-disaster recovery plans with the Texas Division of Emergency Management.

Detect and Deter Fraud, Waste, and Abuse
Created by the Legislature in 2003, the Office of Inspector General (OIG) protects the integrity
of health and human services programs in Texas, as well as the health and welfare of program
II. Key Functions and Performance 5 HHSC