Texas Department of Family and Protective Services
Advisory Council Meeting

June 8 , 2007,  10:00a.m.

The Texas Department of Family and Protective Services (DFPS) Advisory Council met in the Public Hearing Room at the Brown-Heatley Building, 4900 North Lamar Boulevard, Austin, Texas. Council Members present were Chair Ommy Strauch, Imogen Papadopoulos, Gigi Edwards Bryant, Richard Hoffman, Faith Johnson, Mamie Salazar-Harper, and Linda Bell Robinson. Also present were Commissioner Carey Cockerell and Department staff.

Agenda Item 1 – Call to Order

Call to order by Chair Ommy Strauch at 10:00 a.m.

Agenda Item 2 – Public Testimony

Nancy Holman, Executive Director of Texas Alliance of Child and Family Services, addressed the Council regarding bringing all child care providers up to the same level of reimbursement; she noted some rates are more repressed in reimbursement relative to actual costs than others.  Ms. Holman explained that due to the fiscal impacts resulting from the new licensing standards, her organization has modified its fiscal note, based on some feedback from the HHSC, and still comes up with a $37 million fiscal note over the biennium, which is a 4-percent rate increase.  Ms. Holman believes additional revenue is needed to correct two things:  (1) Addressing the cost of licensing standards and (2) changing the variances in reimbursements so all provider groups receive 100 percent reimbursement of actual cost.  Ms. Holman also discussed the unit rate reimbursement system currently in use and cautioned that one long-term implication will be in quantity of services, in other words, capacity.  She cited evidence that the unit rate reimbursement system over time has compressed both the system and costs because a provider cannot stay viable and continue operation if costs continue to outstrip reimbursement. Ms. Holman noted that this type of methodology, if not adjusted for new costs and inflation, will eventually have an impact on quantity and quality of care.  In closing, Ms. Holman stated that the new standards are an additional cost burden and, because providers are operating through a three-year lag, those standards will not be picked up in cost reports for three years. She suggested that new standards with possible substantial fiscal impact be allotted funding and that such new standards should be modeled into the rates before being implemented.

Monica Thyssen, Children’s Mental Health Policy Specialist with Advocacy, Inc., addressed the Council and reminded members that Advocacy, Inc. is the designated protection and advocacy organization for individuals with disabilities in the state of Texas.  Ms. Thyssen stated that while her group is supportive of both the rate increase and the psychiatric hospitalization step-down for children, there are concerns regarding implementation. She noted that Advocacy, Inc. will be monitoring implementation to ensure a true step-down process into something more of a foster care family-type setting, as opposed to residential treatment-type setting, and also that children are not involved in the process for undue periods of time.  Ms. Thyssen expressed concern that the current standards for child-placing agencies and residential treatment centers will change, and she said that the increases in the minimum standards have been good and provide adequate protections for children and that Advocacy, Inc. will not be supportive of any additional changes.

Connie Barker, Director of Government Affairs for DePelchin Children’s Center in Houston, opened her remarks by declaring her and her organization’s concurrence with Ms. Holman’s earlier comments; she also reminded the Council of the recommendation to HHSC to effect a rate adjustment to reflect the regulations adopted last year.  Ms. Barker requested that DFPS reiterate that recommendation and work towards that in preparation for the next legislative session.  Ms. Barker further noted that DePelchin subsidizes foster care $10 a day and, for 600 children, that equates to $6,000 a day; DePelchin subsidizes residential treatment at $125 a day.   Ms. Barker stated that one difficulty with the rate-setting methodology, particularly regarding residential treatment, is that the cost methodology conflates the rate and providers have to cut services due to the fact that they don’t have charitable sources; she opined that the reason children aren’t receiving placement may be that many residential treatment providers have been forced out of business.  Ms. Barker discussed the step-down rate and she noted that this population is very challenging.  She suggested the Commissioner be given the flexibility to determine the length of children’s eligibility.  Ms. Barker noted that because DePelchin employs a model of no restraint for these children unless another person could be harmed, property damage can also be quite costly and gave three examples at Depelchin. In closing, Ms. Barker remarked that because the children in many of these cases have really “been through the mill” and are quite unstable, 60 days is probably not adequate for step-down care, and she recommended more flexibility on a case-by-case basis.

3. Agency Briefings

3.a. Commissioner’s Report - Carey D. Cockerell

Commissioner Cockerell discussed the ongoing challenges DFPS is facing in securing placements for children and the increasingly frequent result of some of these children staying overnight in CPS offices supervised by CPS staff. He noted his concern over such activity and stated it is not DFPS’ choice and DFPS is working hard to prevent it.  The Commissioner reviewed some of the steps being taken to try to ameliorate this situation and noted his office receives daily reports regarding overnight stays so as to enable immediate action by staff. Staff meets every day to discuss every child in this situation, not only because of concern for the children, but also concern for CPS staff.  Commissioner Cockerell stated that his office is providing additional operational support and policies for assigned CPS staff in order to ensure safety and security, and they have a 24-hour turnaround on any requests to amend or increase a facility’s licensed capacity.  He noted that to date, three facilities’ capacities have been amended.  The Commissioner reported that regional meetings are being conducted with provider groups to hear concerns and request assistance and bed availability, and CPS policy related to service-level reviews and processes is being changed.  He also noted that during daily reviews of each child, if an increase to or waiver of the current rate or service level is deemed necessary, his office is expediting such matters in order to facilitate placement.  Commissioner Cockerell referred to the changes pertaining to the provider rate increase and noted that while these new rates were not originally intended to address our particular capacity problem, he’s hopeful they will relieve some of the difficulties. He stated that he and agency staff will continue on a daily basis to monitor overnight stays and give immediate assistance to regional staff as needed.

The Commissioner briefly highlighted two of the several key bills affecting the agency that were passed during the 80th Legislature:  The appropriations bill and Senate Bill 758, the CPS Reform II bill.  He stated SB 758 allows a pilot project in which DFPS would contract for case management services for 10 percent of CPS cases; the bill also directs DFPS to implement a plan for improving services for children and families and keeping them together, reduce the length of time children are in state care, improve the accountability and quality of foster care and reduce the rate of growth in foster care.  Commissioner Cockerell stated the legislature allocated $2.6 billion to DFPS for the biennium and noted that included in the funding are a 4.3-percent Foster Care rate increase, approximately 1,300 additional staff positions, $99 million for continued CPS reform, $4.6 million for prevention services to serve an additional 1,495 clients per month, and $11.1 million for the new post-psychiatric hospitalization step-down rate.  The Commissioner concluded by noting that the next few months will be spent developing plans to implement the 100-plus bills affecting DFPS that were passed by the legislature, and he expressed his belief that the additional resources and guidance from the legislature represent improved services for DFPS clients.

Agenda Item 4 – New Business

4.a. Recommendation to propose new rule changes in the Rate Setting Methodology for 24-hour Residential Child-Care Reimbursements.*- Carolyn Pratt, HHSC

Carolyn Pratt, HHSC Director of Rate Analysis, presented the rule changes and noted that the current rules expire August 31, 2007 and the new rules propose a new methodology for provider rates and psychiatric step-down services which DFPS is to begin providing September 1, 2007.  Ms. Pratt informed the Council that DFPS does not currently have a step-down program and the rules provide that rates be established according to a model based on similar programs’ guidelines, staffing requirements and costs; she noted that the rules also revise the reimbursement methodology employed by DFPS to pay Foster Care.  Ms. Pratt discussed the rule proposal and said it reflects language from Rider 33, Article 2, of the Appropriations Act for the DFPS, regarding rates, and said foster families are ensured a 4.3-percent rate increase effective September 1, 2007; Rider 33 also includes a provision to proportionately distribute the remaining appropriation funds to emergency shelters, residential treatment facilities and child-placement agencies, based on these groups’ most recent audited cost reports and how far off those audited costs are from the rates.  Ms. Pratt noted that, by definition, each of those three groups of providers will not receive the same rate increase and that emergency shelters and residential treatment facilities would see rate increases above the 4.3 percent, but child-placing agencies, if using a strict interpretation of the rule, would see rates below 4.3 percent.  Ms. Pratt stated her office has met with Commissioner Hawkins and DFPS and they are researching ways to ensure that child-placing agencies would receive a minimum 4.3-percent rate and that increases above 4.3 percent be provided to emergency shelters and residential treatment facilities, as costs for those facilities are outpacing the average effect of an across-the-board 4.3 percent increase.  In summary, Ms. Pratt indicated her group will soon be proposing rates that reflect differentiation in rate increases and a minimum of 4.3 percent for the child placing agencies and greater amounts for emergency shelters and residential treatment facilities.

Ms. Pratt stated that all interested parties have been provided the proposed changes and announced a rate hearing set for July 17 at 1:30 p.m., which is likely to be at the HHSC north offices. She will report back to the Council regarding feedback from the rate hearing, as well as proposed final rates, during the Council’s July 19, 2007 work session.    In closing, Ms. Pratt recommended the Council approve the proposed rules so they can be published for public comment in the Texas Register.  After a brief question-and-answer session, Ms. Robinson moved recommendation for proposal by the HHSC of the amended rule changes, and Ms. Salazar-Harper seconded the motion.  There was no further discussion, and the motion was passed.

4.b. Recommendation to propose new rules in 40 TAC, Chapter 700, Subchapter W, Level-of-Care Service System (Intensive Psychiatric Transition Program).* - Joyce James

Joyce James, Assistant Commissioner for Child Protective Services, presented the proposed changes and noted that the legislature approved an exceptional item to the DFPS legislative appropriation request of $11 million. This funding is to provide children in DFPS conservatorship who have experienced more than three psychiatric hospitalizations more intense levels of supervision and therapeutic interventions in order to help stabilize their emotional conditions and, therefore, their placements.  She discussed the minimum eligibility requirements for these funds, and stated the proposed length of eligibility is up to 60 days. There will be an ability to obtain a waiver for an additional 60 days with approval of the CPS Assistant Commissioner. Ms. James stated the most recent data demonstrates 344 children currently qualify for this program.  She provided information regarding the fiscal note for the first five years:  In 2008, approximately $3.8 million; in 2009, slightly above $4 million; in 2010, $4-1/2 million; in 2011, $4.8 million, and; in 2012, in excess of $5 million.  Ms. James reported that an emergency procurement, to be effective September 1, 2007, is near completion and her group will research the benefits and needed services to implement this program effectively; an RFI and an RFP will be issued this fall.  Ms. James concluded her remarks by requesting that the Council recommend to Executive Commissioner Hawkins and Commissioner Cockerell publication of the proposed rule changes in the Texas Register for formal public comment.  After questions and brief discussion, Ms. Bryant moved that the Council recommend proposal by the HHSC of the rule changes, and Mr. Hoffman seconded.  No further discussion ensued, and the motion carried.

5. Adjourn*

Chair Ommy Strauch adjourned the meeting at 11:45 a.m.

*Denotes Action Item