Interim Report to the st Texas Legislature House Select Committee on Services for Individuals Eligible for Intermediate Care Facility Services December 2008 HOUSE SELECT COMMITTEE ON SERVICES FOR INDIVIDUALS ELIGIBLE FOR INTERMEDIATE CARE FACILITY SERVICES TEXAS HOUSE OF REPRESENTATIVES INTERIM REPORT 2008 A REPORT TO THE HOUSE OF REPRESENTATIVES 81ST TEXAS LEGISLATURE LARRY PHILLIPS CHAIRMAN COMMITTEE CLERK DOISE MIERS POLICY ANALYSTS AMANDA BRANT COURTNEY REID Select Committee On Services for Individuals Eligible for Intermediate Care Facility Services December 11, 2008 Larry Phillips P.O. Box 2910 Chairman Austin, Texas 78768-2910 The Honorable Tom Craddick Speaker, Texas House of Representatives Members of the Texas House of Representatives Texas State Capitol, Rm. 2W.13 Austin, Texas 78701 Dear Mr. Speaker and Fellow Members: The Select Committee on Services for Individuals Eligible for Intermediate Care Facility Services of the Eightieth Legislature hereby submits its interim report including recommendations and drafted legislation for consideration by the Eighty-first Legislature. Respectfully submitted, _______________________ Larry Phillips, Chairman _______________________ ______________________ John Zerwas, Vice-Chairman Myra Crownover _______________________ ______________________ Susan King Armando Martinez _______________________ ______________________ Dora Olivo Joe Pickett _______________________ ______________________ Patrick Rose Vicki Truitt John Zerwas Vice-Chairman Members: Myra Crownover, Susan King, Armando Martinez, Dora Olivo, Joe Pickett, Patrick Rose, Vicki Truitt Table of Contents I. Introduction ............................................................................................... 1 II. Overview of Current System .................................................................. 1 The Department of Aging and Disability Services (DADS) ...................................2 Organizational Structure ..............................................................................2 Programs and Services under DADS Authority ..........................................3 The Department of Family and Protective Services (DFPS)...................................3 The Department of State Health Services (DSHS)..................................................3 The Department of Assistive and Rehabilitative Services (DARS) ........................4 The Health and Human Services Commission (HHSC)..........................................4 The Texas Education Agency (TEA).......................................................................4 Local Mental Retardation Authorities (MRA's) ......................................................4 Services provided by MRA's .......................................................................4 MRA Relationships with other Agencies ....................................................5 MRA Challenges and Issues ........................................................................5 MRA Catchment Areas................................................................................6 Private Providers......................................................................................................8 Types of Facilities........................................................................................8 III. Texas Population Eligible for ICF/MR Services................................. 8 Severity of Mental Retardation................................................................................8 Pervasive Developmental Disorders & Related Conditions ....................................9 Level of Need (LON).............................................................................................10 Medical Fragility....................................................................................................11 Dual Diagnosis.......................................................................................................11 Behavioral Management Needs .............................................................................12 IV. Services and Supports.......................................................................... 12 Non-Medicaid Services..........................................................................................12 Mental Retardation General Revenue Services .........................................12 In-Home Family Support for Persons with Mental Retardation................14 Medicaid Entitlement Services ..............................................................................14 Primary Home Care ...................................................................................15 Community Attendant Services .................................................................15 Comprehensive Care Program ...................................................................16 Early Childhood Intervention ....................................................................16 Intermediate Care Facilities for Person with Mental Retardation .............17 Waiver Services .....................................................................................................19 Community Based Alternatives .................................................................20 i Home and Community-Based Services .....................................................20 Community Living Assistance and Support Services................................21 Deaf Blind Multiple Disabilities................................................................22 Medically Dependent Children Program ...................................................22 Consolidated Waiver Program...................................................................23 Texas Home Living....................................................................................23 V. Residential Facilities .............................................................................. 24 Intermediate Care Facilities for Persons with Mental Retardation........................24 Group Homes through Home and Community-Based Services ............................27 Foster/Companion Care .........................................................................................28 State Mental Retardation Facilities........................................................................28 Admission Categories and Criteria ............................................................31 State Schools and Centers......................................................................................33 Abilene State School..................................................................................33 Austin State School....................................................................................34 Brenham State School................................................................................34 Corpus Christi State School.......................................................................34 Denton State School...................................................................................35 El Paso State Center...................................................................................35 Lubbock State School ................................................................................35 Lufkin State School....................................................................................36 Mexia State School ....................................................................................36 Richmond State School..............................................................................37 Rio Grande State Center ............................................................................37 San Angelo State School............................................................................37 San Antonio State School ..........................................................................38 VI. Quality Assurance ................................................................................ 39 Quality Assurance and Improvement Unit Projects...............................................39 Regulatory and Investigatory Responsibilities ......................................................40 VII. Legislative and Legal Background.................................................... 41 Legal Background..................................................................................................41 Lelsz vs. Kavanagh, 1974..........................................................................41 Olmstead vs. L.C., 1999.............................................................................42 Legislative Background .........................................................................................42 SB 700, 65th Legislature............................................................................42 ICF/MR Waiver Program Established, 1985.............................................43 SB 257, 70th Legislature............................................................................43 HB 2377, 74th Legislature.........................................................................43 SB 367, 77th Legislature............................................................................43 SB 368, 77th Legislature............................................................................43 Executive Order RP-13..............................................................................44 Rider 55, HB 1, 78th Legislature...............................................................44 HB 2292, 78th Legislature.........................................................................44