1. Health and Human Services Commission
Sonja Gaines
Deputy Executive Commissioner, Intellectual and Developmental Disability and Behavioral Health Services

2. Latest Org chart

3. IDD-BH 2019 Exceptional Items
Requested Funds
Awarded for Biennium
Percentage Awarded for Biennium
Enhance Mental Health Capacity
59,055,770
100%
Mental Health Grants
22,725,000
Residential Treatment Center Beds
2,739,695
2,535,474
92%
Community Inpatient Psychiatric Beds
39,410,480
25,973,849
66%
Substance Use Disorder Treatment
45,756,175
28,634,844
63%
IDD Outpatient Crisis
11,937,104
3,000,000
25%
IDD - ECC & TST
13,995,710
3,400,000
24%
IDD Crisis Intervention & Respite
20,515,152
4,000,000
19%
Enhance Real-Time BH Data Sharing
435,265
Enhance Procurement and Contract Management Functions
5,673,124
1,873,904
33%
Grand Total
216,135,086
149,180,770
 68%
Enhanced Mental Health Capacity: for community-based mental health outpatient services
Mental Health Grants: to maintain funding for HB 13 and SB 292
RTC Beds: for all 10 requested beds, but not the requested 1 FTE
Community Inpatient Beds: for 50 beds and 2.7 FTEs (requested 75 beds and 4.1 FTEs)
SUD Treatment: $5 M for overall rate increases and $23.6 M for women/children and pregnant women waitlists. Separate SUD rider to study rates.
IT project to enhance data sharing between local authorities and TLETS fully funded at $435,265.

4. Other HSC Exceptional Items
State Hospitals and SSLCs
Exceptional Item
Percentage Awarded for Biennium
Requested Funds
Awarded for Biennium
Prevent loss of services
90%
46,762,600
42,337,600
Expand capacity at SASH and KSH
100%
15,514,375
Salary Increases for Facility Staff
50%
38,951,436
19,461,844
Enhancing Services Through Technology
39%
31,115,880
12,028,000
Addressing Major Building, Fleet, Equipment Failures
84%
279,128,215
234,903,815
Hospitals were fully funded to address their declining revenue and cost growth.
Hospitals were fully funded for the operations of new beds at SASH and Kerrville, so we expect to have another 110 beds online by the end of the biennium (70 MSU).
 HSCS Received the Following to start new construction:
$90,054,363 for construction of a 100-bed non-maximum security unit at Rusk State Hospital;
$165,000,000 to begin construction of a 240-bed replacement campus of Austin State Hospital; and
$190,300,000 to begin construction of a 300-bed replacement campus of San Antonio State Hospital.
HHSC requested 4,639 slots ($117.8m GR) for waiver interest list reduction and received funding for 1,628 waiver slots ($24.8m GR).
Note: No funding for Promoting Independence slots in HCS, but language was added to the rider to provide legislative intent around PI activities and authorizes HHSC to allocate HCS funding provided for IL reduction toward PI if needed.
IDD Interest List Slots
Program
Requested
Received
CLASS
719
240
DBMD 8
HCS
2,375
1,320
MDCP
235 60
STAR+PLUS HCBS
397
TxHmL
905
TOTAL
4,639
1,628

5. Mental Health Block Grant Expansion
BRIDGING GAPS:
Service Coordination:
Expand Coordinated Specialty Care Program from 10 LMHA/LBHAs to 23: $3.8 M per year.
Community Outreach:
Expand Recovery-Focused Clubhouses through a competitive procurement in FY 2020: $1.2 M per year. Expand the International Center for Clubhouse Development (ICCD) Model, including community outreach and supports, aimed at increasing Recovery, Independence, Education, Employment..
Increase funding for the seven Consumer Operated Services Programs: $600 K per year Increasing Peer Support, Skills Training, Advocacy, Community Outreach, and Service Coordination
Housing Assistance:
Expand Supportive Housing Rental funds to an additional 16 LMHA/LBHAs in FY 2020: $1.5 M per year. Expand housing options for individuals with mental illness an co-occurring disorders at risk of homelessness, providing case management, psychosocial rehab, and skills training, reducing homelessness, crisis service utilization, and hospitalizations.
INCREASING WORKFORCE KNOWLEDGE
Suicide Prevention: Suicide Care Initiative: $2 M per year Work to implement the Zero Suicide Framework, establish Regional Suicide Care Support Centers, and increase the ability to respond to calls to the National Suicide Prevention Lifeline from Texas residents
Mental Health Interventions: $2.4 M per year. Mental Health First Aid (MHFA) Outreach Worker Development Program: Expand the number of persons trained in MHFA and increase the number of certified trainers of MHFA.
Behavioral Health Awareness Online Training: $500 K per year. Education for lay persons who may encounter individuals living with mental health or substance use disorders to help them recognize issues and develop confidence in knowing how to find help for vulnerable persons
MentalHealthTX.org Website: $1 M per year. Improve the website and market it extensively to make it a “one-stop shop” for behavioral health-related services from state agencies, local governments, service providers, and community organizations.
Development
Initiation
Execution
Monitoring
Evaluation
Clubhouses
Consumer Operated Service Providers
Coordinated Specialty Care
Supported Housing Rental Assistance Program
Mental Health First Aid Outreach Workers
MentalHealthTX.org web site
Behavioral Health Awareness Online Training
Suicide Care Initiative

6. Statewide Behavioral Health Coordinating Council
OFFICE OF MH Coordination: MHFA-trained over 50,000 school, state gov and university employees, MH Advisory, CRCGS, Vet matching grant program, System of Care
highlights the statewide BH coordinating council representing 23 state agencies that receive $2.1 billion annually in BH funding
Legislative direction during the 84th session, in July 2016 publish the first Statewide BH Strategic Plan in input from close to 1000 stakeholders-Gained National attention, it is foundational in unify state agencies as well as minimizing duplication and maximizing resources-The plan has been a game changer!
5 major goal areas: Coordination, Service Delivery, Prevention and Intervention, Financial Alignment and statewide data collaboration
Impact: Matching Grant Programs, Exceptional Item vetting, Coordinated disaster response, joint agency conf, coordinated response to Gov school safety plan
Because of the incredible success, the Coordinating Council plan has published an update to BH plan and introduction of IDD foundational info with input from more than 3000 stakeholders
The plan can be found at Mentalhealthtx.org
State government agencies work together to address behavioral health issues across Texas
Health and Human Services Commission
Department of State Health Services
Office of the Governor
Texas Education Agency
Texas Veterans Commission
Texas Tech University System
Department of Family and Protective Services
Texas Commission on Jail Standards
Texas Military Department
Texas Workforce Commission
University of Texas, Health Science Center at Houston
Texas Department of Housing and Community Affairs
University of Texas, Health Science Center at Tyler
Texas Indigent Defense Commission
Texas Civil Commitment Office
Court of Criminal Appeals
Texas Department of Criminal Justice
Texas Juvenile Justice Department
Health Professions Council (six member agencies)

7. Texas Behavioral Health Unified and Strategic Approach

8. HHSC Mental Health Services
Continuum of Care
Agency-wide initiative involving IDD-Behavioral Health, State Hospitals, Medicaid, and Regulatory,
A priority to the Dr. Courtney Phillips, EC of HHSCS
Short-term initiatives related to the work
Pilot furlough project for HCBS-AMH
Revising TAC 448
Longer Term Projects
CMS 1115 Demonstration Projects for Severe Mental Illness/Serious Emotional Disturbance
Future Block Grant Funds
Step-Down facility to assist individuals with long term admissions transition to the community

9. Behavioral Health Matching Grant Programs
Implementation teams work collaboratively across initiatives.
Initiatives tie to BH Plan
Assure a strategic distribution of resources across the state
Avoid duplication of effort
Outcomes and reporting
Statewide Behavioral Health Strategic Plan
Texas Veterans + Family Alliance Grant
SB 55-84R
Mental Health Grant for Justice- Involved Individuals
SB R
Healthy Community Collaboratives Grant
SB R
Community Mental Health Grant
HB 13-85R
HB 13 + SB 292 Grant Program Dashboard
Urban Projects 49
Rural Projects 36
Urban + Rural 19
Early Grant Program Outcomes:
Almost $77 million in general revenue to nearly 100 organizations in over 230 counties
Over 3,700 individuals connected with ongoing treatment
Nearly 420 individuals in crisis diverted from hospitals
Over 135 individuals in crisis diverted from emergency rooms
Over 1,630 individuals diverted from coming into contact with the criminal justice system

10. Behavioral Health Matching Grant Report Card

11. (Shows everything we’re doing in rural counties, as lead in to goat video on next slide.)
Implementation of Senator Kolkhorst’s SB 633, Relating to an initiative to increase the capacity of local mental health authorities to provide access to mental health services in certain counties.

12. HCBS-AMH Service Growth
* Regions may be unavailable to participants because:
Only one of the necessary roles is contracted (Provider Agency or Recovery Management entity)
An entity’s contract has been executed, but they have not yet launched services
Available to participants
Number served since the program’s inception = 219 (as of April 2019)
Number served in FY 18 = 161
FY providers
Recovery Management 13 (private)
6 (LMHA)
Provider Agency 20 (private)
4 (LMHA)  
Contracts Executed / Current not available to participants*

13. HCBS-AMH Outcomes CLIENT SATISFACTION:
90.5% of participants happy with the Recovery Manager
90.5% of participants happy with their living arrangements
76.2% satisfied with the services received
81% satisfied with the frequency of services
“I’m not happy; I’m ecstatic.” Person reports the recovery manager “helped me enroll in a GED class.” The RM also helped him get supplies he needed for class.
I am “very happy with [provider agency] and I believe I would still be in a board home or the State Hospital were it not for them.”
“I wanted to rebuild a relationship with my children, and I have done that. I wanted to be clean and sober, and I have done that…and I can’t even imagine going back to that life…”

14. Coordinated Specialty Care
As evidenced by the success stories, housing support and intensive case management early in a person’s struggle with mental health can successfully assist that person to live an independent, productive life – including college graduation and professional employment
Average length of stay is 182 days
Fewer inpatient psychiatric services - 70% reduction
Fewer crisis service contacts – 50% reduction
Note: Statistics are based upon adults enrolled in the CSC programs. Data is for fiscal year 2017 and fiscal year 2018 for the 10 CSC implemented programs.
Success story example: 21-year-old male began with the program following multiple psychiatric crises and hospitalizations for delusions of grandeur, auditory hallucinations, dramatic mood swings, and erratic behavior. Since that time, he has developed insight into his symptoms, started taking medication regularly, and engaged in problem solving efforts with the treatment team. He is currently working a new job and enrolled at a local college.
Success story example: Male/30 years old: Entered the program homeless and sleeping in his car. Client lost custody of children and also lost his job because he was newly diagnosed with his mental illness and did not know how to manage the symptoms. CSC team assisted the client with 3 months of rental assistance and connected the client to a local furniture bank to get furniture for his apartment. Client received assistance to get a job. Client remained employed and took over all utilities and rent in the apartment. Case Manager assisted client with skills training to learn about his mental illness and symptoms associated with it. Client has been able to successfully stay employed and get custody of his children back. Client continues to stay engaged in services, meeting with CSC team weekly.
Fiscal Year
Unduplicated Target # of Clients
Unduplicated # of Clients Served
FY 15
120
149
FY 16
186
FY 17
360
382
FY 18
670
FY 19 To Date
544
Current CSC Sites
Bluebonnet
Burke
Center for Health Care Services
Emergence
Harris
Integral Care
Metrocare
Panhandle
Tarrant
Tropical
Expansion Sites 2019
LifePath Systems
West Texas Centers
Coastal Plains Center
Tri-County Behavioral Health
Denton County MHMR
Texana Community MHMR
Central Counties Services
Community Healthcore
Spindletop Center
Andrews Center
Border Region
Pecan Valley
Texoma Center
Bluebonnet (expanding)

15. Mental Health Waitlist

16. Mental Health Crisis Services
FY Clients Receiving Crisis Services
Within 180 days:
98.5% of those receiving MCOT services were NOT arrested
99% of those receiving other crisis services were NOT arrested
98.4% of those receiving MCOT services were NOT hospitalized
99.7% of those receiving other crisis services were NOT hospitalized

17. Mental Health First Aid
Numbers Trained

18. CCBHC System Impacts
Certified Community Behavioral Health Clinics (CCBHCs)
Federally Qualified Health Centers (FQHCs)
Inpatient Treatment/ Detox Providers
Schools
Medicaid & 1115 Waiver
HCBS-AMH & YES Waivers
Juvenile and Criminal Justice Agencies
Value-Based Payments
Veterans/ Housing/ Employment
Hospitals/EDs
Alignment of Outcome Measures
CCBHCs:
Work with multiple providers across the continuum of care and within the community (e.g. FQHCs, Inpatient/Detox, Schools, Veterans, Hospitals)
Are being used for Value-Based payments in BH care
Are aligning outcome measures across the system ( e.g. MCOs, Performance Contracts)

19. Texas Targeted Opioid Response Services
Safe Drug Disposal- safe drug disposal initiatives such as take back events, drop-boxes and disposal pouches. The goal is reducing the availability of unused medications that can lead to opioid misuse
Utilization of the Prescription Monitoring Program –increase prescriber enrollment and meaningful use of the Prescription Monitoring Program to ensure not only patient screening but identification of problematic opioid use and appropriate referral to treatment
Safe Prescribing –support of prescriber education through online training modules aimed at reducing opioid misuse through safe prescribing practices
Overdose Prevention –overdose prevention education, access to overdose reversal medication, and overdose reversal tracking tools with the goal of providing timely community response and reducing overdose death.
Office Based Opioid Treatment –Increase access to medication assisted treatment in the office setting by increasing the number of physicians providing medication assisted treatment, expanding opportunities for physicians to obtain DATA 2000 Waiver training, creating a professional peer mentoring network, and expanding the network of state-funded treatment providers.
Opioid Treatment Services–increase MAT capacity by expanding opioid treatment services at new and existing sites and enable them to treat both primary opioid use disorder along with co-morbid conditions such as hepatitis C, psychiatric, and wound care at a single site.
Peer Support –expand peer recovery support services throughout the state in a variety of settings and provide opportunities for enhanced training in medication assisted recovery for the peer support workforce.
Employment Services–job developer and supported employment services for individuals in medication assisted recovery from opioid use disorders.
Recovery Housing –resources to reduce discrimination and increase safe housing for individuals in medication assisted recovery from opioid use disorders
Reentry- peer support services for individuals at risk for opioid overdose being release from jail. These services include overdose prevention education and access to naloxone, peer recovery support coaching, and linkage to MAT.
Emergency Response –individuals at high risk for overdose and overdose survivors receive treatment induction, recovery support, community paramedicine support, overdose prevention services. In addition, select Mobile Crisis Outreach Teams will provide opioid crisis services.
Community Access –access to treatment, recovery support, overdose prevention, and linkage to care through OSAR services and 24/7 community drop-in sites.
Pre-Arrest Diversion-24/7 drop-in pre-arrest diversion services that include treatment induction, recovery support, overdose prevention, and linkage to care
STR YR 1- $27.4M in funding was focused on two main strategies-reducing unmet treatment need and reducing overdose death. Funding is also necessary for recovery support as it acts as a sustainability plan. Recovery support services assists individuals who require long term treatment in becoming stable and self-sufficient moving them out of state-funded treatment and into treatment funded by insurance or self-pay. As individuals in long term treatment no longer meet financial eligibility criteria, slots become available for indigent care and we are better poised to meet the demand for treatment with fixed funds.
STR YR 1&2 Treatment Outcomes-
increased proportion of people served in evidence based treatment for OUD from 16% to 35%.
Every $1 invested in addiction treatment yields a return of between $4 and $7 in reduced drug related crime, criminal justice costs, and theft alone. When savings related to health care are included, total savings can exceed costs by a ratio of 12:1 (NIDA,2007)
STR YR 1&2 Prevention Outcomes:
Over 41,421 doses of naloxone distributed.
684 Texans trained to reverse an overdose.
111 lives saved as a direct result in just 6 months (from May-October 2018 many more rescues likely go unreported)
Over 1,000 CDC safe prescribing guidelines disseminated
Over 16,000 Texans received information on how to prevent opioid misuse in just 4 months (May-Aug)
Nearly 7,500 medication disposal pouches disseminated in STR YR 2
785 pounds of RX medications returned to TTOR purchased drop boxes/sponsored RX take back events (44 lbs. confirmed as opioids)

20. Increase in Proportion of Individuals with OUD Receiving MAT
Only a small proportion of individuals diagnosed with OUD were getting the evidence based treatment for OUD which is MAT. While we don’t necessarily have an increase total numbers served reflected here (due to treatment contracts delay and data limitations), we do see that a larger proportion of individuals with OUD are getting the right kind of treatment for their diagnosis. This means our messaging about MAT is improved, our recovery support efforts have improved, our intervention efforts such as OSAR have improved in linkage to the right kind of treatment.
2016=pre TTOR
2017= Notice of STR Grant Award May 2017, in June 2017 eight new Office Based Opioid Treatment sites open and all opioid treatment providers receive a rate increase
2018 = Data is complete for FY18

21. SOR Supplemental Funds Interagency Collaboration Plan
Support evidence based primary prevention activities in schools
Expand EMS opioid response programs, EMS support, and data assessment
Expand prison treatment program to include MAT and recovery support
Integrate opioid response services into family planning programs
Support in-home opioid medication monitoring and wellness for older adults
Behavioral Health Coordinating Council & HHSC Partners
$6,000,000
$6,833,923
$1,339,184
$2,580,313
$2,354,945

22. MFP Projects
Through the Money Follows the Person (MFP) Demonstration funding, IDD Services was able to secure funding through August 31, 2019, for two services, Transition Support Teams and Enhanced Community Coordination. The Performance Contracts unit reviewed each LIDDAs allocations to see where funding adjustments needed to be made to ensure LIDDAs had the necessary resources to support these services. HHSC also submitted an Exceptional Item request to keep these programs operating.
Transition Support Teams provide support to individuals transitioning from institutional settings who may have significant medical, behavioral and/or psychiatric support needs. The support teams provide educational activities and materials, technical assistance, and consultative case reviews to aid community providers and LIDDAs to better assist individuals who need support. The top chart shows the number of activities conducted each quarter since fiscal year 2018.
Success Story: A Transition Support Team provided case consultation services to a 10-year old female whose records indicated she was diagnosed with Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder. There was also a suspicion that the girl may have been sexually abused. Referral for case consultation was made because the girl was regressing in completing her activities of daily living, made threats to harm others, and had attempted suicide. Crisis de-escalation techniques which previously appeared to help were no longer effective. After meeting with the girl, members of her treatment team, and her family caregiver, it was determined that the girl may have been misdiagnosed with autism. A contract consultant to the Transition Support Team felt that the girl actually has symptoms stemming in part from a traumatic brain injury which occurred in infancy and in part to trauma which occurred in the family unit. This information assisted in her treatment team getting a neurologist to agree to see the girl; the family caregiver was also able to access needed counseling services. Suggestions on accessing programs that assist persons with traumatic brain injuries were provided.
Enhanced Community Coordination (ECC) service coordinators provide intense monitoring and flexible support to individuals to support success in the community. The ECC service coordinator ensures individuals are linked to critical services, and receive person centered services for up to five years following a transition or diversion. The bottom chart indicates the number of individuals served for ECC.

23. MFP Projects
Through the Money Follows the Person (MFP) Demonstration funding, IDD Services was able to secure funding through August 31, 2019, for two services, Transition Support Teams and Enhanced Community Coordination. The Performance Contracts unit reviewed each LIDDAs allocations to see where funding adjustments needed to be made to ensure LIDDAs had the necessary resources to support these services. HHSC also submitted an Exceptional Item request to keep these programs operating.
Transition Support Teams provide support to individuals transitioning from institutional settings who may have significant medical, behavioral and/or psychiatric support needs. The support teams provide educational activities and materials, technical assistance, and consultative case reviews to aid community providers and LIDDAs to better assist individuals who need support. The top chart shows the number of activities conducted each quarter since fiscal year 2018.
Success Story: A Transition Support Team provided case consultation services to a 10-year old female whose records indicated she was diagnosed with Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder. There was also a suspicion that the girl may have been sexually abused. Referral for case consultation was made because the girl was regressing in completing her activities of daily living, made threats to harm others, and had attempted suicide. Crisis de-escalation techniques which previously appeared to help were no longer effective. After meeting with the girl, members of her treatment team, and her family caregiver, it was determined that the girl may have been misdiagnosed with autism. A contract consultant to the Transition Support Team felt that the girl actually has symptoms stemming in part from a traumatic brain injury which occurred in infancy and in part to trauma which occurred in the family unit. This information assisted in her treatment team getting a neurologist to agree to see the girl; the family caregiver was also able to access needed counseling services. Suggestions on accessing programs that assist persons with traumatic brain injuries were provided.
Enhanced Community Coordination (ECC) service coordinators provide intense monitoring and flexible support to individuals to support success in the community. The ECC service coordinator ensures individuals are linked to critical services, and receive person centered services for up to five years following a transition or diversion. The bottom chart indicates the number of individuals served for ECC.
78% of individuals referred to crisis respite services are reunified to their home and community settings following a crisis event

24. State Plan Amendment (SPA)
HHSC staff submitted a Medicaid state plan amendment to CMS to add a variety of services to the state plan for residents with IDD who are living in Texas Nursing Facilities. The first service to be implemented is Habilitation Coordination. Habilitation Coordination is a case management like service that assigns a coordinator to every resident of a nursing facility with IDD whose responsibility is to help individuals access and monitor the delivery of specialized services.
Phase One – Habilitation Coordination
Workgroup spent more than 1,500 hours to create program from the ground up.
Habilitation Coordination trainings will begin May 1, 2019 and continue through June 30, 2019 across the state to all local authority staff.
The Habilitation Coordination service is anticipated to become effective July 7, 2019.

25. State Plan Amendment (SPA)
The second phase of the state plan amendment adds 5 additional services to the Medicaid state plan for residents with IDD living in nursing facilities. These services are designed to support their habilitative needs during their medically necessary stay in a nursing facility. Adding these services to the state plan will allow the state of Texas to draw down a federal match for these services and no longer rely on state general revenue funding to support these services.
Phase Two – Additional Habilitative Services
The SPA workgroup is beginning to work on the second phase of the SPA relating to the additional habilitative specialized services.
Phase II of the implementation is projected to be finished in Spring, 2020.
The additional specialized services include:
Behavioral Support
Employment Assistance
Supported Employment
Day Habilitation
Independent Living Skills Training

26. Deputy Executive Commissioner
Hospital Avoidance: 99 percent hospital avoidance rate for individuals in ongoing outpatient services. Cost: $14-$45 day vs. $500-$700 for inpatient care.
MH Outpatient Waitlist: Over 90 percent decrease in mental health waitlists in 2018 – from 2,700 to fewer than 300 adults waiting.
Over 200,000 adults and more than 60,000 children served.
32% increase in Texans served and 22% decrease in unmet need.
Peer Services as a Medicaid Benefit: Effective Jan 1, 2019: Allows MH and SUD peer services to bill Medicaid.
Matching Grant Programs Address Unique Challenges:
HB 13 (85R), SB 292 (85R), SB 55 (84R) Matching Grants:
$97 million disbursed to nearly 100 organizations in over 230 counties.
Have served >100,000 Texans and >1800 Texans diverted from hospital, ER, or jails.
>600 Texans showed clinical improvement.
Opioid Response: Increased proportion of people served in evidence based treatment for Opioid Use Disorder from 16% to 35%.
Over 41,421 doses naloxone distributed.
684 Texans trained to reverse an overdose lives saved.
Mental Health First Aid (MHFA) Training: Since 2014, more than 50,000 employees of schools and state agencies have been trained in MHFA.
This past year alone, close to 20,000 were trained during 2018 in response to the Governor’s school safety plan.
MH Disaster Response Teams: Worked in collaboration with LMHA and Education Service Centers to provide Crisis Counseling Services to over 200,000 Texans in disaster affected areas.
Thank you
Sonja Gaines,
Deputy Executive Commissioner
(512)