80th Regular Session, Agency Submission
Texas Department of Assistive and Rehabilitative Services
Mission: To work in partnership with Texans with disabilities and families with children who have developmental delays to improve the quality of their lives and to enable their full participation in society.
DARS is pleased to present this request for legislative appropriations for the biennium beginning September 1, 2007. This plan was developed in compliance with the requirement to limit the agency baseline request for general revenue related funds to 90 percent of the sum of the amount expended in fiscal year 2006 and budgeted in fiscal year 2007. (Note: DARS' Early Childhood Intervention and Disability Determination Services programs are not included in the base for the purpose of this calculation.)
DARS came into existence on March 1, 2004, as part of the consolidation of the Health and Human Services Commission (HHSC) system, authorized in HB 2292, 78th Legislature. DARS administers programs previously provided by Texas Commission for the Blind, Rehabilitation Commission, Commission for the Deaf and Hard of Hearing, and the Interagency Council on Early Childhood Intervention. Programs administered by DARS:
The DARS Council was appointed by Governor Perry in August 2005 and assists the Commissioner in developing rules and policies for the agency. Four federally mandated advisory committees continue to provide additional input on policy in specific program areas.
The agency has approximately 3100 employees and a budget of approximately $500 million annually. From fiscal year 2004 to fiscal year 2007, DARS Full Time Equivalent (FTE) cap was reduced by more than 240 positions, most of which were administrative.
In an effort to better serve DARS consumers and align and standardize consumer purchasing processes in many of our programs, the agency is currently consolidating two consumer case management systems used to support the Vocational Rehabilitation program. The DARS Consumer Support System (DCSS) will be a single, web-based consumer case management solution that replaces the two case management applications used by legacy agencies. DARS expects that DCSS will support a service delivery system that is responsive, accessible, reliable, and focused on meeting Texans' needs, and that allows services to be provided in an integrated and transparent manner between and within DARS divisions.
On March 3, 2006, the agency held a public meeting during which stakeholders provided input on the development of this LAR. Written comments were also taken during the development process. The main items of interest for stakeholders included DARS requesting from the legislature enough general revenue dollars to draw down all available federal match dollars for both the Vocational Rehabilitation and Independent Living programs; putting forth an exceptional item for an increase for the Comprehensive Rehabilitation Services program; and, requesting enhanced funding for Centers for Independent Living to address the growing demand for their services.
Stakeholder input was closely considered during the development of the LAR, as were the following guidelines:
The Individuals with Disabilities Education Act (IDEA) was reauthorized by Congress in November 2004. The Office of Special Education Programs (OSEP) announced that draft regulations would be issued in late spring 2005 and that public hearings would be held in July 2005. Although these hearings were held, draft regulations for Part C have yet to be issued. When the regulations are issued, DARS will adjust its internal rules and procedures to comply with new IDEA requirements. Among the most critical issues awaiting federal regulatory guidance is the implementation of the IDEA language that mirrors the Child Abuse Prevention and Treatment Act (CAPTA) requirements regarding ECI services to children in Child Protective Services (CPS). Until regulations are released, it is difficult to know what OSEP will accept as meeting the implementation requirements.
The Social Security Administration (SSA) has made rule changes regarding the administrative review process for adjudicating initial disability claims, and public comments are currently under review. These rule changes, known as the Disability Service Improvement plan (DSI), will be implemented in the Boston Region and tested for a year. Afterwards, DSI will be rolled out by SSA regions. It is not expected to impact Texas for three to four years. Once implemented, DDS will establish a quick decision unit, and the reconsideration step in the appeals process will be eliminated. SSA will also periodically update the regulations pertaining to specific adult or child impairments that would be considered a basis for disability. Finally, SSA has proposed regulatory changes to the "vocational rules" to bring these regulations into compliance with changes in the SSA retirement age. The "vocational rules" are used in the disability evaluation process when considering a claimant's age, education and job skills to determine if they can perform other work. Since SSA has increased the retirement age from 65 to 66, rules related to age must be changed accordingly.
In an effort to expand and improve services, DRS has redesigned the Transition Program in response to federal oversight entities. This program is designed to assist students with general disabilities (excluding blindness) to successfully transition from school to work. DRS Vocational Rehabilitation Counselors (VRCs) provide consultative and technical assistance to public school personnel to assist in planning the move from school to work for students with disabilities.
Currently, DRS is reorganizing its service delivery staff to establish 100 full-time Transition Vocation Rehabilitation Counselors (TVRC). TVRCs work in the schools and community to effectively connect eligible students to work and adult services. The TVRCs' caseloads will only include students with disabilities.
This roll-out of the program underscores the DARS commitment to provide timely, comprehensive services that promote successful transition from school to work of students with disabilities.
Recognizing the opportunity to improve services for the deaf and hard of hearing population in Texas, DARS merged the Division for Rehabilitation Services and the Division for Deaf and Hard of Hearing Services. This merger organized deaf and hard of hearing experts in teams to focus on areas of greatest need, improved business processes, optimized organizational structure, enhanced outreach and strategies for obtaining consumer feedback and improved technology solutions and resources. This change allowed DARS, by using state funds to match the federal Vocational Rehabilitation grant, to increase resources for the deaf and hard of hearing by population $1.2 million (all funds). Other improvements include adding 4 regional specialists to the existing 11 for increased community outreach and education; and adding 7 hard of hearing specialists to assist with the unique needs of individuals who are hard or hearing, late deafened or oral deaf.
The SSA has introduced an electronic folder concept (dubbed e-dib), which changes the way initial and reconsideration claims are received by SSA and transmitted to DDS. Most case information, including medical evidence, will be stored electronically instead of in a paper format. In Texas, SSA began transitioning to the electronic format in September 2004 and completed the process in December 2005. Some states that have completed the electronic folder transition report that claims examiners were less productive during a "learning curve," mainly because of the increased time it takes to view medical records. Texas did not experience a loss in productivity while making the transition to the electronic format.
The Social Security Advisory Board (SSAB) is considering a recommendation to the President and Congress to change the standard definition of disability in the Social Security Act. Although no specific language has yet been proposed, it is possible that this change would make the definition more amenable to returning Social Security Disability Insurance/Supplemental Security Income consumers to the workplace by focusing on the person's ability to work rather than their inabilities. If enacted by Congress, this change would have a profound impact on the way disability cases are adjudicated. For DDS, this would mean that a new standard would be used to determine SSA disability cases. Currently, the SSAB is engaged in public hearings regarding this issue, and there is no specific timeline for submitting a proposed change to the definition.
As Congress reviews and renews the authorizing statutes of DARS programs, substantial changes could result. Changes in the Workforce Investment Act (WIA), within which is found the Rehabilitation Act, could have a major impact on services and consumers in the Vocational Rehabilitation and Independent Living programs. Currently, S 1021 and HR 27 are the Senate and House bills, respectively, that Congress is considering to reauthorize the Rehabilitation Act. As both bills are currently drafted, a portion of VR funds would be diverted to contribute to infrastructure funding for the workforce "one-stop system" which allows consumers to receive a variety of employment related services in one location. Both the House and Senate versions of the WIA reauthorization contain amendments to Title IV, the Rehabilitation Act, which would require states to provide details in their state plans regarding services to students transitioning from school to work. The Rehabilitation Act may be reauthorized in the current session of the 109th Congress but is more likely to be completed by the 110th Congress.
The federal Child Abuse, Prevention and Treatment Act (CAPTA) requires state child protective services agencies to refer all children under age three in open protective services cases to the state's Part C program, the DARS Division for Early Childhood Intervention Services (ECI). The Individuals with Disabilities Education Act (IDEA) also requires ECI to provide services to all eligible children, including those referred from child protective services. Neither federal statute included additional funding for the costs of the new requirements. CAPTA requirements will result in additional screenings, eligibility determinations, comprehensive services, and follow along services for the Early Childhood Intervention program and a need for increased funding.
Additionally, the Center for Medicare and Medicaid (CMS) has issued a deferral (delay in reimbursement) for 4th quarter FFY 2005 and 1st quarter FFY 2006, at about $1.7 million per quarter. This deferral represents the rate differential for developmental rehabilitation services. The HHSC Medicaid Office is taking the lead role in negotiations with CMS. This deferral is part of a larger issue nationally: administrative claiming. The HHSC Medicaid Office is hopeful this matter will be resolved by the end of the FY06-07 biennium.
The most significant trend impacting DDS continues to be the increase in the number of SSA disability claims expected due to population growth and the aging of the baby boomers. As the population grows, so does the total number of disability claims filed, and the U.S. Census Bureau estimates the Texas population growth is one of the highest in the country. Further, as aging baby boomers reach a more vulnerable stage in life, they will likely apply for disability benefits in increasing numbers.
DARS request includes supplemental information on exceptional items in addition to its basic appropriation request. These schedules seek to meet additional needs requiring state funding above the DARS level in the 2006/2007 biennium. They are as follows:
The rising cost of medical services and increased focus on the most-significantly disabled has contributed to increases in the DRS cost per case. Current federal law authorizes annual increases in federal vocational rehabilitation funding. While the state can earn approximately $3.70 in federal dollars for each state dollar appropriated, in order to effectively utilize additional funding, sufficient GR must be available to match. Adequate state funding for Vocational Rehabilitation will help Texas avoid a waiting list for payment of services and allow us to continue to serve all eligible disabled applicants. A waiting list would have to comply with federal requirements, which specify that people with the most significant disabilities receive VR services first and those with less significant disabilities are served if additional funding becomes available. Consumers with the most significant disabilities need more costly services and take longer to successfully rehabilitate and employ. For this reason, some targeted performance measures may not be achieved if a waiting list were implemented. In addition, if DARS is unable to match the full grant amount available, these funds may go to other states instead of being used to the full extent in Texas.
There is also a necessity to satisfy the maintenance of effort (MOE) requirement in the Vocational Rehabilitation (VR) program. This means Texas must provide at least the same level of non-federal funding in the current year as it did two years prior. Any shortfall will result in a dollar for dollar reduction in federal VR funds. This requirement is in addition to the match requirement.
Centers for Independent Living (CILs) are community based nonresidential organizations that provide services to people with disabilities. Currently there are 21 CILs in Texas and, at the request of advocacy groups, DARS is seeking additional funding to expand and strengthen this existing network. CILs provide services that include independent living skills training, individual and systems advocacy, peer counseling and information and referral. Practically, these services help people with disabilities locate housing, learn to use public transportation and para-transit services, access other community services, utilize relocation services and to overall achieve full community integration.
DARS is requesting funding for 2 new CILs and enough additional general revenue to bring each of the 21 existing CILS to a operating funding level of $250,000 annually, consistent with a study by conducted by Independent Living Research Utilization, (ILRU), in Houston, which found that it costs approximately $250,000 to establish a Center for Independent Living. Currently, there are 10 Texas CILs that are operating below the $250,000 level.
Finally, HHSC will be carrying an exceptional request in its LAR on behalf of DARS. This request will ask for enough general revenue to eliminate the Comprehensive Rehabilitation Services (CRS) and Independent Living Services (ILS) waiting lists during the biennium.
As the Texas population rises, so does the need for the Comprehensive Rehabilitation Services (CRS) program. Like other medical costs, rehabilitation costs are rising. Funds provided by the 80th Legislature to eliminate the CRS waiting list resulted in an increase in referrals to the program. Utilization of rehabilitation services increased as services began being provided in a timelier manner. This results in better outcomes but at a higher cost. While the funds provided by the 80th Legislature were used to eliminate the waiting list, the combination of increased referrals and higher than expected costs resulted in the establishment of a new CRS waiting list. The exceptional request will allow the CRS program to continue in the process of eliminating the waiting list.
The Texas population is growing, aging and living longer which creates growing needs for rehabilitation and increases the demand for IL services. In fact, the number of applicants to the ILS program is steadily increasing. Increasing costs of services also affects program resources. The costs of services, especially medical costs, are increasing significantly each year. Assistive technology, which enables consumers to live independently, is becoming more sophisticated in addressing more kinds of functional needs. Moreover, funding for the ILS program has not been equal to the demand which has resulted in a waiting list.
We look forward to presenting our Legislative Appropriations Request to members of the 80th Legislature.
Terrell I. Murphy