Strategic Fiscal Review
House Appropriations Subcommittee on Article II
October 6, 2014
Veronda L. Durden, Commissioner
Vision and Mission
DARS Vision
A Texas where people with disabilities and families with
children who have developmental delays enjoy the same
opportunities as other Texans to pursue independent and
productive lives
DARS 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
2
Mission and Responsibilities
DARS achieves its mission by
• Assisting Texans with disabilities to find or retain employment
• Serving children with developmental disabilities and delays,
Autism, and blindness to meet educational and developmental
goals
• Helping Texans with disabilities live independently
• Helping survivors of traumatic brain and spinal cord injuries to
regain functionality and independence
• Making disability determinations for Texans who apply for
Social Security benefits
DARS services are time limited and intended to eliminate or
reduce the need for ongoing supports from other public
benefits and services
3
DARS Overview
• DARS provided services to more than 560,000 Texans in fiscal
year 2013—of those, about 230,000 received direct services and
another 330,000 were social security disability claimants
• DARS employs more than 2,800 staff
• Approximately 90 percent of staff work with direct delivery programs,
serving consumers through 146 field offices
• At 12.4 percent, the agency has a lower turnover rate than the
statewide average of 17.6 percent
• Approximately 79 percent of DARS workforce has more than five
years of state service and 57 percent have more than ten years of
service
• Total funding for DARS for the 2014-15 biennium is $1.242
billion, of which 75 percent is federal—DARS receives most
federal funds through the U.S. Department of Education and the
Social Security Administration
4
Strategic Fiscal Review
• DARS is currently undergoing the Sunset review process
• As a result, only GR or GR-related funded programs were chosen for
Strategic Fiscal Review (SFR)
• DARS programs subject to SFR:
• Autism
• Blind Children’s Vocational Discovery and Development Program
• Blindness Education, Screening and Treatment
• Business Enterprises of Texas
• Business Enterprises of Texas – Trust Fund
• Comprehensive Rehabilitative Services
• Deaf and Hard of Hearing Services – Education and Training
• Deaf and Hard of Hearing Services – Interpreter Certification
• Early Childhood Intervention – Respite
5
Autism Program
• The Autism Program provides treatment services to children with autism through contracts with
community organizations in six areas of Texas – Dallas, Ft. Worth, Houston, Rosenberg, Austin,
and San Antonio. DARS will be expanding into El Paso and Corpus Christi in fiscal year 2015
• The goal of the program is to achieve improvements in cognitive and social functioning, with the
potential to positively impact a child’s developmental trajectory
• The Autism Program serves children who:
•
•
•
Are three through fifteen years of age
Have a diagnosis on the autism spectrum
Are Texas residents
• Services include applied behavioral analysis (ABA) and other positive behavior support strategies
in both individual or group settings
• Parent training is a requirement
• Based on pre- and post-testing, 48 to 62 percent of children exiting the program improved their
social communication, motor, behavior and adaptive skills
• Autism Program contractors bill private insurance, when available, and each family must
participate in the cost of services based on a sliding fee scale
• Autism Spectrum Disorder (ASD) is the fastest-growing serious developmental disability in the
United States and according to the Centers for Disease Control and Prevention, 1 in 68 children
may have ASD
6
Autism Program
History
• 2007: The Governor and the Legislative Budget Board directed the Health and
Human Services Commission to transfer $5 million to DARS to provide services,
such as applied behavior analysis, to children ages three to eight with autism
• 2008: DARS awarded contracts to four community-based organizations in
Dallas, Fort Worth, Houston and Rosenberg to begin services on March 13,
2008
• 2009: DARS awarded two additional contracts for services in Austin and San
Antonio
• 2014: DARS began to offer two distinct services – comprehensive and focused,
and performed a competitive procurement for two additional providers
Legal Citations
• Human Resources Code, Chapter 111, Sec. 111.051
• Human Resources Code, Chapter 117
• Government Code, Chapter 531, Sec. 531.0055
• TAC, Title 40, Part 2, Chapter 105
7
Autism Program
• In fiscal year 2014, DARS developed a plan to increase the number of
children served in the program. As part of the plan, DARS worked with
The University of Texas at Austin (UT) to:
• Research evidence-based treatment modalities
• Analyze outcome data for children in the Autism Program
• Make recommendations for changes to the Autism Program to serve more
children with autism while continuing to make a measurable improvement in
their behavior and development
• To supplement research done by UT, DARS:
• Held public hearings in El Paso, Dallas, and San Antonio in January 2014 to
obtain public input
• Obtained input from current Autism Program providers
• Performed internal research on treatment for autism, and attended numerous
research and professional conferences related to autism
8
Autism Program
• Based on the report from UT
(www.dars.state.tx.us/stakeholders/autism) and other stakeholder
input, DARS has modified the Autism Program for FY 2015 to offer
two distinct treatment services:
• Comprehensive ABA Services:
• Serve children ages three through five
• 16-20 treatment hours per week
• Maximum of 24 consecutive months
• Focused ABA Services:
•
•
•
•
Serve children ages three through 15
Maximum of 30 treatment hours per month
Maximum of 24 nonconsecutive months
Children may access services at various milestones of development
• DARS will pilot an innovative treatment program in fiscal year 2015
9
Autism Program
Estimated
Estimated
Budgeted
Budgeted
FY 2014-15
FY 2014-15
FY 2014
FY 2014
FY 2015
FY 2015
GR – R
All Funds
GR - R
All Funds
GR - R
All Funds
$ 4,487,800 $
4,487,800 $ 4,503,056 $
4,623,056 $
8,990,856 $
9,110,856
Performance Measures
Number of Children Receiving Comprehensive Autism Services
Number of Children Receiving Focused Autism Services
Average Monthly Cost Per Child Receiving Comprehensive
Services
Average Monthly Cost Per Child Receiving Focused Services
Other Measures
Average Length of Enrollment for Children Exiting Program
2013
199
2014
238
2015
181
124
$1,370
$1,571
$1,724
$591
15.2
months
16.4
months
1,034
1,122
Interest List
Number of Children on Contractor Interest List (end of year)
Funding Collected by Contractors
Insurance
$287,339 $267,230
Family Cost Share
$309,763 $285,948
10
Blind Children’s Vocational Discovery
and Development Program
• The Blind Children’s Vocational Discovery and Development Program
(BCVDDP) serves children birth through age 22 who have a severe vision
loss
• The goal of the program is to assist children with a severe vision loss to
maximize their potential in education and employment
• The BCVDDP:
• Provides tools, equipment, and training to help children develop the confidence
and competence needed to be an active part of their community
• Works closely with schools to monitor the child’s progress
• Provides training in food preparation, money management, recreational activities,
grooming, and other daily living activities
• Provides information and referral to families about other resources, including
vocational rehabilitation
• Approximately 77 percent of children exiting the program had a successful
closure and achieved the desired outcome of services
• It is estimated that there are more than 59,000 children under the age of 17
in Texas who are blind or have a visual impairment and that number is
expected to increase to more than 62,000 children by 2017
11
Blind Children’s Vocational Discovery
and Development Program
History
•
1943: Texas began operating a program to serve children who are blind and
visually impaired
• 1990: The program enrolls as a Medicaid Targeted Case Management provider
for Medicaid-eligible children who are blind and visually impaired
• 2004: Vision screening services, vision restoration services for temporary vision
impairments, and respite services for parents of severely disabled blind children
were eliminated to remain within available appropriation
Legal Citations
•
•
•
Human Resources Code, Chapter 91, Sec. 91.028
Human Resources Code, Chapter 117, Sec. 117.073
TAC Title 40, Part 2, Chapter 106, Subchapter I, §106.1401-106.1415
12
Blind Children’s Vocational Discovery
and Development Program
Estimated
Estimated
Budgeted
Budgeted
FY 2014-15
FY 2014-15
FY 2014
FY 2014
FY 2015
FY 2015
GR - R
All Funds
GR – R
All Funds
GR – R
All Funds
$
4,370,275 $
4,819,375 $
4,392,066 $
4,830,315 $
8,762,341 $
9,649,690
Performance Measures
Number of Children Receiving Blindness Services
Per Year
Average Monthly Cost per Child
Other Measures
Average Length of Service for Children Successfully
Completing Planned Services
2013
2014
2015
4,417
4,334
4,311
$107
$109
$109
5 Years,
4 Months
5 Years,
7 Months
13
Blindness Education, Screening and
Treatment Program
• The Blindness Education, Screening and Treatment (BEST) program provides vision
screening and eye medical treatment services to adult Texans
• The goal of the program is to help eligible Texans prevent blindness
• BEST services include:
• Non-diagnostic vision screening services
• Treatment services for persons with qualifying eye conditions who do not have insurance or
other resources to pay for services
• BEST vision screenings are provided at locations across the state and, if necessary,
individuals are referred to an eye care professional for further evaluation
• BEST treatment eligibility requirements:
•
•
•
•
Referral from physician or optometrist for eye medical treatment
Texas resident
A qualifying eye condition
Are not covered under an adequate health benefit plan
• The BEST program is funded with a voluntary $1 donation when Texans apply for and
renew their driver’s licenses or DPS-issued identification cards
14
Blindness Education, Screening and
Treatment Program
History
• 1997: The 75th Legislature establishes the BEST Program
• 2002: BEST eliminates education services to remain within available
appropriations
Legal Citations
• Human Resources Code, Chapter 91, Sec. 91.027
• Transportation Code § 521.421(j) and §521.422(b)
• TAC, Title 40, Part 2, Chapter 106, Subchapter J, §106.1601-106.1609
15
Blindness Education, Screening and
Treatment Program
Estimated
Estimated
Budgeted
Budgeted
FY 2014-15
FY 2014-15
FY 2014
FY 2014
FY 2015
FY 2015
GR - R
All Funds
GR – R
All Funds
GR - R
All Funds
$
455,789 $
455,789 $
400,743 $
400,743 $
856,532 $
856,532
Performance Measures
Number of Consumers Receiving Screenings and
Treatment Services
Average Cost of Individual Served by BEST
2013
2014
2015
4,434
3,215
3,035
$97
$142
$132
16
Business Enterprises of Texas
Program
• The Business Enterprises of Texas (BET) program trains and licenses persons who
are blind to operate vending and food service facilities on federal, state, and other
properties
• The goal of the BET program is to provide business opportunities to Texans who are
blind
• Eligible BET managers must:
• Be blind and referred by the DARS Vocational Rehabilitation program;
• Be 18 years old, a Texas resident and a U.S. citizen; and
• Complete all DARS and BET assessment and training requirements
• BET managers operate 120 facilities including:
•
•
•
•
Lackland Air Force Base (San Antonio)
Internal Revenue Service Snack Bar (Austin)
NASA Snack Bar (Houston)
Alfred Hughes Prison Vending (Gatesville)
• BET businesses employ more than 1,600 Texans, many with disabilities
• The program is operated under the authority of the federal Randolph-Sheppard Act
17
Business Enterprises of Texas
Trust Fund
• The BET Trust Fund is the method by which benefits are
provided to current BET managers
• Trust fund revenues are generated by the program from
commissions from vending machines in Texas located
exclusively on federal properties
• The annual fund disbursement is limited to revenues and interest
earned during the prior year
• There are currently 118 managers in the BET program
18
Business Enterprises of Texas
Program
History
• 1936: Federal Randolph-Sheppard Act passed
• 1936: The first BET facility in Texas opens and the State Commission for the
Blind is appointed the licensing agency
• 1979: The 66th Legislature authorizes BET facilities to operate on state properties
• 1999: BET Trust Fund created
Legal Citation
• Human Resources Code, Chapter 94
• TAC, Title 40, Part 2, Chapter 106, Subchapter N, §106.1901 -106.1935
19
Business Enterprises of Texas
Program
Business Enterprises of Texas
Estimated
Estimated
Budgeted
Budgeted
FY 2014-15
FY 2014-15
FY 2014
FY 2014
FY 2015
FY 2015
GR - R
All Funds
GR – R
All Funds
GR – R
All Funds
$
678,644 $
2,466,839 $
675,867 $
2,463,605 $
1,354,511 $
4,930,444
Business Enterprises of Texas – Trust Fund
Estimated
Estimated
Budgeted
Budgeted
FY 2014-15
FY 2014-15
FY 2014
FY 2014
FY 2015
FY 2015
GR - R
All Funds
GR – R
All Funds
GR – R
All Funds
$
404,212 $
404,212 $
404,212 $
404,212 $
808,424 $
808,424
Performance Measures
Number of Individuals Employed by BET Businesses
Average Earnings Per Business
2013
1,559
2014
1,560
2015
1,562
$102,008
$100,000
$99,000
20
Comprehensive Rehabilitation
Services Program
• The Comprehensive Rehabilitation Services (CRS) program provides services to
Texans who have sustained a traumatic brain injury (TBI), a traumatic spinal
cord injury (SCI), or both
• The goal of the program is to help Texans with a TBI or SCI to live
independently in their home and community
• CRS consumers must have a TBI or SCI, or both, and be:
•
•
•
•
At least 16 years old
A U.S. citizen and Texas resident for six months
Medically stable
Willing to participate in services
• The program focuses on three primary areas that affect both function and quality
of life:
• Mobility
• Self-care
• Communication skills
• In fiscal years 2013 and 2014, approximately 90 percent of consumers who
exited the program met their program goals and were living in a private
residence
21
Comprehensive Rehabilitation
Services Program
• CRS provides time-limited services through contracts with local providers and
include:
• In-patient Comprehensive Medical Rehabilitation - Medical experts provide consumers
with therapy, medical care, and other help
• Outpatient Services - Therapists help consumers increase their ability to perform daily
living activities through physical, occupational, speech, and/or cognitive rehabilitation
• Post-Acute Traumatic Brain Injury Services - These services help consumers deal with
forgetfulness or difficulties in solving problems and other mental or thought issues
related to their injury and are offered on a residential and non-residential basis
• The Comprehensive Rehabilitation Fund (CRF 107) provides approximately twothirds of the CRS appropriation in fiscal years 2014 and 2015 and is funded by a
percent of funds collected on surcharges on all misdemeanor and felony
convictions
• According to the Texas Brain Injury Alliance approximately
• 440,000 Texans live with a traumatic brain injury
• 144,000 Texans sustain a traumatic brain injury or spinal cord injury annually
• 5,700 Texans are permanently disabled by traumatic brain or spinal cord injuries
annually
22
Comprehensive Rehabilitation
Services Program
• In FY 2013, DARS initiated a CRS Redesign Project to perform a program
review and implement changes in CRS
• The CRS Redesign Project was broken into two phases
• Phase 1 of the project has been completed and included:
• Developing a predictive model for budgeting and planning purposes
• Identifying additional data needs and modifying systems to collect new data
• Developing weekly and monthly CRS reports to report encumbrance and
payment activity
• Developing a tracking and monitoring tool which incorporates and compares
projected revenues, encumbrances, and expenditures to actual revenues,
encumbrances and expenditures
• Developing a monthly budget review process for central office and regional
management
23
Comprehensive Rehabilitation
Services Program
• Phase II of the project began in May 2014 and includes:
•
•
•
•
Determining the core service array for post-acute brain injury (PABI) services
Developing a rate setting methodology for fiscal year 2016 based on research results
Procuring PABI contracts for FY 2016 using the new rate methodology
Developing a utilization review process – projected to be implemented for fiscal year
2017
• In Phase II, DARS is researching best practices for serving consumers who have
traumatic brain and/or spinal cord injuries to assess:
•
•
•
•
•
•
Program outcomes
Array of services to be offered
Customer base
Program priorities
CRS Program service delivery system
Rate setting methodology
• This research includes:
• The structure of similar programs in other states and best practice
• Recommendations for restructuring the CRS program in light of research findings
• Possible impacts of the Affordable Care Act
24
Comprehensive Rehabilitation
Services Program
History
• 1991: The 72nd Legislature established the comprehensive rehabilitation fund and
the Comprehensive Rehabilitation Services program begins serving persons with
traumatic brain injury
• 1997: The 75th Legislature established that the source of the comprehensive
rehabilitation fund would be surcharges on all misdemeanor and felony
convictions and established that the Comprehensive Rehabilitation Fund 107 will
receive 12.37 percent of funds collected
• 2003: The 78th Legislature increased the surcharge and the percent of the
collections that go into fund 107 was decreased to 5.3218 percent (revenue
neutral)
• 2011: The 82nd Legislature increased the percent of collections that go into fund
107 to 9.8218 percent generating additional revenue
Legal Citation
• Human Resources Code, Chapter 111, Sec. 111.052 and 111.060
• TAC, Part 2, Title 40, Chapter 107, Subchapter D
25
Comprehensive Rehabilitation
Services Program
Estimated
Estimated
Budgeted
Budgeted
FY 2014-15
FY 2014-15
FY 2014
FY 2014
FY 2015
FY 2015
GR - R
All Funds
GR – R
All Funds
GR – R
All Funds
$ 22,932,115 $
23,260,588 $ 26,570,894 $ 26,689,374 $
49,503,009 $
49,949,962
Performance Measures
Number of Consumers Served
Average Monthly Cost per Consumer Receiving
Services
Other Measures
Average Length of Service for Consumers Who Met
Their Goals and Were Discharged in Each Fiscal
Year
Number of Consumers Who Met Their Goals and
Who Were Living in a Private Residence at Closure
Number of Consumers Who Met Their Goals
Wait/Interest List
Number of Consumers on Waiting List as of 8/31/14
Number of Consumers on Interest List as of 8/31/14
2013
908
2014
938
2015
1,003
$3,740
$4,232
$4,228
10.8 Months
13.6 Months
430 (91%)
290 (91%)
471
371
0
203
26
Deaf and Hard of Hearing Services
Education Program
• The Deaf and Hard of Hearing Services Education Program trains
public/private entities about hearing loss, effective communication, and
accessibility
• The goal of the program is to promote access to services for people who are
deaf or hard of hearing in order that they remain independent in their homes
and communities
• The program provides:
• Education and training to persons who are deaf or hard of hearing, family
members, service providers, businesses, educators and others
• Demonstrations and training of assistive technology equipment
• Training to interpreters to improve their skills
• Interpreter services for state agencies by contracting with a network of local
interpreter agencies
• According to the US Census American Community Survey more than
990,000 Texans in fiscal year 2017 will be considered deaf or hard of
hearing
27
Deaf and Hard of Hearing Services
Education Program
• The Camp SIGN program is designed to provide an environment of
acceptance and encouragement for children who are deaf or hard of
hearing
• Parents of children in Camp SIGN must pay for travel expenses to the
camp and a fee based on a sliding scale
• Children attending Camp SIGN are typically from environments in which
they are the only person who is deaf or hard of hearing
• Camp SIGN activities include:
•
•
•
•
Archery
Swimming
Arts and crafts
Cross fit training
28
Deaf and Hard of Hearing Services
Education Program
History
• 1979: The 66th Legislature directed the Texas Commission for the Deaf and Hard
of Hearing to develop and implement a statewide program of advocacy and
education to ensure continuity of services to persons who are deaf, deaf-blind, or
hard of hearing
• 1982: Camp SIGN program began
• 1993: Program began contracting with state agencies to provide interpreter
services
Legal Citations
• Human Resource Code, Chapter 81, Sec. 81.006-007
• Human Resource Code, Chapter 81, Sec. 81.013
• Texas Government Code, Chapter 771, Sec. 771.001
29
Deaf and Hard of Hearing Services
Education Program
Estimated
Estimated
Budgeted
Budgeted
FY 2014-15
FY 2014-15
FY 2014
FY 2014
FY 2015
FY 2015
GR - R
All Funds
GR – R
All Funds
GR - R
All Funds
$
398,276 $
1,332,071 $
326,731 $
1,202,982 $
725,007 $
2,535,053
Performance Measures
Number of Consumers Educated and Interpreters
Trained
Average Cost per Consumer Educated or Interpreter
Trained
Other Measures
Number of Children Attending Camp SIGN
Total Amount of Collections from Fee Charged for
Trainings
2013
2014
2015
1,338
2,635
2,375
$296
$201
$202
60
62
$14,894
$18,251
30
Deaf and Hard of Hearing Services
Interpreter Certification Program
•
The DARS interpreter certification program, administrated by the Board for
Evaluation of Interpreters (BEI), tests and evaluates sign language and oral
interpreter candidates to determine their skill level and award certification
• Interpreter certification is not required to provide interpreter services for the deaf
• An advisory board for the BEI assists the agency in administering the program
• The goal of the BEI program is to:
• Improve the quality of interpreter services for Texans who are deaf, hard of
hearing or who are hearing
• Increase the number of qualified interpreters in Texas
• Encourage the assignment of appropriately qualified interpreters for the demands
of each interpreting assignment
• Provide a means of quality control over interpreter services provided in Texas
• Protect the interests of consumers of interpreter services in Texas
31
Deaf and Hard of Hearing Services
Interpreter Certification Program
• To be eligible to take the test to become certified, candidates must:
• Be 18 years of age or older
• Have a high school diploma or its equivalent
• Not have a criminal conviction that would qualify as grounds for denial, probation,
suspension, or revocation of a BEI certificate
• Have earned at least 30 credit hours from an accredited college or university,
with a cumulative grade point average of 2.0 or higher
• The BEI program maintains a registry of certified interpreters by skill level
and specialty
• The Americans with Disabilities Act requires that “qualified” interpreters are
utilized as a reasonable accommodation
32
Deaf and Hard of Hearing Services
Interpreter Certification Program
History
• 1979: The 66th Legislature established the Board of Evaluation of Interpreters
• 1999: The 76th Legislature authorized the development of a certification for
trilingual interpreters
• 2001: The 77th Legislature authorized a court interpreter certification program
• 2005: The 79th Legislature updated statutory language for court interpreters to
require only certified individuals to interpret in a legal setting
Legal Citations
• Human Resource Code, Chapter 81, Sec. 81.007
• Government Code, Chapter 57
33
Deaf and Hard of Hearing Services
Interpreter Certification Program
Estimated
Estimated
Budgeted
Budgeted
FY 2014-15
FY 2014-15
FY 2014
FY 2014
FY 2015
FY 2015
GR - R
All Funds
GR – R
All Funds
GR - R
All Funds
$
273,318 $
356,454 $
395,260 $
621,206 $
668,578 $
977,660
Performance Measures
Number of Interpreter Certificates Issued
Number of Individuals Tested
Average Cost per Interpreter Certificate Issued
2013
1,731
2014
1,749
2015
1,749
480
300
300
$137
$204
$355
1,563
1,557
138
138
$148,965
$161,900
Other Measures
Number of Certified Interpreters
Number of Certified Court Interpreters
Total Amount of Collections from Fees Charged for
the Interpreter Certification Program
34
Early Childhood Intervention
Respite Program
• Early Childhood Intervention (ECI) provides supports and services to
families with children birth to 36 months with developmental delays
or disabilities
• The goal of the ECI respite program is to provide a brief period of
rest and recovery from the demands of caring for an infant or toddler
with complex needs
• Respite services are defined in rule as the care of an ECI enrolled
child by a relative or substitute caregiver on a short-term or
intermittent basis to provide the child's parent with a break from
caring for his or her child and do not include the routine care of a
child for the purposes of allowing a parent to attend work or school
• ECI families are considered for respite services based on the
contractor’s prioritization processes and available funding
35
Early Childhood Intervention
Respite Program
History
• 1999: The 76th Legislature appropriated $1 million for the biennium for the
purpose of providing respite care for families
• 2001: Funding was reduced by $.2 million
Legal Citations
• Human Resources Code, Chapter 73, Sec. 73.005 and Sec. 73.008
• TAC Title 40, Part 2, Chapter 108, Subchapter K, §108.1108
36
Early Childhood Intervention
Respite Program
Estimated
Estimated
Budgeted
Budgeted
FY 2014-15
FY 2014-15
FY 2014
FY 2014
FY 2015
FY 2015
GR - R
All Funds
GR – R
All Funds
GR - R
All Funds
$
400,000 $
400,000 $
400,000 $
400,000 $
800,000 $
800,000
Performance Measures
Average Monthly Number of Children Receiving
Respite
2013
2014
2015
234
250
250
37