JKC H.B. 2509 75(R)BILL ANALYSIS HUMAN SERVICES H.B. 2509 By: Hilderbran 3-31-97 Committee Report (Unamended) BACKGROUND Alzheimer's is a disease that destroys the brain, leaving the afflicted person incapable of mental or physical self-reliance. Currently, there are over 265,000 Texans with Alzheimer's disease. As the elderly population of Texas increases, the demands placed upon Texas' resources and its citizens due to Alzheimer's disease will drastically increase. It is expected that by the middle of the next century, the number of Texans with Alzheimer's will more than double. Estimates indicate that one out of every eight people over the age of 65 will be stricken with Alzheimer's, and that 50 percent of Texans over the age of 85 will be stricken with this illness. Currently, the Medicaid system provides nursing facility care for people who meet specified medical coverage and financial eligibility requirements. Additionally, the Community-Based Alternatives (CBA) program is a Medicaid waiver program which provides community care services to elderly or disabled individuals who wish to delay nursing home entry. These programs, however, do not adequately address the specific medical conditions, functional needs, and behavioral characteristics of most Alzheimer's patients. The continuum of need presented by the individual with Alzheimer's goes well beyond the medical model approach, which drives nursing facility care. Further, the alternative care provided under the CBA program does not meet the special needs of the Alzheimer's client, which often requires more complex and time consuming care than that required by a person without the disease. Therefore, Texas needs to develop specific methods for treating Alzheimer's patients. The existing system of providing long-term care to Alzheimer's patients costs both the patient and the State of Texas. For example, if an Alzheimer's patient cannot receive services in his or her home or community, institutionalization may be necessary in order to receive assistance. Therefore, taxpayers may be forced to finance $36,000 or more per year in nursing facility services (the average annual cost in a Texas nursing facility), which may be inappropriate for the individual's needs. Individualized, community-based services such as nursing care, attendant care, or respite care would allow an Alzheimer's patient to live more cost-effectively in a less restrictive environment. One method of intervention for Alzheimer's patients employs a case management system to coordinate an overall program of individualized services. Through case management, a human services professional attempts to arrange and monitor an optimum package of long-term care, including health and social services, which is most appropriate to the client's needs. A case manager and a client follow a series of problem-solving steps that include assessing the client's needs, developing an individualized plan of care, monitoring the services that are delivered, and reassessing the client's situation periodically and/or as the need arises. In addition to filling gaps in the delivery of care, a case management system seeks to provide clients with the full array of choices relating to their care, ultimately producing better outcomes. Another method of providing more appropriate services for individuals with Alzheimer's is to provide counseling, education, and support services for the care givers and family members of those suffering from Alzheimer's. Studies show that counseling, support, and education services can substantially delay the placement of individuals into nursing facilities, particularly during the middle stage of the illness, when placement is generally less appropriate. As the number of older Texans continues to grow, so will the number of Texans suffering from Alzheimer's disease. In order to address this situation, the state must develop a more comprehensive plan for the treatment of Texans diagnosed with Alzheimer's. PURPOSE The purpose of this bill is to develop and implement a pilot program for the treatment of individuals with Alzheimer's. This pilot program, developed by an advisory committee of interested parties, shall provide for the most appropriate services for Alzheimer's patients, as well their families and care givers. RULE MAKING AUTHORITY It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency or institution. SECTION BY SECTION ANALYSIS SECTION 1.Pilot Program for the Treatment of Alzheimer's Patients. Amends Subchapter B, Chapter 32 of the Health and Safety Code, by adding Sec. 32.0246. Sec. 32.0246. (a)Directs the Department of Human Services, in cooperation with state and federal agencies and with the advisory committee established in subsection (b), to develop and implement a pilot program for the treatment of individuals diagnosed with Alzheimer's. The pilot program must: (1) be operated in one rural county and one urban county contiguous with the rural county, (2) provide a continuum of care and comprehensive case management, address gaps in services, and address the special needs of Alzheimer's patients; and (3) develop and implement counseling, education, and support services for the care givers and family members of Alzheimer's patients. (b)Directs DHS to appoint an advisory committee to assist the department in developing and implementing the pilot program. The advisory committee must be comprised of the following: _4 representatives from Alzheimer's patient advocacy groups _1 representative from a higher education institution _1 clinician _1 representative from the Department on Aging _1 representative from the Department on Human Services _1 representative from the Texas Department of Mental Health and Mental Retardation (c)The pilot program may not make any individual eligible for medical assistance that is not otherwise eligible. (d)DHS may seek and accept gifts, grants, or donations in order to develop and implement the pilot program as long as no donor has a contested case pending before any agency participating in the pilot program. (e)DHS shall report to the legislature on the effectiveness of this program by January 15, 1999. SECTION 2.Emergency clause.