By Naishtat                                          H.C.R. No. 151

                             HOUSE CONCURRENT RESOLUTION

 1-1           WHEREAS, Serving Medicaid long-term care clients in the

 1-2     community has been shown to be a cost-effective alternative to

 1-3     institutional care, and many clients would strongly prefer to

 1-4     remain in their homes, if possible, rather than enter a nursing

 1-5     facility; and

 1-6           WHEREAS, In 1993, the Texas Department of Human Services

 1-7     (TDHS) applied for a federal waiver to provide community-based

 1-8     services to as many as 22,000 clients who would otherwise receive

 1-9     nursing home care; and

1-10           WHEREAS, Due to funding constraints, the 74th Legislature

1-11     appropriated enough to fund only 13,100 waiver slots for the past

1-12     biennium; and

1-13           WHEREAS, Currently, as many as 6,100 authorized slots remain

1-14     unused in the program while approximately 2,000 Texans have applied

1-15     for community-based services and have been placed on a waiting

1-16     list; as a result, these individuals must either become nursing

1-17     home residents even though they do not want to be, or choose to go

1-18     without care; and

1-19           WHEREAS, TDHS previously had unrestricted ability to fund

1-20     shortfalls in one program with surpluses in another by transferring

1-21     money among line items within its overall budget; however, the

1-22     agency's interpretation of current law prevents such transfers to

1-23     expand community-based services without explicit legislative

1-24     direction; and

 2-1           WHEREAS, The state must now submit a waiver amendment to the

 2-2     Health Care Financing Administration to reduce the number of waiver

 2-3     slots to correspond to the funding limitations in the

 2-4     appropriations bill; and

 2-5           WHEREAS, In its report to the 75th Legislature, the

 2-6     Comptroller of Public Accounts recommended that the Community Based

 2-7     Alternatives program be enhanced to serve as many Texans as

 2-8     possible, and the Texas Legislature is convinced that taking such

 2-9     action will greatly benefit individual Texans who need long-term

2-10     care and will prove to be a more cost-effective use of public

2-11     funds; now, therefore, be it

2-12           RESOLVED, That the 75th Legislature of the State of Texas

2-13     hereby direct the Texas Department of Human Services to fill as

2-14     many slots in the Community Based Alternatives program as there are

2-15     eligible clients; and, be it further

2-16           RESOLVED, That in implementing this directive, TDHS and HHSC,

2-17     as appropriate, take the following steps:

2-18           (1)  monitor expenditures by HHS agencies and to the extent

2-19     possible transfer funds not needed by HHS agencies to fill the

2-20     slots in the Community Based Alternatives program;

2-21           (2)  show in its budget outcome measures a level of certainty

2-22     that Community Based Alternatives clients are diverted from nursing

2-23     home care;

2-24           (3)  work with the Legislative Budget Board to develop the

2-25     outcome measures; and

2-26           (4)  adopt any further amendments to eligibility criteria

2-27     necessary to achieve the budget outcome measures; and, be it

 3-1     further

 3-2           RESOLVED, That TDHS, subject to the budget outcome measures

 3-3     and budget neutrality requirements mentioned above and with

 3-4     concurrence from the Health and Human Services Commission and the

 3-5     Legislative Budget Board, petition the Health Care Financing

 3-6     Administration for additional Community Based Alternatives waiver

 3-7     slots beyond the original 22,000 requested in the waiver

 3-8     application of 1993; and, be it further

 3-9           RESOLVED, That the secretary of state forward an official

3-10     copy of this resolution to the commissioner of human services of

3-11     the Texas Department of Human Services.