Presentation to Legislative Oversight Committee on HHS Transformation

1. Presentation to the Transition Legislative Oversight Committee on Transformation of theHealth and Human Services System Chris Traylor, Executive Commissioner January 25, 2016

2. Guiding Principles for HHS Transformation Transformation activities will produce a re-organized HHS system that: • Is easier to navigate for people seeking information, benefits, or services • Aligns with HHS’ mission, business and statutory responsibilities • Fostersgreater program integration • Creates clear lines of accountability within the organization • Develops performance metrics for all organizational areas

3. Guiding Principles for HHS Transformation Transformation will be conducted in a way that: • Does not diminish the array of programs and administrative supports for those programs • Invites internal and external stakeholder input • Keeps leadership, staff, and stakeholders informed • Promotes innovation while retaining institutional knowledge • Focuses on measurable outcomes

4. Major Provisions of HHS Transformation Legislation • Reorganizes the HHS System, consolidating client services, regulatory functions, and residential facility operations at HHSC • Focuses DSHS on public health functions and DFPS on protective services functions • Transfers vocational rehabilitation programs from DARS to the Texas Workforce Commission • Creates a Transition Legislative Oversight Committee (TLOC) to provide guidance to the Executive Commissioner on the HHS system reorganization • Requires the Executive Commissioner to develop and implement a transition plan and to assess the continuing need for DFPS and DSHS as standalone agencies • Creates a new HHS Executive Council to receive public input and advise the Executive Commissioner on agency operations

5. Major Transformation Milestones 2016

6. Major Transformation Milestones (continued) 2017

7. FY2016 Transformation Activities 09/01/2015 -Hazardous chemical reporting regulatory functions from DSHS to Texas Commission on Environmental Quality (TCEQ) -Eight DSHS regulatory programs deregulated -Women’s health programs transfer from DSHS to HHSC 10/01/2015 -Transformation, Policy & Performance division created at HHSC 11/01/2015 -Advisory committee structure evaluated and restructured 02/01/2016 -Four regulatory programs transferred from DSHS to Texas Medical Board -Prevention/Early Intervention programs transferred from HHSC to DFPS 07/01/2016 -Restructured women’s health programs operational at HHSC 09/01/2016 -Vocational rehabilitation programs move from DARS to TWC -Client services programs from DADS, DARS & DSHS to HHSC -Administrative support services considered for consolidation

8. FY2017-2019 Transformation Activities 09/01/2016 -New HHS System Executive Council established -Transition of seven regulatory programs from DSHS to Texas Department of Licensing and Regulation (TDLR) begins dependent on technology infrastructure being in place at TDLR 09/01/2017 -State Hospital operations from DSHS and State Supported Living Center operations from DADS transferred to HHSC -Regulatory programs from DSHS, DADS & DFPS to HHSC 09/01/2018 -Report on future recommendations for DSHS and DFPS continuation submitted to the Legislature 09/01/2019 -Six regulatory programs from DSHS to TDLR

9. Activities Completed • HHS Transformation Steering Committee established with representation from all HHS agencies/divisions (08/03/2015) • Cross-agency transition steering committee established to guide program transfers from DARS to TWC (08/10/2015) • Definitions of client services, regulatory functions, public health functions, functions related to state-operated facilities, and prevention and early intervention services drafted (08/14/2015) • Hazardous chemical reporting regulatory functions transferred from DSHS to TCEQ as required by HB942 (09/01/2015) • DSHS/TMB memorandum of understanding signed regarding transfer of four regulatory programs from DSHS to the Texas Medical Board (09/01/2015)

10. Activities Completed (continued) • Members of the Transition Legislative Oversight Committee (TLOC) appointed (09/18/2015) • Functional analyses of all HHS operational areas completed (10/01/2015) • Cross-functional teams appointed to plan and oversee transformation to the new organizational structure (11/01/2015) • Revised advisory committee structure published in the Texas Register (11/01/2015) • Initial high-level organizational charts for HHSC, DSHS and DFPS drafted (12/18/2015) • Eight regional stakeholder meetings completed across the state to obtain feedback on transformation of the HHS system (01/19/2016)

11. Implementation Challenges HHSC has identified certain challenges to implementation and will determine specific actions to ensure a successful transformation. These challenges include: • Completing the consolidation of all medical and social services programs into a new structure at HHSC by September 1, 2016 • Establishing revised program management structures to support all structural changes to be completed by September 1, 2016 • Transition of information technology systems • Mapping funding structures to align with program changes

12. Advisory Committee Changes • SB200 & SB277 remove authorization for 38 advisory committees from statute • 09/01/2015 Completed review and evaluation of all (133) HHS advisory committees • 09/28/2015 Stakeholder feedback on advisory committees solicited and received via all HHS agency websites • 10/26/2015 Stakeholder input and evaluation data reviewed and recommendations made to the Executive Commissioner on revised advisory committee structure • 10/30/2015 Executive Commissioner approved revised advisory committee structure and published in Texas Register • 07/01/2016 Rules promulgated for all new or revised advisory committees

13. Stakeholder Input Plans • A stakeholder input questionnaire was posted on all HHS agency websites on November 19, 2015 • Regional stakeholder meetings were conducted in eight locations across the state: • An employee input questionnaire was posted on all HHS agency websites on December 14, 2015 • Further input methods will be developed as plan implementation begins

14. Focus Areas For Stakeholder Input • What should be the highest priorities for structural changes in the HHS system? • How can communication & transparency in decision-making and operations be improved? • How can access to services be improved? • How can coordination of services be improved? • How can quality of services be improved? • Are there programs and services working well that should not be changed? • What risks and/or challenges are anticipated in making changes in the system?

15. HHS Staff Workgroups • Seven workgroups are focusing on the organizational structure for core functions of the health and human services system: • Eligibility and Enrollment • Direct Delivery & Contracted Services • Clinical Services & Quality Initiatives • Regulatory Services • State-operated Facilities • DSHS – Public Health • DFPS – Protective Services • Six workgroups are focusing on ways to structure and improve administrative support services for those core functions.

16. Themes from Stakeholder Input Themes from statewide stakeholder hearings and online survey responses: • Transparency and openness of the transformation process • Improving inter-program communication and coordination across the HHS system • Assuring a full array of services and supports are available to persons in all areas of the state • Improving and simplifying information about, eligibility for, and access to available services and supports across the state • Identifying and addressing gaps in mental health services and supports • Increasing focus on services and supports for aging Texans within the HHS organizational structure • Ensuring that regulatory programs are fair, appropriate and strong • Strengthening and improving the contracting process including contract enrollment, oversight and enforcement

17. Next Steps • Transfer $3.8 million FY2016 funds from DARS to TWC to fund vocational rehabilitation program transition efforts. • Incorporate feedback from stakeholder meetings, stakeholder surveys, employee surveys and the 01/25/2016 TLOC meeting into the draft transition plan to be submitted to the TLOC • Final approval of the transition plan by the Executive Commissioner by 05/01/2016 • Complete all organizational, funding and staffing transfers for medical and client services consolidations by 09/01/2016 • Complete transfer of all NorthSTAR behavioral health non-Medicaid services into two new service systems and Medicaid services into managed care in the Dallas area by 01/01/2017 • Begin regulatory program consolidation and state-operated facility consolidation at HHSC by 09/01/2016 and complete no later than 09/01/2017

18. Keys to Success • Organizational structure created by SB 200 and other relevant legislation give clear direction to prioritize client services across the HHS System • HHS System success will determined by agency leadership • Client services focus across programs and agencies • Administrative services and supports which works closely with programs