2/22/17 Texas Appropriations - Testimony About Community First Choice.

You may be aware already that HHSC plans to cut HCS & TxHL Community First Choice rates by 21% effective July 1. This before any discussion, stakeholder input or prior announcement.

Phil Haas, CEO, Beautiful Abilities a provider in Bryan, TX, provided this testimony to the Texas House Appropriations Committee.

My name is Phil Haas and I am the owner and director of a Home and Community based Service (HCS) provider, Beautiful Abilities located in Bryan, TX. As a provider, we offer both HCS and TxHL services to over 65 individuals with Intellectual and Developmental Disabilities (IDD) in the Brazos Valley. I have been serving persons with IDD for over 30 years and worked as a provider for over 25 of those years, managing or leading organizations doing this work across the state. It is more than a job or a career, it becomes a life passion because of the individuals and the families we are blessed to serve and support.

I also feel I need to underscore that as an owner, I am reminded every day and every check that we are also business owners with the same challenges (and often more) and contributions to your communities of any other small business in Texas. I have always appreciated that Texas prided itself in being pro business and a state that cares for Texans. We are a “business” dependent on government funding to meet the requirements, the challenges and needs of those we serve and those we employ to serve in almost every community in Texas.  Both as a provider of services and as a small business, we are being significantly threatened by several funding proposals in the current budget proposal, the most onerous and alarming being the proposed HHSC 21% cut of HCS/TXHL CFC rates effective July 1. We need you and HHSC to strongly reconsider and not cut these rates which will intimately mean cut wages and cut services.

Being realistic of your funding challenges and being fiscally conservative myself, I am not asking for rate increases at this time. I am asking that you not make any cuts given that we have absorbed so many before and ask that you consider funding the Attendant Rate Enhancement fully. I also ask that you fund at a minimum to maintain current HCS/TxHL caseloads, keeping a promise you make to the families and individuals, your constituents, when they receive these services. I also the same in finding funds to serve those on long waiting lists who desperately need those services.

Beautiful Abilities philosophy of care was created to be comprehensive and innovative in serving persons in a way that they are nurtured to use their abilities and be active in their communities.  We strive to always exceed state expectations and minimum requirements the current funding provides. This comes at an added cost, but because of who we serve it is a decision that makes sense and is effective, so we do it by carefully managing the funds across the programs.

The proposed CFC cut and having no funds proposed for rate enhancement combined will immediately affect our Direct Care staff with wage and benefit cuts if enacted as proposed. Currently to be competitive, reduce turnover and striving to move closer to compensate required skill competencies our direct support professions need to serve our individuals, at Beautiful Abilities, we currently pay our staff an average of $10/ hours up to $12/hr. With taxes and benefits included means we pay on average $13-15/hour. In CFC services we also must pay mileage reimbursement or provide vehicles. Several of our individuals need over 900 miles a month to access the community and their services in the community. The current HCS/TxHL rates provide us $8.50/hr. If you have ‘attendant care rate enhancement” it can provide about $8.75/hr. The rate cut means we would have close to or lower than minimum wage in the rate to work with and we would most likely have to adjust salaries to at least $9.00/hr and adjust our administrative oversight for those services to compensate. I anticipate at least 100% turnover within 3-6 months of the rate decrease. This will significantly affect our workforce, recruitment and equally important, those we serve. Our individuals need consistency in their daily lives and they need a skilled staff to remain safe, this rate cut will immediately undermine both.

HCS/TxHL  providers have to manage their funding comprehensively across all services because some are underfunded while others may provide the additional funds to make up the difference. That is how the” rate model” was originally designed to work, although rate cuts over10 years and piecemeal redesign of different parts of the program with added costly regulatory requirements has made that increasingly difficult.

One example is our day program, Integration Station, which is designed to place individuals safely and actively in the community instead of a room for 50-60% of their time during the day. Our program includes meaningful activities where they regularly volunteer in the community, participate in local gyms, participate in group recreational events, and go to community classes. Our participants are happy, exhibit less behaviors, are working to be healthier and are motivates to do more including being competitivelyemployed which we support. Day programs in HCS are currently funded at about $25/person/ day for 6 hours. At Integration Station, we spend over $40/person/day because that’s what it takes to have quality programs and to have them safely active in the community.  The difference comes from administrative fees from all services and from outside sources. This will be significantly affected by the 21% CFC rate cut.

In interest of time and respecting the need to manage priorities, I will stop at these points. I would be happy to discuss further any point. I appreciate your attention and willingness to serve us here. Once again, please do not authorize any rate cuts so we can continue to provide quality services to those with Intellectual & Developmental Disabilities and give us the funds needed to maintain a completive and competent workforce through rate enhancement.