[1. Welcome and opening remarks] [00:00:15] THE MEETING WILL COME TO ORDER. MADE THE RECORD REFLECT THIS MEETING OF THE HHS THE EXECUTIVE COUNCIL CONVENED AT 10:05 A.M. ON NOVEMBER 20. NOW CALL THE ROLL. >> GOOD MORNING. ADVISORY COMMITTEE COORDINATION OFFICE. MEMBERS , AS I CALL YOUR NAME, PLEASE REPLY WITH HERE OR PRESENT. -- CHIEF DIXON, IF YOU'RE ABLE, PLEASE TURN ON YOUR MICROPHONE AND CAMERA TO ACKNOWLEDGE HER PRESENCE. -- YOUR PRESENCE. ROLL CALL ] I WOULD LIKE TO ACKNOWLEDGE THAT SUSAN PYLES, PRINCIPAL DEPUTY INSPECTOR GENERAL, IS PRESENT ON BEHALF OF AN INSPECTOR GENERAL RAYMOND WINTER. AND RICKY GARCIA, DEPUTY EXECUTIVE COMMISSIONER POLICY AND QUALITY IS ATTENDING ON BEHALF OF CHIEF EMILY. EXECUTIVE COMMISSIONER YOUNG, THIS CONCLUDES THE ROLL CALL. >> WILL EXPLAIN THE PROCESS FOR USING THE MICROSOFT TEAMS PLATFORM FOR THIS MEETING. >> GOOD MORNING. WITH THE ADVISORY COMMITTEE COORDINATION OFFICE. THIS MEETING IS BEING CONDUCTED IN COMPLIANCE WITH THE TEXAS OPEN MEETING ACT AND IS OPEN TO THE PUBLIC. TODAY'S MEETING IS BEING HELD AS A MICROSOFT TEAMS MEETING , AS WELL AS IN PERSON. THIS MEETING IS BEING WEBCAST LIVE IN IS BEING RECORDED AS A MATTER OF PUBLIC RECORD. IN ACCORDANCE WITH HHS POLICY, THE USE OF ARTIFICIAL INTELLIGENCE , ALSO KNOWN AS A.I. NOTETAKERS, IS EXPRESSLY PROHIBITED IN THIS MEETING. PRODUCERS WILL NOT ADMIT A BOT OR OTHER AUTONOMOUS AGENTS INTO THE MEETING. IF A BOT SHOULD INADVERTENTLY GAIN ACCESS, IT WILL BE REMOVED BY ONE OF OUR PRODUCERS. FOR THE SAKE OF THOSE VIEWING THE WEBCAST IN COMPLYING WITH THE TEXAS OPEN MEETINGS ACT, WE ASK EACH VIRTUAL ENTITY TURN ON YOUR CAMERA STATE YOUR NAME BEFORE SPEAKING. WE ALSO ASK THAT YOU SPEAK DIRECTLY INTO THE MICROPHONE OF YOUR DEVICE IN YOUR VOICE AND COMMENTS ARE HEARD. ONCE YOU ARE DONE FINISHING SPEAKING, WE ASK THAT YOU TURN YOUR CAMERA OFTEN PLACE HER MICROPHONE ON MUTE. PLEASE LEAVE YOUR CAMERA OFF AND MICROPHONE ON MUTE UNTIL YOU WISH TO SPEAK. WE RECOMMEND MEMBERS AND PRESENTERS USE HEADSETS IF POSSIBLE TO PREVENT FEEDBACK AND MINIMIZE NOISE. WE ALSO ASK THAT MEMBERS, STAFF AND PRESENTERS PARTICIPANTS SEEING VIRTUALLY PUT YOURSELF ON MUTE OR VIBRATE IF YOU NEED TO TAKE A CALL TURN OFF YOUR CAMERA AND MICROPHONE TO AVOID DISRUPTION OF THE MEETING. FOR MEMBER, STAFF AND PRESENTERS PARTICIPATE IN PRISON, WE ASK YOU SPEAK DIRECTLY INTO THE MICROPHONE TO YOUR VOICE AND COMMENTS ARE HEARD. THESE MICROPHONES ARE DIRECTIONAL. WE ASK THAT YOU SPEAK DIRECTLY INTO THE MIC. WE ALSO ASK YOU PLEASE PUT YOUR CELL PHONES ARE MUTE OR VIBRATE IF YOU NEED TO TAKE A CALL STEP OUT OF THE ROOM AND AWAY FROM THE DOORS. MEMBERS OF THE PUBLIC, YOU COULD REGISTER TO PROVIDE ORAL PUBLIC COMMENT VIRTUALLY OR IN PERSON FOR TODAY'S MEETING. MEMBERS OF THE PUBLIC WHO WOULD LIKE TO PROVIDE PUBLIC COMMENTS TODAY WHO DID NOT PREREGISTER TO PROVIDE COMMENTS, OR WHO ARE ATTENDING IN PERSON, SHOULD COMPLETE THE PUBLIC COMMENT REGISTRATION FORM ON THE TABLE OUTSIDE THE DOOR TO THE PUBLIC HEARING ROOM. PLEASE BRING YOUR COMPLETED REGISTRATION FORM TO THE STAFF AT THE FACILITATOR TABLE. THE AGENDA AND HANDOUTS FOR TODAY'S MEETING CAN BE FOUND ON THE HHS WEBSITE CLICKING ABOUT IN THE CENTER OF THE WHITE BANNER AT THE TOP. SELECTING MEETINGS AND EVENTS WITH THE DROP-DOWN MENU AND CLICKING THE LINK FOR HEALTH AND HUMAN SERVICES COMMISSION EXECUTIVE COUNCIL AGENDA. EXECUTIVE COMMISSIONER , I TURNED THE FLOOR TO YOU. >> GOOD MORNING, AND WELCOME TO EVERYONE JOINING US TODAY. I WOULD LIKE TO START OUT BY UPDATING YOU ALL ON ONE OF OUR [00:05:01] MAJOR INITIATIVES . EARLIER THIS MONTH, WE SUBMITTED OUR RURAL HEALTH TRANSFORMATION PROGRAM APPLICATION TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. THIS IS A BIG OPPORTUNITY TO MAKE A LASTING IMPACT ON RURAL HEALTHCARE ACROSS THE STATE. WE HAVE SEVERAL GOALS WE HOPE TO ACCOMPLISH, BUT THE MAIN FOCUS IS TO EMPOWER RURAL TAKE IT THAT'S TEXANS TO MAKE THEIR OWN HEALTH CARE DECISIONS AND PROVIDE HEALTH SERVICES CLOSE TO HOME. THE PUBLIC PLAYED AN IMPORTANT ROLE IN SHAPING THE APPLICATION. WE EXPECT CMS TO ANNOUNCE FUNDING AWARDS BY THE END OF THE YEAR. ALSO THIS FALL BE MOVED INTO THE NEXT PHASE OF THE REVIEW BY THE SUNSET ADVISORY COMMISSION. SUNSET STAFF WILL SPEND THE NEXT YEAR INTERVIEWING HHSC TEAM MEMBERS AND STAKEHOLDERS TO SHAPER REPORT ON THE AGENCY FOR THE TEXAS LEGISLATURE. THAT REPORT SHOULD BE COMPLETED BY OCTOBER 2026. BEFORE WE MOVE TO THE NEXT AGENDA ITEM, I HAVE A FEW LEADERSHIP UPDATES. WE WELCOME BACK DAVID AS DEPUTY EXECUTIVE COMMISSIONER OF REGULATORY SERVICES . DAVID SERVED AT HHSC FROM 2017 THROUGH 2021. HE PLAYED A PIVOTAL ROLE IN CONSOLIDATING REGULATORY PROGRAMS FROM FIVE DIFFERENT AGENCIES INTO HHSC. WE ARE EXCITED TO HAVE HIM BACK. THE CHIEF INFORMATION OFFICER , SYLVIA KAUFMAN, HAS BEEN APPOINTED TO THE PUBLIC SECTOR ARTIFICIAL INTELLIGENCE ADVISORY BOARD. SHE WILL WORK ALONGSIDE HER FELLOW BOARD MEMBERS TO SHAPE HOW A.I. TOOLS ARE USED ACROSS STATE GOVERNMENT. CONGRATULATIONS ON THAT APPOINTMENT. I ALSO WANT TO CONGRATULATE EMILY, IN OUR CHIEF MEDICAID AND CHIP SERVICES OFFICER IN TEXAS MEDICAID DIRECTOR FOR BEING ELECTED TO THE NATIONAL ASSOCIATION MEDICAID DIRECTORS BOARD. IN THIS ROLE, EMILY WILL BE INVOLVED IN HELPING MANAGE THE ASSOCIATION'S STRATEGIC DIRECTION AND FINANCE. THANK YOU ALL FOR YOUR ONGOING COMMITMENT TO THIS AGENCY AND YOUR FELLOW TEXANS. AS WE ENTER THE HOLIDAY SEASON, I HOPE YOU TAKE THE OPPORTUNITY TO SPEND TIME WITH LOVED ONES AND TAKE TIME TO RECHARGE. AGENDA ITEM 1 AGENDA ITEM 1D WILL BE TABLED FOR THIS MEETING. NEXT WE WILL HEAR FROM DS HS COMMISSIONER WHO WILL PROVIDE A PUBLIC HEALTH UPDATE. >> THANK YOU, COMMISSIONER. GLAD TO BE HERE TODAY. THANK YOU FOR GIVING US THE OPPORTUNITY TO UPDATE YOU. BILL IMPLEMENTATION FOLLOWING THE RECENT REGULAR LEGISLATIVE STATION THAT SESSION . WE ARE ALSO UNDER REVIEW BY SUNSET COMMISSION KIND ARE ACTIVELY WORKING WITH SUNSET STAFF TO GET THE INFORMATION THEY NEED TO REVIEW OUR AGENCY. ASIDE FROM BILL IMPLEMENTATION AND SUNSET REVIEW, WE ARE WORKING ON A COUPLE OF LARGE ISSUES RIGHT NOW THROUGH OUR AGENCY. ONE OF THOSE IS PERTUSSIS. PERTUSSIS IS A HIGHLY INFECTIOUS BACTERIAL DISEASE AND VACCINE PREVENTABLE DISEASE THAT CAN CAUSE VERY SEVERE ILLNESS AND DEATHS, ESPECIALLY IN INFANTS . IF AN INFANT GETS PERTUSSIS, ABOUT ONE THIRD WILL REQUIRE HOSPITALIZATION AND CAN RESULT IN DEATH. PRIOR TO WIDESPREAD VACCINE USE, TEXAS WOULD HAVE THOUSANDS AND THOUSANDS OF CASES AND HUNDREDS OF DEATHS EACH YEAR. MANY OF THOSE INFANTS, WHICH WOULD CONTRIBUTE TO THE INFANT MORTALITY RATE. THESE CASES AND DEATHS HAVE DECREASED SINCE THE 1940S SINCE WIDESPREAD VACCINATION. WE HAVE SEEN INCREASES IN CASES OVER THE LAST 25 YEARS AND HAD A RECORD HIGH IN 2013 WHEN WE SAW ABOUT 4000 CASES AND FIVE DEATHS. WE ARE ON TRACK THIS YEAR TO EXCEED OUR 2013 CASE COUNTS. WE HAVE HAD NO CONFIRMED DEATHS SO FAR, BUT WE HAVE RECOGNIZED OUTBREAKS ACROSS THE STATE. VACCINE IS THE BEST WAY TO PREVENT PERTUSSIS . IN THE EVENT THAT A PERSON DOES BECOME INFECTED OR HAS CRITICAL ILLNESS, IT IS IMPORTANT FOR THEM TO GET TREATMENT RIGHT AWAY TO PREVENT TRANSMISSION TO OTHER INDIVIDUALS. WE HAVE PUT OUT A HEALTH ALERT THROUGH DSHS TO PROVIDERS TO LET THEM KNOW THEY NEED TO BE IN THE LOOKOUT FOR THESE CASES SO IDENTIFICATION, DIAGNOSIS AND TREATMENT CAN HAPPEN QUICKLY ALL ACROSS OUR STATE. WE HAVE ALSO SENT OUT INFORMATION OVER SOCIAL MEDIA JUST TO MAKE SURE THERE IS BROAD AWARENESS OF PERTUSSIS IN OUR COMMUNITIES. IN ADDITION TO THAT, WE ARE ALSO WORKING ON AN OUTBREAK OF BOTULISM, INFANT BOTULISM, LINKED TO POWDERED INFANT FORMULA. THERE IS A MULTISTATE OUTBREAK OF INFANT BOTULISM LINKED TO USE OF BY A HARD INFANT FORMULA. THIS IS A SMALLER PRODUCER THAT IS PRESENT IN TEXAS. ALL THE PRODUCTS HAVE BEEN RECALLED AT THIS POINT, AND WE ARE ASSISTING FDA TO ENSURE THAT ALL PRODUCT IS OFF THE SHELVES IN TEXAS. WE HAVE ANNOUNCED SIX CASES IN TEXAS INVOLVING INFANTS . THERE HAVE [00:10:05] BEEN NO DEATHS IN TEXAS OR NATIONALLY THAT HAVE BEEN CONFIRMED AS OF NOW. NATIONALLY THERE HAVE BEEN 31 CASES REPORTED . WE ARE WORKING WITH THE LOCAL HEALTH DEPARTMENT AND CDC TO INVESTIGATE THESE CASES AND GET TESTING OF THE FORMULA PERFORMED . WE ARE ALSO WORKING TO ENSURE THAT ALL OF THESE BABIES WHO ARE SUSPECTED OF HAVING INFANT BOTULISM TO GET TREATMENT IN AN EXPEDITED FASHION. WE WILL CONTINUE WORKING ON BOTH OF THOSE AND OTHER ISSUES THAT ARE GOING ON RIGHT NOW IN PUBLIC HEALTH . WE WILL ALSO WATCH INDICATORS OF COLD AND FLU SEASON AS WE ENTER THESE WINTER MONTHS. IN THE SPIRIT OF THE THANKSGIVING SEASON, I WANT TO THANK EXECUTIVE COMMISSIONER YOUNG AND ALL HER SUPPORT FOR OUR AGENCY, AS WELL AS MY WONDERFUL STAFF THAT HAVE DONE OUTSTANDING WORK THIS YEAR, DESPITE SOME REALLY CHALLENGING CONDITIONS. THANKS TO ALL OF YOU. >> THANK YOU. NEXT WE WILL HEAR FROM DFPS . >> GOOD MORNING. THANK YOU FOR THE OPPORTUNITY TO JOIN YOU THIS MORNING AND SHARE SOME OF WHAT WE HAVE GOING ON AT DFPS. WE ARE DEEP INTO THE SUNSET REVIEW PROCESS AND LOOKING FORWARD TO CONTINUING TO WORK WITH THE SUNSET COMMISSION OVER THE NEXT YEAR PLUS AS WE WORK THROUGH THAT PROCESS IN ADVANCE OF NEXT LEGISLATIVE SESSION. AND OF COURSE, WORKING VERY MUCH ON IMPLEMENTING A NUMBER OF BILLS THAT AFFECT OUR AGENCY OUTSIDE OF THOSE TWO THINGS. I WANTED TO SHARE AN UPDATE ON OUR WORK ON KINSHIP CARE THIS MORNING AND WORK AROUND HIGH ACUITY USE, WHICH IS SOMETHING WE PROVIDE FREQUENT UPDATES TO YOU ALL ON. AROUND KINSHIP CARE, I REALLY WANT TO START WITH A NOTE OF APPRECIATION TO HHSC FOR THEIR WORK AND LEADERSHIP AROUND REVISING OR DEVELOPING NEW KINSHIP LICENSING STANDARDS THAT DFPS IS VERY EXCITED. IT WILL MAKE IT MUCH, MUCH EASIER FOR RELATIVES TO CARE FOR CHILDREN WHEN THEY MUST ENTER THE STATE'S FOSTER CARE SYSTEM. DFPS RIGHT NOW STATEWIDE TEXAS HAS A KINSHIP PLACEMENT RATE OF ABOUT 43%, WHICH ALREADY EXCEEDS THE NATIONAL AVERAGE, WHICH IS ABOUT 38%. WE HAVE SEEN AN INCREASE IN OUR KINSHIP CARE OVER THE LAST YEAR, UP BY ABOUT 3% FROM 2024, WHICH IS PARTICULARLY NOTABLE WHEN YOU TAKE INTO ACCOUNT THAT THE POPULATION OF CHILDREN IN THE STATE'S CONSERVATORSHIP HAS BECOME SMALLER AND THE NEEDS OF THOSE CHILDREN HAVE BECOME HIGHER. THAT REALLY UNDERSCORES THE IMPORTANCE OF THE AGENCIES THAT SUPPORT KINSHIP FAMILIES, WHICH INCLUDES BOTH DFPS AND HHSC AT SUPPORTING THOSE KINSHIP CAREGIVERS SO THEY ARE ABLE TO MEET THE NEEDS OF THE RELATIVE CHILDREN OR AFFECTED CHILDREN THAT THEIR CAREGIVERS FOR THEIR NUMBER OF VERY EXCITING THINGS GOING ON RELATED TO THAT IN ADDITION TO THE NEW LICENSING STANDARDS. THE NEW LICENSING STANDARDS, THOSE WILL GIVE FAMILIES ACCESS TO SIGNIFICANTLY MORE FINANCIAL SUPPORT AND ACTUAL SUPPORT SYSTEM THEY CAN ACCESS. SO THAT IS HUGE FOR THOSE FAMILIES. IN ADDITION TO THAT, DFPS REQUESTED IN THE LEGISLATURE FUNDED INCREASED DAYCARE SUPPORT FOR KINSHIP CAREGIVERS LAST LEGISLATIVE SESSION, AND PROVIDED GRANT SUPPORT FOR BEHAVIORAL HEALTHCARE FOR KINSHIP CAREGIVERS TO ACCESS WHEN THEY HAVE BEHAVIORAL HEALTHCARE NEEDS FOR CHILDREN IN THEIR CARE. THAT IS THROUGH OUR COMMUNITY-BASED CARE CONTRACTORS. THOSE ARE VERY EXCITING. IN ADDITION TO THAT, WE ARE WORKING ON AN EDUCATIONAL CAMPAIGN, ALSO WITH HHSC AND THE GOVERNOR'S OFFICE, TO REALLY SPREAD AWARENESS OF KINSHIP CARE AND MAKE SURE WE ARE INFORMING KINSHIP CAREGIVERS OF ALL THE RESOURCES THAT ARE AVAILABLE TO THEM AS THEY CARE FOR CHILDREN IN THEIR CUSTODY. THAT IS OUR UPDATE ON KINSHIP CARE. SIMILARLY, WE HAVE BEEN WORKING VERY, VERY CLOSELY WITH OUR PARTNERS IN THE STATE HEALTH SYSTEM AROUND MEETING THE NEEDS OF HIGH ACUITY USE . THAT IS -- YOUTH. BOTH THROUGH BEHAVIORAL HEALTH SERVICES AND PARTICULARLY THROUGH THE CREATION OF SOME ADDITIONAL CAPACITY TO BE USED FOR CHILDREN IN DFPS CUSTODY AND AN EXISTING STATE HOSPITAL SITE THAT WILL BE A NEW FACILITY. WE ARE VERY GRATEFUL FOR THAT PARTNERSHIP . WE CONTINUE TO SEE OUR NUMBERS OF CHILDREN WHO DO NOT HAVE A PLACEMENT BE FOCUSED [00:15:02] IN HIGHER ACUITY YOUTH IN OLDER CHILDREN WITH DUAL DIAGNOSIS NEEDS THAT TENDS TO BE YOUTH WHO HAVE A CO-OCCURRING BEHAVIORAL HEALTH CONDITION AND INTELLECTUAL DISABILITY, IN MANY CASES. PROVIDING A SOLUTION FOR THOSE CHILDREN WILL BE VERY, VERY IMPORTANT GOING FORWARD. THE NUMBERS HAVE STABILIZED BETWEEN ABOUT 18 AND 21 YOUTH PER NIGHT WITHOUT PLACEMENT, BUT THAT TENDS -- THAT CONTINUES TO BE A VERY, VERY HIGH NEED POPULATION ENSURING THE SAFETY OF THOSE CHILDREN AND YOUTH AND GETTING THEM TO AN APPROPRIATE PLACEMENT IS A VERY HIGH PRIORITY FOR THE DEPARTMENT. IN THE SPIRIT OF THE HOLIDAY SEASON, I WANT TO EXTEND MY GRATITUDE TO OUR TEAM MEMBERS AT DFPS HE WORKED VERY, VERY HARD EVERY DAY TO PROTECT CHILDREN, FAMILIES AND VULNERABLE ADULTS, AND OUR GRATITUDE TO OUR PARTNERS ACROSS THE SYSTEM HELPING US DO OUR JOB, BECAUSE WE ARE TOTALLY RELIANT ON YOUR SYSTEMS AND VERY GRATEFUL FOR YOUR PARTNERSHIP. >> THANK YOU, COMMISSIONER. NEXT, PRINCIPAL DEPUTY INSPECTOR GENERAL WILL GIVE THE OFFICE OF INSPECTOR GENERAL QUARTERLY REPORT. >> GOOD MORNING. I AM HAPPY TO REPORT THAT IN THE LAST FISCAL YEAR, AS -- WE RECOVERED $465 MILLION , AND THROUGH THE FIRST COUPLE OF MONTHS OF THIS YEAR, ALREADY AT $60 MILLION. THESE ACCOMPLISHMENTS REALLY REFLECT ALL OF THE WORK ACROSS THE AGENCY. I KNOW A LOT OF TIMES HERE WE HIGHLIGHT INDIVIDUAL CASES, BUT TODAY I WANTED TO TALK A LITTLE BIT ABOUT THE SURVEILLANCE UTILIZATION REVIEW TEAM AND THEY ARE COMPOSED PRIMARILY OF CLINICAL STAFF AND LOOK AT MEDICAL RECORDS TO ENSURE PROPER PAYMENT . LAST YEAR THEY BROUGHT IN $22 MILLION AND ARE ALREADY AT 3 MILLION FOR THIS YEAR. REALLY PROUD OF THEM. OUR ACUTE-CARE SURVEY TEAM MORE THAN DOUBLED THE NUMBER CASES THEY DID LAST YEAR TO 246. THEY ARE ALREADY AT 35 IN THE FIRST COUPLE OF MONTHS OF THE YEAR. OUR NURSING FACILITY UTILIZATION REVIEW TEAM LOOKED AT 305 FACILITIES LAST YEAR , INCLUDING LOOKING AT OVER 10,000 CLIENT RECORDS . THEY ACHIEVED A RECORD RECOVERIES OF $8 MILLION. OUR HOSPITAL TEAM REVIEWED ALMOST 16,000 HOSPITAL CLAIMS , AND THEY ARE ALREADY AT 3600 THROUGH THE FIRST COUPLE OF MONTHS OF THIS YEAR. RECOVERIES OF 2.9 MILLION. REALLY GREAT WORK FROM THAT TEAM. APPRECIATE THEM. THEY ALWAYS DON'T GET A LOT OF RECOGNITION BECAUSE THEIR WORK IS NOT AS INTERESTING AS SOME OF THE BIGGER CASES WE DO. YOU CAN ALWAYS FIND OUT MORE INFORMATION ABOUT OUR WORK IN FRONT OF THESE TRENDS IN OUR QUARTERLY REPORT AVAILABLE ON OUR WEBSITE. THE NEXT ONE WILL BE PUBLISHED LATE IN DECEMBER FOR SOME HOLIDAY READING IF ANYBODY WANTS TO TAKE THAT HOME AND READ IN FRONT OF THE FIRE. LIKE EVERYONE UP HERE, WE REALLY APPRECIATE THE PARTNERSHIP OF EVERYBODY WITHIN THE SYSTEM. YOU KNOW, PROVIDERS AND AGENCY FOLKS . YOU KNOW, APPRECIATE EVERYBODY'S TIME AND CONTINUED SUPPORT OF OUR MISSION. THANK YOU. >> THANK YOU. MEMBERS, THAT CONCLUDES AGENDA ITEM 1. WE WILL [2. Rule proposals] NOW MOVE TO AGENDA ITEM 2. AGENDA ITEM 2 , RULE PROPOSALS. THE RULES ARE DIVIDED INTO THREE SECTIONS ON THE AGENDA. AGENDA ITEM 2 A PUBLIC COMMENT PERIOD HAS CLOSED. THERE ARE NO RULE PROPOSALS LISTED UNDER AGENDA ITEM 2 A. WE WILL MOVE TO AGENDA ITEM 2B, RULE PROPOSALS SUBMITTED TO THE TEXAS REGISTER FOR PUBLICATION. THE PUBLIC COMMENT PERIOD REQUIRED BY THE ADMINISTRATIVE PROCEDURES ACT HAS NOT ENDED AS OF THE DATE OF THIS COUNCIL MEETING. DOES ANY MEMBER OF THE COUNCIL HAVE QUESTIONS OR COMMENTS ON ANY OF THE RULES IN AGENDA ITEM 2B? IF COUNCIL MEMBERS HAVE NO QUESTIONS, I OPENED THE FLOOR TO PUBLIC COMMENT. ARE THERE ANY PUBLIC COMMENT CARDS ? >> EXECUTIVE COMMISSIONER, THERE ARE NO PUBLIC COMMENT REGISTRANTS FOR AGENDA ITEM 2B. >> THANK YOU. WE WILL NOW MOVE ON TO AGENDA ITEM 2C, THE RULE PROPOSALS HAVE NOT YET BEEN CEMENTED TO THE TEXAS REGISTER FOR PUBLICATION IN PUBLIC COMMENT UNDER THE ADMINISTRATIVE PROCEDURE. THERE ARE NO RULE PROPOSALS LISTED UNDER AGENDA ITEM 2C. THAT CONCLUDES AGENDA [3. Advisory committee recommendations] ITEM 2. WE WILL NOW MOVE TO AGENDA ITEM 3. AGENDA ITEM 3 IS [00:20:17] ADVISORY COMMITTEE RECOMMENDATIONS. I ASKED THE REPRESENTATIVE OF EACH ADVISORY COMMITTEE TO PRESENT A SUMMARY OF THEIR RESPECTIVE COMMITTEES' RECOMMENDATIONS. I WILL THEN ASK COUNCIL MEMBERS FOR QUESTIONS AND COMMENTS BEFORE OPENING THE FLOOR TO PUBLIC COMMENT. IF ADDITIONAL INFORMATION IS NEEDED, WE WILL HAVE A STAFF CONTACT YOU AS A FOLLOW-UP. PUBLIC COMMENTS WILL BE LIMITED TO THREE MINUTES. I WOULD LIKE TO INTRODUCE LONG-TERM CARE FACILITIES COUNCIL PROGRAM AREA REPRESENTATIVE TO LAY OUT THE RECOMMENDATIONS PREPARED BY THE MEMBERS OF THE LONG-TERM CARE FACILITIES COUNCIL. >> HELLO. THANK YOU SO MUCH FOR THAT. YES, I WILL GO AHEAD AND STATE THE RECOMMENDATIONS. THESE RECOMMENDATIONS WERE PREPARED BY THE MEMBERS OF THE TEXAS COUNCIL ON LONG-TERM CARE FACILITIES. THE OPINIONS AND SUGGESTIONS EXPRESSED IN THESE RECOMMENDATIONS ARE THE MEMBERS' OWN AND DON'T REFLECT THE VIEWS OF THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION, EXECUTIVE COUNCIL OR TEXAS HEALTH AND HUMAN SERVICES COMMISSION. THE RECOMMENDATIONS TO HHSC ARE AS FOLLOWS. HHSC SHOULD ADOPT RATE FOR NURSING FACILITIES WITH PROPORTIONAL ADJUSTMENTS TO ALL RATE COMPONENTS, INCLUDING, BUT NOT LIMITED TO, DIRECT CARE, DIETARY, GENERAL AND ADMINISTRATIVE AND FIXED CAPITAL COMPONENTS OF MEDICAID REIMBURSEMENT. THESE ADJUSTMENTS SHOULD OCCUR BIANNUALLY, UTILIZING THE MOST RECENT ANNUAL COST REPORT DATA TO MAINTAIN FAIRNESS AND ADEQUACY AND FUNDING. IN LINE WITH THE CURRENT RULES INTENT, HHSC SHOULD CLARIFY A CHANGE OF OWNERSHIP BETWEEN NONSTATE GOVERNMENT OWNED ENTITIES WILL NOT AUTOMATICALLY RESULT IN THE EXCLUSION OF THE FACILITY FROM THE QUALITY INCENTIVE PAYMENT PROGRAM DURING THE CURRENT YEAR PROVIDED BY ALL OTHER QUALIFICATIONS ARE MET. HHSC SHOULD SEEK A WAIVER FROM CMS TO ALLOW QUALIFIED NURSING FACILITIES TO MAKE PRESUMPTIVE MEDICAID ELIGIBILITY DETERMINATIONS FOR ELDERLY AND DISABLED RESIDENTS WHILE THEIR APPLICATIONS ARE BEING PROCESSED. THIS PROCESS ALREADY ALLOWED FOR QUALIFIED HOSPITALS WOULD INCREASE ACCESS FOR TEXANS PENDING MEDICAID APPROVAL WHO ARE QUALIFYING FOR NURSING HOME STAYS, AND IT WILL REQUIRE HHSC TO ESTABLISH CRITERIA FOR NURSING FACILITIES TO APPLY FOR THIS DESIGNATION. HHSC SHOULD ADOPT RATES FOR ICF FACILITIES TO INCREASE THE INCREASED OFF OF STAFFING IN CARE ENVIRONMENT. THE INCREASED COST WITH INFLATION FOR ITEMS SUCH AS GROCERIES AND TRANSPORTATION ARE UNSUSTAINABLE. CURRENT STAFFING RATES AS LOW AS $10.60 PER HOUR ARE UNSUSTAINABLE. THIS HAS RESULTED IN HIGH TURNOVER, CREATING INSTABILITY IN CARE, STRAINING ALREADY LIMITED RESOURCES, AND APPEARS TO BE THE CAUSE FOR CLOSURE OF MULTIPLE HOMES THROUGHOUT THE STATE. HHSC SHOULD CONTINUE PARITY WITH STAFFING NEEDS PROVIDED TO STATE SUPPORTED LIVING CENTERS. HHSC SHOULD ADOPT RATES TO RECOGNIZE THE INCREASED COST OF CARE PROVIDED TO RESIDENTS IN NURSING FACILITIES WITH BEHAVIORAL SUPPORT NEEDS RELATED TO I/DD OR AUTISM. THESE COSTS OF CARE ARE OFTEN NOT APPROPRIATELY REFLECTED IN MDS DATA. THIS DISCREPANCY COULD LEAVE PERSONS WITH I/DD OR AUTISM LIMITED CHOICES AND PLACES FOR CARE DUE TO UNREIMBURSED COSTS OF CARE FOR PROVIDERS. HHSC SHOULD PROVIDE AND ENCOURAGE ADDITIONAL OPPORTUNITIES FOR TRAINING FOR FRONTLINE STAFF FOR ANY LONG-TERM CARE PROVIDERS OFFERING CARE TO PERSONS WITH I/DD. CURRENTLY, THERE ARE LIMITED TRAINING OPPORTUNITIES FOR DSP, CMA OR NURSES CARING FOR PERSONS WITH I/DD. HHSC SHOULD IMPLEMENT A UNIFORM TIMELINE FOR COMPLAINT INVESTIGATIONS TO ENSURE COMPLETE SURVEYS ARE COMPLETED IN A TIMELY MANNER AND THE WELFARE OF RESIDENTS ADDRESSED PROMPTLY. HHSC SHOULD IMPLEMENT A SYSTEM WHERE INFORMAL RESULTING DATA WILL BE PUBLISHED TO PROVIDERS AND THE PUBLIC ON AT LEAST A QUARTERLY BASIS, INCLUDING A LINK TO THE DATA ON THE HHSC WEBSITE. CERTIFIED NURSING ASSISTANTS, SKILLS TEST SHOULD BE OFFERED IN SPANISH IN ADDITION TO ENGLISH, TO ADDRESS WORKFORCE SHORTAGES, PROMOTE EQUITY AND ENHANCE CARE QUALITY IN THE LONG-TERM CARE INDUSTRY. TEXAS HAS A SIGNIFICANT SPANISH-SPEAKING POPULATION, AND MANY POTENTIAL CNES PHASE UNNECESSARY BARRIERS WHEN THE TESTS ARE ONLY AVAILABLE IN ENGLISH. EXPANDING ACCESS TO SPANISH SPEAKERS ALLOWS THE STATE TO TAP INTO A LARGER DIVERSE TALENT POOL WHILE IMPROVING CULTURALLY AND LINGUISTICALLY APPROPRIATE CARE FOR SPANISH-SPEAKING RESIDENTS AND CAREGIVERS. THOSE ARE ALL OF [00:25:03] THE RECOMMENDATIONS PROVIDED BY THE LONG-TERM CARE FACILITIES COUNCIL. THANK YOU VERY MUCH. >> THANK YOU . DOES ANY MEMBER OF THE COUNCIL HAVE QUESTIONS OR COMMENTS? IF COUNCIL MEMBERS HAVE NO QUESTIONS, I OPENED THE FLOOR TO PUBLIC COMMENT. ARE THERE ANY PUBLIC COMMENT CARDS ? >> EXECUTIVE COMMISSIONER, THERE ARE NO PUBLIC COMMENT [4. Recent Rule Adoptions - Information item not for discussion] REGISTRANTS FOR AGENDA ITEM 3 LETTER A. >> THAT BRINGS US TO AGENDA ITEM FOR. THE RULES LISTED UNDER AGENDA ITEM FOR HAVE EITHER BEEN SUBMITTED FOR ADOPTION OR PUBLISHED AS ADOPTED IN THE TEXAS REGISTER SINCE THE OCTOBER 16, 2025 EXECUTIVE COUNCIL MEETING AND ARE PROVIDED FOR YOUR INFORMATION. THAT BRINGS US TO AGENDA ITEM 5 AND CONCLUDES ALL BUSINESS ON THE AGENDA. THANK YOU TO THE COUNCIL MEMBERS FOR YOUR TIME. PLEASE NOTE FOR THE RECORD THAT AT 10:31 A.M. THIS MEETING * This transcript was compiled from uncorrected Closed Captioning.