[00:00:03] GOOD MORNING. THE MEETING WILL COME TO ORDER. [1. Welcome and opening remarks] MAY THE RECORD REFLECT THAT THIS MEETING OF THE EXECUTIVE COUNCIL CONVENED AT 10:11 A.M. ON OCTOBER 15TH. KAYLA, WILL YOU PLEASE CALL THE ROLL? STEPHANIE. MUTH. JORDAN DIXON. PRESENT. SILVIA, I APOLOGIZE. MEMBERS RESPOND HERE. PRESENT. IF YOU'RE ATTENDING ON BEHALF OF A MEMBER, PLEASE STATE THE CHIEF YOU'RE REPRESENTING WHEN YOU HEAR THEIR NAME. SYLVIA KAUFMAN. GINA CARTER HERE FOR SYLVIA KAUFMAN. THANK YOU. DAVID COTHREN PRESENT. MOLLY REGAN. CHRISTOPHE RADKE HERE FOR MOLLY REGAN. IMELDA GARCIA HERE. RAYMOND CHARLES WINTER. EUGENIA CRAIG HERE FOR RAY WINTER. TREY WOOD. PRESENT. STEPHANIE STEPHENS HERE. AUDREY O'NEILL. JENNIFER SIMS HERE FOR AUDREY O'NEILL. THIS CONCLUDES ROLL CALL. THANK YOU KAYLA. AND WE APOLOGIZE FOR THAT DELAY. WE HAD SOME TECHNICAL DIFFICULTIES. I'M GOING TO START WITH SOME COMMENTS ON BEHALF OF OUR EXECUTIVE COMMISSIONER. WE ARE FINISHING OUT THE FIRST YEAR OF RURAL TEXAS, STRONG AND WORKING HARD TO AWARD UP TO $281 MILLION IN GRANTS BY THE END OF THIS MONTH. AND I WANT TO RECOGNIZE TREY WOOD, OUR CHIEF FINANCIAL AND OPERATING OFFICER, AND HIS TEAM, FOR LEADING THAT EFFORT TO KEEP EVERYONE INFORMED. WE ARE POSTING WEEKLY UPDATES ON THE HHS WEBSITE SHOWING THE STATUS OF THE AWARDS AS FUNDING DECISIONS ARE ANNOUNCED. WE ALSO RECENTLY EXPANDED OUR INPATIENT PSYCHIATRIC CAPACITY. OUR EXECUTIVE COMMISSIONER ATTENDED A RIBBON CUTTING LAST MONTH FOR SUNRISE CANYON HOSPITAL AND HOPE CENTER FOR HELP AND HEALTH AND WELLNESS IN LUBBOCK. SUNRISE CANYON DOUBLED ITS INPATIENT CAPACITY. EXCUSE ME. IT'S INPATIENT PSYCHIATRIC CAPACITY FROM 30 TO 60 BEDS, THANKS TO A $60 MILLION INVESTMENT BY GOVERNOR GREG ABBOTT AND THE TEXAS LEGISLATURE. THROUGH THIS PARTNERSHIP WITH SUNRISE CANYON, WE ARE EXPANDING ACCESS TO CARE FOR WEST TEXANS IN NEED OF INPATIENT PSYCHIATRIC CARE. WE HAVE A COUPLE OF LEADERSHIP ANNOUNCEMENTS. MICHELLE DION HAS BEEN NAMED DEPUTY CHIEF FOR REGULATORY SERVICES, AND RENE BLANCHE HALEY HAS BEEN NAMED DEPUTY EXECUTIVE COMMISSIONER FOR LONG TERM CARE REGULATION, MICHELLE'S PREVIOUS POSITION. SO CONGRATULATIONS TO BOTH OF THEM AND TO DAVID. WE WILL NOW MOVE ON TO SOME AGENCY UPDATES. WE WILL FIRST HEAR A DEPARTMENT OF STATE HEALTH SERVICES UPDATE FROM INTERIM DEPUTY CHIEF COMMISSIONER IMELDA GARCIA COMMISSIONER GARCIA. THANK YOU JORDAN. GOOD MORNING EVERYONE. MY NAME IS IMELDA GARCIA AND I'M SERVING AS INTERIM COMMISSIONER. SO A COUPLE OF UPDATES THAT I WANTED TO START OFF WITH. SO LAST WEEK WE ACTUALLY KICKED OFF FLU SEASON. AND THIS IS WHERE THE TIME WHERE WE START LOOKING AT NOT ONLY THE TRENDS FOR INFLUENZA, BUT FOR RESPIRATORY SYNCYTIAL VIRUS AS WELL AS COVID 19. AND WE LOOK AT EMERGENCY ROOM DEPARTMENT VISITS, WE LOOK AT HOSPITALIZATIONS, AND THEN WE START TO TREND DEATHS AS WELL. SO RIGHT NOW SINCE IT JUST KICKED OFF THE FLU. TRENDS ARE CURRENTLY LOW, BUT THEY ARE INCREASING FOR RESPIRATORY SYNCYTIAL VIRUS. THAT ACTIVITY REMAINS LOW. AND THEN MOST RECENT, THE EMERGENCY DEPARTMENT VISITS RELATED TO MOST OF THOSE VISITS HAVE BEEN RELATED TO COVID 19 AND FLU, WHICH IS TYPICAL FOR THIS TIME OF YEAR. YOU CAN FIND OUR RESPIRATORY DASHBOARD@HEALTHDATA.TEXAS.TEXAS.GOV. WE HAVE ALL OF THE DATA ON OUR WEBSITE UPDATED WEEKLY. IF YOU GO TO THAT WEBSITE. AND THEN IN THE MIDDLE, THERE IS A DISEASES TAB. AND THEN YOU CAN CLICK ON THE TEXAS RESPIRATORY VIRUS SURVEILLANCE TAB AS WELL. AND THEN YOU'LL BE ABLE TO SEE THE TRENDS OVER TIME. AND YOU CAN TOGGLE AND SEE DIFFERENT ITERATIONS FOR EACH OF THOSE CONDITIONS. THE OTHER REPORT THAT WE HAVE THAT IS WIDELY USED BY THE TEXAS HEALTH CARE PROFESSIONALS IS OUR RESPIRATORY SURVEILLANCE REPORT. AND SO THIS REPORT GIVES A WHOLE BUNCH OF DETAILS ABOUT SOME OF THE POSITIVITY RATES AND THINGS, [00:05:03] SO THAT HEALTH CARE PROVIDERS CAN KNOW WHAT'S GOING ON ACROSS THE STATE. AND THEN SIMILARLY COINCIDENTALLY TODAY, OCTOBER 15TH IS GLOBAL HANDWASHING DAY AND JUST WASHING YOUR HANDS IS ONE OF THE TRIED AND TRUE PUBLIC HEALTH INTERVENTIONS IN ORDER TO HELP REDUCE THE SPREAD OF MANY DISEASES, INCLUDING RESPIRATORY DISEASES. AND SO WANTED TO JUST HIGHLIGHT THAT THE CDC RECOMMENDS WASHING HANDS FOR AT LEAST 20S, PARTICULARLY BEFORE EATING, AFTER GOING TO THE BATHROOM AND AFTER SNEEZING OR COUGHING. AND THEN FOR ALSO IN OCTOBER. I ALSO WANTED TO HIGHLIGHT THAT IT IS BREAST CANCER AWARENESS MONTH, AND IT GIVES ME THE OPPORTUNITY TO BE ABLE TO JUST DO A REMINDER FOR ALL WOMEN IN THE STATE TO PRIORITIZE TIME FOR YOURSELF AND GO SEE YOUR HEALTH CARE PROVIDER AND GET YOUR MAMMOGRAMS. THE EARLIER THAT IT IS DETECTED, THE BETTER. THE HEALTH OUTCOMES IN THE LONG TERM ARE FOR EVERYONE. AND SO IT'S REALLY IMPORTANT FOR US TO TAKE CARE OF THOSE HEALTH SCREENINGS. AND THEN JUST WANTED TO ACKNOWLEDGE AND THANK ALL OF THE, THE STAKEHOLDERS AND PARTNERS AND HEALTH CARE PRACTITIONERS THAT WE HAVE ACROSS THE STATE. WE COULD NOT BE ABLE TO PROVIDE INFORMATION ABOUT TRENDS AND DISEASES WITHOUT THEIR PARTNERSHIP AND REPORTING AND SHARING WHAT IS HAPPENING OUT IN THE FIELD. AND SO I JUST WANTED TO TAKE SOME TIME TO SAY THANK YOU. THANK YOU IMELDA. WE WILL NOW HEAR A DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES UPDATE FROM JENNIFER SIMS, DEPUTY COMMISSIONER OF OPERATIONS. GOOD MORNING EVERYONE. I JUST WANTED TO UPDATE YOU ON A COUPLE OF THINGS. ONE AS OF NOVEMBER 1ST, WE ARE MAKING A MAJOR TRANSITION IN THE DALLAS FORT WORTH AREA IN THAT REGION. WE ARE TRANSITIONING OUR COMMUNITY BASED CARE CONTRACTORS FROM A SINGLE CONTRACTOR TO TWO DIFFERENT CONTRACTORS. SO TEXAS CARING FAMILY NETWORK WILL, WILL BE HANDLING DALLAS STARTING IN, IN NOVEMBER 1ST. AND THEN THE NINE OUTLYING COUNTIES AROUND THAT AREA WILL BE COVERED BY OSI. OKAY. OUT OF FORT WORTH. THIS IS THE FIRST TIME WE'VE MADE THIS KIND OF TRANSITION AND IT'S LUCKILY GONE VERY SMOOTH. BUT DEFINITELY A HEAVY LIFT FOR EVERYONE INVOLVED. SO GREATLY APPRECIATE THAT EFFORT. AS USUAL, I WANT TO GIVE YOU A QUICK UPDATE. IT'S STAGGERING TO TELL YOU THIS, BUT WE ESTIMATED WE WOULD DO ABOUT 1.1 MILLION CHECKS. AND SO FAR WE HAVE DONE 2.1 MILLION CHECKS FOR THE CMAQ SYSTEM. SO IT IS ABSOLUTELY WORKING AS DESIGNED. IT IS A REALLY GREAT EXAMPLE OF STATE AGENCIES WORKING TOGETHER TOWARDS A COMMON GOAL. THE PARTNERSHIP HAS JUST BEEN STUPENDOUS. IT'S JUST HARD TO IMAGINE THE TEAMWORK THAT HAS GONE INTO THIS. AND JORDAN WAS A BIG PART OF THIS AT THE BEGINNING, SO WE'RE REALLY PLEASED WITH HOW IT'S GOING. THE SYSTEM IS WORKING AS IT'S DESIGNED. WE'RE, YOU KNOW, WHEN YOU DON'T EXPECT THAT VOLUME, YOU ARE STILL HAVING TO MAKE SOME ADJUSTMENTS PRETTY REGULARLY, BUT THE SYSTEM IS REALLY WORKING WELL AND WE'RE PLEASED THAT UNFORTUNATELY OR FORTUNATELY, WE'VE HAD A NUMBER OF INDIVIDUALS STOPPED FROM WORKING IN PLACES THAT THEY SHOULDN'T WORK. BECAUSE OF THE, THE CHECKS THAT ARE BEING DONE, BEING DONE ACROSS THE SYSTEM. SO REALLY POSITIVE OUTCOME. AND THEN THE LAST THING I WANTED TO MENTION IS OUR TEXAS CHILD CENTERED CARE OR T3C AS WE CALL IT. WE ARE, WE'RE ABOUT A YEAR AWAY FROM TRANSITIONING FROM OUR CURRENT SYSTEM OF PAYMENTS TO THE NEW T3C MODEL FULLY. SO PROVIDERS REALLY HAVE UNTIL SEPTEMBER 1ST OF 2027 TO MAKE THE SWITCH. AND SO WHAT I JUST REALLY WANT TO ENCOURAGE PROVIDERS TO START THAT WORK. NOW, IF YOU WAIT UNTIL THE VERY END, IT'S GOING TO BE A REAL PROBLEM TO, TO MAKE. THERE'S A, THERE'S A PROCESS. YOU HAVE TO BECOME CREDENTIALED TO SERVE A CERTAIN SERVICE PACKAGE. AND PEOPLE REALLY SHOULDN'T WAIT. THEY SHOULD GET STARTED NOW MAKING THAT TRANSITION SO THAT THEY CAN CONTINUE TO SERVE CHILDREN IN OUR CARE. AND WE REALLY ENCOURAGE THAT. AND IF INDIVIDUALS NEED HELP WITH THAT PROCESS, WE ARE EAGER TO HELP THEM TO MAKE THAT, THAT SWITCH. RIGHT NOW, WE HAVE ABOUT 70% OF THE KIDS IN OUR CARE ALREADY SERVED THROUGH T3C, SO WE'RE KIND OF GETTING DOWN TO THE END OF THE LINE AND REALLY ENCOURAGE FOLKS TO, TO MAKE THE TRANSITION SOONER RATHER THAN LATER. WITH THAT, THAT'S IT FOR FBS. THANK YOU, JENNIFER. AND I WANT TO ECHO YOUR COMMENTS ABOUT C MARK. IT WAS A REALLY GREAT COLLABORATION AND THANK YOU TO DSPS FOR PROVIDING LEADERSHIP ON THE COORDINATION OFFICE. WE WILL NOW MOVE ON TO AN UPDATE FROM THE OFFICE OF INSPECTOR GENERAL BY EUGENIA CREAGH, THE CHIEF OF STAFF. GOOD MORNING. I'M EUGENIA CREAGH, CHIEF OF STAFF FOR THE TEXAS HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL HERE ON BEHALF OF INSPECTOR GENERAL WINTER, [00:10:09] WHO IS ATTENDING A MEETING OF THE TEXAS FRAUD PREVENTION PARTNERSHIP THIS MORNING. I'D LIKE TO PROVIDE A BRIEF AUDIT UPDATE ON OUR AUDITS OF THE OF TEXAS LOCAL MENTAL HEALTH AND BEHAVIORAL HEALTH AUTHORITIES AS PART OF SENATE BILL 26 PASSED DURING THE 88TH TEXAS LEGISLATIVE SESSION, THE OIG IS REQUIRED TO AUDIT AND LL.B. AT LEAST ONCE EVERY FIVE YEARS. BY THE END OF FISCAL YEAR 2026, THE OIG COMPLETED 18 AUDITS, WITH NINE CURRENTLY IN PROGRESS. THOSE COMPLETED AUDITS COVER AUTHORITIES SERVING 134 OF TEXAS'S 254 COUNTIES. THE OIG RELEASED FOUR AUDIT REPORTS IN FISCAL YEAR 2024, FIVE IN FISCAL YEAR 2025, AND NINE IN FISCAL YEAR 2026. BASED ON THE CURRENT SCHEDULE, WE EXPECT TO COMPLETE THE REMAINING AUDITS BY THE END OF FISCAL YEAR 2028. IN JULY, WE RELEASED A REPORT SUMMARIZING THE RESULTS OF THE FIRST TEN AUDITS. THE REPORT IS AVAILABLE AT REPORT TEXAS.COM UNDER REPORTS AND AUDITS. THANK YOU FOR YOUR TIME AND CONTINUED SUPPORT OF THE OIG MISSION. THANK YOU. EUGENIA. WE HAVE A COUPLE OF HHS UPDATES. [2. Agency updates] DOCTOR RYAN VAN RAMSHORST WILL PROVIDE AN UPDATE ON PRIVATE DUTY NURSING CARE DELIVERY ACROSS TEXAS. AND WE WILL CALL YOU DOCTOR RYAN VAN RAMSHORST. FOR THE RECORD, BUT I WILL CONTINUE TO CALL YOU DOCTOR V AFTER THIS. CHIEF DIXON MEMBERS, THANK YOU SO MUCH FOR THE OPPORTUNITY TO PRESENT SOME INFORMATION TO YOU AND THE PUBLIC THIS MORNING ABOUT PRIVATE DUTY NURSING. AGAIN, MY NAME IS RYAN VAN RAMSHORST. I SERVE AS THE CHIEF MEDICAL DIRECTOR FOR MEDICAID CHIP SERVICES HERE AT HHS. AND TODAY I'LL BE SHARING AN UPDATE REGARDING DATA ABOUT THE DELIVERY OF PRIVATE DUTY NURSING SERVICES ACROSS TEXAS AND ACROSS OUR MEDICAID PROGRAM. NEXT SLIDE. SO I'D LIKE TO START BY PROVIDING A BIT OF BACKGROUND INFORMATION ABOUT PRIVATE DUTY NURSING, ABBREVIATED PD. PD IS A TYPE OF SKILLED NURSING CARE DESIGNED TO SUPPORT CHILDREN WITH SPECIAL HEALTH CARE NEEDS TO RECEIVE INDIVIDUALIZED, CONTINUOUS NURSING SERVICES THAT CAN SUPPORT THEIR HEALTH AND SAFETY AT HOME. THIS SERVICE MUST BE DETERMINED MEDICALLY NECESSARY FOR IT TO BE COVERED. PD AND SERVICES MAY PREVENT PROLONGED OR FREQUENT HOSPITALIZATION OR THE NEED FOR INSTITUTIONALIZATION. PD IS WHAT WE REFER TO AS ESTATE PLAN SERVICE, WHICH MEANS THAT PD N IS AVAILABLE TO ANY INDIVIDUAL LESS THAN 21 YEARS OF AGE, AND ANY OF OUR MEDICAID PROGRAMS TO INCLUDE THE STAR PROGRAM, THE STAR KIDS PROGRAM, AND THE STAR HEALTH PROGRAM. AGAIN, SO LONG AS THOSE SERVICES ARE MEDICALLY NECESSARY. THE NEED FOR SKILLED NURSING CARE THROUGH PD N MAY BE IDENTIFIED BY A CHILD'S PRIMARY CARE PROVIDER. IN CONSULTATION WITH THE CHILD'S FAMILY. THE PRIMARY CARE PHYSICIAN WOULD THEN WRITE AN ORDER OR A PRESCRIPTION FOR A PRIVATE DUTY NURSING. NURSING ASSESSMENT A NURSING PROVIDER WOULD THEN GO TO THE CHILD'S RESIDENCE AND PROVIDE A COMPREHENSIVE ASSESSMENT TO DETERMINE THE CHILD'S NURSING NEEDS. THAT INFORMATION IS THEN REVIEWED BY THE CHILD'S MANAGED CARE ORGANIZATION OR MCO. OF NOTE, THIS SERVICE DOES REQUIRE PRIOR AUTHORIZATION, WHICH IS DESCRIBED IN DETAIL IN THE TEXAS MEDICAID PROVIDER PROCEDURES MANUAL, WHICH IS AVAILABLE ON OUR WEBSITE. PD. PD HOURS ARE INDIVIDUALLY DETERMINED BASED ON MEDICALLY NECESSARY SKILLED NURSING NEEDS. NEXT SLIDE. HERE YOU CAN SEE SOME KEY DIFFERENCES BETWEEN PRIVATE DUTY NURSING AND OTHER TYPES OF SERVICES THAT A CHILD MAY NEED. LET'S START WITH WHAT PD IS. AS YOU CAN SEE, PD IS INDIVIDUALIZED CONTINUOUS SKILLED NURSING CARE BEYOND THE LEVEL OF INTERMITTENT OR PART TIME HOME HEALTH SKILLED NURSING VISITS. NOW LET'S TALK ABOUT WHAT PD IS NOT. PD IS NOT INTERMITTENT OR PART TIME CARE, SUCH AS A NURSE VISITING TO CHECK BLOOD PRESSURE OR CHANGE A WOUND DRESSING ON A PERIODIC BASIS. PD IS ALSO NOT CHILD CARE ACTIVITIES OF DAILY LIVING, PROVIDING HOUSEHOLD CHORES, NON-SKILLED SERVICES OR TASKS THAT A HOME HEALTH AIDE, COMPANION OR HOMEMAKER COULD SAFELY DO. BEFORE I PRESENT THE DATA THAT'S THE SUBJECT OF TODAY'S PRESENTATION, I'D LIKE TO TAKE A MOMENT VERY QUICKLY TO TALK ABOUT EFFORTS OF IMPROVING ACCESS TO PRIVATE DUTY NURSING AND OTHER MEDICALLY NECESSARY SERVICES IN OUR MANAGED CARE PROGRAM. AS YOU KNOW, ONE OF THE HALLMARKS OF THE MANAGED CARE MODEL IS SERVICE AND CARE COORDINATION. [00:15:03] SOME OF THE ROLES OF SERVICE COORDINATORS INCLUDE IDENTIFYING A CHILD'S NEEDS, COORDINATING SERVICES SUCH AS PTEN, AND FOLLOWING UP ON WHETHER AUTHORIZED SERVICES ARE IN PLACE. WORKING IN CLOSE CONSULTATION WITH THAT CHILD'S PROVIDER CARE TEAM AND THE FAMILY. NEXT SLIDE. NOW I'D LIKE TO FOCUS ON THE DATA THAT WE HAVE TO SHARE. STAKEHOLDERS HAVE REQUESTED DATA THAT SHOWS HOW MANY HOURS MEDICAID MANAGED CARE ORGANIZATIONS AUTHORIZE FOR PDN SERVICES COMPARED TO THE NUMBER OF HOURS ACTUALLY STAFFED. TO BETTER UNDERSTAND THIS, WE ANALYZED MANAGED CARE ORGANIZATIONS, SELF-REPORTED DATA RELATED TO PRIVATE DUTY, NURSING AUTHORIZATION, BILLING AND PAYMENT, AND WE REVIEWED DATA FOR STATE FISCAL YEARS 2023 AND 2024. ACROSS THE STAR, STAR KIDS AND STAR HEALTH PROGRAMS. NEXT SLIDE PLEASE. HERE ON THE RIGHT, YOU CAN SEE WHAT WE AFFECTIONATELY REFER TO AS OUR FUNNEL DIAGRAM, WHICH IS REPRESENTATIVE OF ALL UNITS OF PRIVATE DUTY NURSING AGGREGATED ACROSS STAR, STAR KIDS AND STAR HEALTH. AND ON THAT FUNNEL DIAGRAM, YOU CAN SEE THAT THERE'S THE TOTAL NUMBER OF UNITS AUTHORIZED, THEN THE NUMBER OF UNITS BILLED, AND THEN THE NUMBER OF UNITS THAT WERE PAID. AND WE'RE USING UNITS BILLED AND UNITS PAID AS A PROXY MEASURE FOR HOURS OR UNITS THAT WERE ACTUALLY STAFFED. AND THE KEY FINDING WAS THAT OUT OF ALL PD N SERVICES AUTHORIZED, 69% WERE BILLED AND 68% WERE PAID. AND ON THE BOTTOM RIGHT, YOU CAN SEE THE TOTAL NUMBER OF UNITS AUTHORIZED FOR EACH OF THOSE FISCAL YEAR. EACH BROKEN OUT BY UNITS BILLED AND ALSO UNITS PAID. AS IS THE CASE WITH ANY DATA SET. THIS DATA HAS SEVERAL IMPORTANT LIMITATIONS. FIRST, THIS DATA WAS SELF-REPORTED BY THE MCOS. DUE TO SYSTEM LIMITATIONS, WE WERE UNABLE TO INDEPENDENTLY VALIDATE THE ACCURACY OF THE DATA. ON THIS NOTE, HHS HAS BEEN WORKING IN COLLABORATION WITH THE MCOS TO OPERATIONALIZE A PRIOR AUTHORIZATION DATA MART THAT WILL LIKELY HELP THE AGENCY BETTER UNDERSTAND INFORMATION SUCH AS THIS. WE ANTICIPATE THAT DATA MART WILL BE OPERATIONAL NEXT YEAR. THE RATE THAT WE DISCUSSED ALSO DOES NOT ACCOUNT FOR SITUATIONS WHERE THE CAREGIVER DECLINED THE NURSING SERVICE FOR WHATEVER REASON, OR AN INSTANCE WHERE A CHILD WAS HOSPITALIZED. AND NOW I'D LIKE TO CALL OUT A FEW TRENDS THAT ARE NOT PICTURED HERE. FIRST, THERE WAS SOME VARIABILITY ACROSS SERVICE DELIVERY AREAS. OUR STATE IS DIVIDED UP INTO MULTIPLE SERVICE DELIVERY AREAS, IN WHICH SOME OF THE MCOS WILL OPERATE ACROSS SOME OF THE PROGRAMS I DESCRIBED. SO THERE WAS SOME VARIABILITY. WE SAW THAT RATES SEEM TO BE LOWER IN MORE RURAL AREAS OF THE STATE, BUT THAT WASN'T THE CASE FOR ALL RURAL SERVICE AREAS. WE ALSO SAW VARIABILITY BETWEEN INDIVIDUAL MCOS AND BETWEEN PLANS THAT PARTICIPATE IN STAR KIDS AND STAR VERSUS PLANS THAT ONLY PARTICIPATE IN THE STAR PROGRAM. AND JUST FOR BACKGROUND AND CONTEXT, OUR STAR KIDS PROGRAM IS OUR PROGRAM FOR CHILDREN WITH MEDICAL COMPLEXITY, AND OUR STAR PROGRAM IS LARGELY MADE UP OF HEALTHY, TYPICALLY DEVELOPING CHILDREN, PREGNANT AND POSTPARTUM WOMEN, AS WELL AS PARENT AND CARETAKER RELATIVES. GENERALLY SPEAKING, THERE IS A FAR LOWER NUMBER OF CHILDREN IN THE STAR PROGRAM RECEIVING PRIVATE DUTY NURSING THAN IS THE CASE FOR THE STAR KIDS PROGRAM, AND THIS MEANS THAT THERE ARE FEWER UNITS OVERALL TO BE STAFFED. I'D LIKE TO NOW DISCUSS SOME NEXT STEPS AND SHARE A FEW OTHER THOUGHTS. WE APPRECIATE CONTINUED ENGAGEMENT WITH STAKEHOLDERS THROUGH PUBLIC MEETINGS SUCH AS THIS AND SOME OF OUR KEY ADVISORY COMMITTEE MEETINGS. WE ALSO APPRECIATE THE INPUT AND SUGGESTIONS RECEIVED FROM STAKEHOLDERS THROUGH SUBMISSIONS, THROUGH OUR TOPIC, NOMINATION PROCESS, PUBLIC COMMENT, AND OTHER FORUMS. WE ALSO APPRECIATE THE MCOS HAVE BEEN PARTNERING WITH PRIVATE DUTY NURSING PROVIDERS THROUGH ALTERNATIVE PAYMENT MODELS, BY WHICH NURSING AGENCIES CAN EARN ADDITIONAL DOLLARS ON TOP OF THEIR REGULAR PAYMENT RATE THROUGH PROMOTING QUALITY OUTCOMES, SUCH AS HELPING ENSURE A CHILD STAYS UP TO DATE WITH THEIR WELL-CHILD VISITS. WE HOPE TO SEE CONTINUED PROGRESS WITH INNOVATIVE MODELS SUCH AS THESE WITH REGARDS TO THE DATA. SPECIFICALLY, WE WILL CONTINUE TO WORK WITH INDIVIDUAL MCOS TO BETTER UNDERSTAND WHAT THIS DATA MEANS AND HOW WE CAN WORK COLLECTIVELY TO IMPROVE THE RATE OF AUTHORIZED HOURS BEING STAFFED BY IDENTIFYING ROOT CAUSES. AND WE WILL VERY MUCH CONTINUE ENGAGEMENT WITH STAKEHOLDERS ON THIS IMPORTANT TOPIC. ONCE AGAIN, THANK YOU FOR THE OPPORTUNITY TO PRESENT. THANK YOU DOCTOR. ARE THERE ANY QUESTIONS? OKAY. THANK YOU FOR BEING HERE. WE WILL NOW HEAR FROM OUR STATE MEDICAID DIRECTOR, STEPHANIE STEVENS, [00:20:03] WITH AN UPDATE ON PROVIDER REVALIDATION. GOOD MORNING EVERYONE. AND BEFORE I GET TO MY UPDATE, I WOULD JUST THANK DOCTOR LEE AND HIS TEAM FOR YOUR WORK ON PULLING THIS DATA TOGETHER. SO WE'VE BEEN SHARING INFORMATION AT THIS MEETING ABOUT OUR EFFORTS AROUND PROVIDER REVALIDATION AND WANTED TO GIVE YOU AN UPDATE TODAY AS TO WHERE THINGS STAND. AND JUST AS A REMINDER PROVIDERS ARE ENROLLED IN THE MEDICAID PROGRAM AND TYPICALLY ARE REQUIRED TO REVALIDATE TO CONTINUE TO PARTICIPATE TYPICALLY EVERY FIVE YEARS. AND IN JUNE OF THIS YEAR, WE BEGAN ENROLLING PROVIDERS WHO DO NOT TIMELY APPLY FOR THEIR REVALIDATION. AND SO WE WANTED TO SHARE SOME INFORMATION ABOUT WHAT THE DISENROLLMENTS LOOK LIKE AT THIS POINT. SINCE MID-JUNE, WE'VE DISENROLLED ABOUT 17,000 NPIS FOR NOT REVALIDATING. WE WOULD HIGHLIGHT THAT 62% OF THOSE PROVIDERS WERE INACTIVE, MEANING THEY'VE NOT BEEN PAID BY MEDICAID IN THE LAST YEAR. AND THE NEXT 60 DAYS, THERE ARE APPROXIMATELY 16,751 PROVIDERS DO FOR REVALIDATION, AND 34% ARE AT RISK OF DISENROLLMENT BECAUSE THEY HAVE NOT SUBMITTED THEIR APPLICATION. AND ABOUT 34% OF THOSE AT RISK. OF THOSE, 34% AT RISK, ABOUT HALF HAVEN'T BEEN PAID BY TEXAS MEDICAID IN OVER A YEAR. SO ARE CONSIDERED INACTIVE. SO I HAVE A COUPLE ASKS FOR ANY PROVIDERS LISTENING. PLEASE LOG IN TO THE PROVIDER ENROLLMENT MANAGEMENT SYSTEM AND CHECK YOUR REVALIDATION DATE. IF IT'S WITHIN 180 DAYS, PLEASE START THAT REVALIDATION PROCESS. YOU SHOULD RECEIVE A NOTICE ABOUT YOUR REVALIDATION DATE USING THE EMAIL ADDRESS ON FILE. SO PLEASE ALSO MAKE SURE WE HAVE ACCURATE CONTACT INFORMATION FOR YOU. AND THEN WE ALSO MAIL A LITTLE OLD FASHIONED, BUT WE ALSO SEND YOU SNAIL MAIL ABOUT YOUR REVALIDATION 90 DAYS PRIOR TO YOUR DUE DATE. AND WE ARE CONTINUING TO PROVIDE FLEXIBILITY IN THE SENSE THAT IF YOU START YOUR REVALIDATION PROCESS TIMELY, WE WILL GIVE YOU AN EXTENSION TO GET THROUGH THAT PROCESS. SO WE ARE ISSUING 60 DAY EXTENSIONS, BUT YOU NEED TO SUBMIT THE APPLICATION TIMELY TO QUALIFY FOR THOSE EXTENSIONS. AND WE'RE DOING OTHER EXTENSIVE OUTREACH, PARTICULARLY THROUGH OUR MANAGED CARE ORGANIZATIONS. SO THEY ARE GETTING DATA ABOUT THEIR PROVIDERS THAT ARE UP FOR REVALIDATION. AND THEN WE'RE ALSO SHARING INFORMATION WITH THEM ABOUT HIGH BILLING PROVIDERS. SO THOSE PROVIDERS THAT ARE REALLY ACTIVE IN MEDICAID AND ARE PAID MORE THAN $1 MILLION SO THAT THEY CAN ALSO CONDUCT TARGETED OUTREACH TO PROVIDERS. SO I WOULD ALSO SAY WE, WE DO ACKNOWLEDGE THAT THERE ARE CHALLENGES IN THE ENROLLMENT AND REVALIDATION PROCESS AROUND TIMELINESS AND SYSTEMS ISSUES. SO WE HAVE AN EFFORT UNDERWAY TO REDESIGN THE WHOLE PROVIDER ENROLLMENT MANAGEMENT SYSTEM THAT THAT'S SET TO DEPLOY NEXT YEAR. BUT IN THE MEANTIME, WE ARE LOOKING AT HOW WE CAN CONTINUE TO PROCESS THOSE APPLICATIONS MORE TIMELY AND HOW WE CAN ADDRESS ANY SYSTEMS ISSUES THAT ARE CAUSING SIGNIFICANT ISSUES. SO THAT'S OUR STANDARD PROVIDER REVALIDATION PROCESS. AND THE CENTERS FOR MEDICARE AND MEDICAID SERVICES EARLIER THIS YEAR ALSO REACHED OUT TO STATES AND REQUESTED THAT STATES PERFORM OFF CYCLE REVALIDATION FOR CERTAIN HIGH RISK PROVIDERS. SO WE HAVE SUBMITTED OUR PLAN TO CMS. THAT PLAN IS AVAILABLE ON THE WEBSITE. BUT THIS MEANS THAT CERTAIN PROVIDERS MAY BE REQUIRED TO REVALIDATE OFF CYCLE. AND WE WILL BE SENDING OUT NOTICES TO THOSE PROVIDERS. THOSE NOTICES ARE SCHEDULED TO BEGIN IN NOVEMBER. AND WE WILL ALSO BE SENDING OUT COMMUNICATIONS THROUGH TMHP OUR VENDOR, AS WELL AS THROUGH OUR HHS GOV DELIVERIES. SO IF YOU RECEIVE A NOTICE, PLEASE RESPOND TO THAT NOTICE. AS I MENTIONED, WE DO RECOGNIZE THAT THERE ARE SOME DATA ISSUES. AND SO WE ARE WORKING THROUGH THOSE DATA ISSUES. AND THAT ALSO MAY TRIGGER A REVALIDATION REQUIREMENT. AND SO WE WILL NOTIFY YOU IF YOU ARE IN THAT CATEGORY. IF THERE'S DATA THAT IS CORRECTED AND YOU NEED TO TAKE ANY ACTION. [00:25:02] WE ARE ALSO PROVIDING CMS UPDATES AND THOSE UPDATES ARE AVAILABLE ON OUR WEBSITE. SO IF YOU'RE WONDERING ABOUT THE STATUS OF THESE REVALIDATION EFFORTS. YOU CAN FIND THAT INFORMATION ON OUR WEBSITE AS WELL. SO THANK YOU. THANK YOU STEPHANIE. ANY QUESTIONS? THANK YOU FOR THAT UPDATE. WE ARE GOING TO MOVE ON TO AGENDA ITEM THREE RULE RULES PROPOSALS. [3. Rule proposals] FIRST WE HAVE CHRISTY CARR WHO WILL PROVIDE A SUMMARY ON A PROPOSAL CONCERNING RESIDENTIAL TREATMENT FACILITIES. GOOD MORNING, CHIEF DIXON AND MEMBERS OF THE COUNCIL. MY NAME IS CHRISTY CAR. I SERVE AS THE ASSOCIATE COMMISSIONER OVERSEEING THE STATE HOSPITAL. TEXAS HEALTH AND HUMAN SERVICES COMMISSION IS PROPOSING NEW RULES IN TITLE 26. PART ONE, CHAPTER 306 SUBCHAPTER J CONCERNING RESIDENTIAL TREATMENT FACILITIES. THE PROPOSED PROJECT IS TO DESIGNATE THE TERRELL CENTER FOR YOUTH AS A RESIDENTIAL TREATMENT FACILITY IN ACCORDANCE WITH HOUSE BILL 109 AND SENATE BILL ONE OF THE 89TH LEGISLATURE REGULAR SESSION FROM 2025. HOUSE BILL 109 PROVIDES THAT HHS DESIGNATES STATE FACILITIES FOR USE AS RESIDENTIAL TREATMENT FACILITIES FOR ADOLESCENTS WITH SIGNIFICANT BEHAVIORAL OR MENTAL HEALTH NEEDS. THE PROPOSED RULES GOVERN THE ADMISSION, TREATMENT, EDUCATIONAL SERVICES AND DISCHARGE OR TRANSFER OF ADOLESCENTS SERVED BY THE CENTER FOR YOUTH. THEY ALSO DESCRIBE A MEMORANDUM OF UNDERSTANDING, SPECIFYING THE ROLES AND RESPONSIBILITIES OF THE TEXAS DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES AND THE TERRELL CENTER FOR YOUTH. THE PUBLIC BENEFIT WILL BE AN INCREASE IN APPROPRIATE AND UNINTERRUPTED PLACEMENT OPTIONS FOR ADOLESCENTS WITH HIGH ACUITY WHO ARE IN THE CONSERVATORSHIP OF THE TEXAS DEPARTMENT OF PROTECTIVE AND FAMILY SERVICES. THAT CONCLUDES MY REMARKS, CHIEF. THANK YOU. CHRISTY. OKAY. NEXT WE WILL HEAR FROM TIFFANY FORD WHO WILL PROVIDE A SUMMARY ON SHRIMP LABELING. GOOD MORNING. MY NAME IS TIFFANY FORD. I'M A COMPLIANCE OFFICER WITH THE MANUFACTURED FOODS PROGRAM WITHIN THE DSHS CONSUMER PROTECTION DIVISION, THE TEXAS HEALTH AND HEALTH AND HUMAN SERVICES COMMISSION, ON BEHALF OF THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES, PROPOSES AN AMENDMENT AND NEW RULES IN TEXAS. ADMINISTRATIVE CODE, TITLE 25, PART ONE. CHAPTER 229 CONCERNING SHRIMP LABELING. THIS RULE PROJECT WAS INITIATED TO IMPLEMENT SENATE BILL 823 FROM THE 89TH REGULAR LEGISLATIVE SESSION, WHICH PROHIBITS FOOD SUPPLIERS FROM SELLING SHRIMP IN TEXAS UNLESS THE SHRIMP'S LABEL CLEARLY STATES WHETHER THE SHRIMP IS IMPORTED. ADDITIONALLY, IT PROHIBITS RESTAURANTS FROM LABELING OR REPRESENTING IMPORTED SHRIMP AS DOMESTIC SHRIMP. AND THOSE ARE ALL MY COMMENTS. THANK YOU. TIFFANY. QUESTIONS? OKAY. BRIANNA WILL NOW PRESENT A SUMMARY CONCERNING BULK MILK REGULATIONS. GOOD MORNING. I AM BRIANNA HALL, MILK OPERATIONS MANAGER WITHIN THE CONSUMER PROTECTION DIVISION AT THE DEPARTMENT OF STATE HEALTH SERVICES, DSHS IS UPDATING RULES RELATED TO BULK MILK REGULATIONS BY PROPOSING AN AMENDMENT TO RULES IN TITLE 25 OF THE TEXAS ADMINISTRATIVE CODE. TITLE 25 PART ONE. SUBCHAPTER 217 SORRY. CHAPTER 217. SUBCHAPTER D CONCERNING BULK MILK REGULATIONS. THE PROPOSED AMENDMENTS ALIGN BULK MILK REGULATIONS WITH THE FEDERAL GRADE A PASTEURIZED MILK ORDINANCE, AND CURRENT INDUSTRY PRACTICES. PROPOSAL PROJECT 26 R 066 UPDATES TERMINOLOGY, IMPROVES CLARITY, AND INCORPORATES PLAIN LANGUAGE REVISIONS TO ENHANCE READABILITY AND UNDERSTANDING. THE PROPOSED AMENDMENTS ALSO REMOVE. DUPLICATE OR UNNECESSARY PROVISIONS AND CLARIFY EXISTING REQUIREMENTS WITHOUT CREATING NEW REGULATORY OBLIGATIONS. THANK YOU BRIANNA. AND I SHOULD JUST NOTE THAT THE, THE PAST THREE [00:30:10] RULE PROPOSALS ON RESIDENTIAL TREATMENT FACILITIES FROM LABELING AND THE BULK MILK REGULATIONS BRIANNA JUST SPOKE ABOUT ARE PROPOSALS THAT HAVE BEEN SUBMITTED TO THE TEXAS REGISTER WITH A OPEN PUBLIC COMMENT PERIOD. CURRENTLY ITEMS IN THREE B AGENDA ITEM THREE B ARE RULE PROPOSALS SUBMITTED TO THE TEXAS REGISTER BUT NOT PUBLISHED. THE PUBLIC COMMENT PERIOD HAS NOT OPENED. WE HAVE ONE RULE IN THAT CATEGORY. JOANNE HANCOCK WILL PRESENT BOTH SUMMARIES FOR THIS AGENDA ITEM. THE FIRST CONSENT CONCERNING TEXAS RADIATION ADVISORY BOARD CONSOLIDATION AND THEN INDUSTRIAL RADIATION MACHINES. JOANNE. GOOD MORNING. I'M JOANNE HANCOCK, DIRECTOR OF THE RADIATION SECTION OF THE CONSUMER PROTECTION DIVISION FOR THE DEPARTMENT OF STATE HEALTH SERVICES. THE FIRST PROPOSAL FOR 26063 AIMS TO IMPROVE PUBLIC ACCESS TO DSHS ADVISORY COMMITTEE, COUNCIL, OR TASK FORCE AND BOARD ROLES BY MOVING ALL ADVISORY COMMITTEE, COUNCIL TASK FORCE OR BOARD ROLES INTO A SINGLE CHAPTER. DSHS IS RELOCATING THE CURRENT TEXAS RADIATION ADVISORY BOARD. TRAB ROLE FROM TEXAS ADMINISTRATIVE CODE, TITLE 25, CHAPTER 289 TO 25. TAK. CHAPTER THREE. THE NEW TRAB RULE IS UPDATED TO ALIGN WITH THE HEALTH AND HUMAN SERVICES ADVISORY COMMITTEE RULE TEMPLATE. MINOR CHANGES INCLUDING ADDING ADDING SUBSECTION H REQUIRING TRAINING AND SUBSECTION M DATE OF ABOLISHMENT. TRAB IS ESTABLISHED BY STATUTE, IS NOT SUBJECT TO ABOLISHMENT AND WILL REMAIN IN EFFECT AS LONG AS STATE LAW REQUIRES IT. THIS RULE APPLIES SPECIFICALLY TO THE TRABS ORGANIZATION AND OPERATIONS AND WAS PRESENTED TO THE TRAB ON APRIL 17TH, 2026. TRAP IS AWARE OF THE PROPOSED RULE, RELOCATION AND UPDATES. NO COMMENTS WERE RECEIVED FROM THE TRIBE MEETING. THE PROPOSAL WILL OPEN THE PUBLIC COMMENT FROM OCTOBER 23RD THROUGH NOVEMBER 23RD. ANY QUESTIONS? NO QUESTIONS. OKAY. THE NEXT ONE IS DSHS IS UPDATING SECTION 289.228. RADIATION SAFETY REQUIREMENTS FOR INDUSTRIAL RADIATION MACHINES. THE PROPOSED AMENDMENT UPDATES AND MODERNIZES THE RULE BY REORGANIZING REQUIREMENTS BY MACHINE TYPE, REMOVING THE MINIMAL THREAT CATEGORY, UPDATING TERMINOLOGY AND CLARIFYING DEFINITIONS. THE PROPOSAL ALSO CLARIFIES REQUIREMENTS FOR TRAINING, DOCUMENTATION, OPERATION PROCEDURE AND EQUIPMENT AND SAFETY DEVICE TESTING, INCLUDING PROVISIONS ADDRESSING BOMB DETECTION DEVICES. WHOLE BODY SECURITY SCANNERS AND OCCUPATION VEHICLE SCREENING. THE PROPOSED RULE CHANGES CHANGES ALIGN WITH CURRENT INSPECTION CRITERIA AND PROVIDE TRANSPARENCY AND COMPLIANCE AND ENFORCEMENT REQUIREMENTS. DSHS PRESENTS THE DRAFT ROLE TO THE TEXAS EXCUSE ME. DSHS PRESENTED THE DRAFT RULE TO THE TEXAS RADIATION ADVISORY BOARD ON APRIL 21ST, 2026. THE DRAFT RULE WAS POSTED TO THE HHS RULE PAGE FOR AN INFORMAL COMMENT PERIOD JUNE 11TH THROUGH 23RD DSHS RECEIVED FOR COMMENTS. ALL COMMENTS WERE REVIEWED AND INCORPORATED INTO THE PROPOSAL. THE PROPOSAL WILL OPEN FOR PUBLIC COMMENT OCTOBER 23RD THROUGH NOVEMBER 23RD. QUESTIONS. OKAY. THANK YOU. THANK YOU FOR BEING HERE. WE WILL NOW MOVE ON TO AGENDA ITEM FOUR ADVISORY COMMITTEE REPORTS. [4. Advisory Committee Reports] DOCTOR JADA JACKSON, THE TEXAS RESPITE ADVISORY COUNCIL CHAIR, WILL PRESENT THE RECOMMENDATIONS PREPARED BY I COUNCIL MEMBERS. THANK YOU. GOOD MORNING EVERYONE. I'M DOCTOR JADA JACKSON. I CURRENTLY SERVE AS CHAIR OF THE TEXAS RESPITE ADVISORY COMMITTEE. OR TRACK. TRACK ASSIST HHS IN DEVELOPING STRATEGIES TO REDUCE BARRIERS TO RESPITE SERVICE ACCESS. IMPROVE THE QUALITY OF RESPITE SERVICES. PROVIDE TRAINING, EDUCATION, AND SUPPORT TO FAMILY CAREGIVERS. I REALLY APPRECIATE THE OPPORTUNITY TO PRESENT THE COMMITTEE'S ANNUAL REPORT RECOMMENDATIONS. THE REPORT WAS DEVELOPED AND APPROVED BY TRACK MEMBERS THROUGH DISCUSSION DURING REGULAR SCHEDULED MEETINGS HELD IN ACCORDANCE WITH THE TEXAS OPEN MEETINGS ACT. THE REPORT WAS SUBMITTED TO THE AGENCY AS REQUIRED BY SECTION THAT 0 TO 0 FIVE OF THE TEXAS GOVERNMENT CODE. THE OPINIONS AND RECOMMENDATIONS EXPRESSED IN THE REPORT ARE THOSE OF TRACK MEMBERS [00:35:04] AND DO NOT REFLECT THE VIEWS OF HHS OR THE HHS EXECUTIVE COUNCIL. NOW, BEFORE PRESENTING THE RECOMMENDATIONS, I WOULD LIKE TO DEFINE RESPITE BRIEFLY. ACCORDING TO THE ARCH NATIONAL RESPITE NETWORK AND RESOURCE CENTER, RESPITE CARE IS PLANNED OR EMERGENCY CARE PROVIDED TO A CHILD OR ADULT TO OFFER TEMPORARY RELIEF TO FAMILY CAREGIVERS. SO IN PRACTICAL TERMS, RESPITE GIVES CAREGIVERS TIME TO MEET PERSONAL NEEDS, ATTEND APPOINTMENTS, REST OR SPEND TIME WITH FAMILY AND FRIENDS. THESE BRIEF BREAKS CAN BE ESSENTIAL TO SUSTAINING CAREGIVERS OVER TIME. THE ANNUAL REPORT EXAMINES THE CURRENT STATE OF RESPITE CARE IN TEXAS, INCLUDING ACCESS TO SERVICES, FUNDING, WORKFORCE CHALLENGES AND OPPORTUNITIES TO SUPPORT BETTER CAREGIVERS AND IN THE INDIVIDUALS WHO RELY ON THEM. TODAY, I WILL BRIEFLY HIGHLIGHT FOUR RECOMMENDATIONS FOR CONSIDERATION. ONE. HHS SHOULD REQUEST ADDITIONAL STATE GENERAL REVENUE FOR THE AGENCY'S RESPITE RELATED PROGRAMS DURING THE 90TH LEGISLATIVE SESSION. CURRENT STATE FUNDING FOR RESPITE RELATED PROGRAMS IS NOT SUFFICIENT TO MEET THE LEVEL OF NEED ACROSS TEXAS. LIMITED FUNDING MAY CONTRIBUTE TO LONGER INTEREST LIST. FEWER AVAILABLE SERVICE HOURS AND REDUCED ACCESS FOR FAMILIES SEEKING SUPPORT. ADDITIONAL STATE GENERAL REVENUE WOULD HELP STRENGTHEN ACCESS TO RESPITE SERVICES AND SUPPORT THE STABILITY OF THESE PROGRAMS. IT WOULD ALSO HELP TO ADDRESS WORKFORCE CHALLENGES THAT AFFECT SERVICE AVAILABILITY, INCLUDING LOW WAGES, RECRUITMENT BARRIERS, TURNOVER AND LIMITED TRAINING OPPORTUNITIES. TWO. HHS SHOULD ADOPT STRATEGIES TO ATTRACT AND RETAIN SKILLED RESPITE WORKERS AND COLLABORATE WITH THE TEXAS WORKFORCE COMMISSION TO DEVELOP A CAREER PATH MODEL FOR INDIVIDUALS INTERESTED IN THE RESPITE CARE WORKFORCE. NOW, THE SHORTAGE OF QUALIFIED RESPITE WORKERS CONTINUES TO AFFECT SERVICE DELIVERY. AN ESTIMATED 6.5 MILLION TEXANS BENEFIT FROM SOME FORM OF CAREGIVER SUPPORT. EXCUSE ME. AND CAREGIVERS PLAY A CRITICAL ROLE IN HELPING INDIVIDUALS REMAIN SAFE, HEALTHY, AND CONNECTED TO THEIR COMMUNITIES. HOWEVER, CAREGIVING CAN BE DEMANDING AND RESPITE SERVICES ARE DIFFICULT TO SUSTAIN WITHOUT A STABLE WORKFORCE. A CAREER PATH MODEL COULD HELP BUILD AND RETAIN THIS WORKFORCE. A STRUCTURED MODEL THAT INCLUDES CREDENTIALS, TIERED TRAINING AND HANDS ON EXPERIENCE WOULD GIVE WORKERS A CLEARER PATH FOR PROFESSIONAL GROWTH WHILE HELPING PROVIDERS RECRUIT AND RETAIN QUALIFIED STAFF. COLLABORATION WITH THE TEXAS WORKFORCE WORKFORCE COMMISSION AND OTHER WORKFORCE PROGRAMS COULD EXPAND ACCESS TO TRAINING, APPRENTICESHIPS AND PAID INTERNSHIPS, INCLUDING IN RURAL AREAS WHERE SERVICE OPTIONS MAY BE LIMITED. THREE. HHS SHOULD ENHANCE THE TAKE TIME TEXAS WEBSITE. THE TAKE TIME TEXAS WEBSITE, EXCUSE ME, IS A VALUABLE RESOURCE, AND WE ALL UNDERSTAND THAT IT'S A RESOURCE FOR CAREGIVERS SEEKING RESPITE SERVICES. ENHANCEMENT TO THE WEBSITE COULD IMPROVE ACCESSIBILITY AND USABILITY BY ALLOWING CAREGIVERS TO SEARCH BY LOCATION TYPE OF CARE AND SERVICE AVAILABILITY. REGULARLY UPDATED PROVIDER INFORMATION WOULD ALSO BE HELPFUL. AND IN REDUCING THE FRUSTRATION OF CAREGIVERS AND MAKE IT EASIER FOR FAMILIES TO IDENTIFY SERVICES CURRENTLY AVAILABLE AND APPROPRIATE TO THEIR NEEDS. FINALLY, FOR HHS SHOULD UTILIZE TECHNOLOGY TO ASSIST CAREGIVERS AND BROADEN SERVICE OPTIONS THROUGHOUT TEXAS. [00:40:03] THE COVID 19 PUBLIC HEALTH EMERGENCY DEMONSTRATED THAT TECHNOLOGY COULD HELP MAINTAIN ACCESS TO SERVICES WHILE REDUCING TRAVEL TIME AND COST. BUILDING ON THOSE LESSONS, HHS COULD CONSIDER A HYBRID TELEHEALTH RESPITE MODEL. WHERE APPROPRIATE, HYBRID MODEL COULD PROVE STRUCTURED, COULD PROVIDE STRUCTURED VIRTUAL ACTIVITY, SOCIAL INTERACTION, OR CAREGIVER SUPPORT DELIVERED BY TRAINED PROFESSIONALS. NOW, THIS APPROACH WOULD BE ESPECIALLY USEFUL IN AREAS WHERE IN-PERSON RESPITE OPTIONS ARE LIMITED. THIS RECOMMENDATION IS NOT INTENDED TO REPLACE TRADITIONAL RESPITE CARE, OF COURSE, BUT RATHER IT WOULD EXPAND THE RANGE OF AVAILABLE OPTIONS AND PROVIDE CAREGIVERS WITH ADDITIONAL FLEXIBILITY. IN CLOSING, TRACK RESPECTFULLY OFFERS THESE RECOMMENDATIONS TO SUPPORT STRONGER RESPITE SERVICES, IMPROVE ACCESS TO FOR CAREGIVERS AND FAMILIES, AND HELP SUSTAIN THE CAREGIVING WORKFORCE IN TEXAS. SO ON BEHALF OF TRACK MEMBERS, THANK YOU FOR YOUR TIME AND YOUR CONSIDERATION. THANK YOU, DOCTOR JACKSON. ANY QUESTIONS? I HAVE A QUESTION ON THE LAST RECOMMENDATION. DOCTOR JACKSON, I THINK THAT THE IDEA OF EXPANDING ACCESS TO RESPITE USING TECHNOLOGY IS INTERESTING. CAN YOU TALK A LITTLE BIT MORE ABOUT WHAT SPECIFIC SERVICES OR ACTIVITIES MIGHT BE APPROPRIATE FOR TELEHEALTH IN THIS SPACE? SURE, SURE. THANK YOU. THANK YOU FOR THAT QUESTION. THAT IS AN IMPORTANT QUESTION. THE REPORT ENVISIONS COMBINING PROFESSIONALLY GUIDED VIRTUAL ACTIVITIES WITH FLEXIBLE IN-PERSON SUPPORT BASED ON EACH PERSON'S NEEDS, OF COURSE. SO THE VIRTUAL COMPONENT MIGHT INCLUDE STRUCTURED SOCIAL INTERACTION, COGNITIVE STIMULATION, AND TAILORED THERAPEUTIC ACTIVITIES. FOR EXAMPLE, A CARE RECIPIENT MIGHT PARTICIPATE IN A GUIDED CONVERSATION MIGHT PARTICIPATE IN MEMORY ACTIVITIES OR AN INTERACTIVE GROUP SESSION WHILE THEIR CAREGIVER CAREGIVER TAKES A SHORT BREAK NEARBY. NOW, OF COURSE, I THINK FOR SOMEONE WHO NEEDS HANDS ON ASSISTANCE OR CONTINUOUS SUPERVISION AND IN-PERSON RESPITE, WORKER WOULD REMAIN PRESENT WHILE A REMOTE PROFESSIONAL LEADS THE ACTIVITY. SO MOBILE RESPITE TEAMS OR OR OR TRAINED COMMUNITY VOLUNTEERS COULD ALSO PROVIDE COVERAGE WHEN CAREGIVERS NEED LONGER BREAKS. BUT THE KEY IS OBVIOUSLY MATCHING THE MODEL TO THE INDIVIDUAL. SO FOR VIRTUAL ENGAGEMENT ALONE WOULD NOT MEET THE NEEDS OF SOMEONE, SAY, WHO REQUIRES PHYSICAL ASSISTANCE OR CANNOT SAFELY PARTICIPATE WITHOUT SUPERVISION. SO AS AN IMPLEMENTATION IMPLEMENTATION STEP WE SUGGEST THAT, YOU KNOW, MAYBE HHS PILOT THE MODEL IN UNDERSERVED COMMUNITIES AND ASSESS ACCESSIBILITY, SAFETY, PARTICIPATION. AND AND I THINK WHAT'S IMPORTANT TO THE ACTUAL RELIEF OF THE CAREGIVERS, YOU KNOW, THE, THE RELIEF THAT THEY, THEY RECEIVE. SO THE MEASURE OF SUCCESS SHOULD BE MEANINGFUL, MEANINGFUL, OF COURSE, FOR THE CAREGIVER, NOT SIMPLY NUMBER A NUMBER OF VIRTUAL SESSIONS DELIVERED. I HOPE I ANSWERED YOUR QUESTION. YES. YOU DID. THANK YOU. THANK YOU FOR THE WORK YOU AND THE COUNCIL PUT INTO THIS REPORT AND FOR THOSE RECOMMENDATIONS. THANK YOU VERY MUCH. WE WILL MOVE TO AGENDA ITEM FIVE PUBLIC COMMENT. KAYLA, ARE THERE ANY PUBLIC COMMENT CARDS? NO, MA'AM. WE HAVE NO PUBLIC COMMENT CARDS FOR THIS MEETING. OKAY. WELL, THANK YOU, COUNCIL MEMBERS, FOR YOUR TIME. THANK YOU, DOCTOR JACKSON FOR BEING HERE. ALL BUSINESS HAS BEEN COMPLETED. PLEASE NOTE FOR THE RECORD THAT AT 10:56 A.M., THIS MEETING IS ADJOURNED. * This transcript was compiled from uncorrected Closed Captioning.