Joint Committee on Access and Forensic ServicesDRAFT Meeting #9 Minutes

Wednesday, September21, 2016

9:00 a.m. to 3:00 p.m.

Austin State Hospital Campus

Building 582

West Auditorium

909 West 45th Street

Austin, Texas 78714

Agenda Item 1:Opening remarks and introductions

The Joint Committee on Access and Forensic Services (JCAFS) meeting commenced at
9:18 a.m. Committee ChairDonald Lee welcomed everyone to the meeting.

Mr. John Chacón, Enterprise Facilitation Services Office, Health and Human Services Commission (HHSC), announced that the meeting was being conducted in accordance with the Texas Open Meetings Act, and noted that a quorum was not present for the meeting.
Table 1 notes Committee member attendance.

Table 1: JCAFS member attendance at the Wednesday, September21, 2016 meeting.

MEMBER NAME / YES / NO / MEMBER NAME / YES / NO
Allison, Jim / X / Lee, Donald / X
Burkeen, Honorable Daniel / P / X / Lewis, Kathryn-called in @12:42 pm / P
Cusumano, Sherry / X / McLaughlin, Darlene MD / X
Davis, Lorie / X / Oncken, Denise -got off call @ 12:10 pm / P
Davis, Susan JD / X / Schnee, Steven PhD / X
Desai, Tushar MD / X / Smith, Shelley / X
Faubion, Matthew MD / X / Smith, James / X
Foley, Erin PhD / X / Suiter, Honorable Wes / X
Gentry, Michael / X / Switzer, Gyl - got off call @ 12:10 pm / P
Glazier, Stephen M. / X / Taylor, Sally MD / X
Hall, Jerry / X / Wilson, Sheriff Dennis / X
Holcomb, Valerie / P / Zamora, April / X
Holstein, Nicholas / X

Yes: Indicates attended the meetingNo: Indicates did not attend the meeting

P: Indicates phone conference call

Agenda Item 2:Approval of minutes from August 31, 2016 Joint Committee meeting

Mr. Lee noted that a quorum was not present to approve minutes from the previous meeting. Mr. Lee noted that this agenda item would be included at the October 26th meeting

Agenda Item 9:System spotlight - Supported Decision Making Transition Program

Ms. Rebecca McGinnis and Andrea Freeman provided a presentation on the Patient Support Program for Decision Making and Support Services, and referred to the power point presentation that was emailed and included in a packet for committee members.

Highlights of the update and discussion included:

  • Many judges will not appoint a guardian for someone with only a psychiatric diagnosis, requiring the presence of an additional neurocognitive diagnosis such as dementia, traumatic brain injury, Parkinson’s, or stroke.
  • Supported Decision Making (SDM) is appropriate for individuals who have the capacity to give informed consent. This is an agreement which does not require approval through the courts and provides a supporter to give the individual tools and counsel for making decisions independently.
  • In the future, the vision is to involve peer specialist staff to participate in the development of the program and the program itself.
  • For individuals on court-ordered medication, it is important to be clear if the individual is willing to comply without the structure of the state hospital.
  • This program is appropriate for a limited group of patients, and finding alternative placements in the community can be a challenge.
  • Committee members expressed interest in receiving data regarding the patient population that might benefit from this program.

Agenda Item 3:Public Comment

No public comment was provided at this time.

Agenda Item 4:Update on individuals waiting for inpatient services

Ms. Lauren Lacefield Lewis provided an overview of exceptional items pertaining to mental health and substance abuse included in the agency Legislative Appropriations Request (LAR) and referred to a DRAFT document not for public distribution titled "Overview of Exceptional Items Related to Mental Health, Substance Use, and Inpatient Hospital Services".

Highlights of the update and discussion included:

  • The agency’s LAR is a good starting point.
  • The number of beds the agency is requesting is not enough to meet the need.
  • There are gaps in the continuum of care that are not addressed in the agency’s LAR.
  • Step-down beds are critical and cost effective, and the absence of such beds is feeding recidivism. Adding subacute beds to the continuum of care is cheaper and frees up acute beds for those needing that level of care.
  • More civil beds are also needed at the state hospitals. If civil patients cannot access inpatient care at the state hospitals, many will get arrested and the demand for forensic beds will increase.
  • If civil beds are not available, it is more difficult to get charges dropped for patients when that is the appropriate option.
  • An increasing number of patients are funded only by General Revenue, which is making it more difficult to meet the criteria for earning Medicaid Disproportionate Share Hospital payments.
  • One benefit of treating patients with Hepatitis C in the community is that LMHAs can get medication through Patient Assistance Programs and the state hospitals cannot.
  • Local authorities are achieving large cost offsets through Patient Assistance Programs. Because a number of medications covered by those programs are nearing the end of their patent periods, local communities are at risk of losing a significant portion of these benefits.
  • Many patients held in jail acquire additional charges due to compliance issues.
  • When possible, patients receiving inpatient competency restoration services are transitioned to outpatient programs when they are stable. However, courts are not always timely in responding to requests to modify commitment orders.
  • The primary reason that potentially eligible individuals are not going to Outpatient Competency Restoration programs is that they are refusing medication.
  • It would be helpful if more jails pursued and administered court-ordered medication.
  • Many courts and jails are not aware of the option of court-ordered medication; this might be an appropriate topic to address in the curriculum required by SB 1507.
  • When individuals are restored to competency and discharged back to jail, it is important for the LMHA to go in immediately to provide information and support to ensure they stay on their medication and remain competent to stand trial.
  • It is important to have the infrastructure needed to maximize opportunities for telemedicine.
  • Any additional beds funded through the LAR will not be available until fiscal year 2018; more beds are needed this year.

Agenda Item 4Public Comment

Ms. Katherine Ligon, Mental Health Policy Analystfrom the Center for Public Policy Priorities provided oral comments in support of the exceptional items presented.

Agenda Item5:Discussion of a letter of advice from the committee regarding the crisis in inpatient capacity and the backlog for forensic hospital admissions

Mr. Don Lee led a discussion of a draft letter of advice from the committee regarding the crisis in inpatient capacity and the backlog for forensic hospital admissions.

  • Members provided initial feedback on draft letter and agreed to send suggested revisions to Mr. Lee, who will prepare a draft for members of the committee (excluding those who are state employees if they so desire) to consider.
  • Mr. Don Lee indicated he would want to have the letter approved before the October 26, 2016 JCAFS meeting, which would require a teleconference call with a quorum.Mr. Lee went on to say that in the event a conference call meeting to discuss and approve letter would not be possible, that this agenda item be included to the October 26, 2016 JCAFS meeting.

ACTION Item 5: Mr. Don Lee asked HHSC and DSHS staff to set up a teleconference meeting prior to the October 26, 2016 JCAFS meeting,and send notice of meeting to committee members.

Agenda Item 6:DSHS committee updates

Due to time constraint, Ms. Tamara Allen referred members to a PowerPoint presentation outlining proposed revisions to the Utilization Review Protocol.

Action Items: Ms. Allen asked committee members to review proposed revisionsto the Utilization Review Protocol and to provide any suggested revisions at the October 26, 2016 JCAFS meeting.

Agenda Item 7:Discussion of the committee's annual report to the HHSC Executive Commissioner

Ms. Tamara Allen referred to a draft of the report, noting the updated utilization review recommendations and the placeholders for further committee recommendations.Ms. Allen noted that additional content will be added in reference to the committee’s report regarding forensic services.

Action Items:Ms. Allen asked committee members to review the annual reportand noted that the report will be discussed and voted on at the October 26, 2016 JCAFS meeting.

Agenda Item 8:Discussion of the agency's legislative report regarding theallocation methodology, utilization review protocol, and other recommendations

Dr. Erin Foley referred members to an outline of legislative requirements pertaining to the report, and noted that the content of the report will be similar to the content of thecommittee’s report. Dr. Foley noted that the committee will have an opportunity to providefeedback on a draft report at the October 26, 2016 JCAFS meeting.

Agenda Item 10:Future meetings and logistics

Mr. Don Lee informed committee members that the goal is for the committee to completeits2016 work (approving the committee’s annual report and providing input on the agency’sreport) at the October 26, 2016 JCAFS meeting. After a two month break, the committeewould reconvenein January and meet every other month or quarterly going forward.

Agenda Item11:Adjourn

Mr. Lee adjourned the meeting at 2:18p.m.

Joint Committee on Access and Forensic Services •September21, 2016 • Meeting #9Minutes • Page 1 of 4