House Appropriations Subcommittee on Article II October 6, 2014 Veronda L. Durden, Commissioner Strategic Fiscal Review

House Appropriations Subcommittee on Article IIOctober 6, 2014

Veronda L. Durden, Commissioner

Strategic Fiscal Review

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Vision and Mission

DARS VisionA Texas where people with disabilities and families with children who have developmental delays enjoy the same opportunities as other Texans to pursue independent and productive lives

DARS Mission To work in partnership with Texans with disabilities and

families with children who have developmental delays to improve the quality of their lives and to enable their full participation in society

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DARS achieves its mission by

• Assisting Texans with disabilities to find or retain employment

• Serving children with developmental disabilities and delays, Autism, and blindness to meet educational and developmental goals

• Helping Texans with disabilities live independently

• Helping survivors of traumatic brain and spinal cord injuries to regain functionality and independence

• Making disability determinations for Texans who apply for Social Security benefits

DARS services are time limited and intended to eliminate or reduce the need for ongoing supports from other public benefits and services

Mission and Responsibilities

DARS Overview

• DARS provided services to more than 560,000 Texans in fiscal year 2013—of those, about 230,000 received direct services and another 330,000 were social security disability claimants

• DARS employs more than 2,800 staff• Approximately 90 percent of staff work with direct delivery programs,

serving consumers through 146 field offices

• At 12.4 percent, the agency has a lower turnover rate than the statewide average of 17.6 percent

• Approximately 79 percent of DARS workforce has more than five years of state service and 57 percent have more than ten years of service

• Total funding for DARS for the 2014-15 biennium is $1.242 billion, of which 75 percent is federal—DARS receives most federal funds through the U.S. Department of Education and the Social Security Administration

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Strategic Fiscal Review

• DARS is currently undergoing the Sunset review process• As a result, only GR or GR-related funded programs were chosen

for Strategic Fiscal Review (SFR)• DARS programs subject to SFR:

• Autism• Blind Children’s Vocational Discovery and Development Program• Blindness Education, Screening and Treatment• Business Enterprises of Texas• Business Enterprises of Texas – Trust Fund• Comprehensive Rehabilitative Services• Deaf and Hard of Hearing Services – Education and Training• Deaf and Hard of Hearing Services – Interpreter Certification• Early Childhood Intervention – Respite

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Autism Program

• The Autism Program provides treatment services to children with autism through contracts with community organizations in six areas of Texas – Dallas, Ft. Worth, Houston, Rosenberg, Austin, and San Antonio. DARS will be expanding into El Paso and Corpus Christi in fiscal year 2015

• The goal of the program is to achieve improvements in cognitive and social functioning, with the potential to positively impact a child’s developmental trajectory

• The Autism Program serves children who:• Are three through fifteen years of age• Have a diagnosis on the autism spectrum• Are Texas residents

• Services include applied behavioral analysis (ABA) and other positive behavior support strategies in both individual or group settings

• Parent training is a requirement

• Based on pre- and post-testing, 48 to 62 percent of children exiting the program improved their social communication, motor, behavior and adaptive skills

• Autism Program contractors bill private insurance, when available, and each family must participate in the cost of services based on a sliding fee scale

• Autism Spectrum Disorder (ASD) is the fastest-growing serious developmental disability in the United States and according to the Centers for Disease Control and Prevention, 1 in 68 children may have ASD

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Autism Program

History• 2007: The Governor and the Legislative Budget Board directed the Health and

Human Services Commission to transfer $5 million to DARS to provide services, such as applied behavior analysis, to children ages three to eight with autism

• 2008: DARS awarded contracts to four community-based organizations in Dallas, Fort Worth, Houston and Rosenberg to begin services on March 13, 2008

• 2009: DARS awarded two additional contracts for services in Austin and San Antonio

• 2014: DARS began to offer two distinct services – comprehensive and focused, and performed a competitive procurement for two additional providers

Legal Citations • Human Resources Code, Chapter 111, Sec. 111.051

• Human Resources Code, Chapter 117

• Government Code, Chapter 531, Sec. 531.0055

• TAC, Title 40, Part 2, Chapter 105

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Autism Program

• In fiscal year 2014, DARS developed a plan to increase the number of children served in the program. As part of the plan, DARS worked with The University of Texas at Austin (UT) to:

• Research evidence-based treatment modalities

• Analyze outcome data for children in the Autism Program

• Make recommendations for changes to the Autism Program to serve more children with autism while continuing to make a measurable improvement in their behavior and development

• To supplement research done by UT, DARS: • Held public hearings in El Paso, Dallas, and San Antonio in January 2014 to

obtain public input

• Obtained input from current Autism Program providers

• Performed internal research on treatment for autism, and attended numerous research and professional conferences related to autism

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Autism Program

• Based on the report from UT (www.dars.state.tx.us/stakeholders/autism) and other stakeholder input, DARS has modified the Autism Program for FY 2015 to offer two distinct treatment services:

• Comprehensive ABA Services:• Serve children ages three through five • 16-20 treatment hours per week• Maximum of 24 consecutive months

• Focused ABA Services:• Serve children ages three through 15• Maximum of 30 treatment hours per month• Maximum of 24 nonconsecutive months• Children may access services at various milestones of development

• DARS will pilot an innovative treatment program in fiscal year 2015

Autism Program

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EstimatedFY 2014 GR - R

EstimatedFY 2014All Funds

BudgetedFY 2015 GR - R

BudgetedFY 2015 All Funds

FY 2014-15 GR – R

FY 2014-15 All Funds

$ 4,487,800 $ 4,487,800 $ 4,503,056 $ 4,623,056

$ 8,990,856 $ 9,110,856

Performance Measures 2013 2014 2015Number of Children Receiving Comprehensive Autism Services 199 238 181Number of Children Receiving Focused Autism Services 124Average Monthly Cost Per Child Receiving Comprehensive Services

$1,370 $1,571 $1,724

Average Monthly Cost Per Child Receiving Focused Services $591Other Measures

Average Length of Enrollment for Children Exiting Program15.2

months16.4

monthsInterest ListNumber of Children on Contractor Interest List (end of year) 1,034 1,122Funding Collected by ContractorsInsurance $287,339 $267,230

Family Cost Share $309,763 $285,948

• The Blind Children’s Vocational Discovery and Development Program (BCVDDP) serves children birth through age 22 who have a severe vision loss

• The goal of the program is to assist children with a severe vision loss to maximize their potential in education and employment

• The BCVDDP:• Provides tools, equipment, and training to help children develop the confidence

and competence needed to be an active part of their community • Works closely with schools to monitor the child’s progress• Provides training in food preparation, money management, recreational activities,

grooming, and other daily living activities • Provides information and referral to families about other resources, including

vocational rehabilitation• Approximately 77 percent of children exiting the program had a successful

closure and achieved the desired outcome of services• It is estimated that there are more than 59,000 children under the age of 17

in Texas who are blind or have a visual impairment and that number is expected to increase to more than 62,000 children by 2017

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Blind Children’s Vocational Discovery and Development Program


History• 1943: Texas began operating a program to serve children who are blind and

visually impaired

• 1990: The program enrolls as a Medicaid Targeted Case Management provider for Medicaid-eligible children who are blind and visually impaired

• 2004: Vision screening services, vision restoration services for temporary vision impairments, and respite services for parents of severely disabled blind children were eliminated to remain within available appropriation

Legal Citations• Human Resources Code, Chapter 91, Sec. 91.028• Human Resources Code, Chapter 117, Sec. 117.073• TAC Title 40, Part 2, Chapter 106, Subchapter I, §106.1401-106.1415

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EstimatedFY 2014 GR – R


BudgetedFY 2015 GR – R


FY 2014-15 GR - R


$ 4,370,275 $ 4,819,375 $ 4,392,066 $ 4,830,315

$ 8,762,341 $ 9,649,690

Performance Measures 2013 2014 2015Number of Children Receiving Blindness Services Per Year

4,417 4,334 4,311

Average Monthly Cost per Child $107 $109 $109Other MeasuresAverage Length of Service for Children Successfully Completing Planned Services

5 Years, 4 Months

5 Years, 7 Months

• The Blindness Education, Screening and Treatment (BEST) program provides vision screening and eye medical treatment services to adult Texans

• The goal of the program is to help eligible Texans prevent blindness

• BEST services include:• Non-diagnostic vision screening services• Treatment services for persons with qualifying eye conditions who do not have insurance or

other resources to pay for services

• BEST vision screenings are provided at locations across the state and, if necessary, individuals are referred to an eye care professional for further evaluation

• BEST treatment eligibility requirements:• Referral from physician or optometrist for eye medical treatment• Texas resident• A qualifying eye condition • Are not covered under an adequate health benefit plan

• The BEST program is funded with a voluntary $1 donation when Texans apply for and renew their driver’s licenses or DPS-issued identification cards

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Blindness Education, Screening and Treatment Program

History• 1997: The 75th Legislature establishes the BEST Program

• 2002: BEST eliminates education services to remain within available appropriations

Legal Citations • Human Resources Code, Chapter 91, Sec. 91.027

• Transportation Code § 521.421(j) and §521.422(b)

• TAC, Title 40, Part 2, Chapter 106, Subchapter J, §106.1601-106.1609

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Estimated FY 2014All Funds


Budgeted FY 2015 All Funds

FY 2014-15 GR - R


$ 455,789 $ 455,789 $ 400,743 $ 400,743 $ 856,532 $ 856,532

Performance Measures 2013 2014 2015Number of Consumers Receiving Screenings and Treatment Services

4,434 3,215 3,035

Average Cost of Individual Served by BEST $97 $142 $132

• The Business Enterprises of Texas (BET) program trains and licenses persons who are blind to operate vending and food service facilities on federal, state, and other properties

• The goal of the BET program is to provide business opportunities to Texans who are blind

• Eligible BET managers must:• Be blind and referred by the DARS Vocational Rehabilitation program;• Be 18 years old, a Texas resident and a U.S. citizen; and• Complete all DARS and BET assessment and training requirements

• BET managers operate 120 facilities including:• Lackland Air Force Base (San Antonio)• Internal Revenue Service Snack Bar (Austin)• NASA Snack Bar (Houston)• Alfred Hughes Prison Vending (Gatesville)

• BET businesses employ more than 1,600 Texans, many with disabilities

• The program is operated under the authority of the federal Randolph-Sheppard Act

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Business Enterprises of Texas Program

Business Enterprises of Texas Trust Fund

• The BET Trust Fund is the method by which benefits are provided to current BET managers

• Trust fund revenues are generated by the program from commissions from vending machines in Texas located exclusively on federal properties

• The annual fund disbursement is limited to revenues and interest earned during the prior year

• There are currently 118 managers in the BET program

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Business Enterprises of TexasProgram

History• 1936: Federal Randolph-Sheppard Act passed

• 1936: The first BET facility in Texas opens and the State Commission for the Blind is appointed the licensing agency

• 1979: The 66th Legislature authorizes BET facilities to operate on state properties

• 1999: BET Trust Fund created

Legal Citation• Human Resources Code, Chapter 94• TAC, Title 40, Part 2, Chapter 106, Subchapter N, §106.1901 -106.1935

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Business Enterprises of TexasProgram

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Business Enterprises of Texas





FY 2014-15 GR - R


$ 678,644 $ 2,466,839 $ 675,867 $ 2,463,605 $ 1,354,511 $ 4,930,444

Business Enterprises of Texas – Trust Fund





FY 2014-15 GR - R


$ 404,212 $ 404,212 $ 404,212 $ 404,212

$ 808,424 $ 808,424

Performance Measures 2013 2014 2015Number of Individuals Employed by BET Businesses

1,559 1,560 1,562

Average Earnings Per Business $102,008 $100,000 $99,000

Comprehensive Rehabilitation Services Program

• The Comprehensive Rehabilitation Services (CRS) program provides services to Texans who have sustained a traumatic brain injury (TBI), a traumatic spinal cord injury (SCI), or both

• The goal of the program is to help Texans with a TBI or SCI to live independently in their home and community

• CRS consumers must have a TBI or SCI, or both, and be: • At least 16 years old• A U.S. citizen and Texas resident for six months• Medically stable• Willing to participate in services

• The program focuses on three primary areas that affect both function and quality of life:

• Mobility • Self-care• Communication skills

• In fiscal years 2013 and 2014, approximately 90 percent of consumers who exited the program met their program goals and were living in a private residence

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• CRS provides time-limited services through contracts with local providers and include:

• In-patient Comprehensive Medical Rehabilitation - Medical experts provide consumers with therapy, medical care, and other help

• Outpatient Services - Therapists help consumers increase their ability to perform daily living activities through physical, occupational, speech, and/or cognitive rehabilitation

• Post-Acute Traumatic Brain Injury Services - These services help consumers deal with forgetfulness or difficulties in solving problems and other mental or thought issues related to their injury and are offered on a residential and non-residential basis

• The Comprehensive Rehabilitation Fund (CRF 107) provides approximately two-thirds of the CRS appropriation in fiscal years 2014 and 2015 and is funded by a percent of funds collected on surcharges on all misdemeanor and felony convictions

• According to the Texas Brain Injury Alliance approximately • 440,000 Texans live with a traumatic brain injury • 144,000 Texans sustain a traumatic brain injury or spinal cord injury annually• 5,700 Texans are permanently disabled by traumatic brain or spinal cord injuries

annually

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• In FY 2013, DARS initiated a CRS Redesign Project to perform a program review and implement changes in CRS

• The CRS Redesign Project was broken into two phases • Phase 1 of the project has been completed and included:

• Developing a predictive model for budgeting and planning purposes

• Identifying additional data needs and modifying systems to collect new data

• Developing weekly and monthly CRS reports to report encumbrance and payment activity

• Developing a tracking and monitoring tool which incorporates and compares projected revenues, encumbrances, and expenditures to actual revenues, encumbrances and expenditures

• Developing a monthly budget review process for central office and regional management

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• Phase II of the project began in May 2014 and includes:• Determining the core service array for post-acute brain injury (PABI) services• Developing a rate setting methodology for fiscal year 2016 based on research results• Procuring PABI contracts for FY 2016 using the new rate methodology• Developing a utilization review process – projected to be implemented for fiscal year

2017

• In Phase II, DARS is researching best practices for serving consumers who have traumatic brain and/or spinal cord injuries to assess:

• Program outcomes• Array of services to be offered• Customer base• Program priorities• CRS Program service delivery system• Rate setting methodology

• This research includes:• The structure of similar programs in other states and best practice• Recommendations for restructuring the CRS program in light of research findings• Possible impacts of the Affordable Care Act

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History• 1991: The 72nd Legislature established the comprehensive rehabilitation fund and

the Comprehensive Rehabilitation Services program begins serving persons with traumatic brain injury

• 1997: The 75th Legislature established that the source of the comprehensive rehabilitation fund would be surcharges on all misdemeanor and felony convictions and established that the Comprehensive Rehabilitation Fund 107 will receive 12.37 percent of funds collected

• 2003: The 78th Legislature increased the surcharge and the percent of the collections that go into fund 107 was decreased to 5.3218 percent (revenue neutral)

• 2011: The 82nd Legislature increased the percent of collections that go into fund 107 to 9.8218 percent generating additional revenue

Legal Citation• Human Resources Code, Chapter 111, Sec. 111.052 and 111.060

• TAC, Part 2, Title 40, Chapter 107, Subchapter D

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FY 2014-15 GR - R


$ 22,932,115 $ 23,260,588 $ 26,570,894 $ 26,689,374

$ 49,503,009 $ 49,949,962

Performance Measures 2013 2014 2015Number of Consumers Served 908 938 1,003Average Monthly Cost per Consumer Receiving Services

$3,740 $4,232 $4,228

Other MeasuresAverage Length of Service for Consumers Who Met Their Goals and Were Discharged in Each Fiscal Year

10.8 Months 13.6 Months

Number of Consumers Who Met Their Goals and Who Were Living in a Private Residence at Closure

430 (91%) 290 (91%)

Number of Consumers Who Met Their Goals 471 371Wait/Interest ListNumber of Consumers on Waiting List as of 8/31/14 0Number of Consumers on Interest List as of 8/31/14 203

Deaf and Hard of Hearing Services Education Program

• The Deaf and Hard of Hearing Services Education Program trains public/private entities about hearing loss, effective communication, and accessibility

• The goal of the program is to promote access to services for people who are deaf or hard of hearing in order that they remain independent in their homes and communities

• The program provides: • Education and training to persons who are deaf or hard of hearing, family

members, service providers, businesses, educators and others• Demonstrations and training of assistive technology equipment• Training to interpreters to improve their skills• Interpreter services for state agencies by contracting with a network of local

interpreter agencies

• According to the US Census American Community Survey more than 990,000 Texans in fiscal year 2017 will be considered deaf or hard of hearing

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• The Camp SIGN program is designed to provide an environment of acceptance and encouragement for children who are deaf or hard of hearing• Parents of children in Camp SIGN must pay for travel expenses to the

camp and a fee based on a sliding scale• Children attending Camp SIGN are typically from environments in which

they are the only person who is deaf or hard of hearing• Camp SIGN activities include:

• Archery• Swimming• Arts and crafts• Cross fit training

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History• 1979: The 66th Legislature directed the Texas Commission for the Deaf and Hard

of Hearing to develop and implement a statewide program of advocacy and education to ensure continuity of services to persons who are deaf, deaf-blind, or hard of hearing

• 1982: Camp SIGN program began

• 1993: Program began contracting with state agencies to provide interpreter services

Legal Citations• Human Resource Code, Chapter 81, Sec. 81.006-007

• Human Resource Code, Chapter 81, Sec. 81.013

• Texas Government Code, Chapter 771, Sec. 771.001

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FY 2014-15 GR - R


$ 398,276 $ 1,332,071 $ 326,731 $ 1,202,982

$ 725,007 $ 2,535,053

Performance Measures 2013 2014 2015Number of Consumers Educated and Interpreters Trained

1,338 2,635 2,375

Average Cost per Consumer Educated or Interpreter Trained

$296 $201 $202

Other Measures

Number of Children Attending Camp SIGN 60 62Total Amount of Collections from Fee Charged for Trainings

$14,894 $18,251

Deaf and Hard of Hearing Services Interpreter Certification Program

• The DARS interpreter certification program, administrated by the Board for Evaluation of Interpreters (BEI), tests and evaluates sign language and oral interpreter candidates to determine their skill level and award certification • Interpreter certification is not required to provide interpreter services for the deaf• An advisory board for the BEI assists the agency in administering the program

• The goal of the BEI program is to:• Improve the quality of interpreter services for Texans who are deaf, hard of

hearing or who are hearing• Increase the number of qualified interpreters in Texas• Encourage the assignment of appropriately qualified interpreters for the demands

of each interpreting assignment• Provide a means of quality control over interpreter services provided in Texas• Protect the interests of consumers of interpreter services in Texas

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• To be eligible to take the test to become certified, candidates must:• Be 18 years of age or older• Have a high school diploma or its equivalent• Not have a criminal conviction that would qualify as grounds for denial, probation,

suspension, or revocation of a BEI certificate• Have earned at least 30 credit hours from an accredited college or university, with

a cumulative grade point average of 2.0 or higher

• The BEI program maintains a registry of certified interpreters by skill level and specialty

• The Americans with Disabilities Act requires that “qualified” interpreters are utilized as a reasonable accommodation

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History• 1979: The 66th Legislature established the Board of Evaluation of Interpreters

• 1999: The 76th Legislature authorized the development of a certification for trilingual interpreters

• 2001: The 77th Legislature authorized a court interpreter certification program

• 2005: The 79th Legislature updated statutory language for court interpreters to require only certified individuals to interpret in a legal setting

Legal Citations• Human Resource Code, Chapter 81, Sec. 81.007

• Government Code, Chapter 57

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Budgeted FY 2015 All Funds

FY 2014-15 GR - R


$ 273,318 $ 356,454 $ 395,260 $ 621,206

$ 668,578 $ 977,660

Performance Measures 2013 2014 2015

Number of Interpreter Certificates Issued 1,731 1,749 1,749

Number of Individuals Tested 480 300 300

Average Cost per Interpreter Certificate Issued $137 $204 $355

Other Measures

Number of Certified Interpreters 1,563 1,557

Number of Certified Court Interpreters 138 138Total Amount of Collections from Fees Charged for the Interpreter Certification Program

$148,965 $161,900

Early Childhood Intervention Respite Program

• Early Childhood Intervention (ECI) provides supports and services to families with children birth to 36 months with developmental delays or disabilities

• The goal of the ECI respite program is to provide a brief period of rest and recovery from the demands of caring for an infant or toddler with complex needs

• Respite services are defined in rule as the care of an ECI enrolled child by a relative or substitute caregiver on a short-term or intermittent basis to provide the child's parent with a break from caring for his or her child and do not include the routine care of a child for the purposes of allowing a parent to attend work or school

• ECI families are considered for respite services based on the contractor’s prioritization processes and available funding

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History• 1999: The 76th Legislature appropriated $1 million for the biennium for the

purpose of providing respite care for families

• 2001: Funding was reduced by $.2 million

Legal Citations• Human Resources Code, Chapter 73, Sec. 73.005 and Sec. 73.008

• TAC Title 40, Part 2, Chapter 108, Subchapter K, §108.1108

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FY 2014-15 GR - R


$ 400,000 $ 400,000 $ 400,000 $ 400,000

$ 800,000 $ 800,000

Performance Measures 2013 2014 2015Average Monthly Number of Children Receiving Respite

234 250 250

Documents

House Appropriations Subcommittee on Article II October 6, 2014 Veronda L. Durden, Commissioner Strategic Fiscal Review