Quick recap

The meeting focused on discussing current challenges and updates in substance use disorder treatment services across Texas, particularly in the context of recent funding changes, regulatory compliance, and operational impacts. Participants shared experiences about weather-related disruptions, discussed the administration's proposed $700 million for services with a focus on faith-based programming, and addressed concerns about state funding allocations and potential budget cuts. Noelle reported that the state is experiencing difficulties with tracking the 25% fund movement allowance due to unpredictable client flows, though HHSC has temporarily paused plans to restrict this flexibility. Multiple providers, including Deirdre and Robert, described challenges with residential treatment capacity, noting decreased patient volumes and shifts in payer mix, particularly following the closure of detox facilities and changes in insurance coverage. The group also discussed recent regulatory inspections, with Robert and Brad sharing experiences about citations and compliance challenges, particularly around electronic health records access and facility requirements like certificates of occupancy in rural areas. Noelle announced upcoming events, including a member meeting in Houston in October and potential collaboration with HHSC on a summit in August.

Next steps

Deirdre

• Share the link to the HUD NOFO and information about local continuum of care contacts with Bill and the group.

Jennifer

• Send CADCA's synopsis of the new $700 million administration funding announcement to Doug and Noelle.

Noelle

• Follow up with Yvonne regarding issues with HHSC reimbursement for maintenance staff salaries and report back to the group as needed.

• Continue discussions with HHSC to identify solutions for tracking and reporting the 25% fund movement to help HHSC understand workflow and meet metrics; solicit suggestions from the group.

• Invite HHSC compliance team to the next member meeting in October for increased collaboration and communication.

• Provide details and updates about the planned joint summit with HHSC in August to the group.

Collaboration

• All members: Submit nominations for the Lone Star Awards as announced by Noelle.

• All members: Be prepared to partner with local housing/homeless service providers in response to HUD's new treatment-first focus; Deirdre to keep group posted on relevant developments.

  
  

Summary

Weather and Funding Concerns Discussion

The group discussed recent weather conditions and funding concerns related to administration announcements about $700 million in services, with particular focus on faith-based programming. Noelle explained that due to changes in SNAP benefits, the state is experiencing budget constraints and is unlikely to provide additional funding, though they may support legislative efforts for rate increases on residential treatment services. Bill added that while the state faces a 5% budget cut, they would not block legislative efforts to increase funding and rates.

HUD Housing Program Policy Changes

The group discussed funding challenges and changes in HUD's approach to housing programs. Deirdre explained that HUD is shifting from a housing-first to a treatment-first focus, requiring more emphasis on substance use treatment beds in community responses. She shared that Partnership Home in Tarrant County must address treatment and substance use beds in their NOFO application, and suggested others could reach out for partnership opportunities. The discussion also touched on challenges with HHSC regarding fund reallocation and allowable expenses for maintenance staff salaries.

Cost Reimbursement Grant Tracking Challenges

Noelle discussed a cost reimbursement grant issue where the state is having difficulty tracking fund movements due to the 25% allowance flexibility, making it challenging to meet metrics. The state had considered removing the allowance but was convinced by ASAP to find alternative solutions. The discussion is ongoing to help the state better understand workflow changes while maintaining the flexibility providers need.

Service Fund Reallocation Discussion

Noelle discussed concerns about moving funds from residential to outpatient services, noting that the state requires residential services to remain in place. Hormand and Doug shared examples of how their organizations had to reallocate funds due to reduced funding or construction issues, with Hormand explaining that such moves are often driven by economic necessity rather than choice. The discussion revealed that providers are struggling to track client trends and determine whether shifts in service delivery are based on data or other factors.

Revenue Projections and Client Demographics

The group discussed varying experiences with revenue projections and client demographics across different organizations. Hormand reported consistent indigent client numbers over six years, while Deirdre noted a decline in residential program admissions post-pandemic, particularly after MHMR Tarrant County's detox closure. Sean observed significant fluctuations in payer mix due to more aggressive identification of third-party payers, though he couldn't determine if this was a new strategic approach or a temporary pattern.

Substance Treatment and Compliance Updates

The group discussed recent changes in substance use treatment and regulatory compliance. Bill reported seeing softening demand for treatment, attributed to overdose deaths affecting frequent users and increased access to MAT treatment. Robert from Sundown Ranch shared insights on adolescent treatment trends, noting a shift from private pay to Medicaid coverage and describing recent HHS inspection findings. The group discussed challenges with HHS compliance inspections, with members sharing experiences about citation issues and suggesting that new collaborative approaches with HHSC leadership might improve the inspection process.