Transformación y conservación del medio

entities affected.

Infectious Diseases

The Legislature authorizes TCID to treat persons with complicated TB who reside or intend to reside in Texas. Persons who are unwilling or unable to follow medical advice for TB receive hospitalization for six months to two years. TCID is the designated hospital for court-ordered (quarantined) TB treatment where a patient’s non-adherence with TB medication regimens has proven to be a threat to public health or safety. TCID treats all patients with Hansen’s disease in the outpatient clinic, one of four clinics statewide contracting with DSHS for these patient services.

RGSC Outpatient Services

RGSC Outpatient Services provides services to residents of Cameron, Hidalgo, Starr, and Willacy counties. The clinic accepts Medicare, Medicaid, and third party payers. For those with no health insurance who do not qualify for any other program assistance, the clinic offers a sliding scale payment option based on income, family size, assets, and other guidelines. The top three diagnoses in fiscal year 2012 were hypertension, hyperlipidemia, and diabetes.

Inpatient Psychiatric Services

DSHS provides Inpatient Psychiatric Services to Texas residents who are experiencing severe mental illness and require treatment in an inpatient facility, as well as offenders in local judicial systems and law enforcement agencies. To be eligible for services, a person must have a mental illness and, as a result of the mental illness, present a substantial risk of serious harm to self or others, or evidence a substantial risk of mental or physical deterioration.

F. Describe how your program or function is administered. Include flowcharts, timelines, or other illustrations as necessary to describe agency policies and procedures. Indicate how field/regional services are used, if applicable.

The MHSA Services Division, State Hospitals Section administers Hospital Services. The State Hospitals Section administratively manages the hospitals according to the State Hospitals Section bylaws for governing bodies. The governing body establishes hospital policy and approves a hospital management plan for each hospital. This plan establishes goals and performance indicators for the State Hospitals. The governing body is responsible for the following:

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 quality of care that each hospital provides,  planning and managing the organization,  implementing performance improvement,  credentialing of the medical staff,

 providing financial management, and

 ensuring that managers assess the competence of all staff members and confirm that staff demonstrate and improve competency.

G. Identify all funding sources and amounts for the program or function, including federal grants and pass-through monies. Describe any funding formulas or funding conventions. For state funding sources, please specify (e.g., general revenue, appropriations rider, budget strategy, fees/dues).

Funding Source Amount

Federal $20,269,328

General Revenue $376,392,801

General Revenue-Dedicated $935,589

Other $77,865,907

H. Identify any programs, internal or external to your agency, that provide identical or similar services or functions to the target population. Describe the similarities and differences.

External Programs

Name Similarities Differences

Private psychiatric hospitals or psychiatric unit in general hospitals

Private hospitals provide psychiatric inpatient hospital services. Services include diagnostics, treatment, and discharge planning.

Some hospitals are not able to provide services to patients who are experiencing the most severe of mental

illnesses and/or are manifestly dangerous or grossly

aggressive and/or require forensic services. The method of reimbursement for services may also be a factor.

Private residential treatment centers (RTC)

Private RTCs provide psychiatric residential treatment services. Services include structured

therapeutic programming and discharge planning.

Some private RTCs are not able to provide services to patients who require specialized therapeutic programming. Method of reimbursement for services

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Name Similarities Differences

may also be a factor in determining service type. UTHSC-Tyler Both UTHSC-Tyler and TCID

have isolation rooms in a contiguous patient care unit, and laboratory, radiology, pharmacy, chaplaincy, and social work services. The medical director serves both facilities. Both participate in and support functions of the Heartland National

Tuberculosis Center. TJC accredits both hospitals.

UTHSC-Tyler is a Medicare- certified acute hospital. TCID is a Medicare-certified long- term acute specialty hospital. UTHSC-Tyler has limited programs for long lengths of stay. UTHSC-Tyler has acute care services, such as surgery and intensive care, available on site, which TCID does not provide.

I. Discuss how the program or function is coordinating its activities to avoid duplication or conflict with the other programs listed in Question H and with the agency’s customers. If applicable, briefly discuss any memorandums of understanding (MOUs), interagency agreements, or interagency contracts.

House Bill 1748, 76th Legislature, Regular Session, 1999, authorizes and describes the parameters of a working relationship among TDH (now DSHS), TCID and TB Elimination Programs; UTHSC-Tyler; and University of Texas Health Science Center-San Antonio. These include the provision of direct patient care services, education, information and referral, case management, and research in support of the public health functions required for statewide TB control. Even prior to the reorganization of the health and human services agencies, SASH and TCID were working together to share functions. Since the reorganization in 2004, 25 administrative, clinical, and support functions serve all or parts of the 15 permanent state agency, academic, and local programs. DSHS secured memorandums of agreement, interagency contracts, intra-agency service level agreements, and grant awards for each level of interaction among the participants in service provision affecting TCID.

Hospital Services consider State Hospitals to be the “provider of last resort.” Each State Hospital has a Utilization Management Agreement with the local LMHA. DSHS also has a contract with each LMHA in the state. Both the agreement and the contract require the LMHA to screen an individual seeking mental health services to determine if the individual requires inpatient psychiatric services. If the screening and assessment indicates inpatient psychiatric services, the LMHA determines the least restrictive treatment setting available. In other cases, a hospital physician screens an individual presenting for admission to a State Hospital when the LMHA has not screened and referred the individual. The hospital physician determines if the person has an emergency psychiatric condition that is appropriate for admission to the State

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Hospital or if the person requires a referral to the LMHA to coordinate alternate services. The physician will also determine if a life-threatening medical condition exists, which may require care in a medical hospital.

J. If the program or function works with local, regional, or federal units of government include a brief description of these entities and their relationship to the agency.

Local Units of Government

Name Description Relationship to DSHS

Justice of the peace courts and county courts

Justice of the peace courts and county courts issue civil mental health commitments to State Hospitals.

DSHS serves patients committed to State Hospitals.

District courts District courts issue forensic commitments to State Hospitals.

DSHS serves patients committed to State Hospitals.

Law enforcement City police and county law enforcement transport patients to hospitals for admission and/or to court for scheduled legal proceedings.

DSHS receives patients for admission.

Local health

departments (LHDs), TB program managers

LHDs provide healthcare services to their respective constituents.

LHDs are contractors with DSHS.

Bexar County Hospital District (University Health System)

The University Health System is a local public general hospital and clinic system supporting TCID patient care.

This hospital district is a contractor with DSHS.

LMHAs LMHAs screen persons seeking mental health services to determine if the person requires inpatient psychiatric services. If the screening and assessment indicates the person requires inpatient psychiatric services, the LMHA determines the least restrictive treatment setting available.

DSHS contracts with LMHAs to provide mental health services in a designated geographic area.

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MHSA – Hospital Services Federal Units of Government

Name Description Relationship to DSHS

CMS Hospitals must comply with

CMS Conditions of Participation to maintain Medicare

certification and receive Medicare reimbursement.

CMS is a contractor and source of funding.

CDC CDC provides information to

enhance health decisions and promotes health through partnerships with state health departments and other organizations.

CDC is a contractor and a source of funding for the Heartland National Tuberculosis Center.

K. If contracted expenditures are made through this program please provide:  a short summary of the general purpose of those contracts overall;  the amount of those expenditures in fiscal year 2012;

 the number of contracts accounting for those expenditures;

 top five contracts by dollar amount, including contractor and purpose;

 the methods used to ensure accountability for funding and performance; and  a short description of any current contracting problems.

DSHS established contracts in this program for the following:  healthcare professional service,

 temporary staffing,  pharmacy service,

 lab and radiology services,

 building maintenance and supplies,  food services and groceries,

 data collection and processing, and  psychiatric residency program.

Amount of contracted expenditures in fiscal year 2012: $66,760,216

Number of program contracts: 637 (includes contracts with no expenditures) The top five contracts for the program are as follows.

Amount Expended FY 12 Contractor Purpose

$1,534,968 Labatt Foodservices LP Food services for clients $1,373,698 United Regional Health Care

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Amount Expended FY 12 Contractor Purpose

$1,273,952 Seton Family of Hospitals Medical services for clients $1,107,390 East Texas Medical Center Medical services for clients

$906,228 Truman Arnold Company Bulk fuel

To ensure accountability, the assigned contract manager monitors contract performance and takes action to resolve performance and compliance issues as needed. Additionally, staff in the Chief Financial Office audits each invoice to confirm accuracy. The accounting system includes edits to match invoices with purchase orders and verification of receipt of goods and services. Staff in the Chief Operating Office performs target financial compliance reviews and provides consultative services and technical assistance on financial management of contracts. DSHS uses an automated contract management system, SOURCE.Net, to document contractor information, contract management activities, and monitoring reports. The program has no known contracting problems.

L. Provide information on any grants awarded by the program. The program does not award any grants.

M. What statutory changes could be made to assist this program in performing its functions? Explain.

DSHS suggests the following statutory changes to assist the program in performing its functions. Criminal Background Checks – Allow DSHS to perform criminal background checks on physicians contracting with hospitals. Currently, DSHS can perform checks on potential employees; contracts require locum tenens companies to complete criminal background checks on physicians they refer.

Competency Restoration – Mandate that prisoners in the Texas Department of Criminal Justice who commit crimes while in prison cannot be sent to a State Hospital for competency restoration until they have completed serving their sentence.

N. Provide any additional information needed to gain a preliminary understanding of the program or function.

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O. Regulatory programs relate to the licensing, registration, certification, or permitting of a person, business, or other entity. For each regulatory program, if applicable, describe: ● why the regulation is needed;

● the scope of, and procedures for, inspections or audits of regulated entities; ● follow-up activities conducted when non-compliance is identified;

● sanctions available to the agency to ensure compliance; and

● procedures for handling consumer/public complaints against regulated entities. Not applicable.

P. For each regulatory program, if applicable, provide the following complaint information. The chart headings may be changed if needed to better reflect your agency’s practices.