Summary of Texas Performance Review Recommendations

Challenging the Status Quo (1999)

As a result of TPR recommendations, the 1999 Texas Legislature reduced the state's cost of determining people's eligibility for Temporary Assistance for Need Families and food stamps.

The Legislature also passed a bill giving people with disabilities additional flexibility and more choices in selecting their own service providers. In addition, the Legislature required the Medicaid program to begin covering the costs of hearing tests for newborns.

Thanks to TPR, the Texas Department of Health can now seek competitive bids for the most cost-effective drug claims processing. In response to a TPR recommendation, the Legislature also increased local communities' control over spending for children's mental health services.

Moreover, the Legislature required health and human services agencies to work together to implement federal standards for electronic processing of health care data and for electronic benefits transfer programs. Based on TPR recommendations, the Legislature also improved the state's method of collecting Medicaid and TANF overpayments and refunds, increased Medicaid third-party reimbursements, and helped counties increase their federal reimbursements.

The Legislature did not adopt all recommendations contained in Challenging the Status Quo. For example, the Legislature did not adopt a recommendation designed to improve the purchase of some Medicaid services by competitive bid. TPR also recommended measures to improve the coordination of services for adults with disabilities that did not gain Legislative approval.

Disturbing the Peace (1997)

As a result of recommendations in Disturbing the Peace, the Legislature improved health care insurance coverage for children covered by child support orders from the Office of the Attorney General. The Legislature also made it easier for parents and other consumers to obtain information on child care facilities from the Department of Protective and Regulatory Services (DPRS).

The Legislature also approved TPR's recommendation to change how the Department of Regulatory and Protective Services (DPRS) purchases protective services, such as residential care, and how DPRS assesses the needs of children under its supervision.

Based on a TPR recommendation, the Legislature set up a system to reduce the cost of medicines the state distributes to individuals enrolled in the Kidney Health and the Chronically Ill and Disabled Children's Program. Moreover, the Legislature saved tax dollars by increasing Medicaid reimbursements, while it also gave health and human services agencies more opportunities to reduce the cost of the health care services the agencies purchase.

To combat inaccurate caseload projections among health and human service agencies, TPR won legislative approval of a system that requires agencies to use a uniform reporting format.

Gaining Ground (1995) and Partnership for Independence (1995)

In 1995, TPR's report, entitled Gaining Ground, recommended creating a Public Assistance Fraud Oversight Task Force and reducing the number of people receiving for Food Stamps and welfare benefits who did not qualify for assistance. The Legislature agreed to the proposals.

In response to a request from then Lt. Governor Bob Bullock, the Comptroller's office also developed that year the Partnership for Independence Report, which provided the foundation for welfare reform enacted in House Bill 1863. Some of these approaches recommended in the report and adopted by the Legislature included: a responsibility agreement signed by welfare recipients, time-limited benefits, fingerprint imaging for fraud detection, one-time benefit payments, improved eligibility determination processes, and an array of pilot work programs for welfare recipients.

During 1995, TPR also recommended consolidating the state's health care service purchasing into a single office. While the Legislature did not adopt this recommendation, it approved another TPR suggestion to create a Health Care Information Office so consumers could obtain comparative information on health care providers.

TPR also recommended and the Legislature agreed to provide flexibility to local communities more flexibility in how they provide health and human services. The Legislature also adopted TPR's suggestion to expand the use of "one stop" service delivery concepts. TPR also recommended a number of ways to increase the amount of federal funds Texas receives by using federal emergency assistance funds for current services.

Against the Grain (1993)

In response to TPR recommendations contained in Against the Grain, the Legislature modified the Medicaid Disproportionate Share Hospital Programs to bring more federal dollars to state hospital programs to cover uninsured clients' health care costs.

In addition, Legislators agreed with TPR to ensure more children in Texas receive immunizations. Additional TPR recommendations to improve third-party reimbursements in the Medicaid program also were adopted.

The Legislature also enacted TPR's recommendation to use neural networks to detect and reduce overpayments in the Medicaid program. The Legislature also adopted TPR's recommendation to increase federal funds for programs using primarily general revenue for services.

In response to a TPR suggestion, the Legislature also agreed that more patients in state mental health facilities should receive atypical psychotic drugs. Moreover, the Legislature also adopted TPR recommendations to increase education, training, and employment opportunities for welfare clients and to establish a franchise tax credit for businesses that hire welfare recipients.

Breaking the Mold (1991)

In 1991, TPR's report, entitled Breaking the Mold, recommended consolidating health and human services agencies into a single Health and Human Services Commission. The Legislature partially adopted this recommendation and later modified it to strengthen the commission's power and authority over its component agencies.

TPR's recommendations on managed care were adopted, and the Medicaid Disproportionate Share Hospital Program and Medicaid eligibility for infants and pregnant women were expanded. The Legislature also agreed to increase the amount of federal dollars available for child protective service.

TPR also suggested, and the Legislature adopted a recommendation to develop objective criteria for closing or consolidating state Texas Department of Mental Health and Mental Retardation (TxMHMR) schools. The Legislature also authorized the issuance of bonds for TxMHMR facilities.