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iSOLATE MEDICATE...STEAL THE ESTATE.  tHIS org is fighing the good fight!

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I have met Hattie Poole.  I have sat in on one of her court hearing in front of Judge Tom Rickhoff.  She was treated as if she was not even in the room.  There was no justice ...She can't even have her own lawyer...and her Ad Litem is the most disgusting piece of trash I have ever witnessed.  She did not fight for her client.  She did not advocate for what Hattie wanted...instead she lined her own pocket.  For shame!

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Kasem Cares Foundation
57 mins · 
Another milestone for the Kasem Cares Foundation!!!
THANK YOU Delegate Sid Saab, we have working together for over 7 months now to get the perfect bill for Maryland!

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Texas Health and Human Services Commission
Public Notice
The Health and Human Services Commission (HHSC) is submitting a request to the Centers for Medicare & Medicaid Services (CMS) for an amendment to the Texas Healthcare Transformation Quality Improvement Program (THTQIP) waiver under section 1115 of the Social Security Act. CMS has approved this waiver through September 30, 2016. The proposed effective date for the amendment is March 29, 2016, with no changes to budget neutrality.
HHSC is proposing four changes in this amendment request:
1) add Home and Community Based Services STAR+PLUS Waiver slots appropriated by the 84th Texas Legislature;
2) clarify the new electronic process for reviewing the Home and Community Based Services STAR+PLUS Waiver individual service plans;
3) allow a dentist to bill for services provided by a substitute dentist, as established under House Bill 1661, 84th Texas Legislature, Regular Session (2015); and
4) delay the quarterly report due dates for quarters 1 through 3 by 45 days and submit the information for quarter 4 report with the Demonstration Annual Report.
Home and Community Based Services STAR+PLUS Waiver Slots
The 84th Legislature (Regular Session) of Texas appropriated additional funds to increase the number of unduplicated participants for the STAR+PLUS 217-like group served by the Home and Community Based Services STAR+PLUS Waiver. The appropriations include 618 waiver slots added at the beginning of State Fiscal Year 2016 (September 1, 2015) and 617 waiver slots to be added at the beginning of State Fiscal Year 2017 (September 1, 2016). HHSC requests to revise Table 4a in the 1115 waiver Special Terms and Conditions, Unduplicated Number of Participants for the STAR+PLUS 217-Like HCBS Group, to reflect the additional slots.
Electronic Process for Reviewing Home and Community Based Services STAR+PLUS Waiver Individual Service Plans
HHSC intends to clarify the new electronic process for reviewing the Home and Community Based Services (HCBS) STAR+PLUS Waiver individual service plans. HHSC worked with a technology contractor to develop a new capability which allows managed care organizations to submit individual service plans in an electronic portal. Service plans are reviewed in the electronic portal with the same logic used by HHSC staff to manually approve or reject service plans. The process is in compliance with 42 CFR 441.301(b)(1)(i). Service plans are rejected from the electronic process and must be manually reviewed by HHSC staff if they:
• are over the established cost limit;
• require Medicaid eligibility staff review;
• are not associated with a valid medical necessity level of care, or;
• have missing or incomplete information.
Individual service plans rejected by the electronic portal are resubmitted directly to HHSC staff through a File Transfer Protocol (FTP) process and manually reviewed and approved based on existing policies.
HHSC has a unit dedicated to HCBS STAR+PLUS Waiver utilization management and review. This unit, in conjunction with the unit manually reviewing and approving individual service plans, will conduct a focused desk review during and immediately following implementation of the electronic process to ensure the portal is processing electronic service plans correctly. As part of the utilization management and review unit's ongoing work, the unit will review a representative sample of service plans approved electronically to ensure the process is functioning as expected. This unit also annually reviews a representative sample of service plans to ensure that services authorized on the plan are appropriate and delivered in a manner consistent with state and federal policy.
Substitute Dentists
Under House Bill 1661, 84th Texas Legislature, Regular Session (2015), to the extent allowed by federal law, HHSC must adopt rules ensuring the same standards applying to a physician who bills the Texas Medicaid Program for services provided by a substitute physician apply also to a dentist who bills the Texas Medicaid Program for services provided by a substitute dentist. Currently, HHSC permits a physician to bill for the services of a substitute physician who sees patients in the billing physician's practice under either a reciprocal or locum tenens arrangement-as permitted by Social Security Act §1902(a)(32)(C). Dentists, like physicians, may be absent from work for reasons such as illness, pregnancy, vacation, continuing education, or active duty in the armed forces. In addition, there may be time-sensitive instances when a patient enrolled with a MCO may require immediate attention by his or her Main Dental Home. HHSC believes a dentist should be given the option to bill for services provided by a substitute dentist. HHSC acknowledges that Social Security Act §1902(a)(32)(C) only applies to physicians, but requests to allow a dentist to bill for the Children's Dental Program and STAR+PLUS HCBS Waiver dental services provided by a substitute dentist.
Quarterly Report
HHSC Managed Care health plans finalize and submit performance data to HHSC about 30-45 days after the close of the state fiscal quarter, which leaves only about 30-45 days for HHSC to review a myriad of health plan data, evaluate contract compliance, analyze trends, document resolution of identified issues and summarize findings before the quarterly report gets routed for internal approval. HHSC's health plan data review and analysis are essential for ascertaining an accurate picture of health plan performance, and at times this process uncovers data errors that then require updated data analysis, leaving less time for writing the report. HHSC is requesting additional time from CMS to submit the quarterly 1115 report to improve the HHSC data review process, which will result in a more thorough description of the managed care programs and health plan performance. HHSC requests delaying the quarterly report due date for quarters 1 through 3 by 45 days and to submit the information for the quarter 4 report with the Demonstration Annual Report.
To obtain copies of the proposed waiver amendment, interested parties may contact Micah Erwin by mail at Texas Health and Human Services Commission, P.O. Box 13247, Mail Code H-600, Austin, Texas 78711-3247, phone (512) 424-6549, fax (512) 730-7472, or by email at
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Filed: September 30, 2015
Public Notice
The Texas Health and Human Services Commission (HHSC) is submitting to the Centers for Medicare & Medicaid Services (CMS) a request for an amendment to the Deaf Blind with Multiple Disabilities (DBMD) waiver program, a waiver implemented under the authority of section 1915(c) of the Social Security Act. CMS has approved this waiver through February 28, 2018. The proposed effective date for the amendment is February 28, 2016, with no changes to cost neutrality.
This amendment request proposes to make the following changes:
1. Appendix B-3: Effective November 2015, rule amendments will be made updating the process for individuals on the DBMD interest list. The primary changes to the waiver application and the rules are in relation to policies for individuals interested in being on the interest list who are military family members temporarily living out of state. Military family members will not be removed from the DBMD interest list for temporarily moving outside of the state of Texas due to the military member's assignment. If an applicant who is a military family member is offered enrollment while temporarily living outside of Texas they shall retain their position on the interest list for up to one year after their family's military service ends. The waiver application also adds clarifying language that the reserved capacity group, "Money Follows the Person," bypasses the interest list.
2. Appendix B-6: The waiver is being amended to remove the requirements for the direct services agency to submit a separate level of care instrument to prevent a gap in services. In addition, the waiver is being amended to add that if reinstatement is granted, reinstatement will only be effective for up to 180 calendar days before the date DADS receives the current Form 8578, or the first day of the new individual plan of care period, whichever is more recent.
3. Appendix C-1: Residential Habilitation (Statutory Service). The majority of activities included as part of the waiver Residential Habilitation (HAB) services are now available through the non-waiver resource state plan Community First Choice (CFC) Personal Assistance Services (PAS)/HAB service. Thus, the service definition for residential habilitation in the DBMD waiver is being amended to reflect this change. The definition of habilitation from the Texas Administrative Code that addresses the DBMD waiver is being added to the waiver application for clarification of what habilitation means in general. The list of services has been altered to bulleted format rather than listed in a paragraph format for ease of reference and consistency with the Texas Administrative Code language. And the limits section has been updated to reflect the language in the Texas Administrative Code as follows: (1) the new language in the limits section reflects that payment will not be made for the routine care and supervision that a family member "is legally obligated to provide." The previous language used in the application was "would be expected to be provided" rather than "is legally obligated to provide"; and (2) the new language in the limits section states that the service may not be provided at the same time that "licensed" assisted living "or licensed home health assisted living" is provided. The quoted language has been added for consistency with the Texas Administrative Code language.
4. Appendix C-1: Prescribed Drugs (Extended State Plan Service) and Appendix J. The waiver is being changed to clarify eligibility for prescription drugs through the DBMD waiver program. As a result of the transition from the fee-for-service delivery method to the managed care delivery method, effective September 1, 2014, individuals in the waiver who are enrolled in managed care for their acute care services receive unlimited prescription medications through their managed care and therefore do not qualify for prescriptions through the waiver. Dual eligible individuals are excluded from enrollment into managed care and, thus, are still eligible for prescription medications through the waiver if they exhaust non-DBMD waiver resources first (such as the Medicare Prescription Drug Plan and the Texas Medicaid State Plan resources). The acute versus waiver dollars for prescriptions will be revised to better reflect the source of funding for prescription costs.
The Deaf Blind with Multiple Disabilities program serves individuals with legal blindness, deafness, or a condition that leads to deaf-blindness, and at least one additional disability that limits functional abilities. The program serves individuals in the community who would otherwise require care in an intermediate care facility/facilities for individuals with an intellectual disability or related conditions intellectual and developmental disabilities (ICF/IID).
To obtain free copies of the proposed waiver amendment, including the DBMD settings transition plan, or if you have questions, need additional information, or wish to submit comments regarding this amendment or the DBMD settings transition plan, interested parties may contact Jacqueline Pernell by mail at Texas Health and Human Services Commission, PO Box 13247, Mail Code H-370, Austin, Texas 78711-3247, phone (512) 428-1931, fax (512) 730-7472, or by email at The complete waiver application can be found online on the DADS website at TRD-201504080
Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Filed: September 30, 2015

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Houston judge may need a competency hearing.  The reason?  Judge Olsen objects to doing his job in a fair and transparent manor.  Judge Violates the Separation of Powers argue that a transparency bill ...violates the Separation of Powers doctrine.  Judge insists he should be allowed to keep cronyism alive and well in Harris county.  Judge insists that his court room should not have to follow the law.  Judge has the worse record in the state of Texas.

Judge Questions Constitutionality of Ad Litem Appointment Bill
Angela Morris, Texas Lawyer
October 12, 2015    

A Houston probate court judge is questioning the constitutionality of a new law that requires judges to appoint attorneys ad litem and guardians ad litem on a rotating wheel basis.
Under Senate Bill 1876, by Sen. Judith Zaffirini, D-Laredo, judges in counties with populations over 25,000 must create a list of qualified attorneys. When a case needs an attorney ad litem or guardian ad litem, the judge must go through the list on a rotating basis and appoint the next lawyer on the list. A judge doesn't have to appoint the next lawyer if he finds good cause not to do it.
Rep. Harold Dutton, D-Houston, recently requested an opinion from the Texas Office of the Attorney General, posing a question for Harris County Probate Court No. 3 Judge Rory Olsen: Is SB 1876 unconstitutional because it violates separation of powers and is too vague?
In response to questions from Texas Lawyer, Zaffirini wrote in a statement that she would submit a brief to the AG's office.
"The bill underwent extensive vetting and received overwhelming support from advocates, legislators, probate judges and attorneys. One judge—Judge Olsen—raised these constitutionality concerns when the bill was being discussed during the legislative session, and they were found to be unwarranted. They are equally unfounded now," wrote Zaffirini. "I am confident not only that the law is constitutional, but also that it will foster fairness, transparency and efficiency in the court appointments system."
But Dutton's letter for Olsen argues that courts have inherent power to control the disposition of their cases in a timely and efficient way and to manage their dockets. The bill interferes with the court's power in both areas, the letter said.
"As characterized by Judge Olsen, SB 1876 requires judges to make a list of 'qualified persons' for appointments, then move down the appointment list in a robotic fashion, 'mindlessly picking the next person on the list, unless there is cause.' The judge is no longer free to pick the best qualified person at his disposal, unless he jumps through the hoop of finding good cause," said the letter. "By requiring a judge to make individual appointments for each case, the legislature is interfering with the manner by which a judge manages his docket."
The letter also claims that the bill is unconstitutionally vague, because it never sets out exactly what makes an attorney "qualified" for an appointment.
"If the Legislature is going to take away a judge's discretion on who and how to make appointments, it should at least provide the judge with some criteria to follow its directive," the letter said.
Olsen didn't return a call seeking comment before deadline.
Zaffirini also authored another bill dealing with ad litem appointments. SB 1369 would require court clerks to prepare a monthly report on most court appointments for attorneys ad litem, guardians ad litem, guardians, mediators or competency evaluators. SB 1369 also requires the Texas Office of Court Administration to conduct a study on establishing a statewide attorney ad litem billing system.

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Congratulations Senator Judith Zaffirini!  Bill No. 1882- Titled the Bill of Rights for the Ward, written and fought for in this last legislative session-, passed into law this year. It is a great step forward in guardianship reform.  The proof of that is that he proposal of a wards bill of rights legislation that has just been approved in the drafting committee by the Uniform Laws Commission. The ULC drafts legislation and enacts such legislation in all 50 states!   You are the one that made this happen!

Our mission:  Reform the Estates Code pursuant to Guardianship Laws in Texas for the people in guardianships or for a person in need of a guardianship that ensures that every individual in a guardianship is appropriately served and protected with the oversight and monitoring that will result in their well being and in preservation of their estates.
Our vision: That the intention of Texas Laws in Guardianship serves and protects every person and their estates in a guardianship and that “any person”  appointed to act in the best interest of Texas most vulnerable citizens will be held accountable under the law.

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Suehs: Give elderly and persons with disabilities peace of mind
Posted: 12:00 a.m. Monday, July 13, 2015 
By Tom Suehs - Special to the American-Statesman
Some have called it the “silver tsunami,” the far-reaching effects of an aging baby boomer population.
From tax revenues and pension funds to transportation, health care and housing options for older adults, the impact of a rapidly aging U.S. population will be significant.
By 2020, about 25 percent of the U.S. workforce will be workers age 55 and over. And by 2030, 20 percent of American workers will be 65 or older.
And as the population ages, those Texans who may no longer drive or be able to live independently face a more daunting challenge.
Imagine if you had your freedom to make decisions about where you live, whom you associate with and your right to decide medical treatments and financial activities taken away, as well as losing your right to vote and to marry.
That’s what can happen when you’re placed into guardianship.
As the numbers of Americans with Alzheimer’s disease, dementia and disabilities increases, the need for guardianship will also rise. More than 50,000 Texans live under guardianship now — a 60 percent increase since 2011.
Ideally, guardianships are supposed to provide protection for adults whom our courts deem incapacitated. Often, guardianship is appropriate and works as intended; ensuring guardians effectively manages the affairs of the elderly and disabled appropriately, honestly and fairly.
Unfortunately, guardianship profoundly limits a person’s decision-making. The guardianship process often opens the door to abuse and neglect, as well as unscrupulous and greedy family members. It has become a legal process deeply in need of reform.
It’s rare to bring together such a broad and politically diverse coalition of people who are elderly, people with disabilities, social workers and health care advocates, but that silver tsunami — along with a history of abuse and neglect under the present guardianship system — was a clarion call to unite us.
The Guardianship Reform and Supported Decision-Making Workgroup, of which I’m a member, brought together more than 15 organizations to champion needed reforms.
This spring, Texas lawmakers, with the leadership of state Sen. Judith Zaffirini and state Rep. John Smithee, embraced a bill of rights for persons under guardianship — commonly referred to as wards. It’s not only landmark in the protections and empowerment it provides persons under guardianship, but it also makes Texas a trailblazer, as we are the first state to pass and sign “supported decision-making” into law.
What is supported decision-making? Texas Supreme Court Chief Justice Nathan Hecht, a strong advocate for these reforms, aptly coined the phrase, “a durable power of attorney light.” It allows people who need help to enter into an agreement with someone they choose and trust to help understand and communicate decisions.
Supported decision-making is a fair and reasonable alternative to guardianship. It ensures Texans and our courts consider all options and work to avoid undue guardianship arrangements.
These reforms enjoyed not only the broad support of advocates, but were endorsed by the Texas Judicial Council, garnering additional credibility and a legal seal of approval.
The path forward looks considerably brighter for persons and guardians in Texas, but we know challenges remain. There is opposition to these reforms from some members in the legal community, who created a cottage industry going after the limited assets of the elderly and individuals with disabilities.
We must remain vigilant that our courts and the guardianship system are used for justice and to protect the most vulnerable Texans, and are not used to support the greed of unscrupulous guardians, family members or lawyers looking to make a fast buck.
Working to enact guardianship reforms and supported decision-making was a solemn promise I made to my late mother-in-law. For her and for the persons and families of Texans in guardianship today, we can truly say to the Texas Legislature, job well-done.
Suehs is a former executive commissioner of the Texas Health and Human Services Commission and is a member of the Guardianship Reform and Supported Decision-Making Workgroup.
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