Transcript DSHS Legislative Appropriations Request for Fiscal Years 2010-11

DSHS Legislative Appropriations Request
for Fiscal Years 2010-11
Presentation to the Senate Finance Committee
February 11, 2009
David L. Lakey, M.D.
Commissioner
DSHS Legislative Appropriations Request
Fiscal Years 2010-11
• Base Budget
 $5,592,709,588 All Funds
• Exceptional Items
 $487,069,478 All Funds
2
DSHS Legislative Appropriations Request
Fiscal Years 2010-11
FY 2010-11 DSHS budget by source
Other
4%
General Revenue
37%
$5.6 billion
biennial
budget
Federal
45%
General Revenue-D
14%
3
DSHS Legislative Appropriations Request
Fiscal Years 2010-11
• Exceptional Items in priority order, ranked
according to:
– Maintaining operating capacity in existing
programs
– Ensuring compliance with current state and
federal requirements
– Moving health forward in Texas
4
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item #1
1. Maintain Current Operations
FY2010*
FY2011*
$39.3
$44.6
* All figures in millions
•
•
•
•
•
•
•
State Hospital Capacity
Mental Health and Substance Abuse Services
Alberto N Settlement
Family Planning Reimbursement
Rabies Bait Drop
Department Operational Costs
Rio Grande State Center FTEs (funded through interagency contract)
$62.8 million GR/$83.9 million All Funds
5
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1 – State Hospital Capacity
 Funding provided
to add beds to the
state hospital
system.
Waiting Lists for Clearinghouse (Non- Maximum Security)
and Maximum Security (MSU)
200
180



160
 SB 867 (80th
Legislature)
provides more
flexibility for
maximum security
admissions.
140
120
100
80
60
40
20
0
Clearinghouse
MSU
May-06
Sep-06
115
153
124
122
Jan-07
May-07
Sep-07
Jan-08
May-08
Sep-08
Jan-09
34
67
192
82
47
57
142
137
168
110
25
58
39
36
 Initial crisis
services funding
allocated.
6
ENSURING COMPLIANCE
Exceptional Items 2 - 8
FY2010*
FY2011*
2. Regulatory Services
$7.3
$11.5
3. Health Care Data
$12.7
$12.3
4. Vital Records
$3.5
$3.2
5. Data Systems
$15.7
$14.6
6. Disaster Preparedness
$16.8
$7.3
7. Stipends for Medical Residents
$1.4
$1.4
8. Maintain Facilities
$43.3
$27.5
* All figures in millions
• Total of Exceptional Items 2-8 equals $104.9M GR/$178.3M All Funds
7
ENSURING COMPLIANCE
Exceptional Item 2 – Regulatory Services
Increase in licenses for the Division for Regulatory Services
2002-2007
100.00%
95.00%
Texas is a growing state.
90.00%
83.07%
85.00%
80.00%
76.60%
75.00%
70.00%
Percentage of Increase
65.00%
From 2002 to 2007, the
number of licenses in
some programs increased
by as much as 80%.
60.00%
55.00%
50.00%
45.00%
40.00%
35.00%
30.76%
32.52%
Summary of all Regulatory licenses
30.00%
24.49%
25.00%
13038 - Food and Drug
13039 - Environmental
20.00%
15.00%
10.73%
13040 - Radiation
10.00%
13041 - Professional Licensing
5.00%
0.00%
13042 - Health Care Facilities
Licenses by Regulatory Strategy
8
ENSURING COMPLIANCE
Exceptional Item 6 – Disaster Response
• Gaps in Public Health
Response
• Key Personnel and Training
– Equipment
– Laboratory Courier System
– Medical Special Needs
Shelter Capacity
– Local Health Services
– Border Public Health
Surveillance and Security
9
ENSURING COMPLIANCE
Exceptional Item 7 – Stipends for Residents
Psychiatrists and
Child Psychiatrists,
Texas - 2007
Psychiatrists per
100,000 Population
0
0.1 - 5.1
5.1 - 10.7
10.7 - 19.6
19.6 - 36.5
10
MOVING HEALTH FORWARD
Exceptional Item 9-13
FY2010*
FY2011*
9. Substance Abuse Services
$34.8
$34.9
10. Community Mental Health Services
$38.4
$47.1
11. Chronic Disease
$10.9
$15.0
12. Infectious Diseases
$8.1
$8.8
13. Maintenance of Services - LMHAs
$13.4
$13.4
* All figures in millions
• Total of Exceptional Items 9-13 equals $209.0M GR/$224.8M All Funds
11
MOVING HEALTH FORWARD
Exceptional Item 9 & 10
• Substance abuse and mental illness have a significant impact on
Texans, their families and communities.
– The economic cost of substance abuse in Texas for 2007 is estimated at
$33.4 billion including lost productivity, crime and the criminal justice
system, premature death and morbidity, and the cost of substance abuse
prevention and treatment.
– Individuals with severe mental illness have a life expectancy that is
25 years shorter than the overall population.
– Underserved populations with MH or SA issues often go to ERs for
treatment.
• Additional funding will mitigate the effects of substance abuse and
mental illness on Texans and Texas.
12
MOVING HEALTH FORWARD
Exceptional Item 11 – Chronic Diseases
Obesity Prevalence Trends in Texas Adults 1990 to 2007
Obese
Normal Weight
60
50
~34% of Texans are
normal weight
40
30
20
10
0
~29% of Texans
are obese
19
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
90 991 992 993 994 995 996 997 998 999 000 001 002 003 004 005 006 007
Texas Comptroller: www.window.state.tx.us/specialrpt/obesitycost/summary/
13
MOVING HEALTH FORWARD
Exceptional Item 12 – Infectious Diseases
Racial Disparity in Persons Living with HIV/AIDS in Texas, 2003-2007
25,000
1000.0
23,802
900.0
18,604
Number
18,113
15,000
15,532
10,000
11,089
5,000
800.0
Rate per 100,000
20,000
22,712
700.0
600.0
500.0
400.0
300.0
200.0
100.0
0
891.1
713.7
200.9
165.9
177.0
146.7
0.0
2003
2004
2005
2006
2007
2003
2004
Year
White
Black
Hispanic
White
2005
Year
Black
2006
2007
Hispanic
The number (left graph) of black persons living with HIV/AIDS surpassed that of whites in
2005. The rate (right graph) in 2007 was nearly 5 times higher for blacks than for others.
14
DSHS Legislative Appropriations Request
Summary
Exceptional Items Summary
FY 2010
EXCEPTIONAL ITEM
GR
FY 2011
All Funds
GR
BIENNIAL TOTAL
All Funds
GR
All Funds
FY 2010
FY 2011
FTEs
FTEs
Exceptional Items:
1. Maintaining Current Operations
2. Regulatory
$
28,782,048 $
7,279,996
39,268,566 $
7,279,996
34,059,971
11,506,211
$
44,627,245
11,506,211
$
62,842,019 $
18,786,207
83,895,811
18,786,207
87.5
57.7
87.5
133.7
3. Health Data Collection & Analysis
9,652,427
12,675,338
9,060,534
12,282,835
18,712,961
24,958,173
54.6
68.9
4. Vital Statistics
3,492,794
3,492,794
3,162,250
3,162,250
6,655,044
6,655,044
14.2
24.3
5. Information Technology Support for Critical Programs
15,654,867
15,654,867
14,635,242
14,635,242
30,290,109
30,290,109
12.1
12.1
6. Disaster Recovery and Public Health Preparedness
16,754,841
16,754,841
7,311,530
7,311,530
24,066,371
24,066,371
37.8
37.8
7. Stipends for Psychiatrist and Medical Residents
1,386,399
1,386,399
1,350,396
1,350,396
2,736,795
2,736,795
-
-
8. Building & Equipment Repair & Replace
2,071,806
43,337,891
1,591,673
27,516,157
3,663,479
70,854,048
-
-
27,050,629
34,796,731
27,195,549
34,872,984
54,246,178
69,669,715
15.2
15.2
10. Community Mental Health Services
38,430,919
38,430,919
47,105,578
47,105,578
85,536,497
85,536,497
16.2
16.2
11. Chronic Disease Prevention
10,748,330
10,889,491
14,867,553
15,024,604
25,615,883
25,914,095
27.3
27.3
8,079,969
8,113,423
8,759,736
8,793,190
16,839,705
16,906,613
35.7
35.7
13,400,000
13,400,000
13,400,000
13,400,000
26,800,000
26,800,000
-
-
182,785,025 $
245,481,256 $
9. Substance Abuse Services
12. Infectious Disease Prevention
Community Mental Health Services - Maintenance of
13.
Critical Services at LMHA
Total Exceptional Items
$
194,006,223
$
241,588,222
$
376,791,248
$
487,069,478
358.3
458.7
Note: GR shown above includes GR and GR-Dedicated funds
15
Issues for FY 2009
• FTEs
– Funded from Interagency Contracts /Federal Funds
• Capital Budget Authority
• Medicare Part D Savings Use Plan
16
HHSC Exceptional Items Affecting DSHS
• In the HHSC LAR
– Medical Professional Recruitment and Retention
– Vehicles
– Information Technology
– Data Center Services Increased Costs
• In the HHS Consolidated Budget
– Rate Increases for Providers
– Staff Recruitment and Retention
17
DSHS Legislative Appropriations Request
for Fiscal Years 2010-11
APPENDIX A
Exceptional Item Detail
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1
• State Hospital Capacity
• Mental Health and Substance Abuse Services
• Alberto N Settlement
• Family Planning Reimbursement
• Rabies Bait Drop
• Department Operational Costs
• Rio Grande State Center FTEs (funded through
interagency contract)
19
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1 – State Hospital Capacity
 Funding provided
to add beds to the
state hospital
system.
Waiting Lists for Clearinghouse (Non- Maximum Security)
and Maximum Security (MSU)
200
180



160
 SB 867 (80th
Legislature)
provides more
flexibility for
maximum security
admissions.
140
120
100
80
60
40
20
0
Clearinghouse
MSU
May-06
Sep-06
Jan-07
May-07
Sep-07
Jan-08
May-08
Sep-08
Jan-09
115
153
34
67
192
82
47
57
142
124
122
137
168
110
25
58
39
36
 Initial crisis
services funding
allocated.
20
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1 – State Hospital Capacity
• Cost Drivers
– 24/7 psychiatric and medical care
– Maintaining capacity at 2477 beds
– Increasing competition for clinical staff in local markets
– Increased cost for pharmaceuticals
– Outside medical costs
– Increased cost of food
– Other unavoidable costs
21
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1 – State Hospital Capacity
• Inflation in Clinical Salaries
– Competition in local markets for professions with
limited labor pool
– Average salary increase for clinical staff, rose by 6%
above legislative pay increases (FY 2005-07)
– 64% of hospital employees are clinical staff
22
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1 – State Hospital Capacity
• Pharmaceutical cost increases
– Psychiatric drugs (82% of purchases)
• 9% increase in cost
– All other drugs
• 25% increase in cost
23
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1 – State Hospital Capacity
• Outside Medical Services
– DSHS responsible for health care of patients
– Need for these services is difficult to predict
– Examples of individual patient medical costs in FY
2008:
Cardiovascular
End stage renal
Dialysis
Pneumonia
Neck cancer
Cardiovascular
$133,000
$334,000
$177,000
$148,000
$145,000
$178,000
24
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1 – State Hospital Capacity
• Examples of Other Operating Costs
– Food
– Equipment
– Furnishings
25
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1
• Mental Health & Substance Abuse Services
– Sustain substance abuse treatment rate increase
in FY 2008 to stabilize provider base
– Provide resources to sustain consumer-focused
mental health contracts
26
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1
•
Alberto N Settlement
– Funding provides personal care services for children on Medicaid.
– Funding was phased-in during FY 2008-09.
– This request maintains 2009 funding levels for crisis services.
• Family Planning Reimbursement Rates (Non-Medicaid)
– Reimbursement rates for oral contraceptives are significantly lower
than costs.
– The department faces possible loss of providers due to increasing
financial pressures meaning a potential loss of primary care services
for women.
– This request would more closely align family planning
reimbursement rates with costs.
27
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1
• Rabies Bait Drop
– Rabies vaccination bait dropped annually in South and West Texas
by airplane.
– This funding will cover an increase in transportation costs for the
program.
• Rising costs across the agency
– Laboratory
– Hospital pharmaceuticals, medical supplies and food
– Travel/fuel costs
– Utilities
28
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1
FY2010*
FY2011*
$19.7
$25.0
Mental Health and Substance Abuse Services
8.0
$8.0
08-09 Phased-In Services – Alberto N
$1.1
$1.1
Family Planning Reimbursement
$3.6
$3.6
Rabies Bait Drop
$0.8
0.8
Increased Costs
$3.2
$3.5
Rio Grande State Center FTEs (IAC)
$2.7
$2.7
$39.3
$44.6
State Hospital Capacity
Total:
* All figures in millions
29
ENSURING COMPLIANCE
Exceptional Item 2 – Regulatory Services
• DSHS Regulatory Division ensures the safety of
the products and services Texans use every day.
– Food
– Hospitals, Surgical Centers and Dialysis Centers
– Health professionals, including EMS, Medical
Radiologic Technicians, Professional Counselors
– Medical Devices
– Radiation
30
ENSURING COMPLIANCE
Exceptional Item 2 – Regulatory Services
Increase in licenses for the Division for Regulatory Services
2002-2007
100.00%
95.00%
Texas is a growing state.
90.00%
83.07%
85.00%
80.00%
76.60%
75.00%
70.00%
Percentage of Increase
65.00%
From 2002 to 2007, the
number of licenses in
some programs increased
by as much as 80%.
60.00%
55.00%
50.00%
45.00%
40.00%
35.00%
30.76%
32.52%
Summary of all Regulatory licenses
30.00%
24.49%
25.00%
13038 - Food and Drug
13039 - Environmental
20.00%
15.00%
10.73%
13040 - Radiation
10.00%
13041 - Professional Licensing
5.00%
0.00%
13042 - Health Care Facilities
Licenses by Regulatory Strategy
31
ENSURING COMPLIANCE
Exceptional Item 2 – Regulatory Services
• Regulatory programs are supported by fees.
• Regulatory programs provide standards to protect the
public’s health and safety.
• New licensees require resources for licensure
processing, compliance inspections, response to
complaints, and enforcement.
• DSHS uses risk-based inspections in most programs.
Regulatory Services
FY2010*
FY2011*
$7.3
$11.5
* All figures in millions
32
ENSURING COMPLIANCE
Exceptional Item 3 – Health Care Data
• Funds are requested to improve the timeliness, completeness, and
validity of health information collected through registries and
disease surveillance systems.
• Using more effective technology to replace sub-standard systems
will:
– Improve the collection of information on cancer, birth defects,
trauma, lead poisoning, and occupational diseases.
– Make data more timely and readily available to the public and
researchers for prevention efforts and measurement of communities’
health status.
– Make disease reporting for local hospitals and health providers more
efficient.
• The funding will establish a health care associated infections
reporting system.
• The funding will provide for linking of health information systems.
33
ENSURING COMPLIANCE
Exceptional Item 3 – Health Care Data
• Purpose of the Registries
– Collect and analyze health information to improve the health
of Texans
• Uses
– Public health and health-related research
– Analysis of health issues to guide appropriate public health
strategies or prevention efforts
– Provide information to communities about environmental risks
– Provide information to assist in consumer decision-making
regarding health care
34
ENSURING COMPLIANCE
Exceptional Item 3 – Health Care Data
• Cancer Registry
– Collects, analyzes, and disseminates data on cancer in Texas
 Type, extent, location and initial treatment
 Data for research, cancer prevention and control planning
– Meets national standards
– Supports cancer prevention and research priorities, including
children’s cancer research
– Helps communities assess risk
 Kelly Air Force Base, San Antonio
 Houston Ship Channel
 El Campo trichlorethylene
– Provides significant information for national data set
35
ENSURING COMPLIANCE
Exceptional Item 3 – Health Care Data
• Birth Defects Registry
– Collects, manages, analyzes, and disseminates data
 Occurrence of birth defects
 Type of defect
 When and where diagnosed
– Identifies and describes patterns of birth defects in Texas,
investigates clusters, and shares with researchers for
epidemiologic studies
– Evaluates strategies to reduce birth defects risks and factors
impacting survival of children with birth defects
– Identifies areas where children with birth defects have little access
to pediatric genetics clinics
– Evaluates factors playing a role in survival of children with birth
defects
36
ENSURING COMPLIANCE
Exceptional Item 3 – Health Care Data
• EMS/Trauma Registry
– Collects, analyzes, and disseminates information on:
 Emergency medical services runs
 Occurrence of trauma, including:
 Spinal cord injuries
 Traumatic brain injuries
 Submersion injuries
– Investigates the causes of injuries, their distribution, health outcomes, and
associated costs
– Analyzes ambulance diversion patterns
– Compares patients across service areas to improve timeliness and quality of
patient care
– Identifies hazardous environments, such as dangerous intersections
– Evaluates local injury prevention planning
• EMS providers, acute care hospitals, and trauma centers report
trauma cases to the EMS/Trauma Registry.
37
ENSURING COMPLIANCE
Exceptional Item 3 – Health Care Data
• Child and Adult Blood Lead Surveillance System
– Works to prevent and eliminate child lead poisoning in Texas by:
 Testing and monitoring children who are at risk for lead poisoning and
ensuring treatment if necessary
 Identifying and removing lead hazards in the child’s environment
 Educating the public and healthcare providers about lead poisoning and how
it can be prevented
• Additional funds will assist the Child and Adult Blood Lead
program to:
– Replace an aging information technology system.
– Meet requirements for screening, notification, case follow-up, and
outreach education.
– Improve the screening rate for Medicaid children (currently 20-30%).
– Meet obligations from the settlement of the Frew lawsuit.
38
ENSURING COMPLIANCE
Exceptional Item 3 – Health Care Data
• Occupational Disease Conditions Surveillance
– The Texas Occupational Disease Reporting Act mandates
reporting of the two principal causes of work-related
pneumoconiosis (interstitial lung disease), asbestosis and
silicosis.
– These are diseases that lead to lung impairment, disability, and
premature death.
– From 1968 to 1999, asbestos deaths among U.S. residents age
15 and over have increased from fewer than 100 to more than
1,250 annually, with no apparent leveling off to this trend.
– In 2005, there were 202 newly identified individuals with
asbestosis and 138 new reports of silicosis in Texas.
39
ENSURING COMPLIANCE
Exceptional Item 3 – Health Care Data
• Healthcare Associated Infections (HAI)
– Leading cause of death from infectious disease in the U.S.
– 200,000 infections and almost 9,000 deaths in Texas each
year.
– Staph infections (including MRSA) account for 25% of
HAI.
– In Texas, HAI-related healthcare costs are estimated at
more than $500 million annually.
– Up to 60% of HAI infections are preventable through
improved application of existing infection control
recommendations and guidelines.
40
ENSURING COMPLIANCE
Exceptional Item 3 – Health Care Data
• Healthcare Associated Infections (HAI) - SB 288 required DSHS
to:
– Establish a Healthcare Associated Infections (HAI) Reporting System.
 Hospitals and Ambulatory Surgical Centers
– Develop and publish a summary of infections reported by healthcare facilities.
– Provide education and training to healthcare facility staff.
– Provide accurate comparison of HAI data to help the public make informed
decisions about choosing healthcare facilities.
• To implement SB 288, DSHS will:
– Adopt CDC’s National Healthcare Safety Network as the HAI Reporting System.
 National trend – many other states will use this system as well.
– Employ staff to analyze source of infections and ensure accuracy to reporting.
• Accuracy of information is critical:
– Facilities will use the information to improve.
– Consumers will use the information to make choices.
41
ENSURING COMPLIANCE
Exceptional Item 3 – Health Care Data
FY2010*
FY2011*
Disease Registries – Chronic
$4.2
$2.6
Disease Registries – Healthcare
Associated Infections Reporting
$1.5
$2.8
Blood Lead Testing & Follow-Up
$6.0
$6.4
Newborn Screening Linkage
$0.8
$0.3
Center for Health Statistics
$0.12
$0.13
$12.7
$12.3
Total:
* All figures in millions
42
ENSURING COMPLIANCE
Exceptional Item 4 – Vital Records
• Vital Records – birth and death records
• Federal mandates – The REAL ID Act of 2005:
– Require states to issue secure driver’s licenses and
identification cards
– Will require other states to verify validity of birth certificates
for individuals born in Texas
– Consequences of not complying – Texans will have to prove
identity beyond a driver’s license in banks and federal
buildings and prior to domestic flights
• Enhancement of Texas’ death registration system
Vital Records
* All figures in millions
FY2010*
FY2011*
$3.5
$3.2
43
ENSURING COMPLIANCE
Exceptional Item 5 – Data Systems
Maintain and Enhance Technology
• 400 programs in nine health regions, 11 state hospitals, and a major
laboratory
• Patient records, client case files, pharmacy inventories and disease
registries at risk
• Internet connectivity between offices unreliable
• Major telephone outages
• Impacts:
– Patient health care and client management for mental and
behavioral health
– Preparedness and response activities
– Protection of sensitive data
– Data center consolidation
44
ENSURING COMPLIANCE
Exceptional Item 5 – Data Systems
FY2010*
FY2011*
Network Interoperability, Video & Voice
Communications and Security
$6.6
$5.8
Seat Management
$1.5
$1.5
Consolidated Health Care Data Collection
$1.2
$1.0
Clinical Management for Behavioral Health
Services
$2.7
$3.8
Hospital Automated Medication Dispensing System
$3.6
$2.5
Total:
$15.7
$14.6
* All figures in millions
45
ENSURING COMPLIANCE
Exceptional Item 6 – Disaster Response
• Disaster Recovery and Public Health Preparedness
– Enhancing response for all-hazards, natural or manmade –
hurricanes to salmonella
– Equipping staff for effective response and personal safety
– Improving timeliness of laboratory tests, environmental
analysis and disease surveillance
– Maintaining skilled workforce for rapid deployment in event
of emergency or disease outbreak
– Expanding local health services
– Enhancing public health surveillance and security on the
border
46
ENSURING COMPLIANCE
Exceptional Item 6 – Disaster Response
Salmonella
Saintpaul
Outbreak
47
ENSURING COMPLIANCE
Exceptional Item 6 – Disaster Response
• INSERT SLIDE ON HURRICANES
Storms lined up across the Atlantic – September 2008
48
ENSURING COMPLIANCE
Exceptional Item 6 – Disaster Response
Impact of
Hurricane Ike
49
ENSURING COMPLIANCE
Exceptional Item 6 – Disaster Response
FY2010*
FY2011*
Public Health Emergency Preparedness Response
$3.9
$3.4
Response Equipment
$4.0
--
Laboratory
$2.1
$1.0
Shelters – Renovation of State Facilities
$4.0
--
Local Health Services Expansion
$0.5
$0.5
Border Public Health Surveillance and Security
$1.0
$1.0
Behavioral Health Positions in DSHS Regional Offices
$0.6
$0.7
Recruitment and Retention
$0.8
$0.8
$16.8
$7.3
Total:
* All figures in millions
50
ENSURING COMPLIANCE
Exceptional Item 7 – Stipends for Residents
• DSHS is experiencing difficulty recruiting & retaining medical staff.
– Only 6.4 psychiatrists per 100,000 Texans
– 67.9 physicians per 100,000 Texans
• This funding will provide stipends for residency placements in state
hospitals and for preventive medicine residents to strengthen the
public health workforce.
• Medical residents are a cost-effective means of increasing medical
care in underserved areas and in hospitals.
• Physicians often remain in the community where they served as
medical residents.
Stipends for Psychiatric & Preventive Medicine Residents
FY2010*
FY2011*
$1.4
$1.4
* All figures in millions
51
ENSURING COMPLIANCE
Exceptional Item 7 – Stipends for Residents
Psychiatrists and
Child Psychiatrists,
Texas - 2007
Psychiatrists per
100,000 Population
0
0.1 - 5.1
5.1 - 10.7
10.7 - 19.6
19.6 - 36.5
52
ENSURING COMPLIANCE
Exceptional Item 8 – Maintain Facilities
Building & Equipment Repair & Replacement
• Hospitals must comply with Life Safety Code
and Joint Commission accreditation
standards.
• Broken, unsafe or unusable equipment and
patient furniture must be replaced to provide
a safe patient environment.
53
ENSURING COMPLIANCE
Exceptional Item 8 – Maintain Facilities
Infrastructure Description
• 11 State Mental Health Facility
campuses
• 3,032 acres, 552 buildings, 4.9
million square feet
• $866 million replacement value
• Average age is 55.2 years old.
• Most buildings were well built
and remain structurally sound,
but are in need of renovation to
meet today’s standards and
programmatic requirements.
• Over 84% of total building area
is dedicated to patients and
patient support.
54
ENSURING COMPLIANCE
Exceptional Item 8 – Maintain Facilities
FY10-11 Capital Construction Needs
• Identified deficiencies
(deferred maintenance):
$233 million
250.0
$233M
$198.3M
200.0
• $198.3 million in capital
150.0
construction needs have
been identified for FY10-11
funding for State Hospitals. 100.0
• Of that, $70.9 million has
been identified as the most
critical.
$70.9M
50.0
0.0
Deferred
Maintenance
Needs
Requested
55
ENSURING COMPLIANCE
Exceptional Item 8 – Maintain Facilities
Categories of Capital Equipment
• Furniture
• Medical/Adaptive
• Food Service
• Grounds
• Heating
• Air conditioning
• Motorized
• Emergency
• Other
•
Average life expectancy of most of the State Hospital
capital equipment is 5 to 8 years.
•
Average years of actual use for much of the State
Hospital capital equipment is 11+ years, far
surpassing its life expectancy, creating a potential
risk to patients and staff.
56
MOVING HEALTH FORWARD
Leading Causes of Death – Texas 2005 and 2001
Heart Diseases
Cancer
Stroke
Accidents
Lower Respiratory Disease
2001
Diabetes
2005
Alzheimers
Flu & Pneumonia
0
10,000
20,000
30,000
40,000
50,000
Number of Deaths
DSHS Center for Health Statistics
57
MOVING HEALTH FORWARD
Actual Causes of Death* Shaped by Behavior
Tobacco
Overweight/Obesity
Alcohol
Auto Accidents
Drugs
Suicide
DWI
Homicide
Sexual Behavior
0
*Texas 2001
5000
10000
15000
Chronic Disease in Texas 2007, DSHS
20000
25000
30000
58
MOVING HEALTH FORWARD
Exceptional Item 9 – Substance Abuse
• Increase treatment rates to maintain
provider base
• Increase treatment capacity to serve
individuals
• Expand prevention services
• Provide Medicaid outpatient benefit to
leverage federal funds
59
MOVING HEALTH FORWARD
Exceptional Item 9 – Substance Abuse
$136
Untreated
$136
ER Cost
per Medicaid Client
per Month
ER COST OFFSET
- $47
Average per Client per Month
35%
REDUCTION
Treated
$89
$0
Fiscal Year 2005 Texas average monthly emergency room costs were 35 percent lower for Medicaid
clients with substance abuse problems who received needed DSHS substance abuse treatment.
Source: FY2005 ER Cost per Medicaid Client per Month for Those Who Needed Substance Abuse Services But Did Not Receive Them (Untreated) vs. Those Who Needed
Substance Abuse Services and Did Receive Them (Treated): Initial data set consisted of all persons who had Medicaid paid Substance Abuse ER visits during FY2005.
Clients were divided into those who received DSHS Substance Abuse services based on match between DSHS Substance Abuse dataset with Medicaid dataset. Dependent
variable was Total ER costs or dates or service during FY2005. Data sources: DSHS Substance Abuse services = BHIPS, Medicaid ER = TMHP AHQP Claims Universe.
Prepared by Research Team, Strategic Decision Support, HHSC, 3/23/2006.
60
MOVING HEALTH FORWARD
Exceptional Item 9 – Substance Abuse
• Reduced use of medical services, leading to cost savings
• Lower medical costs by reducing low birth weight babies,
Fetal Alcohol Spectrum Disorders and use of neonatal ICU
• Benefit to the child welfare system through services to
women of childbearing age
• In 2006, twenty percent of inmates in TDCJ were convicted
of drug offenses
– That does not count those convicted of other offenses to
which substance abuse was a contributing factor
• Services eligible for Medicaid leverage state funds with
federal funds (40 percent state/60 percent federal)
61
MOVING HEALTH FORWARD
Exceptional Item 9 – Substance Abuse
FY2010*
FY2011*
Treatment Services
$15.6
$15.6
Prevention Services
$4.5
$4.5
Medicaid for Outpatient Substance Abuse Services
$13.8
$13.8
Increased Contract Management Costs
$0.9
$1.0
$34.8
$34.9
Total:
* All figures in millions
62
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
• Impact of Mental Illness
– Individuals with severe mental illness have a life
expectancy that is 25 years shorter than the overall
population.
– Significant mental illness is often linked to obesity,
smoking and substance abuse.
– Underserved populations with MH or SA issues often
go to ERs for treatment.
– One-third of military service members returning from
current conflicts are affected by PTSD, major
depression or traumatic brain injury.
63
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
• Mental Health Crisis Services were phased-in for 2008.
• The base bill maintains 2009 funding levels for crisis services.
• Crisis mental health services funded by the 80th Legislature have
been implemented and are showing indicators of success.
–
–
–
–
–
–
–
AAS Accredited Hotlines
Mobile Crisis Outreach Teams
Crisis Stabilization Units
Extended Observation Units
Crisis Residential Facilities
Crisis Respite Facilities
Outpatient Competency Restoration
FY 2007
1
4
3
3
10
4
1
FY2008
38
38
3
6
13
14
4
64
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
Percent of Crisis Service Episodes Followed by a
Psychiatric Hospitalization within 30 Days
Percent of Crisis Service Episodes Followed by Psychiatric Hospitalization
Number of Crisis Service Episodes
40%
125,000
102,162
91,368
30%
SFY2008
Annual
Target = 17%
100,000
84,199
75,000
20%
19.6%
(17,888)
21.0%
(17,706)
10%
50,000
16.9%
(17,247)
25,000
0%
0
SFY2006
SFY2007
SFY2008
Sources: DSHS Client Assignment and Registration (CARE) system and DSHS NorthSTAR Data Warehouse,
10/02/2008.
65
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
Need for Crisis Expansion
Betty Hardwick
Helen Farabee
Central Plains
Tarrant County MHMR
Heart of Texas
West Texas
Burke Center
Bluebonnet
Tri-County
El Paso
Spindletop
Austin-Travis County MHMR
Hill Country
Areas Currently Funded for
Expanded Crisis Services
Nueces County MHMR
Tropical
66
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
• Part 1: Expand options to underserved
communities with crisis funds, assuring
targeted services to children and adolescents
– Provide more Psychiatric Emergency Services
Centers and Children’s Crisis Projects (e.g.,
Respite)
– Serve an additional 8,736 individuals/year
– Serve an additional 226 children/year
67
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
IMPLEMENTATION OF CRISIS REDESIGN
5,000
3,940
4,000
2,885
3,000
2,548
2,442
1,997
2,433
2,381
2,859
2,692
2,609
1,868
2,000
1,000
0
20
Y
SF
06
Q
1
20
Y
SF
06
Q
2
20
Y
SF
06
Q
3
20
Y
SF
06
Q
4
20
Y
SF
07
Q
1
20
Y
SF
07
Q
2
20
Y
SF
07
Q
3
20
Y
SF
07
Q
4
20
Y
SF
08
Q
1
20
Y
SF
08
Q
2
20
Y
SF
08
Q
3
Average Monthly Number of Persons Receiving
Community Mental Health Front-Door Crisis Services Increasing
Sources: DSHS Client Assignment and Registration (CARE) system. Note: SFY2008 YTD includes persons served with old + new GR.
68
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
Need for Transitional Services
Number of Persons Receiving Front-Door Crisis Services
Number Transitioning to On-Going Services
30,000
25,000
22,710
Number of Persons
20,712
20,000
19,478
15,000
10,000
5,000
3,254
(17%)
3,633
(16%)
3,340
(16%)
0
SFY2006
SFY2007
SFY2008 YTD (Q1-Q3)
Sources: DSHS Client Assignment and Registration (CARE) system, DSHS Mental Retardation and
Behavioral Health Outpatient Warehouse (MBOW), and DSHS Behavioral Health Integrated Provider System
(BHIPS).
69
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
• Part 2: Transitional services for difficult to
engage high-need individuals
– Goal is to break the cycle of
crisis-stabilization-crisis
– Serves 4,163 adults/year
– Serves 630 children/year
70
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
Need for Intensive Ongoing Services
Average Monthly Service Package
Distribution for Adults after
Receiving Crisis Services
(03/2008-05/2008)
Level 4
3%
Level 3
23%
Level 2
5%
ADULT RDM LEVELS OF CARE
Level 1 Pharmacological Management, Patient and
Family Education, and Routine Case
Management
Level 2 Pharmacological Management, Patient and
Family Education, Routine Case Management,
and Counseling
Level 3 Psychosocial Rehabilitation
Level 4 Assertive Community Treatment
Level 1
69%
71
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
• Part 3: Increase capacity for intensive
services for current clients
– Focus on difficult-to-serve clients transitioning
from crisis
– Serves 1,984 persons in FY10 and 3,967 in
FY11
72
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
• Veteran’s Mental Health
– Training for public behavioral health
practitioners in evidence-based practices for
PTSD
– Web-based application for simplifying
determination of eligibility
– Support for coordination among agencies
73
MOVING HEALTH FORWARD
Exceptional Item 10 – Mental Health Services
FY2010*
FY2011*
Psychiatric Emergency Centers & Children's Respite Services
$14.2
$14.2
Transitional Services
$12.5
$12.5
Intensive ongoing services targeting recipients of transition
services
$9.6
$19.2
Veterans Mental Health Training and Coordination
$1.1
$0.1
Increased Contract Management
$0.9
$0.9
External Evaluation of Crisis Projects
$0.2
$0.2
$38.4
$47.1
Total:
* All figures in millions
74
MOVING HEALTH FORWARD
Exceptional Item 11 – Chronic Diseases
– 70% of deaths are related to chronic disease
– 10% of population have major limitations in
daily living
– About 75% of health care costs come from
obesity, high blood pressure, high cholesterol
and Type 2 diabetes
– Tobacco is implicated in 25,000 deaths in Texas
annually
– Cost of $3.3 billion to Texas businesses in 2005
75
MOVING HEALTH FORWARD
Exceptional Item 11 – Chronic Diseases
Obesity Trends* Among U.S. Adults
1998
1990
2007
No Data
<10%
10%–14%
15%–19%
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
20%–24%
25%–29%
≥30%
Source: CDC Behavioral Risk Factor Surveillance System 76
MOVING HEALTH FORWARD
Exceptional Item 11 – Chronic Diseases
• Many of these conditions are preventable.
• We can reduce the disease burden and the economic
burden by promoting:
– Avoidance of tobacco
– Healthy eating
– Physical activity
– Maintaining a healthy weight
– Controlling blood pressure and cholesterol
77
MOVING HEALTH FORWARD
Exceptional Item 11 – Chronic Diseases
• Obesity
– Interventions to improve nutrition and increase physical activity
– Improved screening, diagnosis and treatment for cardiovascular
disease and stroke
– Support of the Mayor’s Fitness Council Grant program
• Tobacco
– Expand cessation services for Texans who want to quit
– Increase partnerships with communities with anti-smoking
activities
• Newborn Screening
– Expand detection of cystic fibrosis and case management
– Early intervention to improve lung functioning
78
MOVING HEALTH FORWARD
Exceptional Item 11 – Chronic Diseases
FY2010*
FY2011*
Obesity Prevention
$3.3
$5.9
Tobacco Prevention
$3.8
$4.7
Cardiovascular Council Projects
$1.0
$1.0
Cystic Fibrosis
$2.9
$3.4
$10.9
$15.0
Total:
* All figures in millions
79
MOVING HEALTH FORWARD
Exceptional Item 12 – Infectious Diseases
70,000
6,000
60,000
5,000
50,000
40,000
New Cases
4,000
PLWHA
3,000
30,000
2,000
20,000
Deaths
1,000
10,000
0
Number: New Cases and
Deaths
Number: PLWHA
HIV/AIDS in Texas: Persons Living with HIV/AIDS, New Diagnoses of HIV/AIDS, and
Deaths among those with HIV/AIDS
0
2003
2004
2005
2006
2007
New diagnoses are holding steady. The number of persons living with HIV/AIDS is
rising because they are surviving longer.
80
MOVING HEALTH FORWARD
Exceptional Item 12 – Infectious Diseases
Racial Disparity in Persons Living with HIV/AIDS in Texas, 2003-2007
25,000
1000.0
23,802
900.0
18,604
Number
18,113
15,000
15,532
10,000
11,089
5,000
800.0
Rate per 100,000
20,000
22,712
700.0
600.0
500.0
400.0
300.0
200.0
100.0
0
891.1
713.7
200.9
165.9
177.0
146.7
0.0
2003
2004
2005
2006
2007
2003
2004
Year
White
Black
Hispanic
White
2005
Year
Black
2006
2007
Hispanic
The number (left graph) of black persons living with HIV/AIDS surpassed that of whites in
2005. The rate (right graph) in 2007 was nearly 5 times higher for blacks than for others.
81
MOVING HEALTH FORWARD
Exceptional Item 12 – Infectious Diseases
In 2007, the incidence of Tuberculosis in Texas was 43% higher
than the U.S. incidence rate and second only to California.
Cases per 100,000 population
10
9
8
7
6.3
6
5
4.4
4
3
2
1
0
1998
1999
2000
2001
2002
2003
Year
US
2004
2005
2006
2007
Texas
Tuberculosis Incidence Rates,
Texas and U.S., 1998-2007
82
MOVING HEALTH FORWARD
Exceptional Item 12 – Infectious Diseases
Top 10 High-Morbidity
Counties
Harris
Dallas
Tarrant
Hidalgo
Cameron
Bexar
Travis
El Paso
Webb
Fort Bend
Cases
397
219
106
76
74
72
55
40
40
40
83
MOVING HEALTH FORWARD
Exceptional Item 12 – Infectious Diseases
• CDC recommends expanded testing for HIV
– Earlier detection leads to earlier, more effective treatment
– Reduces the rate of transmission
• Texas is second nationally in TB cases
• Exceptional Item 12 includes:
– Improved HIV testing
– Expand improved testing for TB and STDs
– Tuberculosis services
– Upgrade cervical cancer screening
84
MOVING HEALTH FORWARD
Exceptional Item 12 – Infectious Diseases
FY2010*
FY2011*
HIV/STD Viral Hepatitis Testing
$4.4
$4.7
Tuberculosis Services
$3.2
$3.6
Cervical Cancer Screening
$0.5
$0.5
$8.1
$8.8
Total:
* All figures in millions
85
MOVING HEALTH FORWARD
Exceptional Item 13 – LMHA Services
• Increased Costs for Local Mental Health
Authorities
– Increasing cost for pharmaceuticals, laboratory services
and utilities
– Growing demand
– Increased efforts to keep individuals with mental illness
out of the criminal justice system
Maintenance of Services at LMHAs
FY2010*
FY2011*
$13.4
$13.4
* All figures in millions
86
Other Agency
Legislative Appropriations Requests
• Health and Human Services Commission
– Critical health care shortage positions
• Physicians, psychiatrists, nurses
– Waiting lists for Children with Special Health Care Needs,
Children’s Mental Health Services
– Consolidated enterprise requests for technology and vehicles
• Department of Assistive and Rehabilitation Services
– Accessibility of information technology
• Comptroller’s Judiciary Section
– Sexually Violent Predator Monitoring Program
87
DSHS Legislative Appropriations Request
for Fiscal Years 2010-11
APPENDIX B
Exceptional Item Method of Finance