DSHS Legislative Appropriations Request for Fiscal Years 2010-11 Presentation to the House Appropriations Subcommittee on Health and Human Services February 23, 2009 David L.
Download ReportTranscript DSHS Legislative Appropriations Request for Fiscal Years 2010-11 Presentation to the House Appropriations Subcommittee on Health and Human Services February 23, 2009 David L.
DSHS Legislative Appropriations Request for Fiscal Years 2010-11 Presentation to the House Appropriations Subcommittee on Health and Human Services February 23, 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% Federal 45% $5.6 billion biennial budget 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
DSHS Legislative Appropriations Request
Summary
Exceptional Items Summary EXCEPTIONAL ITEM GR FY 2010 All Funds GR FY 2011 All Funds BIENNIAL TOTAL GR All Funds FY 2010 FTEs FY 2011 FTEs Exceptional Items:
1. Maintaining Current Operations 2. Regulatory 3. Health Data Collection & Analysis 4. Vital Statistics 5. Information Technology Support for Critical Programs 6. Disaster Recovery and Public Health Preparedness 7. Stipends for Psychiatrist and Medical Residents 8. Building & Equipment Repair & Replace 9. Substance Abuse Services 10. Community Mental Health Services 11. Chronic Disease Prevention 12. Infectious Disease Prevention 13.
Community Mental Health Services - Maintenance of Critical Services at LMHA
Total Exceptional Items
$ 28,782,048 $ 39,268,566 $ 34,059,971 $ 44,627,245 $ 62,842,019 $ 83,895,811 87.5 87.5 7,279,996 7,279,996 11,506,211 11,506,211 18,786,207 18,786,207 57.7 133.7 9,652,427 12,675,338 9,060,534 12,282,835 18,712,961 24,958,173 54.6 68.9 3,492,794 3,492,794 3,162,250 3,162,250 6,655,044 6,655,044 14.2 24.3 15,654,867 15,654,867 14,635,242 14,635,242 30,290,109 30,290,109 12.1 12.1 16,754,841 16,754,841 7,311,530 7,311,530 24,066,371 24,066,371 37.8 37.8 1,386,399 1,386,399 1,350,396 1,350,396 2,736,795 2,736,795 - - 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 38,430,919 38,430,919 47,105,578 47,105,578 85,536,497 85,536,497 16.2 16.2 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 $ 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 5
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) 6
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1 - State Hospital Capacity
Waiting Lists for Clearinghouse (Non-Maximum Security) and Maximum Security (MSU)
200 180 160 140 120 100 80 60 40 20 0 Clearinghouse MSU May-06 115 124 Sep-06 153 122 Jan-07 34 137 May-07 67 168 Sep-07 192 110 Jan-08 82 25 May-08 47 58 Sep-08 57 39 Jan-09 142 36 Funding provided to add beds to the state hospital system.
SB 867 (80 th Legislature) provides more flexibility for maximum security admissions.
Initial crisis services funding allocated.
7
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 8
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 9
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 10
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 11
MAINTAINING OPERATIONAL CAPACITY Exceptional Item 1 – State Hospital Capacity
• Examples of Other Operating Costs – Food – Equipment – Furnishings 12
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 13
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.
14
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 15
MAINTAINING OPERATIONAL CAPACITY
Exceptional Item 1
State Hospital Capacity Mental Health and Substance Abuse Services 08-09 Phased-In Services – Alberto N Family Planning Reimbursement Rabies Bait Drop Increased Costs Rio Grande State Center FTEs (IAC)
Total:
* All figures in millions
FY2010*
$19.7
$8.0
$1.1
$3.6
$0.8
$3.2
$2.7
$39.3
FY2011*
$25.0
$8.0
$1.1
$3.6
0.8
$3.5
$2.7
$44.6
16
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 17
ENSURING COMPLIANCE
Exceptional Item 2 – Regulatory Services
100.00% 95.00% 90.00% 85.00% 80.00% 75.00% 70.00% 65.00% 60.00% 55.00% 50.00% 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00%
Increase in licenses for the Division for Regulatory Services 2002-2007
30.76% 76.60% 32.52% 10.73% 24.49% 83.07%
Licenses by Regulatory Strategy Texas is a growing state.
From 2002 to 2007, the number of licenses in some programs increased by as much as 80%.
Summary of all Regulatory licenses 13038 - Food and Drug 13039 - Environmental 13040 - Radiation 13041 - Professional Licensing 13042 - Health Care Facilities 18
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
* All figures in millions
FY2010*
$7.3
FY2011*
$11.5
19
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.
20
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
21
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
22
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
23
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.
24
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.
25
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.
26
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.
27
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.
28
ENSURING COMPLIANCE
Exceptional Item 3 – Health Care Data
Disease Registries – Chronic Disease Registries – Healthcare Associated Infections Reporting Blood Lead Testing & Follow-Up Newborn Screening Linkage Center for Health Statistics
Total:
* All figures in millions
FY2010*
$4.2
$1.5
$6.0
$0.8
$0.12
$12.7
FY2011*
$2.6
$2.8
$6.4
$0.3
$0.13
$12.3
29
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*
$3.5
FY2011*
$3.2
30
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 31
ENSURING COMPLIANCE
Exceptional Item 5 – Data Systems
Network Interoperability, Video & Voice Communications and Security Seat Management Consolidated Health Care Data Collection Clinical Management for Behavioral Health Services Hospital Automated Medication Dispensing System
Total:
* All figures in millions
FY2010*
$6.6
$1.5
$1.2
$2.7
$3.6
$15.7
FY2011*
$5.8
$1.5
$1.0
$3.8
$2.5
$14.6
32
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 33
ENSURING COMPLIANCE
Exceptional Item 6 – Disaster Response
Salmonella Saintpaul Outbreak 34
ENSURING COMPLIANCE
Exceptional Item 6 – Disaster Response
• INSERT SLIDE ON HURRICANES Storms lined up across the Atlantic – September 2008 35
ENSURING COMPLIANCE
Exceptional Item 6 – Disaster Response
Impact of Hurricane Ike 36
ENSURING COMPLIANCE
Exceptional Item 6 – Disaster Response
Public Health Emergency Preparedness Response Response Equipment Laboratory Shelters – Renovation of State Facilities Local Health Services Expansion Border Public Health Surveillance and Security Behavioral Health Positions in DSHS Regional Offices Recruitment and Retention
Total:
* All figures in millions
FY2010*
$3.9
$4.0
$2.1
$4.0
$0.5
$1.0
$0.6
$0.8
$16.8
FY2011*
$3.4
- $1.0
- $0.5
$1.0
$0.7
$0.8
$7.3
37
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.
FY2010* FY2011*
Stipends for Psychiatric & Preventive Medicine Residents * All figures in millions $1.4
$1.4
38
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
39
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.
40
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.
41
ENSURING COMPLIANCE
Exceptional Item 8 – Maintain Facilities
FY10-11 Capital Construction Needs • Identified deficiencies (deferred maintenance): $233 million
250.0
200.0
• $198.3 million in capital construction needs have been identified for FY10-11 funding for State Hospitals.
150.0
100.0
• Of that, $70.9 million has been identified as the most critical.
50.0
0.0
$233M Deferred Maintenance $198.3M Needs $70.9M Requested
42
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.
43
MOVING HEALTH FORWARD Leading Causes of Death – Texas 2005 and 2001
Heart Diseases Cancer Stroke Accidents Lower Respiratory Disease Diabetes Alzheimers Flu & Pneumonia 0 2001 2005 DSHS Center for Health Statistics 10,000 20,000 30,000
Number of Deaths
40,000 50,000 44
MOVING HEALTH FORWARD Actual Causes of Death* Shaped by Behavior Tobacco Overweight/Obesity Alcohol Auto Accidents Drugs Suicide DWI Homicide Sexual Behavior *Texas 2001 0 5000 10000 15000 20000 25000 30000
Chronic Disease in Texas 2007, DSHS 45
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 46
MOVING HEALTH FORWARD
Exceptional Item 9 – Substance Abuse
$136 ER Cost per Medicaid Client per Month Untreated $136 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.
47
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) 48
MOVING HEALTH FORWARD
Exceptional Item 9 – Substance Abuse
Treatment Services Prevention Services Medicaid for Outpatient Substance Abuse Services Increased Contract Management Costs
Total:
* All figures in millions
FY2010*
$15.6
$4.5
$13.8
$0.9
$34.8
FY2011*
$15.6
$4.5
$13.8
$1.0
$34.9
49
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.
50
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 80 th 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
51
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% 30% SFY2008 Annual Target = 17% 20% 10% 0% 91,368 19.6% (17,888) 84,199 21.0% (17,706) 102,162 16.9% (17,247) 125,000 100,000 75,000 50,000 25,000 0 SFY2006 SFY2007 SFY2008
Sources:
DSHS Client Assignment and Registration (CARE) system and DSHS NorthSTAR Data Warehouse, 10/02/2008. 52
MOVING HEALTH FORWARD
Exceptional Item 10 - Mental Health Services
Need for Crisis Expansion Betty Hardwick Tarrant County MHMR Helen Farabee Central Plains Heart of Texas West Texas El Paso Burke Center Bluebonnet Tri-County Spindletop Austin-Travis County MHMR Hill Country Areas Currently Funded for Expanded Crisis Services Tropical Nueces County MHMR
53
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 54
MOVING HEALTH FORWARD
Exceptional Item 10 - Mental Health Services
IMPLEMENTATION OF CRISIS REDESIGN 5,000 4,000 3,000 2,000 1,000 1,997 1,868 2,442 2,548 2,433 2,381 2,885 2,609 2,692 2,859 3,940 0 S FY 20 06 Q 1 S FY 20 06 Q 2 S FY 20 06 Q 3 S FY 20 06 Q 4 S FY 20 07 Q 1 S FY 20 07 Q 2 S FY 20 07 Q 3 S FY 20 07 Q 4 S FY 20 08 Q 1 S FY 20 08 Q 2 S FY 20 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. 55
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 20,000 19,478 22,710 20,712 15,000 10,000 5,000 3,254 (17%) 3,633 (16%) 3,340 (16%) 0 SFY2006 SFY2007 SFY2008 YTD (Q1-Q3)
Sources:
(BHIPS).
DSHS Client Assignment and Registration (CARE) system, DSHS Mental Retardation and Behavioral Health Outpatient Warehouse (MBOW), and DSHS Behavioral Health Integrated Provider System 56
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 57
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% 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 2 5% Level 1 69%
58
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 59
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 60
MOVING HEALTH FORWARD
Exceptional Item 10 - Mental Health Services
Psychiatric Emergency Centers & Children's Respite Services Transitional Services Intensive ongoing services targeting recipients of transition services Veterans Mental Health Training and Coordination Increased Contract Management External Evaluation of Crisis Projects
Total:
* All figures in millions
FY2010*
$14.2
$12.5
$9.6
$1.1
$0.9
$0.2
$38.4
FY2011*
$14.2
$12.5
$19.2
$0.1
$0.9
$0.2
$47.1
61
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 62
MOVING HEALTH FORWARD
Exceptional Item 11 – Chronic Diseases
Obesity Trends* Among U.S. Adults
1990 1998 2007
No Data <10% 10% –14% 15%–19% 20%–24% 25%–29% ≥30% (*BMI 30, or about 30 lbs. overweight for 5’4” person) Source: CDC Behavioral Risk Factor Surveillance System 63
MOVING HEALTH FORWARD
Exceptional Item 11 - Chronic Diseases
Obesity Prevalence Trends in Texas Adults 1990 to 2007 Obese Normal Weight 60 50 40 30 20 10 0 ~34% of Texans are normal weight ~29% of Texans are obese 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07
Texas Comptroller: www.window.state.tx.us/specialrpt/obesitycost/summary/ 64
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 65
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 66
MOVING HEALTH FORWARD
Exceptional Item 11 – Chronic Diseases
Obesity Prevention Tobacco Prevention Cardiovascular Council Projects Cystic Fibrosis
Total: FY2010*
$3.3
$3.8
$1.0
$2.9
$10.9
FY2011*
$5.9
$4.7
$1.0
$3.4
$15.0
* All figures in millions 67
MOVING HEALTH FORWARD
Exceptional Item 12 - Infectious Diseases
HIV/AIDS in Texas: Persons Living with HIV/AIDS, New Diagnoses of HIV/AIDS, and Deaths among those with HIV/AIDS 70,000 6,000 60,000 5,000 50,000 New Cases 4,000 PLWHA 40,000 30,000 3,000 2,000 20,000 10,000 Deaths 1,000 0 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. 68
MOVING HEALTH FORWARD
Exceptional Item 12 - Infectious Diseases
25,000 20,000 15,000 10,000 5,000 Racial Disparity in Persons Living with HIV/AIDS in Texas, 2003-2007 18,604 18,113 11,089 23,802 22,712 15,532 0 2003 2004 White 2005
Year
Black 2006 2007 Hispanic 1000.0
900.0
800.0
700.0
600.0
500.0
400.0
300.0
200.0
100.0
0.0
713.7
165.9
146.7
891.1
200.9
177.0
2003 2004 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.
69
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.
10 9 8 3 2 1 0 7 6 5 4 1998 1999 2000 2001 2002 2003
Year US Texas
2004 2005 2006 2007
6.3
4.4
Tuberculosis Incidence Rates, Texas and U.S., 1998-2007 70
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 71
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 72
MOVING HEALTH FORWARD
Exceptional Item 12 - Infectious Diseases
HIV/STD Viral Hepatitis Testing Tuberculosis Services Cervical Cancer Screening * All figures in millions
Total: FY2010*
$4.4
$3.2
$0.5
$8.1
FY2011*
$4.7
$3.6
$0.5
$8.8
73
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 * All figures in millions
FY2010*
$13.4
FY2011*
$13.4
74
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 – Data Center Services Increased Costs • In the HHS Consolidated Budget – Rate Increases for Providers – Staff Recruitment and Retention 75
Issues for FY 2009
• FTEs – Funded from Interagency Contracts/Federal Funds • Capital Budget Authority • Medicare Part D Savings Use Plan 76
DSHS Legislative Appropriations Request for Fiscal Years 2010-11 APPENDIX A Exceptional Item Method of Finance