DSHS Legislative Appropriations Request for Fiscal Years 2010-11 Presentation to the House...

DSHS Legislative Appropriations Requestfor Fiscal Years 2010-11

Presentation to the House Appropriations Subcommittee on Health and Human Services

February 23, 2009

David L. Lakey, M.D.Commissioner

2

DSHS Legislative Appropriations RequestFiscal Years 2010-11

• Base Budget

$5,592,709,588 All Funds

• Exceptional Items

$487,069,478 All Funds

3


$5.6 billionbiennialbudget

FY 2010-11 DSHS budget by source

4


• 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

5

DSHS Legislative Appropriations RequestSummary

FY 2010 FY 2011

GR All Funds GR All Funds GR All Funds FTEs FTEs

1. Maintaining Current Operations $ 28,782,048 $ 39,268,566 $ 34,059,971 $ 44,627,245 $ 62,842,019 $ 83,895,811 87.5 87.5

2. Regulatory 7,279,996 7,279,996 11,506,211 11,506,211 18,786,207 18,786,207 57.7 133.7

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 - -

9. Substance Abuse Services 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

12. Infectious Disease Prevention 8,079,969 8,113,423 8,759,736 8,793,190 16,839,705 16,906,613 35.7 35.7

13.Community Mental Health Services - Maintenance of Critical Services at LMHA

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

EXCEPTIONAL ITEMFY 2010

Total Exceptional Items

Exceptional Items Summary

FY 2011 BIENNIAL TOTAL

Exceptional Items:

6

• 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)

MAINTAINING OPERATIONAL CAPACITY

Exceptional Item 1

7

Waiting Lists for Clearinghouse (Non-Maximum Security) and Maximum Security (MSU)

0

20

40

60

80

100

120

140

160

180

200

Clearinghouse 115 153 34 67 192 82 47 57 142

MSU 124 122 137 168 110 25 58 39 36

May-06 Sep-06 Jan-07 May-07 Sep-07 Jan-08 May-08 Sep-08 Jan-09

MAINTAINING OPERATIONAL CAPACITYExceptional Item 1 - State Hospital Capacity

Funding provided to add beds to the state hospital system.

SB 867 (80th Legislature) provides more flexibility for maximum security admissions.

Initial crisis services funding allocated.

8

MAINTAINING OPERATIONAL CAPACITYExceptional 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

9


• 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

10


• Pharmaceutical cost increases– Psychiatric drugs (82% of purchases)

• 9% increase in cost

– All other drugs • 25% increase in cost

11


• 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 $133,000End stage renal $334,000Dialysis $177,000Pneumonia $148,000Neck cancer $145,000Cardiovascular $178,000

12


• Examples of Other Operating Costs– Food

– Equipment

– Furnishings

13


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

14


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.

15


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

16


Exceptional Item 1

FY2010* FY2011*

State Hospital Capacity $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

Total: $39.3 $44.6* All figures in millions

17

ENSURING COMPLIANCEExceptional 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

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Summary of all Regulatory licenses

13038 - Food and Drug

13039 - Environmental

13040 - Radiation

13041 - Professional Licensing

13042 - Health Care Facilities

Increase in licenses for the Division for Regulatory Services2002-2007

30.76%

76.60%

32.52%

10.73%

24.49%

83.07%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

50.00%

55.00%

60.00%

65.00%

70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

Licenses by Regulatory Strategy

Per

cen

tag

e o

f In

cre

ase

Texas is a growing state.From 2002 to 2007, the

number of licenses in some programs increased

by as much as 80%.

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• 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.


FY2010* FY2011*

Regulatory Services $7.3 $11.5* All figures in millions

20

ENSURING COMPLIANCEExceptional 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.

21


• 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

22

• 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


23

• 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


24

• 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.


25

• 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.


26

• 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.


27

• 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.


28

• 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.


29

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

Total: $12.7 $12.3

* All figures in millions


30

ENSURING COMPLIANCEExceptional 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

FY2010* FY2011*

Vital Records $3.5 $3.2


31

ENSURING COMPLIANCEExceptional 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

32


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

ENSURING COMPLIANCEExceptional Item 5 – Data Systems

33

ENSURING COMPLIANCEExceptional 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

34


Salmonella Saintpaul Outbreak

35


• INSERT SLIDE ON HURRICANES

Storms lined up across the Atlantic – September 2008

36


Impact of Hurricane Ike

37

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

Total: $16.8 $7.3



38

ENSURING COMPLIANCEExceptional 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 $1.4 $1.4* All figures in millions

39

ENSURING COMPLIANCEExceptional Item 7 – Stipends for Residents

Psychiatrists per 100,000 Population

00.1 - 5.15.1 - 10.710.7 - 19.619.6 - 36.5

Psychiatrists and Child Psychiatrists,

Texas - 2007

40

ENSURING COMPLIANCEExceptional 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.

41

• 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.

Infrastructure Description


42

• Identified deficiencies (deferred maintenance): $233 million

• $198.3 million in capital construction needs have been identified for FY10-11 funding for State Hospitals.

• Of that, $70.9 million has been identified as the most critical.

FY10-11 Capital Construction Needs

$233M

$198.3M

$70.9M

0.0

50.0

100.0

150.0

200.0

250.0

DeferredMaintenance

Needs Requested


43

• 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.

Categories of Capital Equipment• Grounds• Heating• Air conditioning

• Motorized• Emergency• Other

• Furniture• Medical/Adaptive• Food Service


44

MOVING HEALTH FORWARDLeading Causes of Death – Texas 2005 and 2001

0 10,000 20,000 30,000 40,000 50,000

Flu & Pneumonia

Alzheimers

Diabetes

Lower Respiratory Disease

Accidents

Stroke

Cancer

Heart Diseases

Number of Deaths

2001

2005

DSHS Center for Health Statistics

45

MOVING HEALTH FORWARD Actual Causes of Death* Shaped by Behavior

0 5000 10000 15000 20000 25000 30000

Sexual Behavior

Homicide

DWI

Suicide

Drugs

Auto Accidents

Alcohol

Overweight/Obesity

Tobacco

Chronic Disease in Texas 2007, DSHS*Texas 2001

46

MOVING HEALTH FORWARDExceptional 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

47

Treated

$89

Untreated

$136

$0

$136

ER Costper Medicaid Client

per Month

ER COST OFFSET

- $47Average per Client per Month

35%REDUCTION

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.


48

• 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)


49


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

Total: $34.8 $34.9


50

MOVING HEALTH FORWARDExceptional 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.

51

• 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.

FY 2007 FY2008– AAS Accredited Hotlines 1 38– Mobile Crisis Outreach Teams 4 38– Crisis Stabilization Units 3 3– Extended Observation Units 3 6– Crisis Residential Facilities 10 13– Crisis Respite Facilities 4 14– Outpatient Competency Restoration 1 4


52

Sources: DSHS Client Assignment and Registration (CARE) system and DSHS NorthSTAR Data Warehouse, 10/02/2008.

16.9%(17,247)

21.0%(17,706)

19.6%(17,888)

91,36884,199

102,162

0%

10%

20%

30%

40%

SFY2006 SFY2007 SFY2008

0

25,000

50,000

75,000

100,000

125,000

Percent of Crisis Service Episodes Followed by Psychiatric Hospitalization

Number of Crisis Service Episodes

SFY2008 Annual

Target = 17%

Percent of Crisis Service Episodes Followed by a Psychiatric Hospitalization within 30 Days


53

El Paso

Tropical

Nueces County MHMR

Austin-Travis County MHMR

Bluebonnet

Tri-County

Spindletop

Burke Center

Heart of Texas

Central Plains

Betty Hardwick

Hill Country

West Texas

Helen FarabeeTarrant County MHMR

Areas Currently Funded for Expanded Crisis Services


Need for Crisis Expansion

54

• 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


55Sources: DSHS Client Assignment and Registration (CARE) system. Note: SFY2008 YTD includes persons served with old + new GR.

Average Monthly Number of Persons Receiving Community Mental Health Front-Door Crisis Services Increasing

1,997 1,868

2,442 2,548 2,433 2,381

2,8852,609 2,692

2,859

3,940

0

1,000

2,000

3,000

4,000

5,000

SFY20

06 Q

1

SFY20

06 Q

2

SFY20

06 Q

3

SFY20

06 Q

4

SFY20

07 Q

1

SFY20

07 Q

2

SFY20

07 Q

3

SFY20

07 Q

4

SFY20

08 Q

1

SFY20

08 Q

2

SFY20

08 Q

3

IMPLEMENTATION OF CRISIS REDESIGN


56

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).

19,478

22,710

20,712

3,340(16%)

3,633(16%)

3,254(17%)

0

5,000

10,000

15,000

20,000

25,000

30,000

SFY2006 SFY2007 SFY2008 YTD (Q1-Q3)

Nu

mb

er o

f P

erso

ns

Number of Persons Receiving Front-Door Crisis Services

Number Transitioning to On-Going Services

Need for Transitional Services


57

• 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


58

Average Monthly Service Package Distribution for Adults after

Receiving Crisis Services(03/2008-05/2008)

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

Need for Intensive Ongoing Services


59

• 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


60

• 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


61

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

Total: $38.4 $47.1



62

MOVING HEALTH FORWARDExceptional 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

63(*BMI 30, or about 30 lbs. overweight for 5’4” person)

1998

2007

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: CDC Behavioral Risk Factor Surveillance System

Obesity Trends* Among U.S. Adults


64

0

10

20

30

40

50

60

Obese Normal Weight

Obesity Prevalence Trends in Texas Adults 1990 to 2007

~34% of Texans are normal weight

~29% of Texans are obese

Texas Comptroller: www.window.state.tx.us/specialrpt/obesitycost/summary/

MOVING HEALTH FORWARDExceptional Item 11 - Chronic Diseases

65

• 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

MOVING HEALTH FORWARD Exceptional Item 11 – Chronic Diseases

66

• 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

MOVING HEALTH FORWARD Exceptional Item 11 – Chronic Diseases

67

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

Total: $10.9 $15.0



68

MOVING HEALTH FORWARDExceptional 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

New diagnoses are holding steady. The number of persons living with HIV/AIDS is rising because they are surviving longer.

PLWHA

Deaths

New Cases

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

2003 2004 2005 2006 2007

Nu

mb

er:

PL

WH

A

0

1,000

2,000

3,000

4,000

5,000

6,000

Nu

mb

er:

New

Cas

es a

nd

D

eath

s

69

Racial Disparity in Persons Living with HIV/AIDS in Texas, 2003-2007

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.


22,71218,604

23,802

18,113

15,532

11,089

0

5,000

10,000

15,000

20,000

25,000

2003 2004 2005 2006 2007

Year

Nu

mb

er

White Black Hispanic

165.9200.9

891.1713.7

146.7 177.0

0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

800.0

900.0

1000.0

2003 2004 2005 2006 2007

Year

Ra

te p

er

10

0,0

00

White Black Hispanic

70


In 2007, the incidence of Tuberculosis in Texas was 43% higher than the U.S. incidence rate and second only to California.

0

1

2

3

4

5

6

7

8

9

10

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007Year

Ca

se

s p

er

10

0,0

00

po

pu

lati

on

US Texas

6.3

4.4

Tuberculosis Incidence Rates,Texas and U.S., 1998-2007

71

Top 10 High-Morbidity Counties

Cases

Harris 397Dallas 219Tarrant 106Hidalgo 76Cameron 74Bexar 72Travis 55El Paso 40Webb 40Fort Bend 40


72

• 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


73


FY2010* FY2011*

HIV/STD Viral Hepatitis Testing $4.4 $4.7

Tuberculosis Services $3.2 $3.6

Cervical Cancer Screening $0.5 $0.5

Total: $8.1 $8.8


74

MOVING HEALTH FORWARDExceptional 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

FY2010* FY2011*

Maintenance of Services at LMHAs $13.4 $13.4* All figures in millions

75

Other AgencyLegislative 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

76

Issues for FY 2009

• FTEs– Funded from Interagency Contracts/Federal Funds

• Capital Budget Authority

• Medicare Part D Savings Use Plan

DSHS Legislative Appropriations Requestfor Fiscal Years 2010-11

APPENDIX A

Exceptional Item Method of Finance

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DSHS Legislative Appropriations Request for Fiscal Years 2010-11 Presentation to the House...

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