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Department of State Health Services Legislative Appropriations Request for Fiscal Years 2012 -2013 David Department of State Health Services Legislative Appropriations Request for Fiscal Years 2012 -2013 David Lakey, M. D. Commissioner Governor’s Office of Budget, Policy and Planning Legislative Budget Board Joint Hearing September 13, 2010

Overview • DSHS Base Request for FY 2012 -13 • FY 2012 -13 Ten Overview • DSHS Base Request for FY 2012 -13 • FY 2012 -13 Ten Percent Schedule • Exceptional Items – Maintaining current services – Ensuring compliance with state & federal requirements – Moving health forward in Texas 2

FY 2010 -11 Appropriations (By Source) $6. 16 billion biennial budget 3 FY 2010 -11 Appropriations (By Source) $6. 16 billion biennial budget 3

Legislative Appropriations Request Fiscal Years 2012 -13 Base Budget § $5, 952, 644, 233 Legislative Appropriations Request Fiscal Years 2012 -13 Base Budget § $5, 952, 644, 233 All Funds Exceptional Items § $281, 201, 396 All Funds 4

FY 2012 -13 Base Budget • According to the budget instructions, the FY 2012 FY 2012 -13 Base Budget • According to the budget instructions, the FY 2012 -13 appropriations requests may not exceed FY 2010 expenditures and FY 2011 budgeted funds adjusted for the full five percent reduction targets. • The full 5% reduction for DSHS is equivalent to $123. 4 million in General Revenue and General Revenue. Related funds. • A number of the DSHS reductions made in 2010 -11 were one-time opportunities. • The five percent adjustments were taken in a crossenterprise manner--HHSC is providing some reductions for other agencies. • As a result, the 2012 -13 DSHS request contains adjustments for reductions of $39. 9 million rather than $123. 4 million. 5

FY 2012 -3 Base Budget (continued) • This request includes restoration of the ARRA FY 2012 -3 Base Budget (continued) • This request includes restoration of the ARRA funds for community mental health services as part of the base. • It also includes increases for caseload growth in Medicaid programs. • It does not include restoration of the ARRA funds in the following areas: – One-time TANF funding in Family Planning – ARRA funding for beds at North Texas State Hospital 6

FY 2012 -3 Base by Strategy GOAL 2010 -11 All Funds 2012 -13 All FY 2012 -3 Base by Strategy GOAL 2010 -11 All Funds 2012 -13 All Funds A. Preparedness & Prevention Services 1, 243, 611, 434 1, 086, 689, 573 B. Community Health Services 3, 706, 877, 855 3, 656, 431, 475 C. Hospital Facilities and Services 874, 304, 269 883, 276, 458 D. Consumer Protection Services 145, 847, 016 145, 049, 554 E. Indirect Administration 112, 204, 513 117, 068, 159 78, 392, 897 64, 129, 014 6, 161, 237, 984 5, 952, 644, 233 F. Capital Items TOTAL 7

FY 2010 -11 Appropriations (By Goal) 8 FY 2010 -11 Appropriations (By Goal) 8

First 5% of Reduction Schedule 9 First 5% of Reduction Schedule 9

Total 10% Reduction Schedule 10 Total 10% Reduction Schedule 10

Ten Percent Reduction Options (By Strategy) Strategy A. 2. 1 A. 3. 3 A. Ten Percent Reduction Options (By Strategy) Strategy A. 2. 1 A. 3. 3 A. 3. 4 A. 3. 5 B. 1. 1 B. 1. 2 B. 1. 4 B. 2. 1 – B. 2. 4 B. 2. 5 B. 3. 1 B. 3. 3 B. 3. 4 C. 1. 2 C. 1. 3 D. 1. 4 E. 1. 1 – E. 1. 3 Description Immunizations – Adult Immunizations – Children’s Outreach Health Program Diabetes Obesity Prevention Kidney Transportation Donate Life Registry Kidney Medical Children with Special Health Care Needs Epilepsy Farmer’s Market Women & Children’s Services – Dental Services Primary Care Community Mental Health Services Substance Abuse Intervention EMS/Trauma Indigent Health Care Reimbursement to UTMB County Indigent South Texas Health Care system State Mental Health Hospital System Massage Therapy Support Activities TOTAL First 5% 1 0 0. 5 1 4. 5 0. 4 1 0 0. 45 0. 85 0 6 35. 3 4 20 4. 5 6 2. 5 30 0 0. 7 119. 2 Second 5% 0 7. 7 0 0. 5 0 0 0 6 24 0 0 1. 6 3 47. 9 0 5 4 0 2. 5 14. 8 1. 5 0. 7 119. 2 Total 1 7. 7 0. 5 1 1 4. 5 0. 4 7 24 0. 45 0. 85 1. 6 9 83. 2 4 25 8. 5 6 5 44. 8 1. 5 1. 4 238. 4 11

Ten Percent Reduction Options • $137 million – Reductions in State Mental Health Hospital Ten Percent Reduction Options • $137 million – Reductions in State Mental Health Hospital capacity, Community Mental Health Services for adults and children, and Substance Abuse Intervention services • $58 million – Reductions in several programs that provide health and dental services, including vaccination, primary care and services for children with special health care needs, among others • $41 million – Reductions in funding for uncompensated care reimbursed to counties and hospitals, as well as prevention and education programs • $3 million – Reductions in support and administrative savings 12

Additional Funding Needs The process for identifying additional funding needs and developing them into Additional Funding Needs The process for identifying additional funding needs and developing them into exceptional items included: • Developing and conveying guiding principles to staff • Cross functional internal teams to ensure funding requests were holistic, integrated and aligned with the strategic plan • Input from stakeholders through various forums • Input from DSHS Council • Consideration of the impacts of Health Care Reform 13

Exceptional Item Requests Exceptional Items in priority order, ranked according to: • Maintaining current Exceptional Item Requests Exceptional Items in priority order, ranked according to: • Maintaining current services • Ensuring compliance with state and federal requirements • Moving health forward in Texas 14

Exceptional Item Requests 15 Exceptional Item Requests 15

MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload Persons Living with HIV/AIDS, New Diagnoses MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload Persons Living with HIV/AIDS, New Diagnoses of HIV/AIDS, and Deaths among those with HIV/AIDS New diagnoses and deaths are holding steady. The number of persons living with HIV/AIDS is rising because they are surviving longer. 16

MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload Source: 2010 Texas Integrated Epidemiologic Profile MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload Source: 2010 Texas Integrated Epidemiologic Profile for HIV/AIDS Prevention and Services Planning: HIV/AIDS in Texas, Department of State Health Services, Publication Number E 13 -11937 (Revised April 2010). 17

MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload By 2013, the number of Kidney MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload By 2013, the number of Kidney Health Care clients is expected to rise by five percent above the FY 2009 level. 18

MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload DSHS Regulatory Division ensures the safety MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload DSHS Regulatory Division ensures the safety of the products and services Texans use every day. 19

MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload • Additional licensees increase the demand MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload • Additional licensees increase the demand for regulatory business services, such as: – licensure processing, – compliance inspections, – response to complaints, and – enforcement. • To ensure that regulatory services are costeffective, DSHS uses risk-based inspections in most programs. • Regulatory programs are fee-supported. 20

MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload Montgomery County Mental Health Facility • MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload Montgomery County Mental Health Facility • DSHS Rider 97 appropriated $7. 5 million in General Revenue • Appropriation is for mental health services from March 1, 2011, to August 31, 2011 • Appropriation for a full biennium will be $30 million – $22. 5 million above the base 21

MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload • DSHS anticipates the following increases MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload • DSHS anticipates the following increases in costs in FY 2012 -13 above the FY 2010 -11 biennium – Utilities: 2% – Gasoline: 18% – Travel: 4% – Postage: 5% • DSHS has 384 vehicles that currently meet standards for replacement based on age and mileage requirements. – DSHS is seeking funding for 16 vehicles for regional offices in this exceptional item. 22

MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload Exceptional Item 1 FY 2012 HIV MAINTAIN CURRENT SERVICES Maintain Current Services/Address Increasing Caseload Exceptional Item 1 FY 2012 HIV Medications --- Kidney Health Care --- FY 2013 Biennium 22, 668, 987 846, 983 Montgomery County Annualized 7, 500, 000 Regulatory Services Annualized 2, 510, 780 2, 510, 779 5, 021, 559 Newborn Screening Annualized 479, 793 479, 973 959, 586 Vital Statistics Annualized 220, 796 220, 795 441, 591 1, 710, 535 2, 915, 060 4, 625, 595 151, 357 174, 176 325, 533 Agency Costs – Utilities, Transportation, Postage Replace Aging Vehicles Total 12, 573, 261 15, 000 22, 500, 000 44, 816, 573 57, 389, 834 23

MAINTAIN CURRENT SERVICES Maintain Hospital Operations Increasing Costs at State Hospitals • Increases in MAINTAIN CURRENT SERVICES Maintain Hospital Operations Increasing Costs at State Hospitals • Increases in medications: 7% • Increased food costs: 5% Outside Medical Services • DSHS is responsible for health care of patients • Need for these services is difficult to predict • Examples of individual patient medical costs in FY 2010: – – – – Unstable blood chemistry Respiratory Distress (COPD) Pneumonia/Abdominal Pains Aorta Aneurysm/Pneumonia Non-Hodgkins Disease/Chemotherapy Renal Failure Abdomen/Bowel Obstruction/Heart Attack Congestive Heart Failure $125, 000 $ 92, 387 $134, 241 $189, 835 $358, 291 $121, 844 $188, 026 $136, 086 24

MAINTAIN CURRENT SERVICES Maintain Hospital Operations Average Starting Salaries for Psychiatrists Compared to DSHS MAINTAIN CURRENT SERVICES Maintain Hospital Operations Average Starting Salaries for Psychiatrists Compared to DSHS • ~16 percent higher at TDCJ • ~20 percent higher at DADS • ~27 percent higher in private sector • Up to ~54 percent higher at Veterans’ Administration (with bonuses) 25

MAINTAIN CURRENT SERVICES Maintain Hospital Operations • Psychiatrists are needed to maintain accreditation and MAINTAIN CURRENT SERVICES Maintain Hospital Operations • Psychiatrists are needed to maintain accreditation and a safe therapeutic environment. • A shortage of psychiatrists on staff results in: – A risk to the quality of patient care and to the safety of patients and staff – A decline in the psychiatric care provided to patients will likely increase rates of injuries and adverse events, and may lead to litigation against the state. – Increased costs of overtime and temporary psychiatric staffing – Reduction of the time hospital psychiatrists can spend on clinical and administrative duties – A risk to accreditation and certification status and the potential loss of payment from Medicare, Medicaid, Disproportionate Share, and third party payment 26

MAINTAIN CURRENT SERVICES Maintain Hospital Operations Exceptional Item 2 FY 2013 Maintain Current Capacity MAINTAIN CURRENT SERVICES Maintain Hospital Operations Exceptional Item 2 FY 2013 Maintain Current Capacity 7, 222, 452 8, 582, 266 15, 804, 718 Market-level salaries for psychiatrists and advanced practice nurses 4, 959, 660 4, 959, 661 Additional Staffing Requirements 7, 762, 000 15, 524, 000 After Hours Pharmacy Coverage 660, 000 Total 20, 604, 112 660, 000 Biennium 9, 919, 321 1, 320, 000 21, 963, 927 42, 568, 039 27

MAINTAIN CURRENT SERVICES Maintain FY 10 -11 Services Funded by ARRA Exceptional Item 3 MAINTAIN CURRENT SERVICES Maintain FY 10 -11 Services Funded by ARRA Exceptional Item 3 FY 2012 FY 2013 Biennium North Texas State Hospital beds funded by ARRA 1, 250, 000 2, 500, 000 Supplemental TANF funds used for Family Planning 2, 100, 000 4, 200, 000 Total 3, 350, 000 6, 700, 000 FTEs 49 49 This item included 49 FTEs associated with the beds at North Texas State Hospital inadvertently not included in the FTE cap. 28

MAINTAIN CURRENT SERVICES State Hospital Capacity Growth in the Clearinghouse Waiting List for Forensic MAINTAIN CURRENT SERVICES State Hospital Capacity Growth in the Clearinghouse Waiting List for Forensic Commitments, Calendar Years 2008 and 2009 29

MAINTAIN CURRENT SERVICES State Hospital Capacity Growth in the Number of Forensic Patients, 2001 MAINTAIN CURRENT SERVICES State Hospital Capacity Growth in the Number of Forensic Patients, 2001 -2010 For patients discharged within a year of admissions, the average length of stay is 32 days for patients on a civil commitment, but 110 days for patients on a forensic commitment. 30

MAINTAIN CURRENT SERVICES State Hospital Capacity Growth in Forensic Patients and its Effect on MAINTAIN CURRENT SERVICES State Hospital Capacity Growth in Forensic Patients and its Effect on Capacity for Civil Commitments 31

MAINTAIN CURRENT SERVICES State Hospital Capacity • 614 individual have been patients of state MAINTAIN CURRENT SERVICES State Hospital Capacity • 614 individual have been patients of state mental health hospitals for longer than one year • Analysis of data for these patients indicates some of the patients do not require hospitalization, but are not capable of living with full independence • The state has a lack of “step down” alternative settings for these individuals • Funding “step down” alternatives would free up state hospital capacity 32

MAINTAIN CURRENT SERVICES State Hospital Capacity • DSHS is experiencing difficulty recruiting & retaining MAINTAIN CURRENT SERVICES State Hospital Capacity • DSHS is experiencing difficulty recruiting & retaining psychiatrists. – Only 6. 7 psychiatrists per 100, 000 Texans • This funding will provide stipends for residency placements in state hospitals. • Medical residents are a cost-effective means of increasing psychiatric care in hospitals. • Physicians often remain in the community where they served as medical residents. 33

MAINTAIN CURRENT SERVICES State Hospital Capacity Exceptional Item 4 FY 2012 FY 2013 Adult MAINTAIN CURRENT SERVICES State Hospital Capacity Exceptional Item 4 FY 2012 FY 2013 Adult Mental Health Long-term Care: 25 beds 1, 688, 125 3, 376, 250 Victory Field Residential: 50 beds 2, 939, 894 3, 872, 114 6, 812, 008 Bonds: Renovation Victory Field 2, 277, 975 U. B. 2, 277, 975 Increase Capacity at Harris County Psych Center for Forensic: 20 beds 4, 964, 000 9, 928, 000 Peer Support 575, 075 1, 150 Stipends for Psychiatrists and Advanced Practice Nurses 156, 836 441, 286 598, 122 Increase funding for Hospitality House 216, 553 433, 106 12, 818, 458 11, 757, 153 24, 575, 611 Total Biennium 34

MAINTAIN CURRENT SERVICES Hospital Equipment/Repair & Renovation Texas State Mental Health Hospitals • 11 MAINTAIN CURRENT SERVICES Hospital Equipment/Repair & Renovation Texas State Mental Health Hospitals • 11 State Mental Health Facility campuses. • 1, 967 acres, 557 buildings, 5. 0 million square feet. • $897 million replacement value. • Average is over 55 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. 35

MAINTAIN CURRENT SERVICES Hospital Equipment/Repair & Renovation FY 12 -13 Capital Construction Needs $165. MAINTAIN CURRENT SERVICES Hospital Equipment/Repair & Renovation FY 12 -13 Capital Construction Needs $165. 8 M • Identified deficiencies (deferred maintenance): $165. 8 million • $165. 5 million in capital construction needs have been identified for FY 1213 funding for State Hospitals. • Of that, $68. 9 million has been identified as the most critical. 36

MAINTAIN CURRENT SERVICES Hospital Equipment/Repair & Renovation Categories of Capital Equipment * Furniture * MAINTAIN CURRENT SERVICES Hospital Equipment/Repair & Renovation Categories of Capital Equipment * Furniture * Grounds * Motorized * Medical/Adaptive * Heating * Emergency * Food Service * Air conditioning * 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. • DSHS has 384 vehicles that currently meet standards for replacement based on age and mileage requirements. – DSHS is seeking funding for 199 vehicles for State Hospitals in this exceptional item. 37

MAINTAIN CURRENT SERVICES Hospital Equipment/Repair & Renovation Exceptional Item 5 FY 2012 Bonds for MAINTAIN CURRENT SERVICES Hospital Equipment/Repair & Renovation Exceptional Item 5 FY 2012 Bonds for Renovation of Aging Facilities Critical IT equipment/services Emergency Preparedness Critical Capital Equipment for Hospitals Consolidated Laundry Operations Vehicles 68, 899, 645 FY 2013 Biennium UB 68, 899, 645 2, 155, 000 611, 000 2, 766, 000 307, 050 49, 260 356, 310 5, 784 939, 178 6, 724, 962 264, 048 --- 264, 048 2, 595, 375 2, 751, 520 5, 346, 895 Total, General Revenue 11, 107, 257 4, 350, 958 15, 458, 215 Total, All Funds 80, 006, 902 4, 350, 958 84, 357, 860 38

ENSURING COMPLIANCE Patient Safety • The number of preventable health care associated infections (HAIs) ENSURING COMPLIANCE Patient Safety • The number of preventable health care associated infections (HAIs) continues to increase year over year – Leading cause of death from infectious diseases in the U. S. and in Texas – HAIs kill 99, 000 people each year – Cause an estimated 1. 7 million infections in the U. S. • HAIs are the leading cause of infectious deaths in Texas with: – 8, 000 -9, 000 deaths each year – HAIs also add more than $500 million in annual medical costs 39

ENSURING COMPLIANCE Patient Safety Successes • The 81 st Legislature provided $2. 2 million ENSURING COMPLIANCE Patient Safety Successes • The 81 st Legislature provided $2. 2 million to create a Healthcare-Association Infections Reporting System. • In addition, DSHS received $1. 2 million in ARRA funding to help develop the system. • Milestones: – Development of a plan for CDC – HAI system will be ready for facilities to report in mid 2011 – Patient safety plan to implement Preventable Adverse Events when funding becomes available – HAI training contract awarded to Association for Professionals in Infection Control and Epidemiology – HAI rules are in process for posting to the Texas Register 40

ENSURING COMPLIANCE Patient Safety Michigan Keystone Intensive Care Unit Project • Johns Hopkins and ENSURING COMPLIANCE Patient Safety Michigan Keystone Intensive Care Unit Project • Johns Hopkins and Michigan Health & Hospital Association • Targeted catheter-related bloodstream infections in 100 ICUs • Created a checklist – hand washing, cleaning patient’s skin, using a cap, gown and mask, and more careful catheter use • Results: – 66 percent reduction in these infections – In 18 months, 1, 500 lives and $200 million saved – Return on investment was $200 to every $1 spent 41

ENSURING COMPLIANCE Patient Safety Exceptional Item 6 FY 2012 FY 2013 1, 940, 240 ENSURING COMPLIANCE Patient Safety Exceptional Item 6 FY 2012 FY 2013 1, 940, 240 1, 651, 186 3, 591, 426 Targeted Interventions for HAI – Prevention Collaboratives 264, 893 371, 899 636, 782 Quality Assurance Teams across Texas 564, 076 663, 762 1, 227, 838 2, 769, 209 2, 688, 847 5, 456, 056 Implementing SB 203 – PAE data reporting Total Biennium 42

ENSURING COMPLIANCE Food and Environmental Safety Food Safety • Texas had salmonella outbreaks in ENSURING COMPLIANCE Food and Environmental Safety Food Safety • Texas had salmonella outbreaks in both 2008 (raw vegetables) and 2009 (peanuts). • Those outbreaks demonstrated the need to strengthen the lab’s testing capacity for bacteria that cause food borne illnesses. • Also, strengthening investigative capacity will increase the chances of identifying the source of contaminated food faster. • Warnings could be issued and recalls take place faster as a result. • DSHS would also be able to compare data with other states to determine if they are experiencing similar patterns. • CDC recommends testing of these isolates as a matter of prudent food safety practices. 43

ENSURING COMPLIANCE Food and Environmental Safety Ensuring Care for Children Exposed to Lead • ENSURING COMPLIANCE Food and Environmental Safety Ensuring Care for Children Exposed to Lead • Dangers of Exposure to Lead for Children – Problems learning/reading, delayed growth and hearing loss – At high levels, permanent brain damage and death • This funding would provide additional case management and improve automation systems – In general, identify more children before lead exposure creates long-term effects and improve their outcomes by targeting high-risk areas – Increase the number of children screened (on or before second birthday) – Identify more children with lead exposure earlier – Allow DSHS to help children find medical providers and treatment more quickly – Allow DSHS to conduct environmental investigations more quickly to identify the cause 44

ENSURING COMPLIANCE Food and Environmental Safety Exceptional Item 7 FY 2012 FY 2013 Food ENSURING COMPLIANCE Food and Environmental Safety Exceptional Item 7 FY 2012 FY 2013 Food Safety Detection and Investigation Improvement 1, 371, 291 1, 443, 114 2, 814, 405 Child Blood Lead Poisoning 1, 336, 009 656, 477 1, 992, 486 860, 700 --- 860, 700 3, 568, 000 2, 099, 591 5, 667, 591 Regulatory Automation System Total Biennium 45

MOVING HEALTH FORWARD Healthy Babies • Infant mortality rate in 2007 = 6. 2 MOVING HEALTH FORWARD Healthy Babies • Infant mortality rate in 2007 = 6. 2 • The infant mortality rate rose 9% from 2000 -2006, totaling nearly 2, 500 infant deaths. • Infant mortality and prematurity rates are significantly higher among nonwhite Texans 46

MOVING HEALTH FORWARD Healthy Babies 47 MOVING HEALTH FORWARD Healthy Babies 47

MOVING HEALTH FORWARD Healthy Babies The Texas pre-term birth rate in 2008 and 2009 MOVING HEALTH FORWARD Healthy Babies The Texas pre-term birth rate in 2008 and 2009 was 13. 6 percent -- the national average is 12. 3% 48

MOVING HEALTH FORWARD Healthy Babies The percentage of Texas infants born with low birth-weight MOVING HEALTH FORWARD Healthy Babies The percentage of Texas infants born with low birth-weight (under 5. 5 pounds) rose from 7. 4 percent of all births in 2000 to 8. 4% in 2006 – representing nearly 34, 000 infants 49

MOVING HEALTH FORWARD Healthy Babies are Worth the Wait…Success of the Kentucky Model • MOVING HEALTH FORWARD Healthy Babies are Worth the Wait…Success of the Kentucky Model • Preterm birth rates decreased in the project sites and in Kentucky • C-Section rates in the intervention sites increased by 2. 2 percent, compared with 11. 9 percent in the comparison sites • Smoking rates during pregnancy decreased 10 percent in the intervention sites, and 8 percent in the comparison sites • Provider behavior changed – providers are the intervention sites talked to patients about Quit Line, domestic violence and home visitation program and dental care at twice as much as comparison sites (the baseline was that there was no difference in the sites). 50

MOVING HEALTH FORWARD Healthy Babies Implementing Healthy Babies Initiative in Texas • Expect preterm MOVING HEALTH FORWARD Healthy Babies Implementing Healthy Babies Initiative in Texas • Expect preterm birth rate to decrease by 8 percent over 2 years • Translates into savings of approximately $7. 2 million in Medicaid costs over 2 years • Evidence-based interventions will be used, but communities will have flexibility to adapt those that fit their population the best • Local partnerships and coalitions will have a major role in shaping programs in their communities 51

MOVING HEALTH FORWARD Healthy Babies Birth Defects • Each year, more than 17, 000 MOVING HEALTH FORWARD Healthy Babies Birth Defects • Each year, more than 17, 000 Texas infants have major structural malformations or chromosomal anomalies. • For every 10, 000 live births: § ~6 births are affected by neural tube defects § ~11 babies are born with cleft lip § ~13 babies are born with Down Syndrome • In 2007, birth defects resulted in nearly 35, 000 hospitalizations among infants in Texas, with total charges of nearly $2. 4 billion. § Average length of stay: 11. 7 days § Average cost per hospitalization: $68, 000 52

MOVING HEALTH FORWARD Healthy Babies Rate of infants born with a birth defect per MOVING HEALTH FORWARD Healthy Babies Rate of infants born with a birth defect per 10, 000 live births: 435. 6 • Certain birth defects exhibit higher rates in some racial/ethnic groups than others. 53

MOVING HEALTH FORWARD Healthy Babies Exceptional Item 8 FY 2012 Reducing Top Causes of MOVING HEALTH FORWARD Healthy Babies Exceptional Item 8 FY 2012 Reducing Top Causes of Infant Mortality: Preterm/Low Birth. Weight, Birth Defects and SIDS FY 2013 Biennium 4, 833, 961 5, 167, 651 10, 001, 612 Improve collection of Birth Defects data 550, 860 548, 044 1, 098, 904 Expand Newborn Screening to Secondary Targets 998, 967 831, 462 1, 830, 429 Total, General Revenue 5, 862, 270 5, 645, 825 11, 508, 095 Total, All Funds 6, 383, 788 6, 547, 157 12, 930, 945 54

MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services • 3% of Texans MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services • 3% of Texans suffer from a severe and persistent mental illness • 1 in 10 children between 9 and 17 years of age suffers from a serious emotional disturbance • Mental health disorders are the leading cause of disability in the United States 55

MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Texas Crisis Redesign Services MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Texas Crisis Redesign Services Leading to Fewer Psychiatric Hospitalizations as a Percent of Crisis Episodes SFY 2008 Annual Target = 17% SFY 2009 Annual Target = 13% Sources: DSHS Client Assignment and Registration (CARE) system and DSHS North. STAR Data Warehouse. Percent of Crisis Episodes at DSHS-Funded Community Mental Health Centers Followed by a State or Community Psychiatric Hospitalization within 30 Days 56

MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Texas Crisis Redesign Leading MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Texas Crisis Redesign Leading to Fewer Emergency Room (ER) Visits SFY 2008 Annual Target = 13% SFY 2009 Annual Target = 11% Percent of Crisis Episodes among Medicaid Clients at DSHS-Funded Community Mental Health Centers Followed by an ER Visit within 30 Days Sources: DSHS Client Assignment and Registration (CARE) system, DSHS North. STAR Data Warehouse, and HHSC Medicaid Database. *The ER data utilized for this measure was for the period September 2008 to December 2008 only, due to Medicaid data lag and as specified in the ABEST definition of this measure. Therefore, this number does not represent the total annual effect of Crisis Redesign on Medicaid ER use in FY 2009. 57

MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Illicit Drug Use in MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Illicit Drug Use in the Past Year by Age Group in Texas Marijuana Use Cocaine/Crack Use Nonmedical Use of Codeine Cough Syrup Youth Population: Grade 7 to 12 30% 25% 21% 20% 19% 20% 16% 15% 10% 5% 5% 2000 2002 5% 6% 5% 5% 5% 4% 3% 0% 2004 2006 2008 * The question of nonmedical use of codeine cough syrup was added to Texas School Survey in 2004. Data Source: Texas School Survey of Substance Use Among Students: Grades 7 -12, Texas Department of State Health Services. 58

MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Alternatives to Incarceration or MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Alternatives to Incarceration or Hospitalization • 2009 data shows that the state is spending about $11 million on individuals accused of committing non-violent misdemeanor offenses. • Fund at least two programs to provide family and communitybased treatment services to children and youth arrested or at risk of arrest for non-violent offenses • Fund at least one program to provide diversion and treatment services to adults arrested or at risk of arrest for non-criminal offenses • Comprehensive mental health services will include services to persons with dual diagnosis of mental illness and substance abuse • One project for youth and one for adults modeled on Access to Recovery, providing access to a full range of treatment and recovery services 59

MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Expansion of Border Services MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Expansion of Border Services • DSHS will develop a comprehensive, community-based model program based in Del Rio, El Paso and Harlingen to target issues associated with border violence and substance abuse. – Family and youth prevention training programs – Youth and adult counseling intervention services – Evidence-based curriculum for prevention of substance abuse, gang violence and violence among youth – Mental health and short term counseling to help with fear and trauma caused with intensified violence – Build community mobilization to strengthen border counties against drug trafficking and youth gang activities and violence – Increase the use of trained volunteers, promotoras and community health workers to provide training on substance abuse and violence prevention. 60

MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Clinical Management for Behavioral MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Clinical Management for Behavioral Health Services (CMBHS) • CMBHS is a comprehensive electronic health records system for behavioral health • Adds the following functionalities to the existing system: – Enhance support for jail diversion – Computerize physician’s order entry – E-Prescriptions interface – Data exchange with service providers using national standards 61

MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Exceptional Item 9 FY MOVING HEALTH FORWARD Community Mental Health & Substance Abuse Services Exceptional Item 9 FY 2012 FY 2013 Alternatives to Incarceration or Hospitalization 7, 447, 257 7, 449, 489 14, 896, 746 Border Expansion Behavioral Health 1, 150, 264 2, 300, 528 775, 000 600, 000 1, 375, 000 Clinical Management for Behavioral Health Services (CMBHS) Total, General Revenue Total, All Funds Biennium 9, 372, 521 9, 199, 753 18, 572, 274 10, 629, 502 10, 456, 737 21, 086, 239 62

MOVING HEALTH FORWARD Obesity Prevention • 29% of Texans are obese (BMI 30 or MOVING HEALTH FORWARD Obesity Prevention • 29% of Texans are obese (BMI 30 or greater) – 66% of Texans are overweight or obese (BMI 25 or greater) – More than 40% of Texans are projected to be obese by 2040 • 3 of the 5 leading causes of death in Texas are chronic diseases linked with obesity – heart disease – cancer – stroke • Obesity cost Texas businesses ~$3. 3 billion in 2005 • Costs include health care, absenteeism, decreased productivity & disability 63

MOVING HEALTH FORWARD Obesity Prevention (*BMI 30, or about 30 lbs. overweight for 5’ MOVING HEALTH FORWARD Obesity Prevention (*BMI 30, or about 30 lbs. overweight for 5’ 4” person) 2006 1990 2010 No Data 29% <10% ≥ 30% 10%– 14% 15%– 19% 20%– 24% 25%– 64

MOVING HEALTH FORWARD Obesity Prevention Obesity & Overweight (BMI > 25) Texas vs. the MOVING HEALTH FORWARD Obesity Prevention Obesity & Overweight (BMI > 25) Texas vs. the United States Prevalence of Overweight & Obesity (BMI > 25. 0) (Age-Adjusted) 2000 -2009 BRFSS Texas vs. United States 68. 0 66. 0 64. 0 Percentage 62. 0 60. 0 58. 0 56. 0 54. 0 52. 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 Survey Year Texas United States 65

MOVING HEALTH FORWARD Obesity Prevention 66 MOVING HEALTH FORWARD Obesity Prevention 66

MOVING HEALTH FORWARD Obesity Prevention Obesity in the Texas Border Area In 2002 -2005, MOVING HEALTH FORWARD Obesity Prevention Obesity in the Texas Border Area In 2002 -2005, almost 30 percent of adults who lived in South Texas were obese. The prevalence of obesity in South Texas was higher than the prevalence in the rest of Texas or nationwide. From South Texas Health Status Review, Institute for Health Promotion Research, UT Health Science Center San Antonio. 67

MOVING HEALTH FORWARD Obesity Prevention 68 MOVING HEALTH FORWARD Obesity Prevention 68

MOVING HEALTH FORWARD Obesity Prevention Exceptional Item 10 FY 2012 Community Grants FY 2013 MOVING HEALTH FORWARD Obesity Prevention Exceptional Item 10 FY 2012 Community Grants FY 2013 Biennium 1, 599, 104 2, 400, 897 4, 000, 001 • This exceptional item expands the funding from the 81 st Legislature by increasing the number grants to communities. • The grants program assists communities in implementing sustainable projects to increase access to: – healthy foods – safe environments for physical activity 69

MOVING HEALTH FORWARD Preventable Hospitalizations • “Potentially preventable” hospitalizations – Those hospitalizations that might MOVING HEALTH FORWARD Preventable Hospitalizations • “Potentially preventable” hospitalizations – Those hospitalizations that might not have occurred if the patient had access to and cooperated with outpatient care. • Evidence-based strategies, such as vaccination, smoking cessation or nutrition and physical activity can be employed to prevent these conditions. • From 2005 -8, adult residents of Texas received $24. 9 billion in hospital charges – public and private – for these conditions. – That is equivalent to $1, 418 per adult Texan. 70

MOVING HEALTH FORWARD Preventable Hospitalizations are considered potentially preventable for the following ten conditions: MOVING HEALTH FORWARD Preventable Hospitalizations are considered potentially preventable for the following ten conditions: • • • Bacterial Pneumonia Dehydration Urinary Tract Infection Angina (without procedures) Congestive Heart Failure Hypertension Asthma Chronic Obstructive Pulmonary Disease Diabetes Short-Term Complications Diabetes Long-Term Complications 71

MOVING HEALTH FORWARD Preventable Hospitalizations 72 MOVING HEALTH FORWARD Preventable Hospitalizations 72

MOVING HEALTH FORWARD Preventable Hospitalizations Exceptional Item 11 FY 2012 Grants to Counties FY MOVING HEALTH FORWARD Preventable Hospitalizations Exceptional Item 11 FY 2012 Grants to Counties FY 2013 2, 533, 299 2, 586, 703 Biennium 5, 120, 002 • 92 counties have potentially preventable hospitalization rates more than 50 percent higher than the state rate. • DSHS proposes preventable hospitalization grants to enable Texas counties to move forward with community-based efforts to reduce those rates. • This is an opportunity to use accessible data developed by the state to improve quality of life, improve health care, and avoid unnecessary costs. • This exceptional item includes 5 FTEs to manage grants and provide technical assistance to counties. 73

MOVING HEALTH FORWARD Infectious Disease Prevention Texas ranks 2 nd to California in the MOVING HEALTH FORWARD Infectious Disease Prevention Texas ranks 2 nd to California in the number of TB cases in the United States • Rate dropped from 9. 1 per 100, 000 in 1998 to 6. 0 in 2009 (U. S. rate in 2009 = 3. 8) • Though TB case rates in the U. S. dropped 11. 4%, Texas reported 1, 501 cases in 2008 and 2009 or 13% of all U. S. TB cases • The TB rate along the Texas-Mexico border is ~ twice as high (11. 6) as the state rate (5. 6) 74

MOVING HEALTH FORWARD Infectious Disease Prevention • Source: Department of State Health Services 2000 MOVING HEALTH FORWARD Infectious Disease Prevention • Source: Department of State Health Services 2000 -2009 Tuberculosis Surveillance Data • Note: The HP 2010 Target for TB is 1. 0 new case per 100, 000 population. 75

MOVING HEALTH FORWARD Infectious Disease Prevention The new Texas Center for Infectious Diseases will MOVING HEALTH FORWARD Infectious Disease Prevention The new Texas Center for Infectious Diseases will open September 22, 2010. Additional funding is required to staff the 40 additional beds that will now be available to treat tuberculosis patients. 76

MOVING HEALTH FORWARD Infectious Disease Prevention Source: Emerging and Acute Infectious Disease Branch, Infectious MOVING HEALTH FORWARD Infectious Disease Prevention Source: Emerging and Acute Infectious Disease Branch, Infectious Disease Control Unit 77

MOVING HEALTH FORWARD Infectious Disease Prevention In 2009, there were 3, 358 cases of MOVING HEALTH FORWARD Infectious Disease Prevention In 2009, there were 3, 358 cases of pertussis reported to the CDC from Texas. There were 3 pertussis-related deaths, all in children under 3 months of age. There were also 296 pertussis patients that required hospitalization in 2009. Source: Department of State Health Services, Emerging and Acute Infectious Disease Branch, Infectious Disease Control Unit, July 1, 2010. ote: N The HP 2010 Target for Pertussis is less than 2, 000 cases nationally among children under 7. 78

MOVING HEALTH FORWARD Infectious Disease Prevention Reducing Pediatric Hospitalizations • Rotavirus is the leading MOVING HEALTH FORWARD Infectious Disease Prevention Reducing Pediatric Hospitalizations • Rotavirus is the leading cause is gastroenteritis – it causes 44% of these cases • Range of symptoms for rotavirus: – Diarrhea, vomiting, dehydration, stroke, even death • Rotavirus infection is preventable through immunization • Effective prevention through immunization could reduce overall pediatric hospitalizations by up to 22% 79

MOVING HEALTH FORWARD Infectious Disease Prevention IMMTRAC – Immunizations Registry • Originally established as MOVING HEALTH FORWARD Infectious Disease Prevention IMMTRAC – Immunizations Registry • Originally established as the Texas Immunization Registry in April 1996 • Used as tracking and reporting tool for both vaccines and antivirals • Recently expanded for adults and for community preparedness • Repository of immunization histories for over 83 million immunizations recorded • The current system is outdated and does not meet current state and federal requirements. • A new IMMTRAC system is required to meet programmatic needs and current health information technology standards. 80

MOVING HEALTH FORWARD Infectious Disease Prevention Exceptional Item 12 FY 2013 Biennium Texas Center MOVING HEALTH FORWARD Infectious Disease Prevention Exceptional Item 12 FY 2013 Biennium Texas Center for Infectious Disease – Full Capacity 1, 435, 654 2, 380, 154 3, 815, 808 Tuberculosis and Pediatric Protection 1, 467, 352 1, 566, 058 3, 033, 410 Improve immunization data collection and other surveillance systems 3, 250, 000 1, 250, 000 4, 500, 000 Total 6, 153, 006 5, 196, 212 11, 349, 218 81

Other Exceptional Items Additional DSHS Exceptional Items are included in other agency legislative appropriations Other Exceptional Items Additional DSHS Exceptional Items are included in other agency legislative appropriations requests. • Health and Human Services Commission – – – CSHCN, MH Adult and Children Waiting Lists Increased Costs for Data Center Recruitment and Retention Veteran’s Mental Health Information Technology for State Mental Health Hospitals • Comptroller’s Judiciary Section – Sexually Violent Predator Monitoring Program 82