The Legislative Budget Board met on September 10 to hear from the Department of State Health Services concerning the agency’s Legislative Appropriation Request for the 86th Session and key exceptional items.
This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. It is not a verbatim transcript of the hearing, but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.
Agency Presentation
John Hellerstedt – Department of State Health Services (DSHS)
- Described DSHS Mission – to minimize impact of disease and disaster on residents of Texas
- Written testimony – shows outline of agency programs and services
- The agency benefits from having one mission as opposed to divided goals within the agency that may not be wholly related to public health
Donna Shepard – DSHS
- Overall budget is $1.6 billion
- $800 million in GR
- funding from fee generated revenue
- Preparedness and prevention received the largest amount of federal funding
- Over 40% work away from Austin
- Budget issues related to revenues: falling below SB 1 appropriations
- HIV rebated have helped patch up funding issues and is not sustainable
- EMS trauma partners account reserves have been spent down
- Harvey Response – some funds are tied up until reimbursed
- Laboratory budget has significant shortfall
- Exceptional Items:
- Related to public health reference laboratory – addressing shortfall by requesting gap funding, implementing XALD newborn screening, requests for funs and FTEs to maintain the laboratory – building is at an age which requires maintenance to remain in service, retention of lab staff – increase salaries to get closer to other laboratories
- Related to information technology infrastructure – data center services and data management
- Maternal mortality – maternal safety bundles with prenatal care and continuation of care, additional funding to provide stipends to qualified hospitals for AIM bundles – success so far with the voluntary program, includes risk assessment in variety of circumstances
- Safe maintenance of vital records – need to hire consultant to prioritize and maintain million of records, and capital items, security tracking mechanisms and physical security
- Requesting 2 FTEs for Death Certificate data
- Staffing – to retain specialized staffing through increased salaries
- Increased TB response – grants to local health departments to increase capacity
- Technical capacity – support for IT Staff, Server Space, database for data synthesis
- Infectious disease identification and response – two assets, maintaining reporting system and response unit capability
- Vehicles – current fleet is 120 vehicles, would like to replace about 50 of them, requesting staging areas for emergency response vehicles
Questions from Joint Legislative/LBB Panel
- Question – What is the agency’s approach to allocate federal funds in the LAR?
- It tends to be over many years, we’ll allocate what we think will be spent of a five-year allocation in the two-year biennium
- Sometimes the unspent funds roll to the third year – it will even out over the 5 years
- Question – was there something that limited the agency under Article 9 that the rider would not allow you to do?
- It would just give the agency authority to do it
- Question – regarding employees, with a high turnover rate does it limit your ability to do what you need to do?
- Hellerstedt – short answer is yes
- It also costs another person’s time to do the training
- Question – emergency backup generator is in the $12 million range but there could be some saving through lease?
- There are options for leasing that would allow for options on payments
- Question – federal funds account for 40% of the budget, did the agency exhaust all of those funds?
- The funds in the LAR are expected to roll over into 2021
- We do eventually exhaust all of those funds
- Question – why are the federal funds not used for the exceptional items requests?
- There are limits on the federal funds and are already budgeted on very specific items
- Question – do you expect a supplemental appropriation in 2019?
- Not expected to at this time
Public Testimony
Jeffery Beason, Texas Trauma and Acute care Association (TTAF)
- Need a coordinated care effort across Texas on a daily basis
- RACs play an important role in the emergency response system
- Encourage legislation to increate funding to the trauma system
- Concern with trauma funding in the departments 10% reduction schedule
Sharon Crook – Texans Standing Tall
- Tobacco prevention funding is needed
- Need to be able to purchase media advertising
- Cutting tobacco prevention funds is a step backwards
Steven Ross, Texans Standing Tall
- Need funding for training for the tobacco prevention program specialists within DSHS
- Concerned with vaping and electronic cigarettes
Nathanial Fombai, Texans Standing Tall
- Have been making effort to push back against big tobacco and reduce use of tobacco in youth
- Need to properly fund tobacco prevention programs
Charlie Gegan, American Cancer society
- 28,000 deaths per year due to tobacco
- Need to increase tobacco prevention funding
- Concern with rider that prevents DSHS from using media to combat tobacco
Jason Sabo, Unknown
- Need to prioritize vaccinating adults
- Increase funding to vaccination programs
- Need full funding for adult safety net program for vaccination programs
- Noted need for first responder’s immunization registry
Phillip Hoang, Austin Public Health Department and Texas Medical Association
- Concern over 10% reduction schedule
- Supports each of the exceptional items
- State laboratory is an essential public health resource
- Vital records systems are vital
- Supports funding for Infectious disease and TB surveillance and response programs
Shelby Massey, American Heart Association
- Need for additional tobacco prevention and secession funding
- Would like it returned to FY 2016 levels
- Removal of Rider 31 B
- Need to increase promotion of cardiovascular health programs