Below is the HillCo client report from the September 25 Legislative Budget Board hearing regarding the Department of State Health Services.
The report focuses on the presentation relating to DSHS agency LAR.
Dr. David Lakey, DSHS Commissioner
- Briefly covered overview of agency
- Slide 4 had budget breakdown by source – 39% of funds come from state GR
- Over 50% of All Funds go to safety net and 35% to Mental Health
- 67% of GR funds go into Mental Health and 22% into Safety Net
- Public Health (6%), Regulatory (2%), and Administration (3%) cover the remaining 11%
- Some federal government funding streams have been reduced
- Specifically the hospital preparedness fund has been targeted for reductions
- Additional federal grants/awards have been defunded or decreased
- Budget drivers include initiatives from 83rd Session and capacity and maintenance related to state hospitals
- Total request of $6.6 billion
- FTE request will remain the same
- Exceptional items overview
- State Hospital needs to be priority (item #6 now will be Priority #3)
- In order maintain current level of services there will need to be an additional $31 million (items such as Trauma care and to cover reduction in tobacco funds)
- $88 million is needed to repair hospitals ($198 million is need) – these are critical items
- Average age of buildings are 52 years (range 2years to over 100 years)
- Will demolish some buildings
- Will need to replace 220 vehicles (most are from state hospitals)
- Air chillers and other critical infrastructure items will be replaced and repaired
- Slide 18 provides the breakdown of critical items
- Enhanced expanded primary health care ($100 million last session)
- Have ramped up program over last year
- Worked to fill gaps, call CEOs of major hospital system, etc
- Still significant need – 3.3 million women in need
- 20% next step – $10 million per year
- With funding will provide services to over 34k each year and total clients per year will be over 200k
- Comprehensive approach to women’s health
- 1481 births averted – savings in Medicaid
- 3600 getting prenatal care
- 30k screening for Breast and Cervical cancers
- 34k women treated and screen for hypertension
- 9k women screened and treated for diabetes
- Women in need are shown on map (slide 19)
- 54 entities that are part of program – location shown on slide 20
- Substance abuse – (last session investment in treatment)
- Housing options, partnership with DFPS, etc over the last two years because of 83rd
- Behavioral health prevention and Neonatal Abstinence Syndrome
- Behavioral health prevention – $28 billion
- Expanding youth programs – serve almost 600k more
- Speak your mind expansion – public awareness campaign
- Online training expanded
- Slide 23 shows 133 of 254 counties have presence in
- Neonatal Abstinence Syndrome – $17 million
- Over last decade 300% increase in the U.S.
- Bexar county is hardest hit but also includes Harris county, etc.
- Slide 26 more detail on approach to addressing problem
- Includes pregnant and postpartum intervention
- Community Mental Health Services – (build upon improvements from last session and 10 year plan of state hospitals)
- $90 million – for 5 items
- Crisis services
- Last session decisions provided for hotlines, etc
- Still gaps in system – can fill with additional funds – will develop crisis sites and provide variety of services
- Slide 29 has map of funded crisis projects – 9 of those do not have enhanced crisis projects provided through 1115 waiver
- $39 million for mental health surge
- Screening and appropriate placement – will be doing in partnership with DADS and HHSC
- Expand pilot by 20 beds to a total of 30 beds
- 83rd Pilot program – instead of loss of custodial rights to get treatment, bring into treatment centers – 10 beds and successful program
- Waiting list of 20 individuals now
- Parents were involved
- $2.5 million to develop Clubhouses
- One in Bexar and Travis – non-medical approach to improving behavioral health
- Partner with businesses to guarantee work
- 96% decreased readmission to hospitals in Bexar
- Will use funding to develop 7 clubhouses across state of Texas
- Clinical management and behavioral health – technical upgrades include addressing invoicing issues, mental health crisis mobile application, etc $7.6 million
- Major improvements in state hospitals (does not include $90 million for basic repairs to keep functioning)
- This was priority item #6 and has been moved to item #3
- Purchase beds in private sector over next biennium approx.. $40 million – will buy 50 beds and RFI has been sent out
- At end of next biennium will have another 150 beds that DSHS is not managing
- Slide 38 shows chart of individuals on waiting list – it is starting to trend up
- Workforce challenge – training ground for psychiatrist by partnering with academics institutions – increase to slots to 19 slots
- Provide training support decisions makers to move individuals into community based programs
- Hospital IT improvements – $12 million – includes expanded wireless network, enhanced/expanded security
- Waiting list for Children – $18 million (this is the whole waiting list)
- Services are for kiddos with physical and medical problems and they require an inordinate amount of health care
- 4 priority groups and significant improvement after last legislative session appropriation
- Sexual Transmitted Infections
- Identification process – targeting gonorrhea – testing, referral to treatment, etc.
- Will also identify others with STDs
- Will focus on counties that have more than 1k identified each year
- Chronic Diseases – $26 million all items bundled for this exceptional item
- Driver for poor health
- Variety of strategies – focus on asthma ($3.8 million using evidence based programs), expanding a pilot program to decrease HAI’s (support of 14 additional counties – data provided on success of previous pilot), diabetes prevention and control ($7.6 million) and tobacco prevention
- Technology and mobility for employees during disaster events (ie disease outbreaks) – $6.2 million
- Include enhanced network security
- Local emergency planning – $5 million in accumulated GR account
- Use statute authority to access funds for Tier II communities so they are better prepared for disasters
- Reductions of 10% slide shows will impact significant part of safety net and mental health services in Texas – services they want to build on this next legislative session
Q (LBB panel) & A (DSHS panel)
- In regards to construction funding last session – what is current status of projects?
- In terms of Victory fields will be done in biennium, in regards to bonds those have been allocated out
- Will bonds increase beds?
- Those dollars do not increase bed capacity – those dollars make it safer for patients that are there
- Federal funding sources – are any federal laws affecting revenues or funding receiving?
- There have been changes of funds – the one that had significant impact was the movement of dollars of ACA put in CDC and defunded certain things like community transformation grants, etc but the movement around of funds has impacted
- Safety net services provided – but with rollout of ACA there are some people who could purchase products through exchange but the challenges include window of when can apply
- There are different population groups and funding strategies that are being moved around
- In regards to state hospitals – getting 150 beds – simple or forensics
- Would be a mix
- RFI to find out what type of beds are out there
- Believes legislature will want to weigh in on report coming out – as to how many beds in total are needed
- Will also need to figure out how to replace some facilities over next 10 years and cost can be significant
- Needs to be a priority this session and upcoming session
- HHSC exceptional items included LVNs/RNs and Psychiatric nurse assistance
- Paid $9.50 prior to last session so turnover rate was above 30 so 10% increase was given last session – looks like vacancy rate is fluctuating but turnover still high so asking for additional dollars this session
- Is Big Spring near…how is it going?
- Challenging – as all areas that see increase in fracking
- Hard to retain workforce and finding a place to stay
- Exceptional item 3 – expanding primary health care program – is this just for women and difference from HHSC program
- There are a few men but it is primarily women
- It is different from HHSC program – women eligible for this program would not be eligible for HHSC and it is more comprehensive
- Provider base is different from HHSC – worked out well for DSHS
- DSHS serves 170k and 34k increase would be on top of that
- Funding will be distributed by greatest need
Public Testimony
Emily Edwards, Austin Clubhouse
- Phsyco/social rehabilitation center
- Voluntarily and focused on vocational and social experiences
- There are 3 in Texas
- Rely on private funding
- Support DSHS recommendation to expand scope/responsibility and starting new clubhouses
Cheryl Freedman, Austin Clubhouse
- Received mental health support from clubhouse
Grace Davis, ED for Hays Caldwell Alcohol and Drug Abuse prevention
- Support request for additional funding for prevention
- Program does make a difference provides examples of what she has seen in her community
- Funding cut means they no longer see 3rd -5th graders
Jamilla Lee, Hogg Foundation for Mental Health
- Waiver only mechanism and rider should continue so they can help children at risk of relinquishment
- Offers residential treatment for children in crisis – much less to provide children support through this mechanism than to take a child into conservatorship
- Critical workforce shortage – recommend expand opportunities for peer support services in a variety of settings
Lee Johnson, Deputy Director Texas Council of Community Centers
- Thanks members for support of investment of mental health services
- Generally support overall LAR
- Support access to more beds in community, etc.
Katherine Ligon, Center for Public Policy Priorities
- Positive attention towards mental health in last few years which has resulted in more access to services
- Will take several years before benefits of substantial investment are realized
- Important to maintain services at current level along with exceptional items
- Peer support specialists important to provide wrap around – would like it to be enhanced
- 35% of inmates have previously received public mental health services
Gyl Switzer, Mental Health America Texas
- Agree with all exceptional items
- Improvement suggestions included: funding for suicide prevention (adult), concerned about purchasing of additional beds (not all beds are the same – some acuity levels may not be accepted), do focuses give biggest bang for bank, very supportive of public awareness campaigns but disappointed on some aspects of Speak Your Mind Campaign, SB 126 directing data publication/user friendly – still missing certain data and focus on outreach to those who don’t seek treatment
- Jails are therapeutic environments so would not support that funding
Josette Saxton, Texans Care for Children
- Supports maintaining investments made last session as well as strengthening them
- Supports efforts to reach young children
- School health program is also opportunity to reach children at young ages
Lauren Dimitri, Texans Care for Children
- Very supportive of many efforts underway including exceptional item #4
- Need to focus, strengthen and expand school health program
- Serves as central resource and clearinghouse
GK Sprinkle, Texas Ambulance Association
- Working on getting funds accumulated in dedicated funds for ambulance/EMS personnel
- More funding toward regulatory – ambulance services to further regulate ambulance services
- Spot inspections would result in cost savings in the long term
Jerry Hall, ASAP
- Success stories of program
- Encourages treatment funding continuation
Amy Granbury, ASAP and 150 treatment center in Corpus Christi
- Treatment is cost effective strategy
- Support improvements to electronic/technical system and need it to be current
- Need comprehensive evaluation of rates
- Substance abuse prevention programs do have a return on investment
Written testimony from MD Anderson, Texans Care for Children, Texas Medical Association, etc was provided to LBB members