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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

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dshs legislative appropriations request for fiscal years 2010 11

DSHS Legislative Appropriations Requestfor Fiscal Years 2010-11

Presentation to the House Appropriations Subcommittee on Health and Human ServicesFebruary 23, 2009David L. Lakey, M.D.Commissioner

dshs legislative appropriations request fiscal years 2010 11
DSHS Legislative Appropriations RequestFiscal Years 2010-11
  • Base Budget
    • $5,592,709,588 All Funds
  • Exceptional Items
    • $487,069,478 All Funds
dshs legislative appropriations request fiscal years 2010 111
DSHS Legislative Appropriations RequestFiscal Years 2010-11

FY 2010-11 DSHS budget by source

$5.6 billion

biennial

budget

dshs legislative appropriations request fiscal years 2010 112
DSHS Legislative Appropriations RequestFiscal 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
slide6

MAINTAINING OPERATIONAL CAPACITYExceptional 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)
maintaining operational capacity exceptional item 1 state hospital capacity
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.

maintaining operational capacity exceptional item 1 state hospital capacity1
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
maintaining operational capacity exceptional item 1 state hospital capacity2
MAINTAINING OPERATIONAL CAPACITYExceptional 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
maintaining operational capacity exceptional item 1 state hospital capacity3
MAINTAINING OPERATIONAL CAPACITYExceptional Item 1 – State Hospital Capacity
  • Pharmaceutical cost increases
    • Psychiatric drugs (82% of purchases)
      • 9% increase in cost
    • All other drugs
      • 25% increase in cost
maintaining operational capacity exceptional item 1 state hospital capacity4
MAINTAINING OPERATIONAL CAPACITYExceptional 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 $133,000

End stage renal $334,000

Dialysis $177,000

Pneumonia $148,000

Neck cancer $145,000

Cardiovascular $178,000

maintaining operational capacity exceptional item 1 state hospital capacity5
MAINTAINING OPERATIONAL CAPACITYExceptional Item 1 – State Hospital Capacity
  • Examples of Other Operating Costs
    • Food
    • Equipment
    • Furnishings
maintaining operational capacity exceptional item 1
MAINTAINING OPERATIONAL CAPACITYExceptional 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
maintaining operational capacity exceptional item 11
MAINTAINING OPERATIONAL CAPACITYExceptional 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.
maintaining operational capacity exceptional item 12
MAINTAINING OPERATIONAL CAPACITYExceptional 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
ensuring compliance exceptional item 2 regulatory services
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
ensuring compliance exceptional item 2 regulatory services1

Summary of all Regulatory licenses

13038 - Food and Drug

13039 - Environmental

13040 - Radiation

13041 - Professional Licensing

13042 - Health Care Facilities

ENSURING COMPLIANCEExceptional Item 2 – Regulatory Services

Increase in licenses for the Division for Regulatory Services

2002-2007

100.00%

Texas is a growing state.

From 2002 to 2007, the number of licenses in some programs increased by as much as 80%.

95.00%

90.00%

83.07%

85.00%

80.00%

76.60%

75.00%

70.00%

65.00%

60.00%

55.00%

Percentage of Increase

50.00%

45.00%

40.00%

35.00%

32.52%

30.76%

30.00%

24.49%

25.00%

20.00%

15.00%

10.73%

10.00%

5.00%

0.00%

Licenses by Regulatory Strategy

ensuring compliance exceptional item 2 regulatory services2
ENSURING COMPLIANCEExceptional 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.

* All figures in millions

ensuring compliance exceptional item 3 health care data
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.
ensuring compliance exceptional item 3 health care data1
ENSURING COMPLIANCEExceptional 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
ensuring compliance exceptional item 3 health care data2
ENSURING COMPLIANCEExceptional 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
ensuring compliance exceptional item 3 health care data3
ENSURING COMPLIANCEExceptional 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
ensuring compliance exceptional item 3 health care data4
ENSURING COMPLIANCEExceptional 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.
ensuring compliance exceptional item 3 health care data5
ENSURING COMPLIANCEExceptional 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.
ensuring compliance exceptional item 3 health care data6
ENSURING COMPLIANCEExceptional 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.
ensuring compliance exceptional item 3 health care data7
ENSURING COMPLIANCEExceptional 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.
ensuring compliance exceptional item 3 health care data8
ENSURING COMPLIANCEExceptional 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.
ensuring compliance exceptional item 4 vital records
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

* All figures in millions

ensuring compliance exceptional item 5 data systems
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
ensuring compliance exceptional item 6 disaster response
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
ensuring compliance exceptional item 6 disaster response2
ENSURING COMPLIANCEExceptional Item 6 – Disaster Response
  • INSERT SLIDE ON HURRICANES

Storms lined up across the Atlantic – September 2008

ensuring compliance exceptional item 7 stipends for residents
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.

* All figures in millions

ensuring compliance exceptional item 7 stipends for residents1
ENSURING COMPLIANCEExceptional Item 7 – Stipends for Residents

Psychiatrists and Child Psychiatrists, Texas - 2007

ensuring compliance exceptional item 8 maintain facilities
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.
slide41

ENSURING COMPLIANCEExceptional 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.
ensuring compliance exceptional item 8 maintain facilities1
ENSURING COMPLIANCEExceptional Item 8 – Maintain Facilities

FY10-11 Capital Construction Needs

  • 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.
ensuring compliance exceptional item 8 maintain facilities2
ENSURING COMPLIANCEExceptional 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.
slide44

MOVING HEALTH FORWARDLeading Causes of Death – Texas 2005 and 2001

DSHS Center for Health Statistics

moving health forward actual causes of death shaped by behavior
MOVING HEALTH FORWARDActual Causes of Death* Shaped by Behavior

*Texas 2001

Chronic Disease in Texas 2007, DSHS

moving health forward exceptional item 9 substance abuse
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
slide47

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.

MOVING HEALTH FORWARDExceptional Item 9 – Substance Abuse

ER COST OFFSET

- $47

Average per Client per Month

35%

REDUCTION

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.

moving health forward exceptional item 9 substance abuse1
MOVING HEALTH FORWARDExceptional 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)
moving health forward exceptional item 10 mental health services
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.
moving health forward exceptional item 10 mental health services1
MOVING HEALTH FORWARDExceptional 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 80th Legislature have been implemented and are showing indicators of success.

FY 2007FY2008

    • 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
slide52

SFY2008

Annual

Target = 17%

MOVING HEALTH FORWARDExceptional Item 10 - Mental Health Services

Percent of Crisis Service Episodes Followed by a

Psychiatric Hospitalization within 30 Days

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

moving health forward exceptional item 10 mental health services2

Betty Hardwick

Tarrant County MHMR

Helen Farabee

Central Plains

Heart of Texas

West Texas

Burke Center

Bluebonnet

Tri-County

El Paso

Spindletop

Austin-Travis County MHMR

Hill Country

Nueces County MHMR

Tropical

MOVING HEALTH FORWARDExceptional Item 10 - Mental Health Services

Need for Crisis Expansion

Areas Currently Funded for Expanded Crisis Services

slide54

MOVING HEALTH FORWARDExceptional 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
slide55

MOVING HEALTH FORWARDExceptional Item 10 - Mental Health Services

IMPLEMENTATION OF CRISIS REDESIGN

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.

slide56

MOVING HEALTH FORWARDExceptional Item 10 - Mental Health Services

Need for Transitional Services

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).

slide57

MOVING HEALTH FORWARDExceptional 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
slide58

MOVING HEALTH FORWARDExceptional 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)

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

slide59

MOVING HEALTH FORWARDExceptional 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
moving health forward exceptional item 10 mental health services3
MOVING HEALTH FORWARDExceptional 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
moving health forward exceptional item 11 chronic diseases
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
slide63

1998

1990

2007

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

MOVING HEALTH FORWARDExceptional Item 11 – Chronic Diseases

Obesity Trends* Among U.S. Adults

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

Source: CDC Behavioral Risk Factor Surveillance System

obesity prevalence trends in texas adults 1990 to 2007
Obesity Prevalence Trends in Texas Adults 1990 to 2007

MOVING HEALTH FORWARDExceptional Item 11 - Chronic Diseases

~34% of Texans are normal weight

~29% of Texans are obese

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

moving health forward exceptional item 11 chronic diseases1
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
moving health forward exceptional item 11 chronic diseases2
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
moving health forward exceptional item 12 infectious diseases
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.

racial disparity in persons living with hiv aids in texas 2003 2007
Racial Disparity in Persons Living with HIV/AIDS in Texas, 2003-2007

MOVING HEALTH FORWARDExceptional Item 12 - Infectious Diseases

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.

moving health forward exceptional item 12 infectious diseases1
MOVING HEALTH FORWARDExceptional 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.

6.3

4.4

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

moving health forward exceptional item 12 infectious diseases2
MOVING HEALTH FORWARDExceptional 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
moving health forward exceptional item 13 lmha services
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

* All figures in millions

other agency legislative appropriations requests
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
issues for fy 2009
Issues for FY 2009
  • FTEs
    • Funded from Interagency Contracts/Federal Funds
  • Capital Budget Authority
  • Medicare Part D Savings Use Plan
dshs legislative appropriations request for fiscal years 2010 111

DSHS Legislative Appropriations Requestfor Fiscal Years 2010-11

APPENDIX A

Exceptional Item Method of Finance