Posts Tagged ‘budget’

Our New Strategic Plan

October 17th, 2012

The vision of the Department is to ideally achieve a state of Health and Wellness for all Arizonans and our mission is to promote, protect, and improve the health and wellness of individuals and communities in Arizona. The updated mission and vision statements are helping us build public health value in-house as well as in the community.  The format was modernized and ADHS is making an effort to educate our partners and reinvigorate staff on our goals.

We’re among the largest and most complex of state agencies. With over 1,600 employees and an annual budget of more than $1.8B, we provide a wide variety of services and a diversity of programs housed within its five divisions: behavioral health; licensing; planning and operations; public health prevention; and public health preparedness. The two-fold mission of public health services includes prevention and preparedness for the state. The public behavioral health system oversees services for 150,000 enrolled clients and the state’s only public psychiatric hospital, the Arizona State Hospital. The division for licensing is charged with certification of nursing homes, assisted living and child care centers, hospitals and other health care facilities. The division for planning and operations oversees the budget, procurement, audit and special investigations, information technology, workforce development, rule-making, human resources, policy, continuous quality improvement, and accreditation.

Our strategic priorities are the pathways we use to achieve targeted improvements in public health outcomes. We’re committed to moving along with our partners in local health departments toward voluntary public health accreditation. The work towards accreditation will require the agency to look at the statewide public health system as a whole, collaborate with stakeholders, and provide evidence that our work meets the ten essential public health services. The ten essential services were set as a national standard in 1994 by a steering committee consisting of all US Public Health Service agencies and representatives from other major public health organizations. Accreditation focuses on quality, transparency, and partnerships. Through the accreditation process, our leadership will identify strengths, weaknesses, and opportunities for continuing to build public health infrastructure in a way that will best align our resources with key priorities.

Our new updated Strategic Plan lays out the framework for how we’ll use quality improvement, lean methodologies, best practices, and strategic alignment to achieve our vision of “Health and Wellness for All Arizonans

Public Health Budget

May 9th, 2012
 The Governor signed the budget this week – here’s a look at how some of it affects public health:

Behavioral Health Services for folks that don’t Qualify for Medicaid

The budget that was just signed includes about $39M in new funding for services for folks with a serious mental illness that don’t qualify for Medicaid.  With it, we’ll be able to provide some services like supported employment and housing, peer and family support, living skills training, and health promotion to help folks along their Recovery journey.  We’ll also be expanding the list of medications for the folks with a serious mental illness so it matches the list for folks that qualify for Medicaid.  Our behavioral health team has already begun working closely with the RBHAs, providers, and members/families to plan for the most effective use of this funding.

Newborn Screening

Our newborn screening program has been running in the red for the last couple of years- despite the fact that we’ve squeezed just about every efficiency out of the program and are collecting more than 95% of our service fees.  The current screening fee is $30 for the 1st (hospital) screen and $40 for the 2nd (which happens in the pediatric office a couple of weeks after birth).  These fees haven’t been raised in several years- meanwhile the instruments and reagents we use have become increasingly expensive.  We’ve been supplementing the program with Title V funds that really should be used for other more effective purposes. The budget that was just signed allows us to set new fees for the 2nd screen in Rule…  and we’ll be starting that process shortly.

County Contribution toward Hospital Patients and Residents

The “Budget Reconciliation Bill” or BRBs included specific instructions regarding how much counties are obligated to pay (50%) for the patients and residents at the Hospital and ACPTC (the sexually violent person’s unit).

ASH Administration building

Hospital Operating Fund

Despite all our efforts to reduce overtime, cut shift overlap, streamline services and other efficiency measures- our hospital operating fund was headed for big trouble next fiscal year- partly because the Hospital Fund (which had provided funds to operate the Hospital) went dry. The state budget that was just signed rescued us from needing to cut our staffing ratio’s to below Licensing standards (which would have put us in jeopardy of losing Medicare and Medicaid funds).  Whew.

ADHS Looking for a Forward-thinking Assistant Director

May 8th, 2012

Promoting Health and Wellness for all Arizonans” is the motto of the Arizona Department of Health Services.  We promote and protect the health of Arizona’s children and adults and set the standard for personal and community health through direct care, science, public policy and leadership.  Want a piece of the action? 

We’re looking for an experienced and proactive leader to become our new Assistant Director for Licensing Services. This key position reports directly to me and manages six different state and federal licensing units including Long Term Care, Medical Facilities, Child Care, Assisted Living, Behavioral Health, and Special Licensing.  The job oversees about 200 employees and a budget of $17M.  But- what makes the job exciting is that you’ll have a unique opportunity to lead a dynamic team and use your talents and skills to make Arizona a healthier place- “Promoting Health and Wellness for All Arizonans”.

Arizona’s Behavioral Health Provider Network

August 12th, 2011

We’ve had to make lots of difficult decisions in response to the ongoing funding shortfalls in our behavioral health system (as well as everywhere in state government).  Many decisions (while painful in the short term) have been necessary to maintain long term system stability as Arizona continues to emerge from this unprecedented fiscal crisis.  While Arizona is gaining ground economically, the progress is slow and requires ongoing, innovative approaches and strong collaboration by all behavioral health system partners.  Because of our partnerships- our system remains strong.

State government has been working hard to protect coverage and services for individuals with behavioral health needs.  A recent public letter from Dr. Nelson outlined some of our innovations to creatively reinforce our behavioral health system.  We’ve needed to reduce behavioral health provider reimbursement rates, but we’ve taken other actions to help out behavioral health providers and folks that receive services.  For example, we increased the percentage that must be spent on services and decreased the amount of profit behavioral health authorities are allowed to earn- pressing a larger percentage of the total money into services.  We’ve also further reduced administrative costs, pressing more of the available funds into services.

We’ve also been encouraging the integration of physical and behavioral healthcare among behavioral health providers with acute care health plans and community health centers around the state.  While these partnerships should also reduce overall healthcare costs, they also aim to improve quality of care and health outcomes. We’re also engaged in exciting planning activities to increase integration of physical healthcare and behavioral healthcare.  In collaboration with AHCCCS, on July 15 we released a Request for Information to seek feedback on the feasibility of developing as “health homes” for folks that have a serious mental illness which we think will offer additional reductions in overall healthcare costs while improving member health outcomes.

Our primary goal—even during these challenging budgetary times—is to provide the best possible behavioral health care to our members and we’re committed to achieving that goal along with our partners in the behavioral health system.

Vital Records Self-sufficiency

June 12th, 2011

One of the budget bills that passed and was signed last legislative session (Laws 2011, Chapter 31, § 7) allows our Office of Vital Records to set new fees for copies of registered certificates, certified copies, amendments, etc. Our Office of Vital Records will use the new fees to “self-fund” the program, meaning we’ll no longer receive State General Funds to run the program.  Not only will this make us self-sufficient, but we’ll have the ability to invest in sorely needed technology infrastructure.  Our Rules, Finance, and Vital Records teams have developed the new proposed fees which are posted on our Rules website. The proposed start date for the new fees is July 1, 2011.

As usual, we’re asking for public comment about the proposed fee changes, and folks can send comments to Tom Salow at thomas.salow@azdhs.gov.  We’ll also be holding a public meeting to receive public comment about the fees on June 23, 2011 at 9:30 a.m. at 1740 W. Adams, Room 411A, Phoenix, AZ 85007.

Next Fiscal Year’s Budget – pt 4

January 27th, 2011

On January 15, 2011, the Governor released her proposed budget for next fiscal year, which begins July 1, 2011. Our part of the budget in the link above is on pages 105 through 111.  You kinda need to be a budgeteer to understand some of it, so I’ll try to distill it down a little in several posts this week.

Biomedical Research Commission
The Governor’s proposed budget also proposes moving the Arizona Biomedical Research Commission to the ADHS.  This Commission was approved by the voters several years ago and is funded by a Tobacco Tax and Health Care Fund. They award contracts for projects that research the causes, epidemiology, treatment and prevention of diseases, including drug discovery and development.  The Commission basically oversees the projects to make sure they do things right.  The proposal would move the Commission to the ADHS along with their funding and staff.

Furloughs
As you remember, state employees took about a 2.5% salary decrease last year along with a reduction of about that amount because of the 6 furlough days per fiscal year.  Because the savings to the State were more than anticipated for the salary reduction, the Governor is proposing to eliminate the remaining furlough day this fiscal year (June 10) and all of the scheduled furlough days next fiscal year.

Summary
I’ve oversimplified the Governor’s proposed budget changes for the ADHS here and I’ve left some stuff out- so please visit the actual proposed budget for next fiscal year if you need detailed information.  Remember that this is a proposed budget and the legislature may make significant changes.  Also remember that some of the budget reductions to Medicaid (the suspension for 2 years of health care for childless adults) requires an approval by the federal government.

Next Fiscal Year’s Budget Series

January 24th, 2011

On January 15, 2011, the Governor released her proposed budget for next fiscal year, which begins July 1, 2011. Our part of the budget in the link above is on pages 105 through 111.  You kinda need to be a budgeteer to understand some of it, so I’ll try to distill it down a little in several posts this week.

Changes to Medicaid

The proposed budget reduction that would have the largest impact to our mission is a proposal to temporarily (for 2 years) roll back a portion of the population (called childless adults) that are currently covered for Medicaid (AHCCCS) healthcare benefits (beginning October 1, 2011).  “Childless adults” refers to people who haven’t had kids or who had kids but the kids are grown (e.g. “empty nesters”).  Currently we’re one of a handful of states that cover childless adults all the way up to the 100% of federal poverty threshold.

The State would need to get permission from the federal government in order to temporarily drop this population from coverage under AHCCCS, so whether this actually happens or not will depend on what the US Department of Health and Human Services says.  The legislature took action in a special session last week that instructs the Executive branch to pursue a waiver to change eligibility levels.  Also, the Governor is pursuing congressional changes to give states more flexibility in this regard.

We currently provide behavioral health services to approximately 5,200 childless adults that have a serious mental illness. While it may appear, and we were originally concerned, that this would mean that childless adults with a serious mental illness may lose their current benefits if the proposal is implemented, we think there’s a way to ensure that more than 80% of these folks can maintain their current benefits under a different Medicaid category.

We believe that most of the childless adults that have a serious mental illness and are currently receiving services from the ADHS could still qualify for their full benefits including behavioral health services under a different federal category for the disabled (called Supplemental Security Income Medical Assistance Only). Qualifying for this new category requires a review of each person’s medical condition to see whether they meet the standard. We believe that more than 80% of the childless adults with a serious mental illness that are receiving behavioral health services can qualify under the Supplemental Security Income Medical Assistance Only category. This means they would maintain their current benefits.

In order to help these individuals retain coverage, we’ve instructed our Regional Behavioral Health Authorities (RBHAs) and our behavioral health providers to immediately implement a coordinated approach to screen every single childless adult with a serious mental illness that is currently receiving services from the ADHS for eligibility under the Supplemental Security Income Medical Assistance Only.  Just in case, the proposed budget includes extra funding to make sure that people with serious mental illnesses who don’t qualify for SSI Medical Assistance Only would still be able to keep their prescriptions for their illness.

Childless adults that currently receive general mental health services from our RBHAs through Medicaid would have their benefits suspended beginning October 2011 under the proposal, saving about $79M of general fund next fiscal year and our budget is reduced by that amount under the plan.

Update on the Governor’s Budget Proposal Regarding Persons with Serious Mental Illness

January 15th, 2011

On January 15, 2011, Governor Brewer released her proposed budget for next fiscal year (which begins July 1, 2011). One of the budget items would change AHCCCS (Medicaid) eligibility for adults without children (called childless adults). The ADHS currently provides behavioral health services to approximately 5,200 persons with serious mental illnesses that are childless adults. While it may appear, and we were originally concerned, that this would mean that childless adults with a serious mental illness may lose their current benefits if the proposal is implemented, we think there’s a way to ensure that more than 80% of these folks can maintain their current benefits under a different Medicaid category.

We believe that most of the childless adults that have a serious mental illness and are currently receiving services from the ADHS could still qualify for their full benefits including behavioral health services under a different federal category for the disabled (called Supplemental Security Income Medical Assistance Only). Qualifying for this new category requires a review of each person’s medical condition to see whether they meet the standard. We believe that more than 80% of the childless adults with a serious mental illness that are receiving behavioral health services can qualify under the Supplemental Security Income Medical Assistance Only category. This means they would maintain their current benefits.

In order to help these individuals retain coverage, we are instructing our Regional Behavioral Health Authorities and our behavioral health providers to immediately implement a coordinated approach to screen every single childless adult with a serious mental illness that is currently receiving services from the ADHS for eligibility under the Supplemental Security Income Medical Assistance Only category.

Successful Budget Load

August 5th, 2010

The first part of the fiscal year (July) is always a busy time for our budget folks. The new fiscal year requires a lot of data entry, cross-checks, analysis and review. It was a busy time of year even when we had several people in the budget office.  This year we got the job done in the same time with fewer people- thanks to good organization, hard work- and some assistance from program financial folks in several areas of the Department.  Thanks for the team effort.

ACPTC

July 7th, 2010

 Our ACPTC  provides for the civil commitment of people who have a mental disorder that predisposes a person to commit sexual acts that pose a danger to the health and safety of others (A.R.S. § 36-3701, et. seq.).  The mission of the center is to provide therapy to those individuals who have been civilly committed- with the goal of reintegrating them into the community if they successfully complete the treatment program and show that their presence in the community doesn’t pose a risk to public safety.  Here’s a link to an interesting AP budget story this week regarding facilities like our ACPTC.