FY 1996 Appropriations Report

Executive Director Operations

Executive Director Operations includes those functions of the Department of Health that provide overall policy and manage-ment direction and administrative support to the divisions, offices and programs of the Department. This organizational category also includes the State Health Laboratory, the Office of the Medical Examiner, the Office of Health Data Analysis, and the Office of Public Health Data. Significant budget changes occurring in this category are listed below.

Funding for Executive Director Operations increased by 20.6 percent from $14,178,111 in FY 1995 (estimated) to $17,099,200 approved for FY 1996.

Senate Bill 197 established a Utah Veterans' Nursing Home and appropriated $500,000 from the General Fund to a newly created expendable trust fund for its operation and $2,807,900 from Federal Funds as matching funds for its construction. (There is $1.8 million in State funds for the construction included in the General Government area.)

Funding to local health departments for the purpose of adding 2nd dose vaccinations for measles, mumps, and rubella (MMR) in the amount of $200,000 was provided as a one-time FY 1996 increase. The Legislature also funded $29,500 to cover a 2 percent increase tied to the compensation component for local health department budgets.

The Medical Examiner's Office received $24,000 in FY 1996 and a supplemental of $23,200 in FY 1995 to meet on-call salary costs for medical doctors on staff.

As part of the Governor's health care reform initiative, House Bill 305 provided $500,000 to the Office of Health Data Analysis for the development or acquisition of hardware and software, the collection of encounter level data, and the auditing and encoding of that encounter level data. Of the total amount, $300,000 is considered ongoing.

The Legislature approved the following items of intent language for FY 1996:

It is the intent of the Legislature that the Division of Laboratory Services may receive donated laboratory equipment and shall use such donated equipment for the purpose of promoting and protecting the public health.

It is the intent of the Legislature that the legislative fiscal analysts for Public Education, Health, Human Services, and the Courts will coordinate the preparation of the FACT budget beginning with the FY 1997 budget.

It is the intent of the Legislature that the appropriations subcommittees for Public Education, Health, Human Services, and the Courts will coordinate the process for legislative review and action on the FACT budget beginning with the FY 1997 budget.

This division also received the following FY 1995 supplementals:

$200,000 to assist local health departments in their purchase of data processing and communication equipment$240,000 for the purchase of additional equipment and building upgrades for the State Health Laboratory$337,000 to fund a public health status survey, completed every five years.

Health Systems Improvement

The mission of the Division of Health Systems Improvement is to facilitate, encourage and coordinate continuous improvement in the Utah health care system. The mission is fulfilled through examination and analysis in terms of service availability, accessibility, acceptability, continuity, quality and cost. The Division includes the Bureaus of Emergency Medical Services, Health Facility Licensing, Medicare/Medicaid Program Certification and Resident Assessment, and Primary and Rural Health Care. Changes in the budget for Health Systems Improvement are listed below.

Overall funding for Health Systems Improvement declined by 12.5 percent from $8,453,600 in FY 1995 to $7,393,200 in FY 1996. The decrease is due to a lower estimate of federal funds available in FY 1996 and the expenditure of non-lapsing balances in FY 1995 that may not be available in FY 1996. The General Fund appropriation was increased by 9.5 percent.

The Bureau of Emergency Medical Services received $43,500 to develop a statewide trauma system. The bureau may also receive matching federal funds for this program.

Another part of the Governor's health care reform initiative covered in House Bill 305 provides $150,000 to the Bureau of Primary Care and Rural Health for the establishment of an area health education center (AHEC) in conjunction with the University of Utah Medical School. (The University also received an appropriation of $150,000 for a total of $300,000 for the AHEC program, which will be an ongoing appropriation.)

Community Health Services

The mission of the Division of Community Health Services is to improve the State's health status by interacting with individuals, community systems, organizations and governmental entities to produce, implement and evaluate policies, rules and programs that protect the health of all people in Utah and improve their quality of life by: preventing and mitigating disease, injury, disability and premature death; promoting availability and access to affordable health services; and promoting healthy lifestyles. The Division strives to encourage statewide leadership on key health policy issues by collecting, analyzing, and disseminating pertinent health information critical to determining public health priorities.

The Division is organized with a Director's Office and five bureaus to accomplish its mission. These bureaus include: HIV/AIDS Prevention and Control, Chronic Disease Control, Epidemiology, Health Promotion and Risk Reduction, and Environmental Services.

The FY 1996 appropriation of $11,581,100 approved by the Legislature is a 3.4 percent increase over estimated expenditures in FY 1995. The General Fund appropriation was increased by 2.4 percent over FY 1995.

The only significant change in this division occurred when the Legislature approved adding funding for tuberculosis (TB) diagnosis in the amount of $59,000. However, that funding came from reducing programs in both Health Promotion/Risk Reduction and Environmental Services.

Family Health Services

The purpose of the Division of Family Health Services in the Utah Department of Health is to assure that in Utah all women, infants, children and their families have access to comprehensive, coordinated, affordable, community-based quality health care. The Division must coordinate the effort, identify the needs, prioritize the programs and develop the resources necessary to accomplish the goals.

The Division is organized into the Office of the Director and three other functional bureaus to carry out its purposes. The three bureaus are Health Education/Support Services, Planning and Primary Care, and Children with Special Health Care Needs.

While the services of the Division are available to all citizens of the State according to their ability to pay, its primary clients are women, infants, and children who have special health needs and problems and are low income.

The major funding source for the Division is federal grants, primarily the Maternal and Child Health (MCH) Block Grant and the Women's, Infants and Children's Nutritional Grant (WIC). In total, federal funds represent approximately 85 percent of the Division's appropriated FY 1996 budget. Most of the federal funds are contracted to local health departments as part of the WIC nutrition program or to provide other services.

The total appropriation for the Division of $51,038,400 for FY 1996 is a decrease of 1.6 percent from estimated expenditures in FY 1995. The General Fund portion of the budget reflects an increase of 2.6 percent.

The Division of Health Care Financing

The Division of Health Care Financing has responsibility for the development and administration of medical assistance programs.

The Legislature appropriated $35,153,100 to the Division of Health Care Financing of which $5,899,400 is from the General Fund.

The Legislature approved a funding increase of $87,000 to replace a portion of lost federal funding.

The Legislature included the following intent statement in the FY 1996 Appropriations Act:

It is the intent of the Legislature that the Division of Health Care Financing (DHCF) and the Division of Services for People with Disabilities (DSPD) will advise the Human Services Interim Committee (in September 1995) and the Health and Human Services Appropriations Subcommittee of their progress in implementing a combined funding stream for the Intermediate Care Facilities (ICF/MRs) and Home and Community-based Services (HCBS) for the disabled. The costs of this combined funding stream will not exceed the costs the State would have incurred absent this initiative. The individual recipient must have the freedom of choice to determine the setting, i.e., ICF/MR or HCBS, in which he/she receives services, consistent with the requirements of Title 62A, Chapter 5, Part 3 Utah Code Annotated, Admission to a Mental Retardation Facility.

Medical Assistance

Medical Assistance includes the Medicaid Base Program, Title XIX funding for Human Services, the Utah Medical Assistance Program (UMAP), the Medicaid Mental Health Program, and a special seeding program funded by assessments on providers (hospitals and nursing homes) to draw additional federal funds. With the exception of UMAP, these programs fund health care for individuals eligible for medical assistance under Title XIX of the Social Security Act. The UMAP program provides a limited array of services to individuals who do not qualify for any other assistance program.

The Legislature appropriated $590,861,200 for Medical Assistance for FY 1996, with $120,575,600 coming from the General Fund.

The Legislature appropriated $11 million to cover individuals who are aged or disabled and are below 100 percent of the federal poverty level. The funding for this expansion is being realized by savings in the movement of the general Medicaid population toward managed health care.

The Legislature appropriated $1,691,900 from the General Fund to cover a reduction in the federal match rate.

The FY 1996 Medicaid budget was increased by $37,754,600 for inflation and utilization.

Due to a decline in utilization trends, Medicaid funding for FY 1995 was reduced by $6,995,000.

The Legislature included the following intent statements in the FY 1996 Appropriations Act:

It is the intent of the Legislature that the Department of Health will review with the Interim Executive Appropriations Committee any Medicaid Program reductions or additions.

It is the intent of the Legislature that the Department of Health Medical Assistance Program not reduce services to accommodate the reduction in funding. This reduction is being made due to the uncertainty in budgeting for Medicaid. If funding levels prove inadequate, the Department of Health will request a supplemental appropriation to maintain current service levels.

Health Policy Commission

The 1994 Legislature established the Health Policy Commission to provide a mechanism through which every Utahn will have access to affordable health insurance in an environment that relies primarily on a market-oriented system that contains cost and enhances quality. (UCA 63C-3). The FY 1996 appropriation of $208,900 reflects a decrease in the Commission's budget. The Commission is required to report to the Legislature and governor and make recommendations on specific issues each year through the year 2000.

Table 23 Department of Health

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