FY 1997 Appropriations Report - Health

Department of Health

     The total FY 1997 appropriation of $751,840,200 for the Department of Health is an increase of 1.1 percent over estimated expenditures in FY 1996. The FY 1997 General Fund appropriation is an increase of 5.9 percent. The appropriations and legislative intent for the divisions and offices of the Department are outlined below.

Executive Director Operations

    Executive Director Operations includes those functions of the Department of Health that provide overall policy and management direction and administrative support to the divisions, offices and programs of the Department. This organizational category also includes the Office of Health Data Analysis, Office of the Medical Examiner, the Office of Public Health Data, and the administration for the Veterans' Nursing Home. Significant budget changes occurring in this category are listed below.

• Funding for Executive Director Operations decreased by 19.2 percent from $13,396,000 in FY 1996 (estimated) to $10,825,800 approved for FY 1997.

• The Legislature approved utilizing $200,000 in the Children's Organ Transplant Trust Account for purposes as outlined in 26-18a-4.

• The Legislature also funded $68,800 to cover a 4.0 percent increase tied to the compensation component for local health department budgets.

• Part of the FY 1997 appropriation includes a one-time appropriation of $290,000 for the continuation of the local public health computer.

    The Legislature approved the following items of intent language for FY  1997:

    It is the intent of the Legislature that the Department of Health present to the Legislative Fiscal Analyst's Office detailed outcome measures for each budget area in each division within the department. These outcome measures shall be, wherever possible, reported in terms of outcomes achieved with the population served in addition to the report of total numbers served. The Legislative Fiscal Analyst's Office shall include the department's report including measurements within its budget presentation on an item by item basis.

    It is the intent of the Legislature that the Office of Attorney General, Commission on Criminal and Juvenile Justice, Department of Corrections, Health, Human Services, and Public Safety, the Office of the State Court Administrator, and the Utah State Office of Education, work cooperatively through the Utah State Council on Domestic Violence to hire, supervise, and fund a State domestic violence liaison position. These agencies will contract with a State agency for domestic violence coordination services to be provided by the domestic violence liaison.

    It is the intent of the Legislature that the funding for the continuation of the statewide public health computer network be considered nonlapsing.

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 10.8 percent from $9,447,500 in FY 1996 to $8,426,300 in FY 1997. The decrease is mainly due to the expenditure of nonlapsing balances in FY  1996 that may not be available in FY 1997. The General Fund appropriation was increased by 9.3 percent.

• The Bureau of Emergency Medical Services received $48,600 to develop a statewide training curriculum.

• The Legislative approved funding in the amount of $350,000 from Mineral Lease Funds to expand medical coverage in Community Health Centers and Indian Health Centers. Also approved was $150,000 in one- time funds for FY 1997 for the expansion of rural telemedicine.

The following intent language was approved for this division.

It is the intent of the Legislature that the $350,000 from the Mineral Lease Account for the Community and Indian Health Centers Grant project be considered nonlapsing.

Epidemiology and Laboratory Services

     The mission of the Division of Epidemiology and Laboratory Services is to protect the health of the people of Utah by identifying and controlling communicable and infectious diseases, outbreaks, environmental health hazards, and occupational risks; and by providing laboratory testing and technical consultation to public agencies, health professionals and the public.

    The division is comprised of three bureaus at the State Health Laboratory, as well as bureaus dealing with HIV/AIDS/Tuberculosis Control/Refugee Health, Epidemiology, and Environmental Services.

    The FY 1997 appropriation of $9,048,900 is an increase of 3.25 percent when compared to the estimated FY 1996 expenditure level. The General Fund increase is 13.01 percent.

    Part of the FY 1997 appropriation includes one-time funding of $286,300 for laboratory equipment. The following intent language dealing with laboratory equipment is included in the FY 1997 Appropriation Act.

    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 $286,300 funding for laboratory equipment be considered nonlapsing.

Community and Family Health Services

     The purpose of the Division of Family Health Services 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 five other functional bureaus to carry out its purposes. The five bureaus are Support Services, Health Education, Maternal and Child Health, Chronic Disease, 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 (WIC) Nutritional Grant. In total, federal funds represent over 79 percent of the Division's appropriated FY 1997 budget. Most of the federal funds are contracted to local health departments as part of the WIC nutrition program or to provide other services.

    Several bills passed during the 1996 Legislative session affecting this division. These include:

• House Bill 302, "Special Population Service - Health Care Provider Financial Assistance", which allocates $100,000 for the assistance program and adds 1 FTE.

• House Bill 222, "Abortion Act Amendments", which requires the department to provide information and a video tape to pregnant women desiring such information, and adds $60,000 to the budget.

• House Bill 43, "Cigarette Tax and Appropriation", which would have provided funding for tobacco prevention programs, training, and development of a statewide comprehensive school health program was vetoed by the Governor.

    In addition, the Legislature approved the second year funding of the 2nd dose measles, mumps, and rubella (MMR) vaccine in the amount of $200,000.

    The total appropriation for the Division of $61,334,700 for FY 1997 is a decrease of 0.1 percent from estimated expenditures in FY 1996. The General Fund portion of the budget reflects an increase of 1.9 percent.

    The following intent language was approved for this division

    It is the intent of the Legislature that the FACT funding for FY 1997 be used to experiment on a community full-service delivery system level to provide data on the merits of moving the concept to a fully- implemented system statewide.

    It is the intent of the Legislature that the State Office of Education, and the Departments of Human Services and Health, in conjunction with the Families, Agencies and Communities Together (FACT) steering committee, study the issues affecting individuals with autism from pre-diagnosis through adult services. The plan will be presented to the Public Education, and Health and Human Services Appropriations Subcommittees during the 1997 General Session of the Legislature.

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 $38,466,000 to the Division of Health Care Financing of which $9,053,300 is from the General Fund.

    The Legislature included the following intent statement in the FY 1997 Appropriations Act:

    It is the intent of the Legislature that the Division of Health Care Financing, as part of its study on implementation of federal block grants for medical assistance, study the feasibility of using vouchers, cash outs, and Medical Savings Accounts for Medicaid financing of long term care. This includes, but is not limited to, long term care provided in facilities, in homes, and in communities. It includes long term care services, provided to the elderly and persons with disabilities. The director of the division shall report to the Human Services Interim Committee before September 30, 1996 regarding the outcome of this study.

    It is the intent of the Legislature that the Department of Health, in conjunction with other interested parties, will complete a study of the Medicaid dental program. The study will include, but not be limited to, an analysis of dental access for Medicaid clients, a review of the Medicaid dental care delivery system and funding levels. Based on the data and analysis from the study, the Department of Health will formulate conclusions, make recommendations, and draft a suggested plan concerning dental services for the Medicaid population.

    It is the intent of the Legislature that the Division of Health Care Financing may expend up to $10,000 of the General Funds allocated for Medical Assistance to provide emergent medical- related services for persons not qualified for Medicaid or the Utah Medical Assistance Program.

    It is the intent of the Legislature that the Department of Human Services, Division of Services for People with Disabilities and the Department of Health, Division of Health Care Financing evaluate the self-determination model - as implemented in New Hampshire and other states - and similar consumer choice models for application by agencies that serve individuals with disabilities in Utah. Directors of the above named divisions will advise the Human Services Interim Committee and the Health and Human Services Appropriations Subcommittee of their findings and recommendations.

    It is the intent of the Legislature that collections in the Division of Health Care Financing from the Utah Medical Assistance Program Dental Clinic for services provided are nonlapsing for FY 1997.

Medical Assistance

    Medical Assistance includes the Medicaid Base Program, Title XIX funding for Human Services, and the Utah Medical Assistance Program (UMAP). 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 $623,513,600 for Medical Assistance for FY 1997, with $127,889,700 coming from the General Fund. The funding includes the following items:

• A General Fund increase of $2,929,400 to cover the reduction in the federal match rate.

• Increases of $17.4 million for projected inflation and utilization rates in FY 1997.

• The personal needs allowance for Medicaid clients in nursing homes was increased from $30 per month to $45 per month.

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.

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 1997 appropriation of $224,900 reflects a increase in the Commission's budget of 7.7 percent. The Commission is required to report to the Legislature and governor and make recommendations on specific issues each year through the year 2000.