COBI 2015 - Disease Control and Prevention

Overview
Issues
Performance
Background
Financials

Sources Uses

FY 2016 Appropriation

The mission of the Division of Disease Control and Prevention is to promote health and reduce the leading causes of death, disease, and disability in Utah. The Division of Disease Control and Prevention works with and for other state, local, and private entities to:

Identify and epidemiologically characterize communicable diseases, human health effects of environmental health hazards, occupational risks of public health concern, injuries, chronic diseases, and risk factors for chronic diseases.
Develop and coordinate public health reporting systems, control measures and prevention activities.
Conduct environmental sanitation policy.
Provide comprehensive public health laboratory testing and technical consultation.
Operate a statewide medical examiner system.

Funding History

Funding Issues

New Federal Surplus Property Resale Program

New federal surplus resale program where state agencies can receive dedicated credits from the sale of property/equipment.

Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $93,535,900 from all sources for Disease Control and Prevention. This is a 106.5 percent increase from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $13,961,600 from the General/Education Funds, an increase of 10.6 percent from revised Fiscal Year 2015 estimates.

Appropriation Adjustments

In addition to statewide compensation and internal service fund cost increases, the following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time 02. Capital Development - Unified State Lab$191,400 ($191,400)

OngoingOne-TimeFinancing Source

$191,400$0General Fund

$0 ($191,400)General Fund, One-time

Prioritized #2 by the subcommittee. Estimated O&M is $747,100.

Alzheimer's State Plan Amendments$161,200$0

OngoingOne-TimeFinancing Source

$161,200$0General Fund

"requires the Department of Health to designate Alzheimer's disease and related dementia as a public health issue and implement a state plan for Alzheimer's disease and related dementia."

Dedicated Credits Increase$10,900$148,100

OngoingOne-TimeFinancing Source

$10,900$148,100Dedicated Credits Revenue

(1) An increase of $802,200 in dedicated credits in FY 2016 in the Department of Health's Executive Director's Operations line item for $383,700 for potential sales from five new products from the All Payer Claims Database, $250,000 for contract for implementing the Master Person Index, and $168,500 for increased fees in vital records to offset declines in fee quantities. (2) An increase of $10,002,000 in dedicated credits in FY 2016 in the Department of Health's Medicaid Mandatory Services line item which is just a shift from the Medicaid Optional Services line item, but no overall increases for dedicated credits in Medicaid services. (3) $27,500 in ongoing dedicated credits beginning in FY 2016 for the Department of Health for a new federal surplus resale program where state agencies can receive dedicated credits from the sale of property/equipment. (4) For the Department of Health's Disease and Prevention Control line item as dedicated credits - Health: "Grant from the Association of Public Health Laboratories for $148,100. The purpose of this proposal is to establish molecular testing (Severe Combined Immunodeficiency) within the Utah Public Health Laboratory. Through this mechanism we explore and implement a cross-testing section process to advance Newborn Screening and the Infectious Disease group. The grant finances research and development work to implement a mandated test. All future cost will be covered completely through revenue generated through test fees."

Federal Funds Adjustments$0 ($19,190,500)

OngoingOne-TimeFinancing Source

$0 ($19,190,500)Federal Funds

Annual adjustments of federal funds based on agency submission of grant changes.

Local Public Health Emergency Fund$0$25,000

OngoingOne-TimeFinancing Source

$0$25,000General Fund, One-time

Assistance to local governments to plan for local health emergencies

Loss of Laboratory FTE$0 ($58,400)

OngoingOne-TimeFinancing Source

$0 ($58,400)General Fund, One-time

During FY 2015 the forensic toxicology section of the state laboratory has been without one FTE for several months. The one-time savings represent the savings the State while this position has remained unfilled.

Office of Medical Examiner 24/7 Body Pick Up$58,000$0

OngoingOne-TimeFinancing Source

$58,000$0General Fund

"Fund 3 part-time additional morgue clerks so that funeral homes can deliver and pick up bodies from the Medical Examiner's office 24/7 - currently restricted pick up times."

Parkinson Disease Registry$0$200,000

OngoingOne-TimeFinancing Source

$0$200,000General Fund, One-time

"Public health." "Little is known about the casuses and treatment of this devasting disease and why the incidence of the disease is increasing so fast in Utah. To learn that information is the purpose of the Utah Parkinson's Disease Registry." "The [Parkinson Disease Registry] is housed at the University fo Utah, along with the Utah Cancer Registry and the Utah Autism Registry…the Parkinson's Disease Registry is requesting $200,000 one-time money…to make the Registry fully functional."

Prescription Drug Abuse, Misuse, and Overdose Prevention$0$500,000

OngoingOne-TimeFinancing Source

$0$500,000General Fund, One-time

Fund public outreach prevention program targeting opioid misuse and death. How Measure Success? 15% decrease in opioid overdoses by 15% over the next two years.

Radon Grant Continuation$0$25,000

OngoingOne-TimeFinancing Source

$0$25,000General Fund, One-time

DEQ was informed by the federal government that radon grant program funding would be discontinued. However, the funding has continued.

Transfer Cytomegalovirus Public Health Initiative from Disease Control and Prevention to Family Health and Preparedness ($40,000) ($40,000)

OngoingOne-TimeFinancing Source

($40,000)$0General Fund

$0 ($40,000)General Fund, One-time

Transfer the $40,000 ongoing General Fund for the item "Additional Funding for HB 81 (2013 General Session, Menlove) Cytomegalovirus Public Health Initiative" from the Department of Health's Disease Control and Prevention line item to the Family Health and Preparedness line item.

Staff Analysis

How does Utah's Health Indicators Compare to the Rest of the Nation?

The Trust for America's Health (http://healthyamericans.org/states/?stateid=UT) reports the following health indicators for Utah as compared to the rest of the nation:

How does Utah's Health Indicators Compare to the Rest of the Nation?

Disease Outbreaks in FY 2014

Below is a list of some of the disease outbreaks the Division managed in FY 2014:

Pertussis - statewide, multiple clusters among families and schools
Healthcare-associated infections - clusters of influenza, stomach flu, and some drug-resistant pathogens
Gonorrhea - increase in cases of 96% to 1,240 over FY 2013 level of 633. The increase in women has been 130% compared to 78% for men.
Salmonella - outbreaks associated with live poultry, junior livestock show, and raw milk
Q Fever and Tularemia - during spring and summer months investigated cases of diseases that pass between animals and humans
Pneumonia - 47 case cluster in a healthcare facility
Middle East respiratory syndrome coronavirus - investigated 10 suspected cases

Cancer Screening Results

The Department of Health pays for breast, cervical, and colorectal cancer screenings for uninsured low income individuals in higher risk groups. In FY 2014 the Department of Health paid $1,391,500 total funds (about $178,700 state funds) for screenings for 8,898 adults which resulted in a diagnosis of cancer 0.7% (less than 1%) of the time or 66 times (54 breast, 12 cervical, and 0 colon).

Additional Measures

Health Promotion

Public Health Laboratory

Percentage of Escherichia Coli and Listeria Foodborne Pathogens With DNA Analysis Completed Within 96 Hours

Percentage of Escherichia Coli and Listeria Foodborne Pathogens With DNA Analysis Completed Within 96 Hours

Statute

The Division of Disease Control and Prevention is governed by the Utah Health Code in Title 26 of the Utah Code.

UCA 26-1-34 establishes the State Laboratory Drug Testing Account to pay for testing drug and alcohol samples for local law enforcement.
UCA 26-4 establishes the Medical Examiner Act, which outlines procedures taken when dealing with various deaths in the State and which deaths the Medical Examiner should investigate.
UCA 26-5 defines chronic diseases and requires the Health Department to establish programs to prevent, delay, and detect the onset of such.
UCA 26-6 and 26-6b give guidelines to control and treat various communicable diseases as well as which providers must report certain diseases to the State.
UCA 26-7 directs the Department to identify the major risk factors contributing to injury, sickness, death, and disability in Utah and establish programs to prevent those outcomes.
UCA 26-10-8 requires the Department of Health to award contracts to non-governmental entities funded by tobacco settlement and/or cigarette tax funds via a competitive request for proposal process at least every five years.
UCA 26-15 outlines the Health Department's efforts, in conjunction with those of local health departments, in relation to general sanitation, including those dealing with the Indoor Clean Air Act.
UCA 26-15a outlines the Department's efforts, in conjunction with those of local health departments, in relation to food safety.
UCA 26-21a requires the Department to create a program to reduce breast cancer mortality.
UCA 26-21a-302 creates the Cancer Research Restricted Account to provide funds for programs that support cancer research.
UCA 26-21a-303 creates the Prostate Cancer Support Restricted Account to raise awareness of prostate cancer as well as detection and prevention of prostate cancer.
UCA 26-23b outlines the procedures for the Department to take during a public health emergency and details reporting requirements for diseases with a 24 to 72 hour reporting requirement to the State.
UCA 26-51 directs the Department to establish scientific standards for methamphetamine decontamination.

Related Links

For more information on obesity trends nationwide, please visit http://knowledgecenter.csg.org/drupal/content/adult-obesity, http://knowledgecenter.csg.org/drupal/content/childhood-obesity, and http://healthyamericans.org/reports/obesity2014/.

The Division of Disease Control and Prevention encompasses the following programs: Director's Office, the Public Health Laboratory, Epidemiology, the Office of the Medical Examiner, and Health Promotion.

Intent Language

HB0003: Item 77

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $500,000 of Item 22 of Chapter 13, Laws of Utah 2014, for the Department of Health's Disease Control and Prevention line item for alcohol, tobacco, and other drug prevention reduction, cessation, and control programs shall not lapse at the close of Fiscal Year 2015. The use of any nonlapsing funds is limited to alcohol, tobacco, and other drug prevention, reduction, cessation, and control programs or for emergent disease control and prevention needs.

HB0003: Item 77

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $525,000 of Item 22 of Chapter 13, Laws of Utah 2014 for the Department of Health's Disease Control and Prevention line item shall not lapse at the close of Fiscal Year 2015. The use of any nonlapsing funds is limited to laboratory equipment, computer equipment, software, and building improvements.

HB0003: Item 77

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $175,000 of Item 22 of Chapter 13, Laws of Utah 2014 for the Department of Health's Disease Control and Prevention line item shall not lapse at the close of Fiscal Year 2015. The use of any nonlapsing funds is limited to maintenance or replacement of computer equipment, software, or other purchases or services that improve or expand the services provided by the Bureau of Epidemiology.

HB0003: Item 77

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $250,000 of Item 21 of Chapter 13, Laws of Utah 2014 fees collected for the Newborn Screening Program shall not lapse at the close of Fiscal Year 2015. The use of any nonlapsing funds is limited to maintenance, upgrading, replacement, or purchase of laboratory or computer equipment and software.

SB0003: Item 116

Under Section 63J-1-603 of the Utah Code the Legislature intends that up to $75,000 funds of Item 22 of Chapter 13, Laws of Utah 2014, not otherwise designated as nonlapsing to the Department of Health - Disease Control and Prevention line item shall not lapse at the close of Fiscal Year 2015. The use of any nonlapsing funds is for services to people with traumatic brain injury.

SB0007S01: Item 2

The Legislature intends that the Department of Health report on the following performance measures for the Disease Control and Prevention line item: (1) Gonorrhea cases per 100,000 population (Target = 18.9 people or less), (2) Percentage of Adults Who Are Current Smokers (Target = 9%), and (3) Percentage of Toxicology Cases Completed within 14 day Goal (Target = 100%) by January 1, 2016 to the Social Services Appropriations Subcommittee.

SB0007S01: Item 2

The Legislature intends that the Department of Health research and report government entities paying for services that could be provided by the State Laboratory and give this information to the Office of the Legislative Fiscal Analyst by September 1, 2015. The report shall include: (1) the name of the government entity, (2) amount paid for the service, (3) what the cost would be if the service was provided by the State Laboratory, and (4) any potential barriers to the State Laboratory for bidding on those services. The Department of Health shall also detail its assumptions for its costs on all laboratory services that government entities are purchasing in the private sector.

SB0007S01: Item 12

The Legislature intends that the Department of Health report on the following performance measures for the Disease Control and Prevention line item: (1) Gonorrhea cases per 100,000 population (Target = 18.9 people or less), (2) Percentage of Adults Who Are Current Smokers (Target = 9%), and (3) Percentage of Toxicology Cases Completed within 14 day Goal (Target = 100%) by January 1, 2016 to the Social Services Appropriations Subcommittee.

SB0007S01: Item 12

The Legislature intends that the Department of Health research and report government entities paying for services that could be provided by the State Laboratory and give this information to the Office of the Legislative Fiscal Analyst by September 1, 2015. The report shall include: (1) the name of the government entity, (2) amount paid for the service, (3) what the cost would be if the service was provided by the State Laboratory, and (4) any potential barriers to the State Laboratory for bidding on those services. The Department of Health shall also detail its assumptions for its costs on all laboratory services that government entities are purchasing in the private sector.

Because of the Department's budget reorganization in FY 2011, some of the detail between FY 2010 and FY 2011 nonlapsing balances do not tie out by line item. For analysis of current budget requests and discussion of issues related to this budget click here.

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Appropriation History by

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Sources of Finance	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
General Fund	8,260,600	11,274,300	12,007,100	12,222,900	12,639,400	0	12,639,400	711,500	13,350,900
General Fund, One-time	339,300	399,700	25,000	(32,400)	86,700	(98,400)	(11,700)	622,400	610,700
Federal Funds	24,407,700	26,166,200	28,682,700	26,844,100	53,759,800	(41,536,800)	12,223,000	46,831,000	59,054,000
American Recovery and Reinvestment Act	1,525,100	1,159,900	151,600	57,200	0	0	0	0	0
Dedicated Credits Revenue	7,725,000	7,282,600	8,177,300	8,003,600	9,499,700	(729,300)	8,770,400	456,300	9,226,700
GFR - Cancer Research Restricted Account	0	0	15,800	13,100	20,000	0	20,000	0	20,000
GFR - Cigarette Tax	2,733,000	3,150,000	3,150,000	3,150,000	3,150,000	0	3,150,000	11,700	3,161,700
GFR - Prostate Cancer Support	0	200	200	0	26,600	0	26,600	0	26,600
GFR - State Lab Drug Testing Account	298,200	322,800	320,300	372,700	681,000	0	681,000	19,200	700,200
GFR - Tobacco Settlement	5,858,100	3,829,500	3,878,700	3,907,000	3,944,700	0	3,944,700	6,800	3,951,500
Dept. of Public Safety Rest. Acct.	100,000	100,000	100,000	100,000	100,000	0	100,000	0	100,000
Transfers	0	0	0	0	700	(700)	0	20,900	20,900
Transfers - Environmental Quality	0	0	(12,500)	0	0	0	0	0	0
Transfers - Human Services	24,600	10,000	10,000	0	10,000	0	10,000	0	10,000
Transfers - Medicaid	1,395,200	828,700	1,196,300	446,900	1,667,200	(1,382,200)	285,000	600	285,600
Transfers - Other Agencies	289,800	100,000	68,900	153,900	0	0	0	0	0
Transfers - Public Safety	49,700	38,800	38,400	0	0	270,800	270,800	0	270,800
Transfers - State Office of Education	15,200	17,000	11,400	17,000	17,000	0	17,000	0	17,000
Transfers - Within Agency	118,200	103,100	140,600	805,500	351,800	(211,200)	140,600	100	140,700
Transfers - Workforce Services	1,861,100	2,047,700	2,602,400	2,365,600	2,560,200	17,200	2,577,400	11,200	2,588,600
Beginning Nonlapsing	721,000	425,000	925,200	975,000	0	445,200	445,200	(445,200)	0
Closing Nonlapsing	(425,000)	(925,200)	(975,000)	(445,200)	0	0	0	0	0
Lapsing Balance	(582,200)	0	(60,100)	0	0	0	0	0	0
Total	$54,714,600	$56,330,300	$60,454,300	$58,956,900	$88,514,800	($43,225,400)	$45,289,400	$48,246,500	$93,535,900

COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.