COBI 2015 - Other Optional Services

Overview
Issues
Background
Financials

Sources Uses

FY 2016 Appropriation

Other Optional Services, depending on a client's eligibility, may include: Personal Care Services, Alcohol and Drugs, Ambulatory Surgical Services, Kidney Dialysis, Private Duty Nursing, Psychologist Services, Podiatrist Services, Enhanced Pregnancy, Skills Development, Medical Supplies, Durable Medical Equipment, Medical Transportation, and Early Intervention.

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, $149,984,300 from all sources for Other Optional Services. This is a 10 percent increase from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $33,424,300 from the General/Education Funds, an increase of 51.3 percent from revised Fiscal Year 2015 estimates.

Appropriation Adjustments

The following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time Anesthesia Services Medicaid Reimbursement Rates$2,931,300$0

OngoingOne-TimeFinancing Source

$870,000$0General Fund

$2,061,300$0Federal Funds

"Medicaid anesthesia services." Health: "It would be a 30 percent increase for [fee-for-service] and [accountable care organization] providers."

Dedicated Credits Increase$2,000$0

OngoingOne-TimeFinancing Source

$2,000$0Dedicated 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."

Medicaid Caseload Growth$0$5,350,000

OngoingOne-TimeFinancing Source

$0$5,350,000General Fund, One-time

The following areas create costs for the state in Medicaid in FY 2016: (1) estimated increase of 1,900 or 1% clients in FY 2016, (2) $3.9 million for a 2% projected increase in accountable care organization contracts starting in January 2016, (3) $3.0 million for a new federal regulation to provide autism spectrum disorder-related services when medically necessary up to age 21, and (4) $3.1 million for cost increases over which the state has no control due to federal regulation or has opted not to exercise more state control. FY 2014 ended and FY 2015 will likely end under budget which reduces the baseline costs for FY 2016. How Measure Success? HEDIS measures (https://health.utah.gov/myhealthcare/reports/hedis) for access to care and how much appropriate care was received.

Medicaid Caseload Reduction$0 ($15,400,000)

OngoingOne-TimeFinancing Source

$0 ($15,400,000)General Fund, One-time

Medicaid also operates the Primary Care Network, which provides a limited array of health services to legal residents or U.S. citizens with incomes up to 100% of the Federal Poverty Level, who do not qualify for regular Medicaid benefits. Covered services include: visits to a primary care provider, up to four prescriptions monthly, routine dental cleaning and examination, family planning services, immunizations, and routine lab services and x-rays. The program has had open enrollment since June 2, 2014. There are no immediate plans to close enrollment. Previously, the program maintains a cap on enrollment and has limited periods for accepting new applicants. The program operates because of special federal authority granted via an 1115 waiver.

Medicaid additionally operates the Utah's Premium Partnership for Health Insurance for adults, which pays monthly up to $150 per adult to pay the premiums of qualifying employee-sponsored health insurance. Adults who qualify can make up to 150% of the Federal Poverty Level.

Since 1977 the State has run some Medical/Dental Clinics to provide access to medical and dental services to Medicaid, Primary Care Network (PCN), and Children's Health Insurance Program (CHIP) clients. There are three medical clinics supported by the Department of Health. They are in Provo, Salt Lake City and Ogden. The State-run medical clinics provide general primary care medical services. These clinics utilize paid staff as well as volunteers to provide regular office visits as well as after-hour visits. The three dental clinics supported by this program are located in Salt Lake City, Ogden, and St. George. The State also operates a mobile dental clinic which serves underinsured clients and provides about 800 services at over 10 rural locations annually.

Intent Language

SB0002: Item 75

The Legislature intends that with the funding appropriated for the building block titled, "Intermediate Care Facilities - Intellectually Disabled," the Department of Health shall: 1) Direct funds to increase the salaries of direct care workers; 2) Increase only those rates which include a direct care service component, including respite; 3) Monitor providers to ensure that all funds appropriated are applied to direct care worker wages and that none of the funding goes to administrative functions or provider profits; In conjunction with Intermediate Care Facilities - Intellectually Disabled providers, report to the Office of the Legislature Fiscal Analyst no later than September 1, 2015 regarding: 1) the implementation and status of increasing salaries for direct care workers, 2) a detailed explanation with supporting documentation of how Intermediate Care Facilities - Intellectually Disabled providers are reimbursed, including all accounting codes used and the previous and current rates for each accounting code, and 3) a conceptual explanation of how Intermediate Care Facilities - Intellectually Disabled providers realize profit within the closed market of providing Intermediate Care Facilities - Intellectually Disabled services.

SB0002: Item 75

The Legislature intends that, if funds are available, Medicaid fee-for-service payments for anesthesia services be increased from the current amount of $18.27 to $23.73 for Fiscal Year 2016.

SB0002: Item 75

The Legislature intends that 5% of all funds provided in the Medicaid program for managed care dental plans be used for contracted plan administration and that any funds provided for the Affordable are Act premium tax not be included in that 5% administrative funds amount.

SB0003: Item 123

Under Section 63J-1-603 of the Utah Code the Legislature intends that up to $3,216,000 of the appropriations provided for the Medicaid Optional Services line item not lapse at the close of Fiscal Year 2016. The use of any nonlapsing funds is limited to a pilot program for assistance for children with disabilities and complex medical conditions to be used in similar amounts over three years with the goal of serving a similar number of clients over three years.

SB0007S01: Item 6

The Legislature intends that the Department of Health report on the following performance measures for the Medicaid Optional Services line item: (1) annual state general funds saved through preferred drug list (Target = $8.5 million general fund or more), (2) count of new choices waiver clients coming out of nursing homes into community based care (Target = 390 or more), and (3) emergency dental program savings (Target = $250,000 General Fund savings or more) by January 1, 2016 to the Social Services Appropriations Subcommittee.

SB0007S01: Item 18

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Funding Source

Expenditure Category

Appropriation Type:

Appropriation History by

Sources of Finance	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
General Fund	34,460,800	7,209,000	35,091,200	2,285,000	27,161,100	4,984,600	32,145,700	1,278,600	33,424,300
General Fund, One-time	(18,876,100)	4,877,800	(22,522,700)	9,632,000	0	(10,050,000)	(10,050,000)	10,050,000	0
Federal Funds	58,761,600	57,645,200	74,498,600	81,539,500	122,181,300	(26,225,800)	95,955,500	2,196,200	98,151,700
American Recovery and Reinvestment Act	4,463,200	0	0	0	35,365,000	(35,365,000)	0	0	0
Dedicated Credits Revenue	9,473,800	8,185,600	13,200,500	13,292,300	13,201,300	91,000	13,292,300	2,000	13,294,300
Transfers	0	0	0	0	200	(200)	0	0	0
Transfers - Human Services	0	0	474,900	525,500	474,900	50,600	525,500	0	525,500
Transfers - Intergovernmental	3,790,700	0	0	0	0	0	0	0	0
Transfers - Medicaid - DHS	11,501,100	152,100	3,134,700	2,932,700	0	1,722,700	1,722,700	0	1,722,700
Transfers - Medicaid - Internal DOH	1,024,700	0	1,986,400	2,328,500	2,319,500	0	2,319,500	0	2,319,500
Transfers - Medicaid - USDB	540,200	334,200	308,600	538,300	325,600	37,700	363,300	89,000	452,300
Transfers - Other Agencies	0	131,100	0	0	0	0	0	0	0
Transfers - Within Agency	549,600	1,306,900	195,500	0	0	0	0	0	0
Transfers - Workforce Services	0	741,200	239,700	94,000	114,200	(20,200)	94,000	0	94,000
Transfers - Youth Corrections	0	1,636,000	0	0	0	0	0	0	0
Beginning Nonlapsing	0	0	16,900	0	0	0	0	0	0
Lapsing Balance	0	0	0	(1,900)	0	0	0	0	0
Total	$105,689,600	$82,219,100	$106,624,300	$113,165,900	$201,143,100	($64,774,600)	$136,368,500	$13,615,800	$149,984,300

Categories of Expenditure	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
Personnel Services	0	23,200	133,100	0	0	0	0	0	0
In-state Travel	0	0	1,600	0	1,600	(1,600)	0	0	0
Out-of-state Travel	0	17,200	19,400	0	19,400	(19,400)	0	0	0
Current Expense	0	1,661,200	1,954,200	(600)	68,100	(68,700)	(600)	2,000	1,400
DP Current Expense	0	20,100	0	9,600	9,400	200	9,600	(100)	9,500
Other Charges/Pass Thru	105,689,600	80,497,400	104,516,000	113,156,900	201,044,600	(64,685,100)	136,359,500	13,613,900	149,973,400
Total	$105,689,600	$82,219,100	$106,624,300	$113,165,900	$201,143,100	($64,774,600)	$136,368,500	$13,615,800	$149,984,300

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Other Indicators	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
Budgeted FTE	0	0	0	3	3	(3)	0	0	0
Actual FTE	0.30	0.10	0.20	0	0	0	0	0	0

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.