Alabama Department of Public Health FY 2021 Budget Request 2 - PowerPoint PPT Presentation

Alabama Department of Public Health FY 2021 Budget Request

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Public Health in Alabama Protective Services  Licensure of hospitals, nursing homes, assisted living facilities  Inspection and permitting of restaurants, food processors, dairies, seafood and on-site sewage disposal systems  Regulation of medical & industrial x-ray and radiation sources; nuclear power plant emergency response  Investigation of vector borne diseases (West Nile, encephalitis, rabies) 3

Public Health in Alabama Clinical Services  Women, Infants, and Children  Newborn Screening (WIC) Nutritional Program  Immunizations  Family Planning  Sexually Transmitted Infections  Chronic Disease Management  Tuberculosis  Home Health  HIV/AIDS  Cancer Prevention  Outbreak investigations  Telehealth 4

Public Health Program Updates  WIC  Monthly average caseload of 115,448 in 2019  $93 million directly into the Alabama economy  HIV/AIDS  Approximately 535 newly diagnosed cases in 2019  ADAP enrollment 12/31/19 – 1,187  Health insurance coverage 12/31/19 - 2,411  Current waiting list – 0  Infant mortality rate  7.0/1,000 births in 2018 5

Public Health Program Updates (continued)  Breast and Cervical Cancer  General Fund appropriation provided breast and/or cervical cancer screening to 2,823 underserved women  Colorectal and Prostate Cancer  Provided colorectal and prostate cancer screening for underserved men and women 6

Source of Funds (In Millions) FY 2019 $7.5 $35.5 $5.8 $16.9 $150.7 Federal Reimbursement General Fund Education Trust Fund Other State Funds Local $506.1 7

Public Health Budget Request Outline  Children's Health Insurance Program (CHIP), ALL Kids  Prescription Drug Monitoring Program (PDMP) enhancements  Licensure and Certification Program  Maternal Mortality Review Committee  Home Health Program  Family Planning Program 8

FY 2021 State Funds Requested Increase (In millions) Education Trust General Fund Fund Continuation Costs Merit Raises 0.5 0.2 Est Supplies and Utility Cost Increases 0.1 CHIP Continuation 38.1 Initiatives Prescription Drug Monitoring Program 0.3 Licensure and Certification Program 0.3 Maternal Mortality Review Committee 0.5 Home Health Program 4.4 Family Planning Program 5.8 Total Request Increase $50.0 $0.2 9

General Fund (In millions) 2019 2020 2021 Actual Budgeted Requested $35.5 $36.2 $48.1 Appropriation (excluding CHIP) $0.00 $35.0 $60.8 General Fund- CHIP Total $35.5 $71.2 $108.9 10

Children’s Health Insurance Program FY 2019 FY 2020 FY 2021 FY 20 – 21 FY 20 – 21 Actual Budget Request Change % Change YEND Caseload 85,265 94,190 99,048 4,858 5.2% Avg Enrollment 85,257 90,026 96,801 6,775 7.5% Cost PMPM $236.06 $244.80 $255.32 $10.52 4.3% General Fund $0.0 $22.6m $60.7m $38.1m 168.6% Note: In FY 2019 , CHIP was 100% federally funded. The state share in FY 2020 is 8.12% and in FY 2021 will be 19.68%. 11

Prescription Drug Monitoring Program/Opioid Council  Migration to Appriss Health Aware Software  Prescriber reports and EHR integration  Requested increase for FY 2020 was not funded FY 2019 FY 2020 FY 2021 Year One Year Two Year Three Support and Maintenance $312,070 $312,070 $312,070 NarxCare $276,000 $276,000 $276,000 EHR Integration $375,700 $513,500 $651,400 Staffing $141,500 $149,275 $157,446 Total $1,105,270 $1,250,845 $1,396,916 12

Results of Increased PDMP Use and Enhancements  3,521,314 patient history searches were performed by Alabama PDMP users in 2018 (does not include users from data sharing states).  Increase in number of PDMP users from 16,876 in 2017 to 20,514 in 2018.  Decrease in number of opioid prescriptions dispensed from 6,685,631 in 2017 to 6,082,954 in 2018.  Decrease in quantity of opioids dispensed from 446,089,858 in 2017 to 392,538,905 in 2018.  Decrease in number of patients who were dispensed opioids from 1,604,855 in 2017 to 1,420,642 in 2018.  Decrease in morphine milligram equivalents dispensed from 4,769,035,680 in 2017 to 3,996,651,294 in 2018. 13

Number of Opioid Prescriptions Dispensed by Year 2014 through 2018 Number of Prescriptions 8,000,000 7,340,111 7,069,219 6,941,744 6,685,631 7,000,000 6,082,954 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 0 2014 2015 2016 2017 2018 Number of Prescriptions 14

Licensure and Certification Program The Assisted Living Facility (ALF) Unit is 100% funded with state dollars.  Responsible for surveying 194 Licensed Assisted Living Facilities, 101 Licensed Specialty Care Assisted Living Facilities (SCALF) and all unlicensed health care facilities.  Surveys conducted in FY 2019  ALF – 128 in 122 facilities  SCALF – 79 in 72 facilities  The Department has 64 pending unlicensed health care facility complaints for calendar years 2017, 2018, and 2019.  Routine surveys of the licensed facilities are conducted every two years. Only minimal surveys of unlicensed health care facilities are being conducted. 15

Maternal Mortality Review Committee  Alabama moms are dying  Alabama ranks 47th in maternity care and infant feeding, 49 th in maternal death rate, and 46 th in health of women and children  41 pregnancy-related deaths occurred in 2017  22 more Black women die for every pregnancy-related death of a white woman  21% of pregnancy-related deaths since 2016  In the United States, 60% of pregnancy related deaths are preventable 16

Maternal Mortality Review Committee 17

Home Health Services FY 2017 FY 2018 FY 2019 Clients 5,425 5,975 5,103 Medicare Episodes 2,867 2,257 1,988 Medicaid Visits 167,003 161,591 148,642 Total Cost $35,945,405 $34,382,410 $34,030,394 Medicaid Match $7,305,572 $6,895,256 $5,756,711  ADPH Home Health is the largest provider of Medicaid home health visits and the only provider for Medicaid pediatric home health services  Medicare episodes have decreased by 31% from FY 2017 to FY 2019  The decrease in Medicare revenue has resulted in less funding to cover match and uncompensated services 18

Home Health Services Medicare Home Health Receipts 18,000,000 16,419,335 16,000,000 15,257,131 15,146,467 14,000,000 12,820,018 12,000,000 10,631,591 10,000,000 8,891,834 8,000,000 7,133,429 5,547,503 6,000,000 4,368,123 4,169,696 4,000,000 2,000,000 0 FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 19

Family Planning Services FY 2017 FY 2018 FY 2019 Clients 68,836 63,953 57,897 Service Visits 143,951 129,646 121,047 Total Cost $33,114,079 $31,751,314 $31,099,234 Medicaid Match $1,707,841 $1,747,507 $1,955,163 Problem Visit Cost $3,761,108 $3,480,384 $3,074,289  ADPH pays a 10% match rate on all Family Planning costs covered by Medicaid  About $5.8 million of Family Planning costs is uncompensated (previously covered by local appropriations and case management revenue)  ADPH does not receive reimbursement for any problem visits (11,966) 20