Department of Health

The Enacted Budget passed by the Legislature on May 1, 2003 makes the following changes to the Executive Budget:

·        Restores $2 million Special Revenue-Other funds in the Health Care Standards and Surveillance Program for Triplicate Prescriptions Forms.

·        Reduces nonpersonal services in the Medicaid Management Information System Program

by $3 million.

The thirty day amendments recommend these changes to the following programs (revised March 7, 2003):

·        Administration and Executive Direction Program: Adds $30,000 in Personal Services to the Special Revenue-Other Vital Records Management Account, adds $478,000 in Nonpersonal Service to the AIDS Institute Program

·        Center for Community Health:  Adds $75,000 in Special Revenue-other  funds in the

Tobacco Enforcement and Education Account

·        Child Health Insurance Program:  Adds $4.8 million in Nonpersonal Service to the Special Revenue-Other Children’s Health Insurance Account

·        Health Care Standards and Surveillance Program:  Personal service is reduced by $1.1 million to reflect the transfer of 18 positions to the Office of Managed Care Program.  Nonpersonal service is increased by $628,000 which may reflect an increase in contractual service for inspectors.  This should be clarified at Labor-Management.

·        Office of Managed Care Program:  Adds $1.1 million in Personal Service to reflect the transfer of 18 positions from the Health Care Standards and Surveillance Program.  The FTE projections in the Executive Budget do not reflect an increase in positions to the Office of Managed Care, which shows a reduction of 9 positions during SFY 2003-04. Also adds a $60,000 Special Revenue Other appropriation for the Continuing Care Retirement Communities.

·        Wadsworth Center for Laboratories and Research Program:  Increases the Special Revenue Other appropriation for the Clinical Laboratory $1.2 million, including $676,000 in personal service.  Increases the Special Revenue Other appropriation for the Environmental Laboratory by $272,000, including $97,000 in personal service.

The Executive Budget recommends (revised February 5, 2003):

·        A net decrease of 199 FTEs, 63 of which will occur in SFY 2003-04, including 58 FTE position abolitions which are the most vulnerable to possible layoffs.  The SFY 2003-04 reductions reflect a decrease of 312 FTEs offset by an increase of 249 FTEs.  Significant net reductions in FTEs occur in the following programs:  Administration and Executive Direction (-54, of which 34 occur in SFY 2003-04);  AIDS Institute (-26, of which 11 occur in SFY 2003-04); Community Health (-35, 9 of which occur in SFY 2003-04); Environmental Health (-41, 15 of which occur in SFY 2003-04); Health Care Standards and Surveillance (-62, 22 of which occur in SFY 2003-04); Laboratories and Research (-16, including 21 FTE reductions in SFY 2003-04); and Office of Medicaid Management (-23, including 31 FTE reductions in SFY 2003-04).  The Institution Management Program is increased by 120 FTEs, including 75 in SFY 2003-04.  The estimated year end workforce will be 5,912 FTEs on March 31, 2004.

·        According to the Assembly budget analysis, the budget proposes the transfer of 136 positions to the Insurance Department.  This includes a shift of 56 positions from the newborn hearing program, as well as all personal service (80 positions) and non-personal service costs from the Center for Community Health Program, to Special Revenue-Other accounts within the State Insurance Department that are funded with insurance assessments.  This transfer is not reflected in the Executive Budget narrative, the Executive Budget bills or DOB’s Workforce Impact Summary Report.  This issue needs to be clarified at Labor/Management.

·        Shifting several positions from general fund or special revenue-federal support to special revenue-other funds, including 19 FTEs in the Administration and Executive Direction Program; 80 FTEs in the Community Health Program; and 50 FTEs in the Laboratories and Research Program.

·        An agency-wide decrease of $29.9 million (-15.2%) in General Fund appropriations.

·        Elimination of a $3 million Maintenance Undistributed appropriation in the Administration program, which was for a time and activity system.

·        A reduction of $1.6 million in the AIDS Institute, including $570,000 in personal services and $1 million in nonpersonal services.

·        A net decrease of $4.8 million in the Center for Community Health Program, including reductions of $4.7 million in personal service and $5.1 million in nonpersonal service, offset by an increase of $5.1 million in Special Revenue-Federal funds.

·        A reduction of $5 million for Wadsworth Laboratories, reflecting the elimination of a Maintenance Undistributed appropriation for the Enhanced Newborn Screening and AIDS Newborn Screening Program.

·        An increase of $16.2 million in Contractual Services for the Office of Medicaid Management, apparently expanding the contract with the private agency that operates this system. Contractual Services in other programs are reduced by a total of $6.8 million.

·        A net increase of $60 million in Special Revenue-Federal funding, including the following   significant changes (+/-$1 million or more):

-         Administration program:  (-$1.5 million) Federal  Food and Nutritional Services Account.

-         Center for Community Health program:  (+$4.4 million) Federal Food and Nutritional Services Account; (+$1.4 million) Health and Human Services Fund 269; (+$2.1 million) Federal Block Grant Fund 269; (-$3.1 million) Individuals with Disabilities Part C Account.

-         Center for Environmental Health program:  (+$13.2 million) Federal EPA Grants.

-         Child Health Insurance:  (-$17.1 million) Children’s Health Insurance Account.

-         Medicaid Management Information Systems:  (+28.2 million) Health and Human Services Fund.

-         Medicaid Audit and Fraud Prevention:  (+$9.6 million) Health and Human Services Fund.

-         Continuing Care:  (+$13.1 million) Health and Human Services-Children’s Hospice.

-         Wadsworth Center:  (+$1.1 million) Block Grant Fund.

·        A net increase of $14.2 million in Special Revenue-Other appropriations, including the following significant changes (+/-$2 million or more) :

-         Child Health Insurance Program:  (-$4,809,000) Child Health Insurance Account, of which $4,781,000 is nonpersonal service.

-         Health Care Standards and Surveillance:  (+$3.8 million) Professional Medical Conduct Account and (-$3.5 million) eliminating the Triplicate Prescription Forms Account.

-         Helen Hayes Hospital; (+$4.8 million); (+$2.4 million) Lower Hudson Veterans Home).  This reflects the increase of 120 FTEs in the Institution Management program.

-         Maintenance Undistributed: (+$15.5 million) Quality of Care Account.

·        Funding for Roswell Park is not in the DOH budget, but appears in the Article VII bill, in the HCRA provisions.  According to the Division of Budget, RPCI’s workforce will remain at 1996 FTEs in SFY2003-04.  The bill provides funding in calendar years, not state fiscal years, in the following amounts:

-         2002:  $85 million

-         2003:  $82.5 million

-         2004:  $80 million

-         January 1-June 31, 2005:  $40 million.

According to the Assembly budget analysis, the Roswell Park appropriation of $80 million for SFY 2003-04 represents a $10 million reduction.

·        Reauthorization of the Health Care Reform Act for an additional two years.  The budget indicates that the bill will “continue critical health care workforce recruitment and retention funding enacted in 2002.” The bill appears to be funded by proceeds from the conversion of Empire Blue Cross and any other not-for-profit insurers to for-profit-entities; World Trade Center relief and recovery costs; and surcharges on health services and the “covered lives” assessment, with changes made to accommodate the loss of Tobacco Settlement payments due to securitizing a portion of those funds.  A detailed analysis of the bill will be provided as soon as possible.

·        A $4.6 million appropriation in the Office of Continuing Care to fund initiatives in collaboration with OMH, the Commission on Quality of Care for the Mentally Disabled, and the State Office for the Aging to undertake a statewide effort to conduct client assessments, improve medication management, initiate enhanced service coordination and other advocacy services, and expand social and recreational activities. The budget indicates that Federal Medicaid matching funds will bring the total funding for this purpose to $8 million.  It does not appear that any of this funding will be used for personal services since there are no planned increases in FTEs in the Office of Continuing Care.