DEPARTMENT: Health
DEPARTMENT HEAD: Colleen M. Bridger, MPH, PhD
COUNCIL DISTRICTS IMPACTED: City Wide
SUBJECT:
Authorizing continuation of six 1115 Waiver projects with the addition of the Stand Up SA project, proposed budgets and personnel complement for a period beginning October 1, 2017 through September 30, 2018.
SUMMARY:
Consideration of the following items relating to the San Antonio Metropolitan Health District’s participation in the Medicaid 1115 (a) Demonstration Waiver Program known as the “Texas Healthcare Transformation and Quality Improvement Program” (the Program) for a period beginning October 1, 2017 through September 30, 2018:
A. An Ordinance authorizing the San Antonio Metropolitan Health District to continue funding and operating the Medicaid 1115(a) Demonstration Waiver Program-Diabetes Prevention and Management Project for a period beginning October 1, 2017 through September 30, 2018, and authorizing a proposed project budget and personnel complement.
B. An Ordinance authorizing the San Antonio Metropolitan Health District to continue funding and operating the Medicaid 1115(a) Demonstration Waiver Program-School Based Oral Health Project for a period beginning October 1, 2017 through December 30, 2018, and authorizing a proposed project budget and personnel complement.
C. An Ordinance authorizing the San Antonio Metropolitan Health District to continue funding and operating the Medicaid 1115(a) Demonstration Waiver Program-HIV and Syphilis Prevention and Screening Project for a period beginning October 1, 2017 through September 30, 2018, and authorizing a proposed project budget and personnel complement.
D. An Ordinance authorizing the San Antonio Metropolitan Health District to continue funding and operating the Medicaid 1115(a) Demonstration Waiver Program-Baby Café Breastfeeding Promotion Project for a period beginning October 1, 2017 through September 30, 2018, and authorizing a proposed project budget and personnel complement.
E. An Ordinance authorizing the San Antonio Metropolitan Health District to continue funding and operating the Medicaid 1115(a) Demonstration Waiver Program-Teen Pregnancy Prevention Project for a period beginning October 1, 2017 through September 30, 2018, and authorizing a proposed project budget and personnel complement.
F. An Ordinance authorizing the San Antonio Metropolitan Health District to continue funding and operating the Medicaid 1115(a) Demonstration Waiver Program-Healthy Neighborhoods Project for a period beginning October 1, 2017 through September 30, 2018, and authorizing a proposed project budget and personnel complement.
G. An Ordinance authorizing the San Antonio Metropolitan Health District to fund and operate the Stand Up San Antonio Program for a period beginning October 1, 2017 through September 30, 2018, and authorizing a proposed project budget and personnel complement.
H. An Ordinance authorizing a proposed operational budget for critical infrastructure support to include monitoring, compliance and sustainability planning for seven projects funded through the Medicaid 1115 Waiver for a period beginning October 1, 2017 through September 30, 2018.
These Ordinances will authorize The San Antonio Metropolitan Health District (Metro Health’s) to continue funding for six public health projects and the addition of a seventh project, Stand Up SA, to be funded out of the 1115 Medicaid Waiver Program. Ordinances will further authorize proposed program and operational budgets, personnel complements, and other related items for a period beginning October 1, 2017 and ending September 30, 2018. Metro Health’s participation in the 1115 Medicaid Waiver program serves a legitimate public purpose in that this funding will support improved health outcomes in Bexar County in seven key areas. This action also authorizes other related items in order to continue funding for program operations to include, incidental expenditures for program participants. The seven projects requested to move forward are as follows:
1) Diabetes prevention and management project
2) Children’s school based oral health project
3) HIV and Syphilis prevention and screening project
4) Baby Café breastfeeding promotion project
5) Teen Pregnancy prevention project
6) Healthy Neighborhoods project; and
7) Stand Up San Antonio project.
BACKGROUND INFORMATION:
On January 31, 2013, City Council authorized the submission of six project proposals for consideration and funding as part of the “Texas Healthcare Transformation and Quality Improvement Program” or “1115 Medicaid Waiver Program”. The 1115 Medicaid Waiver created two new funding pools in Texas for Uncompensated Care reimbursement for hospitals and a Delivery System Reform Incentive Payment (DSRIP) pool program. The DSRIP program provides incentive payments for hospitals and other providers who make investments in delivery system reforms that increase access to healthcare, improve the quality of care, and enhance population health. Six projects were originally approved by the Health and Human Services Commission (HHSC) for funding through the DSRIP pool in two phases of approvals in April and September of 2013. Projects submitted focused on innovative intervention strategies to improve health outcomes in Bexar County in the following areas: diabetes prevention, children’s oral health services, HIV and Syphilis prevention, breastfeeding promotion, teen pregnancy prevention and neighborhood health promotion.
The initial demonstration period came to an end on September 30, 2016. With a 15 month extension period approved by the Centers for Medicare and Medicaid Services set to expire December 31, 2017, HHSC has requested an additional 21-month renewal of the program that if approved, would extend the term of the 1115 Waiver DSRIP pool through September 30, 2019.
In addition to the six initial projects outlined above, Metro Health requests authorization of a seventh proposed project budget and personnel complement to implement the Stand Up SA program. Funding for this program is available in the 1115 Medicaid Waiver DSRIP budget and will support continued operations of the Stand Up SA program and preparations for data collection and reporting for DSRIP outcome measures associated with reducing jail recidivism as outlined in the revised DSRIP renewal application.
ISSUE:
HHSC and CMS are currently working on a 21 month renewal for the 1115 Medicaid Waiver in Texas that will coincide with the end of the extended demonstration period on December 31, 2017. Metro Health has decided to utilize reserve funding to continue the six initial projects with the addition of a seventh project for a period beginning October 1, 2017 through September 30, 2018 until a final decision is received from CMS on the 21 month renewal. Authorization for the 21 month renewal is anticipated some time in the fall of 2017. Therefore, Metro Health seeks City Council authorization to continue funding for the projects utilizing 1115 Medicaid Waiver DSRIP reserve funds through September 30, 2018 to prevent any interruption in service.
ALTERNATIVES:
If Metro Health is not authorized to utilize reserve funding to continue operating each of these projects, the department will forfeit future incentive pay funds available for the project(s) as well as the opportunity to fund the Stand Up SA program.
FISCAL IMPACT:
Metro Health is requesting authorization to fund seven projects, a total of 52 full time positions, and an operational budget to support general operational and sustainability planning needs to include advertising and marketing, information technology, HIPAA compliance, fiscal management and ongoing program evaluation for quality improvement in the amount of $9,921,340.00. Funding for the seven projects is provided through reserve funding from the previous year’s incentive payments received for meeting project deliverables.
|
Project |
Authorized Positions |
Total Project Budget |
|
Diabetes prevention and management |
10 |
$1,119,528.00 |
|
Children’s school based oral health |
2 |
$2,004,422.00 |
|
HIV and Syphilis prevention and screening |
14 |
$1,237,684.00 |
|
Baby Café breastfeeding promotion |
6 |
$472,910.00 |
|
Teen pregnancy prevention |
1 |
$900,456.00 |
|
Healthy Neighborhoods |
2 |
$1,616,857.00 |
|
Stand Up SA |
|
$509,999.00 |
|
Operations |
17 |
$2,059,484.00 |
|
TOTAL FY2018 Budget |
52 |
$9,921,340.00 |
RECOMMENDATION:
Metro Health staff requests City Council approve Ordinances A through H authorizing Metro Health to continue funding operations of the original six projects with the addition of a seventh project to include the following:
1) Diabetes prevention and management project
2) Children’s school based oral health project
3) HIV and Syphilis prevention and screening project
4) Baby Café breastfeeding promotion project
5) Teen Pregnancy prevention project
6) Healthy Neighborhoods project; and
7) Stand Up San Antonio project.
In addition, the department seeks authorization to approve program and operational budgets, personnel complements and other related items to participate in the 1115 Medicaid Waiver DSRIP Program for a period beginning October 1, 2017 through September 30, 2018.