Sen. Nadine Thomas hosted a Human Development Subcommittee meeting today. This Subcommittee is a part of the Senate Appropriations Committee charged with overseeing monies appropriated to the Departments of Human Resources and Community Health. In the hearing today, Sen. Thomas had both Departments make presentations and respond to questions that her Subcommittee had raised prior to the hearing. These discussions centered around the FY 2002 amended budget or "Supplemental Budget." Members of the Subcommittee present, other than Sen. Thomas, included Sens. Phil Gingrey and Mike Crotts.

Sen. Thomas first had the Department of Human Resources ("DHR") make its presentation. Commissioner Jim Martin was not present as he was dealing with the Task Force on Energy Issues. Juanita Blount-Clark represented the "B-Team" from DHR to the Subcommittee to address the various issues.

Ms. Blount-Clark began with an update on TANF (Temporary Assistance for Needy Families). Georgia originally opted that persons on TANF could only receive assistance for up to 48 months (while the federal law provides for states to provide assistance up to 60 months). Thus, Georgia has been allowing an optional fifth year. After the 60 months, there is a provision whereby 20% of the TANF recipients can get further extensions (extensions are allowed when certain hardships or barriers are present - such as a person has severe mental retardation or suffers from a mental health disorder or is a victim of domestic violence, etc.) These extensions are for 90-day intervals. In Georgia, approximately 3-5% of the case load will be extended (which is well within the 20% allotment). There are a number of concerns surrounding TANF including reauthorization by federal government of the program as well as keeping the block grant funding. There are also no set asides in the block grant funding. Thus, Georgia would like to see a more streamlined program and have more coordination with other programs such as food stamps. Additionally, transitional Medicaid for these recipients needs to be reassessed.

Carol Steiner presented a short update on the Cancer Initiative. There have been $3.8 million dollars drawn down from the federal government for breast and cervical cancer education and screening programs. Also, there is now a push to better educate men on prostate screening. The Cancer Registry has also been expanded and now provides better reporting by hospitals. Tracking patients is key, and hospitals are now reporting a greater number of cases. A Request for Proposal will soon be issued for a media campaign on education. Additionally, the Department of Human Resources sill soon announce the Rural Education and Screening Projects (there will be six awards named). These possible award recipients were reviewed based on the counties served and their location as well as the numbers of incidents of breast and cervical cancers. Three mammography providers have been targeted for high incident counties (this has been both a private and public initiative). Additionally, this mammography screening project has been funded through both DHR and the Department of Community Health ("DCH") with a total of $1.5 million. There have also been some challenge grants. There will also be three nursing consultants hired. As far as treatment, the state aid program has increased but there can be no new patients due to the freeze on dollars. With Medicaid funding, the DCH has had assistance with federal dollars to help fund 1,200 women’s treatment who are 200% below the Federal Poverty Level.

Kristin Coates reported on the Tobacco Settlement. In Georgia, there are 10,000 deaths attributed to smoking-related issues each year. There has been some good news in that there has been a 3.4% reduction in smoking which in turn causes less smoking-related illnesses which has a positive Medicaid savings. On November 15, 2001, a toll-free line was implemented in an effort to provide options for counseling on quitting smoking. This toll-free line was implemented after a pilot project in the Columbus area was found to have positive results. There are five counseling options to pick from: 1) information; 2) self-help; 3) single-session counseling; 4) multi-session counseling; and 5) intensive counseling. Additionally, the State has been using the Great Start Program to assist pregnant women to kick the smoking habit. An analysis by health district will soon be released which was prepared in conjunction with the American Cancer Society and the State.

Marty Rotter, with the Office of Regulatory Services at DHR, reported on the kidney dialysis issues. Rules and regulations pertaining to kidney dialysis centers were approved at the DHR Board meeting in November 2001. Consumers and providers provided information on these rules and regulations. DHR is now in the process of hiring three nurses to oversee this program.

Dr. Sherry Dresnick, with the Division of Public Health, reported on the State’s bioterrorism efforts. She indicated that there were different forms of emergencies and there has been coordination between public health and providers in this regard. Additionally, the State has received federal funding for the last two years for the Centers for Disease Control to address preparedness needs, including detection and response. The federal dollars also have assisted in the hiring of epidemiologists and funding laboratory needs in detecting "agents." There has also been a "health alert network" established in an effort to provide for internet connectivity in the event of health emergencies. Epidemiologists have been hired in 13 of 19 districts – this is a program unique to Georgia. The Division would like the State to fund the remaining epidemiologist positions.

Ken Jones, the Budget Director for DHR, reported on various budget items. Money has been requested for the following:

1) Pneumonococal vaccine for children (DHR is requesting 67,000 doses for the uninsured and underinsured);

 2) HIV waiver funding increase;

3) Prescription funding for AIDS (There has been a growth of 25% and the costs of the drugs have increased. Additionally, there are 500 persons on the waiting list with 4,000 persons being served.);

4) Foster care funding;                          

5) Funding to relocate the Paulding and Union County DFACS offices;

6) Funding for Albany "change center" (This is a call center for persons who need to make changes in coordination of receiving their benefits such as food stamps – this eliminates the need for the person to actually physically appear at a DFACS office.);

7) Funding for contract with district attorneys in the amount of $2.6 million so that large counties may tackle child support enforcement. (This brings in $80 million, and if DHR had to be the sole support, it would cost $14 million.);

8) Information systems funding (This will help with the client transportation management system.);

9) Privacy (This money will help with the assessments of programs.);

10) Increases for rents (Money will help bring inflationary costs current.);

11) Funding for DHR’s Georgia Technology Authority infrastructure needs and the Statewide initiative for Microsoft implementation; and

12) Internal transfers – the single point of entry for hospital and Family Connection site.

There were a number of questions raised, for instance, why there were so many different monies requested for "systems" needs. Additionally, Sen. Crotts raised some concerns about those persons rolling off TANF and the numbers of the 20% which were denied extensions.

Sen. Crotts also asked questions concerning the smoking cessation for children and whether such had been convened.

Sen. Crotts also questioned the State’s preparedness on vaccines – apparently, there are no vaccines available in the State for diseases such small pox, anthrax, etc.

As the Session is rapidly approaching all of the Senators were keenly interested in the protections being taken to secure the Capitol’s mail. The Division of Public Health and GEMA have been working closely with the Capitol Police and looking at the vulnerability of targets. Additionally, a meeting with the Governor’s Office has been held and Capitol staff has been trained about handling the mail. One idea is that the mail could be taken through a central location before being distributed at the Capitol.

Lee Smith, the Bioterrorism Director with the Division of Public Health, explained that his office had been working with Homeland Security and Commissioner Hightower in high profile places such as CNN, the Dome, and World Congress Center. Sen. Thomas asked if there was a statewide initiative – Mr. Smith indicated that there was no single plan. If he had been asked the necessity of a single plan three months ago, his answer might have been different. He stressed that there were different responses for radiological, chemical, biological, and explosive problems.

Sen. Crotts asked whether Georgia could do what other states have done (apparently, the State of Idaho made one wide effort to place all children in foster/adoptive care by holding one central meeting). In Georgia, the one of the issues that precludes such from transpiring is the termination of parental rights.

Funding for the disabled was also an issue of importance for Sen. Crotts (he explained that the issue was personal as he has a quadriplegic nephew). His nephew is prohibited from making more than $900 per month so that he can continue on Medicaid. Sen. Crotts believes that there should be a buy back of premium in an effort to help these disabled get some benefits and also continue to work whenever possible.

The Department of Community Health Commissioner Gary Redding presented his Supplemental requests. DCH’s needs are:

1) Funding for the "hole" in the State’s Medicaid program in the amount of $442 million. There are various reasons for this need for additional dollars such as the shortfall of dollars in prior years; higher utilization; mandatory federal changes (there were 74,000 persons added back to Medicaid rolls and kept on for four months in an effort to determine eligibility – now there are approximately 17,000 persons being continued services);

2) Funding for PeachCare as its growth has far exceeded projections (DCH needs $21 million for the 157,000 children);

3) Money for hospice reimbursement (Hospice care must be paid based on the Medicare rate; the State will begin this in April);

4) Realignment of the dollars for Tobacco Funds – this money was in contracts and DCH is requesting that the money be moved to benefits in an effort to pay the Critical Access Hospitals;

5) Funding for the claims payment system so that DCH can get all four of its programs on one platform;

6) Money for HIPAA implementation in the amount of $329,000;

7) Money for the PeachCare eligibility contract;

8) A full year of costs for the pharmacy benefit manager contract (last year, DCH received a partial year of funding);

9) Money for postage ("mail outs" have increased as there are more eligibles);

10) Money for real estate rentals;

11) An additional $125,000 for the contract to pay for resources on planning and forecasting DCH’s budget;

12) Authorization for revenue maximization for school intervention;

13) Funding for the Composite State Board of Medical Examiners two vehicles (This is $40,000); and

14) Funding for the Georgia Board for Physician Workforce (The money would be used to fund seven family practice residents at the Medical College of Georgia in Augusta and for five pediatric residents at Morehouse).

The total FY 2002 DCH Budget request is $475 million. Sen. Thomas asked for more discussion on the funding of medical residents.

Commissioner Redding also gave an update on the Indigent Care Trust Fund. Presently, the State is determining which facilities are eligible. There are approximately 89 hospitals which can participate and 69 of these are rural. Of these 69, 52 are "small" rural hospitals. The Indigent Care Trust Fund will pay out $434 million. The DCH Board will hopefully approve, this week, the public notice which will be sent out for comment on this issue. There has been some concern expressed relating to the calculations, limits and transfers as more requests have been received than usual. Thus, DCH will delay the payments in order to address the questions. These "integrity" issues are of concern; therefore, a revised schedule will then be sent out. The new date for the hospitals to make transfers is January 7, 2002. Once the State has received the facilities "primary care plans" and has approved such, the Indigent Care Trust Funds will be paid. Sen. Thomas asked for DCH to provide the Subcommittee the ways in which the recipient hospitals spend their "15%" on primary care.