Lengthy Budget hearings were held this week at the Capitol.  The news, of course, was rather grim due to the continuing downward spiral of State revenues.

Commencing Budget Week under the Gold Dome, Governor Perdue, offered his final budget recommendations to the House and Senate Appropriations Committees.   Sen. Jack Hill (R-Reidsville) thanked Governor Perdue for his seven years of service to the State of Georgia.  The Governor reemphasized the message of his State of the State Address to Committee members, to "Do the Hard Things Now," to continue to put Georgia in a strong position and protect the core mission and values of the State.  Tough choices and cuts were made to programs that are near and dear to all Georgians, but they were made in an effort to prioritize and to serve Georgians during a time when they depend on Government the most. Georgia has not seen an economic crisis like the current one we are in since the Great Depression.

However, a slight glimmer of hope was given by the Governor, stating that the forecast shows that the State is through the freefall and month after month declines.  Flat revenues are expected for this year.  The Budget faces a $1.2 billion reduction this year, but as this was expected, the State started to lay out plans for cuts in July of 2009.

The Governor highlighted that education and the future of Georgia must be top priority.  Georgia's Department of Education will only be asked to cut a little over three percent as opposed to other agencies, some that will be cutting nine percent.  Teachers will be asked to take three additional furlough days, which will save the state $100 million.  If teachers were not asked to take these additional furlough days, the equivalent would be the lay off of almost 200,000 teachers. However, the Governor did emphasize that furloughs are not a long term management solution.  No furloughs are planned into the FY 2011 Budget.

While most of the belt-tightening adjustments have already been made, Governor Perdue recommended a nine percent increased commitment to Behavioral Health.  As it is no secret that Georgia has struggled in this area, Frank Shelp has taken over the leading agency to provide better outcomes of care, stabilize hospital staffing, and move patients more quickly to community based settings.  This increase includes an additional $20 million in Amended FY 2010 and $50 million in FY 2011.  The Governor implored Committee Members to make this commitment, even though he recognized the struggle that it will take to find the funding.  

Governor Perdue urged the Committee to continue making long term investments in transportation. Before the economy slowed metro roads were choked, as they still are today, and the situation will only continue to get worse as choked roads will only stifle the State's Economy.  Georgia's Transportation system has been under funded since 1980, while long term needs continuously have been crowded out by short-term needs.  The absence of a comprehensive statewide plan will only perpetuate the situation further.

SB 200, put in motion much needed reform, according to the Governor, as it laid out an   Accountability plan for sustained improvement to transportation.  In order to continue the movement, Governor Perdue recommended a $300 million bond package, which the Legislators will have, a choice in choosing.

The Savannah River Harbor deepening project is still waiting for final approval, but the Governor hopes to see this approval at the end of 2010.  The Savannah Harbor is a major economic driver for Georgia and with the widening of the Panama Canal in 2014; the Harbor must be ready to accommodate larger ships. This would continue to make Georgia a completive state, as well as an international player.  The Governor recommended $900 million for the ports deepening project. Georgia has an AAA bond rating, which allows the State to do more with less money.

The Medicaid Budget is facing a gap due to increased needs and less money, while the federal stimulus money will disappear next year, leaving two choices for the State, cut all providers by 16.5 percent in provider reimbursement rates, or implement a provider fee by drawing down three federal dollars for every one dollar imposed by hospitals or providers. The Governor is seeking the provider fee option.

Governor Perdue cited that while this is the last budget he will present to the Committee, he still has the responsibility to prepare a revenue figure that is fiscally sound and conservative. In FY 2012, Georgia will face a loss of $1.4 billion in Stimulus Funds, in addition to the $300 million in one time funds, leaving Georgia with a $2.6 billion gap. However, the Governor's Economist did allude to a slight upward trend over the last six month. Consumer spending is showing signs of life and the labor market in Georgia is beginning to stabilize. This adding optimism that the State will be able to fill the looming budget gaps in 2012.

Department of Revenue

Bart Graham, Department of Revenue Commissioner, provided his Department's overview for FY 2010 Amended and FY 2011.  He stressed Georgia's need for a more fully integrated tax system to get more tax filers.  He mentioned HB 334, passed in 2009, and its achievements.  The initiative requires that any person or business owing more than $500.00 in connection with any return, report, or other document pertaining to sales tax, use tax, withholding tax, or motor fuel distributor tax is now required to file with the Department, for tax periods beginning on or after January 1, 2011, and pay any such sales tax, use tax, withholding tax, or motor fuel distributor tax liability to the State by electronic funds transfer.  This new process permits the State to receive collectable funds on the date such payment is required.  So far, there is 17% compliance but it is not fully implemented.  Automatic notices are now being generated to taxpayers; since April 2009, 45,000 notices have been sent with 12,000 resulting in payments.

The Department's enforcement efforts are now five years old with much being done to tackle past-due accounts.  Private collection agencies have garnered $111.2 million; call centers have procured $51.4 million; IRS offsets have gleaned the most with $165.1 million; and alcohol has provided $96 million.  Aged accounts receivables, as of July 21, 2009, were $1.596 billion (these go back as far as 20 years).

As to collections, the Department has been successful in trying to capture money from captive "REITs" with three settlements bringing in huge amounts for the State.

The Department is also helping perform special investigations with background checks of employees, including refund fraud checks and tax fraud checks.  The Department's work resulted in blocking refunds for 32,265 filers for a total of $34 million.

Sen. Unterman (R-Buford) stressed that the Senate was not being kept up to date on the pilot projects.  She asked that the Department provide the Senate information about pilot initiatives that are being done for city and county requests.

Rep. Greene (D-Cuthbert) inquired about tag operations.  Commissioner Graham stated that processing of tags is now being done by one team with electronic tagging and titling for new cars. He acknowledged that tags, especially the specialty or prestige tags, are a challenge.

Rep. May (R-Monroe) asked about which industries were more likely to engage in sales tax fraud.  Commissioner Graham explained that he had no statistics on such.

Georgia State Financing and Investment Commission

Susan Hart-Ridley spoke to the Appropriations Committees, explaining more about the State's obligations bonds.  Georgia has a "AAA" Bond rating which is attributed to in part because of the State's moderate debt burden; Constitutional provisions on debt; well-funded pension plans; enjoys diverse economic growth; and has limited exposure to market risks.  When Moody reviewed Georgia's bonding, it issued "cautionary language" noting that the State should not rely upon non-recurring fiscal measures and it should avoid any inability to manage financial stresses.

States which have seven percent or less debt service enjoy "AAA" bond ratings; Georgia has held a debt service rate of 6.75 percent but that was prior to revenues declining.  Now, Georgia's debt service is around eight percent (based on debt service to prior receipts).  "BBB" rated entities paid only slightly more for their debt.

Ms. Hart-Ridley discussed interest rates that Georgia has paid over twenty years.  In 1990, Georgia paid 6.2% for five-year debt; in 2009, it paid 1.4889% for five-year debt.  In 1990, Georgia paid 7.2% for 20-year debt; in 2009, (February-May), it paid 3.8% for 20-year debt.  She did state that economists do not think that bond rates will stay this low.

She also touched on Build America Bond Program.  This initiative was created under the federal stimulus plan.  In November 2009, some bonds were issued with 2.99% true interest cost, but these were solely for new money projects.

Georgia has refinanced $1.9 billion since 2004 in bonds.

Georgia's bond package in 2009 totaled $2.5 billion.  Of these, $1.72 million was "new money" and the remaining $790 million was for refinanced projects.

Department of Juvenile Justice

The Department of Juvenile Justice Commissioner, Albert Murray, presented the Amended FY 2010 and FY 2011 to the House and Senate Appropriations Committee. The eleven year oversight by the Department of Justice has now been brought to an end through the support of the General Assembly and the Governor. The Department of Justice saw substantial improvements during this period of time, such as different restraint techniques during crisis management, enhanced services plans, and community program audits. 

The Department looked at all federal and State statutes when creating both the Amended FY 2010 and FY 2011 Budgets and tried to visualize what the agency should look like after budget cuts. Changes to federal Medicaid and Title IV funds are built into budget, but cannot be earned. The Department's budget faces a $7.5 million deficit with the current reductions.

In order to fill in the budget gaps, staff reductions have been made, eliminating 450 staff members within the Department. Twelve furlough days have been implemented and a motor vehicle moratorium has been put in place; however, the lowest paid staff members are not required to take furlough days. A hiring freeze is in effect, saving $1 million and the Bill Ireland facility in Milledgeville has also been closed in a cost saving effort.

The Governor's Budget Recommendations will be achieved in FY 2011 by annualizing the FY 2010 cuts and annualizing the savings cost from closing the Bill Ireland Facility, providing $19 million in savings.

Short term strategies to save money within the Department have been implemented as well; male youths can now serve their short term programs in RYDCs, instead of in long term facilities. Some youths have even been moved to community supervision. An additional $28 million in ARRA funds, federal recovery funds, are also available to fill holes within the Budget.

There are much higher mental health issues on the juvenile side with fourteen percent possessing some sort of mental health issue. Some of the children in the Department of Juvenile Justice fall under the dual supervision of the Department of Human Services.

The Department of Transportation

Newly named Commissioner Vance Smith addressed the Committee about the Department of Transportation's Amended FY 2010 and FY 2011 Budgets. Georgia has 200,000 miles of state, interstate and federal roads to maintain. Georgia is a donor state, so every dollar that is sent to the federal level comes back to Georgia 92 cents on the dollar.

Commissioner Smith emphasized that transportation affects all of Georgia. Vehicle miles in the State are constantly rising, but with the drop in the economy, many have gone down. More rail is being looked at in Georgia, as well as expanding upon the existing MARTA system.

In order to ease the eight percent budget cut, the Department has made some reductions, such as outsourcing HERO, furlough days and reducing staff. On February 2, 2010 a bond sale will take place, but these sales are already included in the general obligations.

The Department of Education

State School Superintendent, Kathy Cox, offered the Department of Education's Budget to the Committee, stating that the guiding principles of the Department were taken into consideration as the budget was prepared, in an attempt to keep money as close as possible to the students and classrooms. Many cuts were made from programs and people that aren't right there with the students in the classrooms.

The Department seeks to give schools a great deal of flexibility about how they utilize their resources, while still trying to provide quality services and support. Federal dollars are limited into what students it can serve, with exception to the $100 million in stabilization funds. Special needs funding will benefit 180,000 students.

State money does not come with flexibility for the most part, any State mandates placed on schools systems must be paid for with State dollars.  Title I funds can only be used as supplements. Thus, funding comes with many dos and don'ts.

Even through budget cuts, progress continues to be made by all schools. A tremendous growth in the State's high school graduation rate has been accomplished, up to an 80 percent graduation rate, but by 2014 all current eighth graders must graduate leaving a 20 percent gap to fill.

In the Amended FY 2010 Budget, the Department will face a four percent reduction, a total of $17.4 million. Equalization is restored at the baseline level in FY 2011. Department employees must take a mandatory 10 furlough days. There is currently a 24 percent vacancy rate in the Department, leaving more federally funded employees than State funded. RESAS are facing a 9.6 percent reduction in Amended FY 2010 Budget and will be completely eliminated in FY 2011. In cost savings efforts, National Board Certification pay has been completely cut as well.

Additionally, in the Amended FY 2010 Budget, Quality Basic Education funding is reduced another $479 million.  School systems have $810 million less from state Quality Basic Education funding than they earned in "QBE," which will not be offset by the ARRA funds. 

Superintendent Cox urged the Legislature to pass HB 908, expenditures control relief and class size relief legislation.

The University System of Georgia

Chancellor Davis addressed the House and Senate Appropriations Committees, with a message of mindfulness and preservation, testifying that the road to a stronger future is through public universities. The Chancellor also warned that Georgia cannot let its professors slip away to other states because of salary constraints. While student enrollment is upwards of 300,000, total state reductions are $633 million. By the end of FY 2011 another $140 million will disappear from the University System's Budget, but the system will be saddled with supporting more students with less funding.

In order to cope with the shortfall, 2400 positions have been eliminated, major health insurance changes have taken place, mandatory six day furloughs have been implemented and payroll has been consolidated across institutions.

The Governor's Budget Recommendations include funding for all seven requested capital projects, $2.5 million for two projects, and $25 million for another two projects.

In the design area, the System requested design for two projects and the Governor recommended $9.5 million.  

Department of Human Services  

Commissioner BJ Walker with the Department of Human Services provided an overview of her Department's FY 2010 Amended and FY 2011 Budgets on January 21, 2010.  Some of the Joint Appropriations Committee's questions focused on the following areas:

Independent Living program which was to receive a cut.  The program would receive $1.3 million in State funds, bringing in a total with federal dollars of $5.5 million.  State funds had previously been around $2 million for this program.

Rep. Keith Heard (D-Athens) asked that the Subcommittee hold a joint meeting with the Commissioner of Labor in an effort to understand what the State was doing in terms of job creation.

Rep. Pat Gardner (D-Atlanta) inquired about efforts to make a one-stop shopping effort for eligibility for each federal program (Medicaid, TANF benefits, and SCHIP (PeachCare).  Her concern was that Georgia was making it cumbersome for individuals to apply for these programs.  Commissioner Walker assured the Lawmakers that her team was in place working on a solution to this issue.

Rep. Carl Rogers (R-Gainesville) raised a question of "size" of the new Department of Human Services.  Commissioner Walker stated that once the changes took place on July 1, 2009, the Department of Human Services shrank from approximately 18,000 employees to 9,000 employees.  His concerns were caused because of a Juvenile Court Judge raised issues in Hall County that there were not enough "front-line" workers handling DFACS cases.  Commissioner Walker stated that she had looked at staffing issues, particularly in response to this inquiry, and had found, looking at "timely" indicators nothing bad in terms of responsiveness or staffing.  Hall County is, however, now sharing staffing across the region.

Rep. Penny Houston (R-Nashville) asked about the replacement of ARRA funds.  She also inquired about uses of State dollars to fund various senior citizen centers (such as Douglas and DeKalb). These centers apparently receive money through the Agencies Area on Aging.  Rep. Houston also remarked that she did not wish to see any elimination of the Meals on Wheels program.  She also asked Commissioner Walker whether the Nursing Home Civil Penalties Fund money was definite; Commissioner Walker said yes.  She also inquired about the cuts to Family Connection (this is a pass-through program of an attached agency).

Department of Community Health

Commissioner Rhonda Medows, M.D. took her turn in the Well to explain her Department's Budgets as proposed by Governor Perdue.  There are essentially eight key areas to the Budget including Medicaid, SCHIP (PeachCare), State Health Benefit Plan, Emergency Preparedness, Healthcare Facility Regulation, Public Health, Healthcare Access and Administration.

In total, approximately $2.2 billion is necessary to fund the Department.  This comprises 12.3% of the State's total budget.

Commissioner Medows highlighted that the Department's administration's budget was made up of 26 percent State funds (approximately $111 million).  There are several vacant positions presently within the Department, including areas such as healthcare facility regulation, managed care management, public health, and legal department areas.  In the amended Budget, the administration is decreased to $92 million.

The Department funds initiatives to provide healthcare access to Georgians, including the Federally Qualified Health Centers and other rural health initiatives.  For FY 2010 Amended Budget, it is proposed to have a budget of $9.6 million (a two million reduction).  In 2011, it is reduced $2.6 million.

Healthcare Facility Regulation (which encompasses health planning or what was previously known as Office of Regulatory Services) has a budget of $6.5 million; it is reduced by $2.2 million in the FY 2010 Amended. The reductions are in the areas of workers compensation and telecommunications.

Public Health receives approximately 20% of its money from State funds.  In total it has $158 million.  It receives a $25 million reduction in the FY 2010 Amended.  One change made is a layer of management is removed within Public Health to achieve better grant-in-aid management.  Most of the changes are "administrative;" however, the Georgia Poison Control initiative will use FMAP money.  There are other fees to offset costs, which would become effective on April 1, 2010.  These fees would be increased fees for labs, HIV testing, lead testing, Hepatitis C testing, and STD testing.  Additionally, an imposition of a $30 well-water testing fee would be imposed.  Fees for birth and death and certificates would also be increased.  For FY 2011, this Budget is again reduced by another $1.8 million; however, Commissioner Medows believes the fee changes will generate $3 million.  Grant-in-Aid money will be reduced $8.2 million in FY 2010 Amended.

Emergency Preparedness has 38% of its total money from State funds (this is around $3.2 million; it previously had around $6 million in State funds).  Trauma will be treated separately.

State Health Benefit Plan presently has 689,000 individuals (including dependents and retirees) enrolled.  Its Budget is a total of $2.8 billion.  While the Department has streamlined administration and introduced the consumer directed health plan initiatives, utilization increased for all plan options (this included more individuals accessing prevention and a higher utilization of prescription costs).  However, Commissioner Medows did tell Lawmakers that this "option" was less costly than the HMO or PPO options.  The Department also saw a larger number of multi-million dollar claims (generally they see four; this past year they experienced seven such claims (cancer and heart)).  The Department has proposed increased premium costs to members; imposition of higher spousal surcharges; and increases for those who smoke.  In 2010, there will be 34 percent of the State Health Benefit Plan members enrolled in the consumer directed health plan products with an anticipated greater savings as a result.

In the Medicaid and PeachCare programs, there will be $8 million provided for the private disproportionate share hospitals which are "deemed."  There will be a shortfall of $506.9 million in State funds for FY 2011 (this is due because of one-time funding such as federal stimulus money, tobacco settlement funds, and elimination of the quality assessment fees on the CMOs).  This "hole" is separate from expenditure growth. 

In order to generate revenue, the Department looked at various scenarios such as mandatory eligibility, mandatory benefits, optional eligibility, and optional benefits.  Some of these cannot be changed because the State took federal stimulus money and that was a condition for the State taking those moneys – no changes could be made to eligibility or benefits.

Provider reimbursement changes, per Dr. Medows, are really not an answer because Medicaid already pays providers poorly (a percentage of what Medicare pays).  To achieve the necessary money to fill the hole, the Department would have to impose a 16.5% provider rate cut; this type of cut would not be sustainable. 

In the Budgets, the Governor assumes that: FMAP will continue through June 2011 (however this has not been passed by Congress); that hospital and managed care fees will be imposed as a new tax source; that there will be a removal of CMOs from the 2.25% premium tax exemption.

Multiple government agencies would also be disrupted if the State eliminated the Medicaid program.  Thus, that is also not an option.

The Governor has proposed that hospitals pay 1.6 percent in a provider tax on net patient revenues.  This tax would generate $247.8 million from the hospitals or a total of 4747 million.  A total of $236.9 million would be returned to providers, paying Medicaid dollars to those facilities which are currently seeing Medicaid patients.  This new scheme would exempt some hospitals such as the psychiatric, rural or those who do not charge for services.  Something may also be done for hospitals which are in "financial crisis."  In total, Commissioner Medows indicated that 39 of Georgia's hospitals are high volume Medicaid facilities which end up being "winners" in this idea; another 39 hospitals would break even; and 84 hospitals would not get anything in return for the payments, unless they became Medicaid providers.

The 1.6 percent would also be imposed on managed care entities (including CMOs and HMOs) to generate $96.1 million.  With the federal match, this would bring a total of $293 million.

Commissioner Medows indicated that the House Bill pending in Congress would be another way to address this problem of funding.  It would permit states to continue accessing the CMO fee.  This idea permits the continuation of the 5.5 percent quality assessment fee, generating $100 million. 

The Governor also proposed that the CMOs be exempted from the 2.2 percent premium tax exclusion.  This would generate $67.9 million.  Of that, $19.8 million would be used to "hold" the CMO rates (which are required to be "sound" by an actuary) and the other $48.1 million would go towards funding care in the Department of Behavioral Health and Developmental Disabilities.

A 1.98 percent rate cut is proposed for providers except hospitals and non-community based services.  This Budget also contemplates the use of nursing home provider fees.

Essentially, Commissioner Medows stressed that there is not $506 million to be found in her Budget through cuts and layoffs.  Thus, Lawmakers must consider taxes and fees.

Rep. Channell stated that he found the State to be in a box for FY 2011.  Some options are not available such as changes to eligibility and benefits. Yet, Medicaid is an entitlement program.

Sen. Goggans inquired about the Independent Care Waiver Program ("ICWP") and the waiting list associated with the program.  He noted that he saw no funds for slots or any money for the ICWP slots for "money follows the person."  He asked what would be the federal impact without that money.  Jerry Dubberly, the State's Medicaid Director, stated that when the Department proposed its Budget to the Governor, those slots were included.  The federal government would then ask for a return of the federal grant funding.  If federal money must be returned, Dr. Dubberly was asked how much that would be, Dr. Dubberly stated he would have to get that total for the Committee.

Sen. Goggans also asked if the Department was considering changes to the Aged, Blind and Disabled Program.  Commissioner Medows stated that yes that was correct; the Department had been reviewing contracts, looking at quality.

Rep. Doug Collins (R-Gainesville) inquired about the Nursing Home Civil Penalties, asking if those were one-time funds.  While this must have CMS approval, there is no guarantee on these moneys.  They are also limited in their use if assessed and received.

Rep. Steve Davis (R-McDonough) asked which hospitals comprised the list of 84 hospitals.  Commissioner Medows answered by telling Rep. Davis the Department would provide the Office of Planning and Budget's list.

Sen. George Hooks (D-Americus) asked about the legal fees necessary for the Department and whether those were to be used to handle CON-related litigation.  Commissioner Medows answered by explaining those fees necessary to handle the suits against the State relating to CON were paid for through the Attorney General's Budget.

Dental services were on the mind of Rep. Jill Chambers (R-Atlanta).  Her questions concerned pre-approval issues with the CMOs.  She also asked how taxing a Medicaid hospital could salvage a Medicaid program.

Kind words were provided to Commissioner Medows by Sen. Renee Unterman (R-Buford) regarding her management of the Department.  However, she noted that grant-in-aid funding for public health was really a concern; she feels that Georgia does not fairly distribute the money and a new formula is necessary.  Rep. Donna Sheldon (R-Dacula) echoed Sen. Unterman's comments.

One-stop eligibility for federal programs was also raised with Commissioner Medows.  Rep. Pat Gardner (D-Atlanta) inquired, noting her desire to see a link made between Medicaid and the PeachCare process so that persons were not required to go through two application processes.

Department of Behavioral Health and Developmental Disabilities

Commissioner Frank Shelp, M.D. explained the Governor's Budget priorities to the Joint Committee.  While the Department focuses on mental health at the moment, it also looks at the use of technology (electronic medical records, information management and telemedicine) and strategic partnerships (with stakeholder involvement).  Mental health care no longer is "custodial." It focuses now on active treatment, guided by a recovery model.

Olmstead requires living in the community with appropriate supports.  There is a current list of these individuals wishing to move.  They must have been in institutional care for more than 60 days and want to transition.  There is $5.567 million annualized 2010 Olmstead waivers; there is an additional $3.250 for new Olmstead developmental disabilities waivers.  Dr. Shelp stated that Olmstead continued to be a financial burden for the State.

In FY 2010, the Governor has proposed an additional $20 million to meet the CRIPPA settlement agreement requirements for safety and care issues in the seven hospitals.  This includes people-staffing (which do not solely remedy the problems in the State's hospitals); training and processes; and technology and infrastructure.  These moneys will also be used to interface between hospitals and community.  The break out these moneys looks like this: $10.3 million for people-staffing; $5.8 million for training and processes; and $4.2 million for technology and infrastructure. 

Some key components and related expenditures for the CRIPPA plan for the following years:

CRIPPA plan	2010	2011
Protection from Harm	$2.9 million	$5.5 million
Mental Health Care	$4.5 million	$11 million
Seclusion/Restraint	$ 0	$ 0
Medical/Nursing	$6.8 million	$16.7 million

In total, in 2010, the State would expend $20.3 million and in 2011, it would spend $42.3 million for CRIPPA.

For FY 2011, GATE expenses occur in all programs; furlough days are imposed; and there continue to be direct service issues.

Sen. Johnny Grant (R-Milledgeville) inquired about the closure of the mental health beds in Milledgeville.  He expressed concern about how this closure would impact middle Georgia, especially in light of the cuts to the Community Service Boards.  Presently, Sen. Grant said that there were backlogs of cases in hospital emergency rooms and this closure would make matters worse.

Commissioner Shelp stated that in November 2009, the Department of Justice visited Central State, finding great concerns including problems with the physical plant in the Powell Building (which is more than 150 years old). There were other problems including issues with patient care and discharge planning.  Closure of Central State is a preemptive measure.  The State is not making any admissions to the Powell Building; rather, patients are being diverted to Augusta, Savannah, and other State facilities.  Commissioner Shelp explained that this would be an "indefinite" diversion.

With these changes, other hospitals have seen improvements.  They are adhering to standards.  Meanwhile, the Powell Building is continuing to discharge patients.  It presently only has around 20 patients while the other State facilities are accommodating the mental health needs.

The Powell Building is a huge expense.  The Department has been assessing the best use of the State's resources.  The Department continues to have staffing issues at the Craig Nursing Home, the developmental disabilities units, and Cook Building. Acute care patients are being sent to Augusta.  Commissioner Shelp intends on talking to Riveredge CSB about crisis services and to Mercer University Medical School and Georgia Hospital Association about available resources and a continuum of care.

Sen. Greg Goggans (R-Douglas) inquired whether the Department had looked at housing savings by reducing or consolidating the regulatory process for developmental disabilities' clients.  Commissioner Shelp answered, "yes."

The topic of privatizing State facilities also was raised.  Rep. Jill Chambers (R-Atlanta) asked whether Georgia had looked at the Florida successes.  Commissioner Shelp stated that he had made a trip to Florida with Rep. Mark Butler (R-Carrollton) to look at two facilities.  However, Florida's patients are different than Georgia's.  Commitment laws are different.  Georgia also utilizes crisis stabilization units; Florida does not.  Average lengths of stay in Georgia are five days; in Florida, they are 21 days.  The Department is not "closed" to privatization and sees its use more with forensic services and perhaps for "fringe business" (such as nursing home care for populations such as those with developmental disabilities).

Rep. Michele Henson (D-Stone Mountain) asked about the number of patients in the seven hospitals.  Commissioner Shelp stated that there are 496 mental health patients; 555 forensic adult patients; 800 developmental disabled patients; and 150 nursing home patients.

Developmental disability "slots" came up in the conversation.  Rep. Jay Powell (D-Camilla) asked about new waiver slots (for transitioning folks from the hospital to the community).  However, there are 6,000 on the waiting list for services.  He also asked about the imposition of "regional offices" and the 400% increase in administrative costs while services were not increasing.  Commissioner Shelp noted that the Department was using the added staff to process waiver applications, survey facilities, and etc.  There were previously 17 regional offices; now, the role of the regional offices is being reviewed and determinations are being made on where those offices should be located.  A regional strategy is expected before the end of the fiscal year.

Rep. Judy Manning (R-Marietta) noted that she did not see anything in the Budget reflecting the needs of children and moving them from institutions to the community.  This remains a concern for her.

Rep. Ellis Black (D-Valdosta) stated he remained concerned about the numbers of persons in prisons who really could be better served in mental health institutions.  Commissioner Shelp concurred and stated that there were similar populations in county/local jails.  The State's Behavioral Health Coordinating Council, along with the judges and Pardons and Paroles, is also trying to address this matter, looking at alternatives to prisons.