BATON ROUGE- Louisiana Department of Health Secretary Bruce D. Greenstein today announced mid-year reductions in department spending of state general funds, and proposed utilization of other means of financing, in order to save $20.8 million in fiscal year 2010-2011. DHH’s savings are part of an overall mid-year reduction plan for each agency to help address the state’s shortfall from FY 2010.
"Governor Jindal was clear in asking us to take a hard look at the way we do business and encouraged us to be innovative in our strategies while keeping a laser-like focus on protecting core services Louisianians depend on,” Secretary Greenstein said. “With this challenge in mind, I asked every office to go through their budget remembering that our top priority is to protect and improve the public’s health.”
Greenstein added, “Starting with administrative staff, including my office, we focused our plan on consolidating functions among staff and streamlining how we work, while considering every source of funding to provide the same services we provide today at less cost.”
Reductions in the non-Medicaid program offices are in line with the department’s overall strategy of eliminating inefficiencies, leveraging existing resources in the private sector to spend state dollars more effectively, using new tools and technologies to streamline functions and working toward a more comprehensive approach to providing services.
“The health care landscape is changing every day, and we need to be nimble enough to change along with it,” Greenstein said. “Throughout this process, over and over again, we found common-sense approaches that achieve the same or better results and save money that are too often overlooked in the bureaucracy of an organization the size of ours.”
A transition task force led by the assistant secretaries for each program office is working with DHH’s Human Resources Division and the Louisiana Department of Civil Service to ensure impacted employees are provided, whenever possible, opportunities to fill needed vacancies in other offices or departments. In addition, the transition task-force is exploring other initiatives to encourage private providers to hire displaced state employees.
Reductions in state general funds (SGF) used for program offices and identified to help cover the Department’s mid-year reductions are listed by program office below (with savings in SGF and total department spending highlighted, plus the number of eliminated positions, or “TO,” included):
Agency-wide Hiring Freeze ($1,999,694 SGF). Savings will be realized from the July 2, 2010 Governor’s Executive Order BJ-2010 – 12, which implemented a limited hiring freeze across all executive departments.
Office of Aging and Adult Services ($750,000 SGF; $47,358 Total; 1 TO). Savings will be realized through better use of already available federal funding in Medicaid to fund services provided by Adult Protective Services (APS), as well as through the reconfiguration and consolidation of certain administrative functions. These reductions preserve all services, which continues a trend of recent years, in which OAAS achieved $5 million in savings in its Long Term Personal Care Services while serving an additional 2,200 people and reduced the cost of its Elderly Disabled Adult Waiver program by $14 million. Both of these programs serve elderly and disabled adults at home. OAAS achieved the savings by simply changing the way it determines the level of services clients should receive based on actual need.
Office of Behavioral Health ($2,086,993 SGF; $2,086,993 Total; 21 TO). OBH achieved savings by removing unobligated funds in its budget. Services will not be impacted. The implementation of Act 384, which merged the Department’s mental health and addictive disorder services, will result in additional savings through reducing administrative positions and consolidating regional management. The merger is one of several efficiencies achieved in recent years in behavioral health services. For example, in a pilot program at an outpatient addictive disorders clinics, OBH decreased wait times from 14 days to 1 day, decreased the no-show rate for appointments from 60 percent to 25 percent, increased patient caseload by 25 percent and increased number of people assessed by 50 percent without increasing costs to taxpayers. This was done by aggressively implementing new national standards and recommendations that bring common sense into scheduling appointments and cuts through red tape. This pilot is now being implemented throughout other facilities.
Office of Citizens with Developmental Disabilities ($1,503,718 SGF; $5,957,678 Total; 89 TO). Eight people currently residing in Bayou Supports and Services Center in Terrebonne Parish will be transitioned to private providers or other state support centers, and the center will close. An additional two residents are already in the process of transitioning. This center currently costs $8.3 million annually to support ten individuals. Pinecrest Supports and Services Center will realize savings through stricter travel regulations and fewer full-time and student worker positions with no impact on direct care. The Northlake Supports and Services Center will not fill vacant positions. Duties for those positions are currently performed by existing personnel. Northlake is also reducing operating and professional services to realize savings with no impact on direct care. Operations of four Leesville group homes housing 19 residents are being transitioned to private providers, who can provide the same services at a lower cost with no impact on direct care. OCDD staff is working closely with the residents and families directly impacted by these changes to ensure a safe and steady transition.
Office of Public Health ($6,802,397 SGF; $6,802,397 Total; 144 TO). Management positions and functions will be consolidated at central and regional administrative offices, as well as in certain programs. Travel, supply and administrative budgets will also be reduced in certain programs. Contracts for several programs are being reduced or eliminated with no impact on direct services. Instead, funding for certain services is being shifted to better utilize available federal funds and work more closely with other providers in the same area who are providing the same service.
OPH will achieve a savings of $3.45 million by redistributing staff and reconfiguring services provided to parish health units throughout the state. The public health unit in Orleans Parish, which is owned by the state, is being closed, and services provided in the St. Bernard Parish Health Unit will be discontinued. Services in both parishes will be transitioned to a network of community clinics in the area that have been partially supported by the Primary Care Access and Stabilization Grant. New funding through a Medicaid waiver for many of those clinics was announced earlier this year. The Wetmore Tuberculosis and the Delgado STD clinics will remain open and WIC services will continue to be provided. Across the state, the number of OPH staff assigned to parish health units will be reduced and in several cases rotated among multiple units to better match capacity with demand for services based on a careful analysis by the department. That extensive parish-by-parish examination considered utilization rates, volume, capacity, demand, geography and other resources available in the area, including private providers and Federally Qualified Health and Rural Health Centers, to determine the final list of service and staff consolidations. OPH will work with each parish that owns a unit impacted by the reductions to communicate scheduling and other changes to the public.
Additionally, OPH is combining the HIV and STD programs to better utilize staff resources and provide more comprehensive services, as well as reducing contracts to hospitals and other vendors in the Children Special Health Services program. These services will be shifted to other available community providers in an effort to preserve services for these children. OPH is also implementing a 6.56 percent reduction to 59 school-based health centers subsidized by the state. OPH staff is supporting efforts to help school-based health centers better maximize their billing for third-party payers, including Medicaid, to become less reliant on state subsidy. The centers will also be making reductions in printing, advertising and conference travel to focus on core services provided to children.
Office of the Secretary ($1,012,306 SGF; $1,012,306 Total; 37 TO). The Office of the Secretary is reducing 37 positions by consolidating regional human resources services and cuts in the central office administrative staff.
Louisiana Emergency Response Network ($57,538 SGF; $57,538 Total; 0 TO). Savings will be realized as a result of contract expenditures that are lower than expected.
Developmental Disability Council ($32,405 SGF; $32,405 Total; 0 TO). Savings will be realized by reducing each Families Helping Families contract by $3,600. These contracts assist in funding nine regional resource centers that provide information, training, referrals and peer-to-peer support services to families.
Human Services Districts ($2,482,965 SGF). Five locally governed Human Services Districts provide outpatient mental health and addictive disorder services for persons with developmental disabilities, and other wrap-around and support services for the citizens of their parish or region. While the budgets of these districts are largely line-item appropriated by the legislature and passed through LDH, the districts operate within their own governance and executive leadership, with the implementation strategy for reductions determined locally. A 1.8 percent reduction of total funds was allocated to each district, including $379,000 for the Florida Parish Human Services District; $602,000 for the Capital Area Human Services District; $490,000 at the Jefferson Parish Human Services authority; $456,000 at the South Central Louisiana Human Services Authority; and $556,000 at the Metropolitan Human Services District (New Orleans metro area).
Bureau of Health Services Financing/Medicaid ($4,076,450 SGF Medicaid Expenditure; 61 TO) Medicaid is closing eight local eligibility processing offices in underutilized areas. Enrollment centers still have a presence in each targeted area. In previous closures of eligibility processing offices in the past year, the department has seen no reduction in eligibility services. The use of new tools and technologies to enroll eligible people into Medicaid continue to streamline this process. Additionally, Medicaid is recognizing funding not required in the Medicaid buy-in program for Medicare Part D.
“Since 2007, the department has reduced its workforce by nearly 24 percent while actually reducing waiting lists and increasing the number of people served through a smarter approach to how we do business. These savings continue that trend and we will seek new ways to operate efficiently. ” Secretary Greenstein said. “This week I announced a new way to work with stakeholders, legislators and the public as we develop a plan to implement a coordinated care strategy in Medicaid that will improve health outcomes while making the best use of available resources. It is imperative that we find new ways to pay for top-notch care and live within our means.”
The Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about LDH, visithttp://www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow DHH’s blog atwww.myhealthla.org, Twitter at http://twitter.com/La_Health_Dept and search for the Louisiana Department of Health on Facebook.