Department of Human Resources

Department of Human Resources
Budget Proposal Fiscal Year 2009 August 15, 2007

Governor’s Instructions
DHR Appropriated FY08 State Funds Budget $1,533,218,551 Less LOC Exemptions -$70,100,000 Less MH Hospital Exemptions -$196,196,091 Equals DHR FY08 State Funds Base Budget $1,266,922,460 2% Proposed Reduction -$25,963,637 2% Proposed Enhancement $26,013,637 9/20/2018 DRAFT PROPOSAL

Division of Aging Services FY2008 Budget
Program/Subprogram State Federal Total Notes Elder Abuse and Fraud Prevention Adult Protective Services $ ,868,694 $ 3,107,602 $ ,976,296 Federal Cuts, FY08/09 (TCM) 4,744 95,389 100,133 Match Elderly Legal Assistance 103,999 52,886 156,885 Long Term Care Ombudsman 1,222,828 443,400 1,666,228 MOE/Match Elder Community Living Services Community Care Services Program $ ,295,474 $ 15,981,891 $ ,277,365 Home and Community Based Services 18,205,774 23,872,236 42,078,010 MOE/Match, Federal Cuts (NSIP) Elder Support Services Senior Community Services Employment $ ,804 $ 1,948,122 $ ,998,926 GeorgiaCares 979,831 3,197,631 4,177,462 Senior Nutrition - 2,360,173 No State Funds Health Promotion (Wellness) 491,367 Other Support Services (NORC, ADRC) Program Administration $ ,130,059 $ 4,432,927 $ ,562,986 Georgia Council on Aging $ ,064 $ $ ,064 Admin. Attached Only TOTAL FY 2008 Budget $ ,055,271 $ 55,983,624 $ ,038,895 9/20/2018 DRAFT PROPOSAL Note: Budget Amounts Include Anticipated Reductions to Federal Funds of $4,750,000. In Addition To Required State Match, Some Programs Require Local Matching Dollars Which Are not Reported In the Annual Budget.

Division of Aging Services FY2009 Reductions
Program Reduction Affected Community Elder Abuse and Fraud Prevention/Elder Abuse/ SAVA $10,000 Associated With CJCC Grant --Statewide –Victims Advocacy Activities Decreased Elder Community Living Services/Home and Community Based Services/NORC $40,000 Fulton County – Decrease Funding for One Naturally Occurring Retirement Community. Elder Community Living Services/Home and Community Based Services/Contracts $116,000 Statewide – Decrease funding for Area Agency on Aging Administration Elder Community Living Services/Home and Community Based Services/GCRC $36,000 Statewide – Decrease Funding for Caregiver Training and Educational Materials 9/20/2018 DRAFT PROPOSAL

Division of Aging Services FY2009 Reductions (continued)
Program Reduction Affected Community Elder Community Living Services/Home and Community Based Services/Wellness & Prevention $488,000 Statewide – Wellness Activities Elder Support Services/ GeorgiaCares $450,000 Statewide – Prescription Assistance Elder Support Services/ Georgia Health Decisions $100,000 Statewide – Critical Decisions Guides Elder Support Services/Contracts $120,000 Statewide – Reduction to AAA Contracts in the Amount of Income Tax Checkoff Received 9/20/2018 DRAFT PROPOSAL

Division of Aging Services FY2009 Reductions (continued)
Program Reduction Affected Community Division of Aging Services/All Programs $50,000 Statewide Reduction in Training $350,000 Statewide – Reduction in Force, To Be Achieved Through Attrition Total $1,760,000 9/20/2018 DRAFT PROPOSAL

Division of Aging Services FY2009 Enhancements
Program Enhancement Affected Community Elder Community Living Services/CCSP Program $488,517 Statewide, State Match For Money Follows the Person Grant Elder Community Living Services/Home and Community Based Services $651,483 Statewide, Direct Client Services -- Meals Elder Support Services/Other Support Services $620,000 Statewide, Transportation Services, AIMS Development and Support Total $1,760,000 9/20/2018 DRAFT PROPOSAL

Division of Aging Services FY2008 Supplemental Budget Request
Program Enhancement Affected Community Elder Abuse Investigations and Prevention Adult Protective Services $3,500,000 Replace decreasing Federal Funds to maintain service to vulnerable adults, including the majority for which DHR has been appointed guardian by the courts. Dollars support 78 Case management and supervisory staff positions. Total 9/20/2018 DRAFT PROPOSAL

Division of Aging Services FY2008 Supplemental Budget Request
Title of Project Replace Discontinued Federal Targeted Case Management Funds With State Funds Population Served At risk elderly Georgians including the majority of clients for which DHR has been appointed guardian by the courts. Problem Statement Adult Protective Services is experiencing a shortfall of $3.5 million Targeted Case Management funds which had, in prior years, been budgeted for APS. Targeted Case Management is a Medicaid fund source that is declining due to more stringent federal regulation by CMS. Potential loss of 78 positions without replacement funding. Project Goal(s) Maintain funding levels for Adult Protective Services by appropriating state funds sufficient to replace federal funds no longer available. To maintain staffing levels sufficient to comply with state law, State funds are requested in the amount of $3.5 million to offset the decrease to federal funds. Describe how goal(s) will be achieved and measured State Funds, if appropriated in the supplemental FY08 and subsequent budgets will be applied to the APS budget. Comparison of Adult Protective Services staffing and caseloads by region will indicate that service levels are appropriately funded statewide. 9/20/2018 DRAFT PROPOSAL

Division of Family & Children Services FY2008 Budget
Program State Federal Total Notes Child Welfare Services 73,149,559 178,048,003 251,197,562 MOE & Match Out of Home Care 113,680,260 84,479,837 198,160,097 Match Afterschool Care 14,000,000 No State Funds Childcare 58,398,695 175,018,410 233,417,105 Energy Assistance 18,623,684 Food Stamp Eligibility 25,547,915 29,693,546 55,241,461 Match at 50/50 Eligibility Determination (Medicaid) 26,942,155 24,377,800 51,319,955 Refugee Services 3,184,000 Support for Needy Families-Basic 10,315,527 77,652,812 87,968,339 Support for Needy Families-Family 19,744,139 67,342,945 87,087,084 Support for Needy Families-Work 26,000,000 40,587,281 66,587,281 MOE Adoption Services 33,139,326 36,632,278 69,771,604 Family Violence 4,701,950 5,849,430 10,551,380 391,619,526 755,490,026 1,147,109,552 9/20/2018 DRAFT PROPOSAL

Division of Family & Children Services FY2009 Reductions
Program Reduction Affected Community Out of Home Care (More efficient in utilization of the front door to services) $7,832,391 RBWO, Family Foster Care and Specialized Foster Care 9/20/2018 DRAFT PROPOSAL

Division of Family & Children Services FY2009 Enhancements
Program Enhancement Affected Community Adoption Services $4,500,000 Adoptive parents & children Foster Parent COLA $1,125,000 Foster Parents Technology Refresh $2,100,000 DFCS Social Service and Eligibility Staff Family Violence $150,000 To address the need for a shelter in the LaGrange and Fayette areas. Total $7,875,000 9/20/2018 DRAFT PROPOSAL

Projected FY08 Supplemental Action
Title of Project Replace Discontinued Federal Targeted Case Management Funds With State Funds Population Served Children under age 18 for whom abuse or neglect has been reported or confirmed. Problem Statement Child Protective Services (CPS) is experiencing a shortfall of $8.8 million in Targeted Case Management funds which had, in prior years, been budgeted for CPS. Targeted Case Management is a Medicaid fund source that is declining due to more stringent federal regulation by CMS. Potential loss of 175 child welfare casemanagers. Project Goal(s) Maintain funding levels for Child Welfare Services by appropriating state funds sufficient to replace federal funds no longer available. To maintain staffing levels sufficient to comply with state law, State funds are requested in the amount of $8.8 million to offset the decrease to federal funds. Describe how goal(s) will be achieved and measured State Funds, if appropriated in the supplemental FY08 and subsequent budgets will be applied to the Child Welfare budget. Comparison of Child Welfare staffing and caseloads by region will indicate that service levels are appropriately funded statewide. 9/20/2018 DRAFT PROPOSAL

DMHDDAD FY2008 Budget Program State Federal/ Other Total Notes
Adult Addictive Diseases $48,231,627 $47,342,127 $95,573,754 MOE Adult Developmental Disabilities $205,758,421 $137,415,939 $343,174,360 Waiver Match Adult Forensic $38,421,374 $1,115,412 $39,536,786 Adult Mental Health $177,314,849 $22,366,625 $199,681,474 Match Adult Nursing Home $2,383,183 $1,547,242 $3,930,425 C&A Addictive Diseases $10,864,229 $17,217,170 $28,081,399 C&A Developmental Disabilities $17,589,662 $6,331,470 $23,921,132 C&A Forensic $3,038,424 $0 C&A Mental Health $105,062,036 $56, 622,457 $161,684,493 Direct Care and Support $108,039,606 $54,552,069 $162,591,675 Medicaid Match MHDDAD Admin $11,249,398 $11,703,980 $22,953,378 TOTAL $727,952,809 $299,592,034 $1,084,167,300 9/20/2018 DRAFT PROPOSAL

DMHDDAD FY2009 Reductions Program Reductions Affected Community
Statewide core community clinical services (Adult and C&A MH/AD) such as diagnostic assessment, physician/nurse care, counseling ($9,662,165) CSBs & core service providers who do not provide pharmacy services and lab services Adult MH contracts (training) ($337,835) Vendors who provide training TOTAL REDUCTIONS ($10,000,000) NOTE: $196,196,091 inn DMHDDAD State general funds appropriations exempt from 2% adjustment. 9/20/2018 DRAFT PROPOSAL

DMHDDAD FY2009 Enhancements
Program Enhancement Affected Community Community-based pharmacy and lab services for Adult and C&A MH/AD $9,662,165 CSBs & core service providers who provide pharmacy and lab services Adult MH Peer Support and Respite Center $337,835 Metro Atlanta TOTAL REDIRECTS $10,000,000 9/20/2018 DRAFT PROPOSAL

DMHDDAD FY2008 Supplemental Budget Request
Program Supplement Affected Community Emergency hospital funding (Adult Forensic, Adult Nursing Home, Direct Care Support Services, Adult & C&A MH/DD) $12,000,000 ($3M Atlanta Regional Turnaround Team; $3.8M hospital overflow capacity; $5.2M hospital deficit that was reduced from $9M in FY07) State hospitals TOTAL 9/20/2018 DRAFT PROPOSAL

Division of Public Health FY2008 Budget
Program State Federal Total Notes Adolescent & Adult Health Promotion $15,859,175 $31,453,078 $47,312,253 MOE & 90/10 Match Adult Essential Health Services $5,709,061 $6,334,611 $12,043,672 MOE Emergency Preparedness $13,347,798 $1,147,507 $14,495,305 Epidemiology $6,000,648 $487,988 $6,488,636 1:1 Match Immunization $11,725,931 $8,817,897 $20,543,828 Infant & Child Essential Health Services $38,961,028 $11,496,480 $50,457,508 MOE & Match Infant & Child Health Promotion $20,972,559 $94,978,071 $115,950,630 9/20/2018 DRAFT PROPOSAL

Division of Public Health FY2008 Budget
Program State Federal Total Notes Infectious Disease Control $39,203,771 $11,294,644 $50,498,415 2:1 Match MOE Injury Prevention $1,067,701 $262,013 $1,329,714 Inspections & Environmental Hazards $15,025,089 $543,734 $15,568,823 Prevention $1,128,009 $10,512,490 $11,640,499 Vital Records $2,830,465 $360,704 $3,191,169 3:1 Match $171,823,575 $177,689,208 $349,512,783 9/20/2018 DRAFT PROPOSAL

Division of Public Health FY2009 Reductions
Program Reduction Affected Community Albany Lab Closure $770,000 Albany & Southwest (11 positions) High Risk Infant Follow-up: Fund Shift $678,500 Some Activity in each Health District Hearing Contract: Fund Shift $137,500 Auditory Verbal Center of Atlanta State Office Efficiencies $1,900,000 Support Services Program Overlap Contract Savings 9/20/2018 DRAFT PROPOSAL

Division of Public Health FY2009 Enhancements
Program Enhancement Affected Community Focused Health Promotion $1,200,000 Competitive Awards to Counties Strengthen (StAR) Families $1,800,000 High Infant Mortality Areas Better Disease Reporting $400,000 30 Hospital ERs; practitioners & Labs Family Services Support $3,740,000 Home Visits 9/20/2018 DRAFT PROPOSAL

Projected FY08 Supplemental Actions
New Born Screening Expansion Fee created to fund the activity Currently fees go to the State General Revenue FY 08 Supplemental request = $5.6M 9/20/2018 DRAFT PROPOSAL

Office of Child Support Services FY2008 Budget
Program State Federal Total Notes Child Support $24,358,230* $51,081,316 $75,439,546 2:1 match *Includes $2,841,500 in fees 9/20/2018 DRAFT PROPOSAL

Office of Child Support Services FY2009 Reductions
Program Reduction Affected Community Child Support –Service Consolidation $1,274,629 Jackson, Monroe, Conyers, Jesup, Thomaston, Ellijay, Dahlonega 9/20/2018 DRAFT PROPOSAL

Office of Child Support Services FY2009 Enhancements
Program Enhancement Affected Community Child Support - Fatherhood $1,274,629 3000 Non-Custodians will have access to employment and training programs statewide 9/20/2018 DRAFT PROPOSAL

Office of Regulatory Services FY2008 Budget
Program State Federal Other Total Notes Health Care Section $2,188,659 $2,726,841 $0 $4,915,500 $65,930 State Medicaid match (75/25) Long Term Care $4,441,198 $3,905,960 $8,347,158 $632,762 State Medicaid match (75/25) Residential Child Care $1,365,334 ORS Administration ** $747,442 $292,233 $70,000 $1,109,675 Totals: $8,742,633 $6,925,034 $15,737,667 ** FY08 Fiscal Affairs- pending approval of moving ORS Admin from DHR Admin to Facility and Provider Regulation 9/20/2018 DRAFT PROPOSAL

Office of Regulatory Services FY2009 Reductions
Program Reduction Affected Community Health Care Section (X-ray use risk adjusted survey schedules) $174,853* Statewide (eliminating routine x-ray surveys) *2% of ORS budget 9/20/2018 DRAFT PROPOSAL

Office of Regulatory Services FY2009 Enhancements
Program Enhancement Affected Community Health Care Section $225,000 Statewide (monitoring serious self-reports—hospitals, hospices) Residential Child Care $232,853 ($174,853 through redirect) (early intervention surveyor, field supervision) IT- ORS $465,000 Internal Operation (refresh computers, support better web presence for info to public) Total: $922,853* *The additional $748,000 in Enhancements will be funded from new licensure fees to be collected for first time in FY2009 9/20/2018 DRAFT PROPOSAL

Reductions Summary Division/Office Program Reduction Various
Departmental Administration -$2,975,410 Child Support Services -$ 433,374 Aging Services Elder Abuse Investigations & Prevention -$160,000 Elder Community Living -$760,000 Elder Support Services -$690,000 DFCS Out of Home Care -$7,800,000 MHDDAD Adult Mental Health Services -$6,457,310 Adult Addictive Diseases -$527,067 Child & Adolescent Mental Health Svcs -$2,373,604 Child & Adolescent Addictive Disease Svcs -$642,019 Office of Regulatory Services Facility and Provider Regulations -$174,853 Division of Public Health Adolescent and Adult Health Promotion -$800,000 Adult Essential Health Treatment Services -$115,000 Emergency Preparedness -$200,000 Infant & Child Essential Health Treatment -$435,000 Immunization -$25,000 Infant & Child Health Promotion -$625,000 Infectious Disease Control -$770,000 9/20/2018 DRAFT PROPOSAL

Enhancement Summary Division/Office Program Enhancement Various
Departmental Administration $2,395,410 Aging Services DAS Admin. (for Transportation) $120,000 Child Support Services $433,374 Elder Community Living $1,140,000 Elder Support Services $500,000 DFCS Child Welfare Services $2,100,000 Out of Home Care $1,100,000 Adoption Services $4,500,000 Family Violence Services $150,000 MHDDAD Adult Mental Health Services $6,457,310 Adult Addictive Diseases $527,067 Child & Adolescent Mental Health Svcs $2,373,604 Child & Adolescent Addictive Disease Svcs $642,019 Office of Regulatory Services Facility and Provider Regulations $174,853 Division of Public Health Adolescent and Adult Health Promotion $1,200,000 Epidemiology $400,000 Infant & Child Essential Health Treatment $1,800,000 9/20/2018 DRAFT PROPOSAL

DHR Concept Papers 9/20/2018 DRAFT PROPOSAL

Concept Paper FY 09 Division of Family & Children Services Room, Board, and Watchful Oversight (RBWO) Population Served: Children age 18 or younger whose families are unable or unwilling to care for them. DFCS purchases residential care in family group homes or facilities. Problem Statement: CMS mandated that Georgia “unbundle” the Level of Care (LOC) per diem effective July 1, DFCS will now purchase Room, Board, and Watchful Oversight (RBWO). A new rate system was developed based on a cost model. Overall rates under RBWO will be less than under LOC. The number of children in LOC have declined over the last year. However, there will be a significant state fund impact because no Medicaid revenues are accessible to support the RBWO system. DFCS will be using state and Title IV-E funds as the primary fund sources for the RBWO system. Project Goal(s): Retain adequate placement resources for children in DFCS custody. Utilization of services will drop an additional 10%. There will be a significant increase in the IV-E penetration rate. Describe how goal(s) will be achieved and measured: Add $28 million in additional state funds to support RBWO. 9/20/2018 DRAFT PROPOSAL

Concept Paper FY 09 MHDDAD
Program Enhancement Affected Community Crisis Services (Mobile Crisis Teams, Detox and Triage programs) – Adult MH / AD $9,300,000 Statewide in each region, especially areas without mobile crisis programs (Athens, Gainesville and South Georgia) Diversion Coordinators – Adult and C&A Forensic $450,000 Metro Atlanta, North Georgia (counties with growth in demand for forensic services higher than rest of state) Basic technology for hospital operations (new PCs, network refresh, physician order entry) $2,840,000 Statewide Utilize private providers to provide care for the medically complicated and to repurpose existing beds to create a system of care made up of short and long term Medicaid reimbursable beds serving people in their communities (Adult and C&A MH / AD) $7,200,000 TOTAL $19,790,000 9/20/2018 DRAFT PROPOSAL

Concept Paper FY 09 MHDDAD DD Waivers
Program Enhancement Affected Community 1,500 DD Waiver service slots (Adult & C&A) $16,657,454 Statewide Rate increase for DD community providers $2,015,357 TOTAL $18,672,811 9/20/2018 DRAFT PROPOSAL

Concept Paper FY 09 MHDDAD Crisis Services
State Dollars $9,300,000 annualized Population Served Adult Mental Health and Adult Addictive Diseases Problem Statement The lack of community-based crisis services forces consumers to seek services in our inpatient settings (state hospitals and crisis stabilization units). Large numbers of these consumers could be better served with community-based crisis services. Currently, DMHDDAD funds mobile crisis teams that cover all of Region 1 and parts of Regions 2 and 3. Though many substance abuse consumers in crisis could be served in outpatient settings, DMHDDAD lacks a way to divert consumers with substance abuse issues to community locations where they can be assessed prior to being referred to the hospital and /or the crisis stabilization programs. Project Goals The proposal will expand mobile crisis services to the upper section of Region 2 and to the remaining 6 counties in Region 3, as well as Regions 4 and 5 and it will introduce community-based crisis triage programs into each of the five Regions. Mobile crisis services will be performed in schools, homes, streets, jails, emergency rooms, and other places in communities. Regional triage centers will provide intake, assessment and outpatient/inpatient treatment referral as well as Drug and Alcohol Detoxification. Performance Measures State hospital admissions for Adult Mental Health services by adult MH / AD consumers. Adult MH / AD consumers readmitted to state hospitals. 9/20/2018 DRAFT PROPOSAL

MHDDAD Concept Paper FY 09 Forensic Diversion Coordinators
State Dollars $450,000 annualized Population Served Adult Forensic Services Problem Statement SB 190, which became effective July 1, 2007, gives judges the authority to divert Incompetent to Stand Trial defendants to community services. Superior and State courts are unlikely and unable to seek out resources for defendants and the default for courts is generally commitment to state hospitals. Providing the courts with access to forensic diversion coordinators will increase judges’ willingness to divert forensic consumers, who do not pose a significant safety risk, to community services. Project Goals The program will consist of forensic diversion coordinators to act as liaisons between the court system and community mental services by providing judges information about alternatives to hospitalization for defendants with mental illness. The forensic diversion coordinators will provide linkage to services and monitor targeted defendants for three to six months. In addition, these case managers will provide outpatient competency restoration training, if needed, to defendants who are Incompetent to Stand Trial and are diverted from hospital commitment. Performance Measures Number of defendants served Number of defendants diverted to community mental health services Hospital utilization of defendants 9/20/2018 DRAFT PROPOSAL

MHDDAD Concept Paper FY 09 Basic Technology
State Dollars $2.84 million ($1.1 million annualized) Population Served Supports all MHDDAD Programs Problem Statement MHDDAD has no base budget for to support technology hardware and special software systems within the state hospitals and the service system. This lack of budget has caused 73% of MHDDAD computers to become obsolete as they currently exceed 8 years in age. Project Goals The proposal will support the purchase of 1,245 new computers to complete refreshment of 4,225 computers MHDDAD wide; cost to provide these new computers is $776,880. Additional technology shortcomings to be addressed by proposal include: $2 million for complete network refresh for MHDDAD hospitals. This will allow all clinical personnel to have quick and reliable access to patient medical records, lab results, allergy and drug interactions information, computerized training, and consumer data to improve patient care. $1.5 million for monitors to complete refresh. MHDDAD system has about 30 monitors fail each month. Many (over 2000 monitors) were bought in 1999 and are failing rapidly. Clinicians, social workers, forensics staff, and management need reliable monitors to view patient information and make decisions on care, community placement, and hospital utilization. $290,000 for Physicians Order Entry: MHDDAD’s pharmacy operations currently rely on faxes and person to person communication and interventions. To reduce drug error, get the right medicine to the right consumer and at the right time requires modern technology. A Physicians Order Entry system keeps doctors, medical staff and pharmacists in sync and will greatly improves patient care. Performance Measures $1.1 million each year and percentage of annual tech refresh (25% per year for 4 years). 9/20/2018 DRAFT PROPOSAL

MHDDAD Concept Paper FY 09 Care for Medically Complicated and Community-Based Acute Care
State Dollars $7,200,000 Population Served C & A Mental Health, Adult Mental Health, Adult Forensic, Adult Nursing Home Problem Statement Currently there are no internal resources that will allow the Division to provide appropriate medical care or supports for severely challenging consumers within the hospital system. In addition, most acute psychiatric care is provided in one of seven state hospitals. Project Goals Through this proposal the Division will purchase resources within a private facility for those consumers with chronic medical conditions or otherwise challenging behaviors. This facility will have the expertise to treat consumers with needs beyond the scope of the hospital system. This proposal will fund the purchase of 40 specialty beds within this private facility that will be located in Georgia . Through this proposal and with the repurposing of state hospital acute care beds, the Division will also establish local, 16 bed inpatient care units that provide short term, 24-hour psychiatric care . Expectation is that care provided by these units would be Medicaid reimbursable. Performance Measures Mortality rates Cost for outside hospitalization Occupancy rate for adult psychiatric units Number of critical incidents (deaths, injuries, accidents, assaults, elopements, etc.) at state hospitals 9/20/2018 DRAFT PROPOSAL

MHDDAD Concept Paper FY 09 1,500 New DD Waivers
State Dollars $16,657,454 6 months funding ($30,194,908 annualized) Other Funds Amount $25,819,305 includes administrative and direct services federal match for 6 months funding ($51,638,611 annualized) Population Served Adult Developmental Disabilities Services, Child & Adolescent Developmental Disabilities Services Problem Statement The most current DD Planning List data indicate that a total of 5,465 Georgians with DD are waiting for services. Of these individuals, 3,255 need a residential service. Also, at the beginning of FY08, there were 1,024 people living in state operated DD hospitals. Over 17,000 Georgians with DD live with caregivers age 60 and over and approximately 1,800 individuals with MR/DD live in nursing facilities in Georgia. These demographics indicate that the demand for residential services will increase over the next decade. Approximately 700 young adults with DD exit special education programs each year. Without new day/employment resources, most of these young people would go home to no services. Many Georgia families rely on the availability of dependable day and employment services for their family member with disabilities in order for parents to be able to work and support the family. Due to the expansion of community services and especially the increased cost of transportation, the need for additional transportation resources has reached crisis levels in Georgia’s DD services system. Without additional resources for transportation, many consumers will not be able to access services that otherwise would be available to them. Project Goals This proposal requests 1,500 DD waiver service slots: These 1,500 new service slots are expected to serve at least 1,300 unduplicated individuals, including 150 people transitioning from institutional to community services. The proposal includes 525 residential type services, 834 day and employment services and 112 family support type services. To support and implement the 1,500 new resources, this proposal includes additional funding aimed at increasing DD system capacity including funding to: respond to challenging consumer behaviors, increase staff and provider competency, identify and address complex consumer medical needs, increase transportation services and strengthen statewide system administration and oversight. Performance Measures Number of individuals on the DD waivers. Number of individuals in State operated DD hospitals. Number of people with DD in employment. 9/20/2018 DRAFT PROPOSAL

MHDDAD Concept Paper DD Provider 7% Rate Increase
State Dollars $2,015,357 6 months funding ($4,030,713 annualized) Other Funds Amount $3,559,895 6 months funding - federal match of state funds ($7,137,792 annualized) Population Served Adult Developmental Disabilities Services, Child & Adolescent Developmental Disabilities Services Problem Statement Mental Retardation Waiver Program (MRWP) service rates were last adjusted for actual accessed costs in FY’94 (based on FY’93 Medicaid cost reports). There have been two increases in DD waiver services since FY’04 - a 4% DD increase in FY’02, and a 4.5% increase in FY’06. During that period, the Consumer Price Index has risen by approximately 29%. The number of people served in DD waivers has increased by more than 400% in the last decade. Even more significant than the growth in numbers of people served in our system is the change in the type and complexity of services that are being provided. An aging consumer population and our decreased dependence on state operated DD hospitals are resulting in significant changes in Georgia’s DD consumer population. Increasingly, consumers are entering community services with complex medical or behavioral challenges that require staff with special skills and/or licensing. When the ability of provider agencies to pay competitive wages is reduced, the quality of the services they deliver is likely to suffer. The health and safety of the people served in DD services is directly related to providers’ ability to attract and retain the best direct care staff and first line supervisors. Project Goals This proposal would provide a 7% rate increase for all DD Medicaid Wavier Services including the 1500 new services requested for FY’09. Although a 7% increase will not reconcile the difference between rate increases since FY’94 and the rise in the Consumer Price Index over that period this request increase is seen as a positive step toward narrowing the gap, attracting quality staff and decreasing staff turnover. Performance Measures Number of individuals on the DD waivers Number of individuals in State operated DD hospitals Number of people with DD in employment. 9/20/2018 DRAFT PROPOSAL

Concept Paper FY 09 Division of Public Health Grant in Aid
Problem: Grant in Aid funds: Based on historical funding 48 counties have a funding inequity Proposal: Bring counties to the state average Calculated shortfall is $11.4 M in FY08: $5.7 M to the “shortfall” counties in FY09 & 10 Use formula (population & poverty) from FY11 No decrease more than 20%/year From FY11, award 20% of funds competitively 9/20/2018 DRAFT PROPOSAL

Concept Paper FY 09 Coordinated Transportation
Population Served: Clients/consumers of the Divisions of Aging, MHDDAD, DFCS and OCSS Problem Statement: There is a lack of adequate transportation for the consumers of DHR who need to access DHR services Increasing aging population needing services DHR serving more of DD population in community; they need transportation services OCSS Fatherhood Program participants need transportation to training DHR currently serving 47% of clients who need services Project Goal(s): Provide funding for four-year plan to meet the needs of growing aging & DD populations & OCSS Maximize increased state funding to draw down federal dollars wherever possible Describe how goal(s) will be achieved and measured: Additional funding in the amount of $4,350,000 for FY09 to begin plan 4-year plan addresses the most needy client groups; will meet 90% of the current unmet need and provide services to an additional 16,500 clients and provide approximately 3.3 million additional one-way trips over the four year period of FY09 through FY12. Matching state funds with Medicaid funds will more than double funds available to both OCSS Fatherhood participants and developmentally disabled clients. New Federal Transit Administration Grants can serve both the developmentally disabled and aging populations. Measures would include: Needs assessment surveys Customer service evaluations Number of clients served and trips provided Cost per trip 9/20/2018 DRAFT PROPOSAL

Concept Paper FY 09 Coordinated Transportation
DIVISION/ OFFICE FY 09 REQUEST (State) AFFECTED COMMUNITY PROJECTED Total FY09 – FY12 Aging $ 1,200,000 Elderly Georgians $ 6,300,000 MHDDAD Funds for developmentally disabled self-directed care clients. $ 7,100,000 OCSS $ ,000 Fatherhood transportation $ ,000 Technology $ ,000 Technology improvements to system. All clients. $ ,000 OFSS FTA 5317 GRANT $ 1,000,000 Matching funds for new FTA Grant. Aging and developmentally disabled clients. $ 1,000,000 Demo Grants $ ,000 Voucher and volunteer programs for Aging / MHDDAD clients. $ 2,400,000 Total $ 4,350,000 $ 17,300,000 9/20/2018 DRAFT PROPOSAL

Concept Paper FY 09 DHR Rental Deficits
Population Served: All DHR clients/consumers and employees Problem Statement: DHR Real Estate Rental expenditures have steadily increased since FY99 with no corresponding regular increase in appropriations This puts a strain on program budgets to cover the increased costs for rental space Project Goal(s): To obtain additional state appropriations to cover the projected continuing increases in rental costs; Describe how goal(s) will be achieved and measured: Additional funding in the amount $1,300,000 ($650,000 State) in FY09 and each year thereafter to keep up with the costs of annual increases in rent. Measures for these projects would include: Cost per square foot for rented space, total costs for leased facilities. Number of county DFCS offices relocated, number of new co-located facilities leased, number of square feet per position. 9/20/2018 DRAFT PROPOSAL

Concept Paper FY 09 Office of Regulatory Services Licensing Fees
Proposal: Collect fees to support improving the quality of regulatory oversight 38 states (including 11 southern states) have licensing fees for all or most licensing programs Georgia charged licensing fees in FY ’07 for 4 provider types generating $700,000, 19 types of providers pay nothing for regulatory services Businesses voluntarily choose to operate in a regulated setting Providers will take more ownership of decision to become a regulated provider Georgia Certificate of Need fees range from $1000 to $25,000 (Generate estimated $750,000 to support improved regulatory activities if fees range from $100 to $1000.) 9/20/2018 DRAFT PROPOSAL

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