Committee on Appropriations A/V — 2018

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Roll Call00:00:20
Department of Social Services00:01:48
Lynne Valenti, Department Secretary introduced staff and gave a brief overview of the department.00:01:50
Jason Simmons, Principal Fiscal Analyst, LRC presented the department's budget.00:07:40
Page 1: The department's budget request represents 24.7% of the state budgeted general funds.00:07:57
Sources of Funds: 60% Federal, 39% General, 1% Other00:08:11
Page 3 - Total budget request: The department's FY19 Governor's recommended budget includes $398,691,554 in general funds, $608,037,127 in federal fund expenditure authority and $9,984,584 in other fund expenditure authority for a total of $1,016,713,265 and 1,552.3 FTE. This is an increase of $43,533,028 ($5,241,853 in general funds, $38,020,525 in federal funds and $270,650 in other funds) and 2.0 FTE.00:08:30
Page 5 - Prior Year Reversions: In FY17 the department had unutilized FTE of 48.8, unutilized general funds of $5,817,518, unutilized federal fund expenditure authority of $71,700,594 and unutilized other fund expenditure authority of $3,042,731 for a total unutilized budget of $80,560,843.00:10:11
Page 6 - FMAP (Federal Medical Assistance Percentage): A decrease of $6,015,837 from the general fund and a corresponding increase of $6,015,837 in federal fund expenditure authority due to changes in the FMAP rate. In FY18 the budgeted FMAP rate will be 56.37% and the state share will be 43.63%, an increase of the federal share by 1.13%.00:10:55
Page 7 - Administration, Secretary of Social Services: FY19 Governor's recommended budget request includes $9,652,470 in general funds, $24,911,997 in federal fund expenditure authority and $701,465 in other fund expenditure authority for a total of $35,265,932 and 182.7 FTE. This is an increase of $748,442 ($23,047 in general funds and $725,395 in federal fund expenditure authority) and 2.0 FTE. 00:11:32
Representative Lake question regarding victim's services and victim's compensation new to this budget. Mr. Simmons said these programs have always been in this department; however, funds were budgeted elsewhere in the budget.00:13:10
Senator Partridge question on the request for 2 FTE in Administration.00:13:50
Secretary Valenti said one FTE is for an accountant in the fiscal office due to increased federal grant requirements and expanded reporting and new state monitoring requirements. The second FTE is a Program Specialist II in Victim's Services. The department has had a significant increase in the federal grant for Victim's Services. This position is 100% federally funded; $29,771 of the $69,244 for the accountant position will be funded with general funds.00:14:19
Senator Peters requested a breakdown of the department's entire fiscal/accounting staff.00:16:08
Laurie Mikkonen, Chief Finance Officer, gave a breakdown of the department's finance staff and agreed to provide further information.00:16:55
Secretary Valenti told the Committee that the additional staff is requested because in addition to other duties, the department monitors over 50 federal grants.00:19:23
Representative Hunhoff question on federal funds in victim's services. Secretary Valenti said the Victim's Services grant has grown from $5.6 million to $6.2 million.00:20:20
Representative Hunhoff asked how much federal expenditure authority was unobligated. Secretary Valenti said $2.5 million was unobligated.00:22:06
Page 9 - A: FMAP: A decrease of $6,724 in general funds and a corresponding increase of $6,724 in federal fund expenditure authority due to the change in the FMAP.00:22:28
Page 9 - No. 1: Accountant: the department requests an increase of $29,771 in general funds and $39,473 in federal fund expenditure authority and 1.0 FTE for an Accountant III position to support workload for continued increase in federal grant monitoring requirements, new state monitoring and reporting requirements, and additional internal controls implementation.00:22:45
Page 9 - No.2: VOCA Program Specialist: the department requests an increase of $65,501 in federal fund expenditure authority and 1.0 FTE for a program specialist to provide technical expertise to agencies servicing victims of crime and to interpret/implement changes for programs to operate within the regulations of the federal Victims of Crime Assistance Grant.00:23:02
Page 9 - No. 3: Victims of Crime Assistant Grant: The department requests an increase of $613,697 in federal fund expenditure authority due to receiving additional disbursements from the federal Victims of Crime Act Fund. These funds will be utilized to strengthen victims of crime assistance services.00:23:15
Page 9 - No. 4: Discretionary Provider Inflation: the department requested an increase of $13,785 in general funds for a 1.8% inflationary increase to provider rates. The Governor did not recommend this request.00:23:28
Senator Peters question on the VOCA grant.00:23:49
Secretary Valenti explained the significant grant increase from $1.6 million to $6.2 million in FY18. In FY17 the department requested and was appropriated $3.9 million federal fund expenditure authority. This year the grant increase went from $5.6 million to $6.2 million. With the additional funding the department has been able to increase services and enhance emergency services to victims.00:24:13
Senator Peters requested additional information on how many people are being served and what has changed that requires an additional FTE.00:25:56
Senator Partridge requested information on the increase in people to be served.00:27:47
Senator Tidemann question on how this program ties into the Marsy Law.00:28:18
Secretary Valenti said the biggest impact was in the compensation to victims of crimes. 00:28:27
Page 11 - Economic Assistance: The FY19 Governor's recommended budget includes $25,339,736 in general funds, $77,345,635 in federal fund expenditure authority, and $341,327 in other fund expenditure authority for a total of $103,026,698 and 320.5 FTE. This is a decrease of $269,119 in general funds and an increase of $16,822,444 in federal fund expenditure authority for a total increase of $16,553,325. 00:30:00
Page 13 - A: FMAP: a decrease of $7,328 in general funds and a corresponding increase of $7,328 in federal fund expenditure authority due to the change in the FMAP.00:31:46
Page 13 - B: Eligibiles and Utilization: Auxiliary Placement: The department requests a decrease of $261,791 in general funds and a decrease of $184,884 in federal fund expenditure authority due to lower projected utilization. 00:32:05
Senator Peters question on the decrease in eligibles and the increase in utilization.00:32:38
Carrie Johnson, Director of Economic Assistance explained that Auxiliary placement pays for the tuition costs for children in state custody and placed in group or residential treatment facilities. There has been a reduction due to the Juvenile Justice Initiative and less youth being committed to the Department of Corrections; more youth are being served in the community and an increase in parent referrals where the Department of Education pays the tuition cost of placement.00:32:58
Senator Peters question are the children still in the system somewhere.00:33:53
Secretary Valenti said the decline in utilization is due in part to kids going to facilities and not being in state custody so the state is not paying the tuition cost. The students are going back to their school districts.00:34:45
Representative Hunhoff question were the children receiving the same funding as if they had been in the school system. Ms. Johnson said yes.00:36:38
Senator Partridge question on the projected number of children to be served.00:36:55
Secretary Valenti said in FY17 the number was 440. That number was revised down and is expected to stay flat.00:37:20
Page 14 - No. 1: Eligibility and Enrollment System Modernization: The department requests an increase of $17,000,000 in federal fund expenditure authority for the eligibility and enrollment system modernization project.00:37:46
Ms. Johnson spoke to the Division of Economic Assistance's current mainframe system (ACCESS) used to determine eligibility and the need for an upgrade.00:38:40
Senator Peters question on how this new system will work with the MMIS system. Ms. Johnson said the two systems will link as well as other systems.00:43:40
Representative Howard question on the department's IT budget with $3.4 million in general funds.00:44:04
Secretary Valenti said funds for development are available in the Secretariat and the department will prioritize this project over other projects. The department is planning ahead because BIT has a plan to get all other systems off the mainframe within 10 years.00:44:30
Representative Howard requested information on the projects that will not be done if the modernization project goes forward.00:45:30
Ms. Johnson said the cost for the project will be spread across fiscal years. Much of the work that is on the mainframe today will shift to this project.00:45:40
Representative Lake question is the department guaranteed the federal funding will be available over the next few years.00:46:18
Ms. Johnson said the federal partners have not indicated that the funds will not be available.00:46:46
Senator Peters question if the reprioritizing of IT projects will cause audit findings.00:46:55
Ms. Johnson said she felt the new system will provide easier access to data they are struggling to gather today.00:47:31
Secretary Valenti said the department will have to balance the projects they have and because the current system does not meet federal guidelines, it isn't certified and needs to be replaced. Because they work in partnership with the federal government, they will not move forward with the project without federal approval.00:48:50
Senator Peters asked why the funding for this project was in the base budget and not a special appropriation.00:50:00
Secretary Valenti said this was a decision made in conjunction with the Bureau of Finance & Management. The line would be removed once the project is complete. The estimated implementation timeframe is 21-36 months.00:50:33
Page 14 - No. 2: Discretionary Provider Inflation: The department requested an increase of $523,868 in general funds and an increase of $10,477 in federal fund expenditure authority for a 1.8% inflationary increase to provider rates. The Governor did not recommend this.00:52:00
Senator Partridge question on the Weatherization Program.00:52:23
Ms. Johnson briefed the Committee on the Weatherization Program and told the Committee the program is 100% federally funded.00:53:16
Senator Partridge asked about the Community Action agencies. Ms. Johnson responded that there are 4 Community Action agencies in South Dakota that have various funding sources and provide a variety of programs.00:55:00
Representative Anderson requested information on the how much is spent on administration of the program vs. dollars spent on actual projects. 00:55:53
Senator Peters question on monitoring the spending in this grant. Ms. Johnson said the grant is are monitored very closely especially the detailed expenditure vouchers.00:57:13
Page 17 & 18 - Medical Services: The FY19 Governor recommended budget includes $232,702,399 in general funds, $419,885,303 in federal fund expenditure authority and $280,701 in other fund expenditure authority for a total of $652,868,403 and 52.0 FTE. This is an increase of $432,849 in general funds and $19,719,012 in federal funds for a total increase of $20,151,861.00:58:25
Page 20 - A. FMAP: a decrease of $5,249,809 in general funds and a corresponding increase of $5,249,809 in federal fund expenditure authority due to the change in the FMAP.00:59:37
Page 20 - B. Mandatory Provider Inflation: The department requested an increase of $7,247,738 in general funds and an increase of $8,003,327 in federal fund expenditure authority for mandatory provider inflation. The Governor recommends an increase of $4,592,759 in general funds and an increase of $5,148,592 in federal fund expenditure authority for mandatory provider inflation.00:59:53
Senator Peters question on how the mandatory inflation was established and the Governor's decrease.01:00:44
Brenda Tidball-Zeltinger, Deputy Secretary explained the rates of inflation and estimated inflation amounts. The federal government releases the estimated rates in the spring with the final rate released in the fall.01:01:12
Representative Hunhoff question on the difference between the department's request and that of the Governor. Ms. Tidball-Zeltinger said the department starts working on the budget in the summer and when the rates are released in the fall and they have better data they are able to make budget adjustments accordingly. 01:02:03
Page 21 - Eligibles and Utilization - The department requests an increase of $7,172,002 in general funds and an increase of $9,673,413 in federal fund expenditure authority due to the projected change in Medicaid enrollment, utilization, and costs. The Governor recommends an increase of $3,805,498 in general funds and an increase of $5,387,995 in federal fund expenditure authority due to the projected change in Medicaid enrollment, utilization, and costs based on updated projections.01:03:50
Bill Snyder, Director of Medical Services spoke to the Division's statistics.01:04:45
Senator Partridge question what is the difference between the 15,570 CHIP children compared to 67,000 Title 19 children.01:06:06
Mr. Snyder said the benefits are the same; however, the levels for eligibility and the funding mechanisms are slightly different. If the child is eligible for both, the department prefers they be in CHIP because the state gets a better federal match. 01:06:44
Senator Cronin question on the increased number of eligibles in FY18 and again in FY19. Mr. Snyder said it was partly a timing issue and with more current data it shows a slower growth in eligibles. There is a slower growth trend in the adult population, not as much in the CHIP.01:08:15
Division of Medical Services - Medicaid Avg. Monthly Eligible Totals01:10:48
Representative Hunhoff asked for the number of children coming into the program and the number going off the program. The department agreed to provide this information.01:12:46
Division of Medical Services Annual Avg. Cost Per Eligible01:13:34
Division of Medical Services FY18 Revised - Annual Avg. Cost Per Eligible01:14:50
Division of Medical Services Annual Avg. Cost Per Eligible: FY1901:15:14
Division of Medical Services FY19 Major Items01:16:08
Representative Hunhoff requested a breakdown for the last 3 years for Physician, Inpatient and Out-Patient cost increases and the top 25 diagnoses.01:16:57
Page 22 - D: Budget Alignment: the department requests a decrease of $2,500,00 in federal fund expenditure authority due to reductions in provider incentives for attaining meaningful use of electronic medical records as part of the federal HITECH Act.01:19:07
Page 22 - E: Fund Shift (Swap): Indian Health Service 100% FMAP: The Governor recommends a reduction of $4,586,090 in general funds and a corresponding increase of $4,586,090 in federal fund expenditure authority for transfer of general fund savings from medical service care coordination. This general fund reduction is offset by increases to fund the recommendations of the Health Care Solutions Coalition.01:19:38
Page 22 - No. 1: Health Homes Enhancements: The department requested an increase of $436,300 in general funds and an increase of $563,700 in federal fund expenditure authority for enhancements to the health homes care coordination program. The Governor did not recommend this request.01:20:14
Senator Peters requested the number of people utilizing health homes and asked how much has the state saved so far.01:20:42
Mr. Snyder said just under 6,000 individuals are using health homes. This program has proven to be very successful. The department estimates they avoided costs of $7.7 million net the PMP payments in the last year.01:21:21
Senator Peters asked what would the potential savings be if this program was funded.01:22:08
Representative Hunhoff asked what enhancements were planned for the Health Home Program.01:22:36
Senator Partridge asked if there was a portion of this program that should be funded.01:23:32
Senator White asked if the funds that were saved could be used for other programs, ie. opoid treatment. Ms. Tidball-Zeltinger said part of the Health Homes do serve behavioral health issues, including drug issues.01:24:14
Ms. Tidball-Zeltinger said this would help the providers provide services across the state. The providers would be ready to practice, once they are enrolled as a Medicaid provider.01:25:24
Page 22 - No. 2: Expand Behavioral Health Providers: The Governor recommends an increase of $265,642 in general funds and an increase of $343,209 in federal fund expenditure authority to implement the recommendation of the Health Care Solutions Coalition to add licensed marriage and family therapists, clinical social workers and licensed professional counselors working toward a mental health designation as Medicaid eligible outpatient behavioral health providers starting in January 2019.01:25:30
Representative Hunhoff question on how will these services be made available. Ms. Tidball-Zeltinger said the department is aware of the number of providers that meet the criteria. This expansion will enable them to enroll independently in the Medicaid Program to provide the services in different parts of the state and bill Medicaid, which they cannot do without the change. 01:26:16
Representative Hunhof asked if the providers are ready to practice. Ms. Tidball-Zeltinger said yes, they would be ready. The department will need to make a change to the state plan to allow the provider to enroll as a Medicaid provider.01:27:25
Representative Bartels question on adding more providers before bringing the current to 100% of their costs.01:27:50
Representative Bartels question on the reimbursement rates. Ms. Tidball-Zeltinger said the department has a fee schedule in the Behavioral Health Program that reimburses providers for outpatient services. The rate is approximately $117/hour. Representative Bartels felt it was more prudent to bring the current providers up to 100% of cost before adding a new group of providers. Ms. Tidball-Zeltinger reminded the Committee this group of providers is currently unable to bill Medicaid.01:28:20
Senator Peters asked how these providers are being paid if they are unable to bill Medicaid. Ms. Tidball-Zeltinger said they may work in a facility that can bill Medicaid or operate under a sliding fee schedule or under an arrangement with the patient.01:30:51
Representative Hunhoff asked why these providers were not enrolled.01:31:31
Ms. Tidball-Zeltinger in the past independent providers were typically not enrolled. A recommendation of the Coalition was to make that change to allow them to enroll in order to provide services and bill Medicaid.01:31:42
Page 23 - No. 3: Shared Savings: The Governor recommends an increase of $630,000 in general funds and an increase of $243,808 in federal fund expenditure authority to implement a tiered shared savings program recommended by the Health Care Solutions Coalition with IHS and non-IHS providers.01:33:18
Representative Hunhoff question on the use of general funds vs. federal funds.01:34:00
Mr. Snyder said federal regulations prohibit matching federal funds.01:34:17
Page 23 - No. 4: Community Health Worker Program: The Governor recommends an increase of $98,168 in general funds and an increase of $126,833 in federal fund expenditure authority to implement a community health worker program recommended by the Health Care Solutions Coalition. This will begin in April 2019.01:34:30
Representative Hunhoff question is there a Community Health Worker Program under IHS.01:35:06
Mr. Snyder said many of the Tribal organizations have a Community Health Worker Program; however, they are not currently reimbursed by the state Medicaid. It is anticipated there will be more Community Health work01:35:15
Representative Hunhoff question will there be training for the Community Health workers.01:36:00
Ms. Tidball-Zeltinger said the department has been work in collaboration with the Department of Health for provider qualification and training. 01:36:12
Representative Hunhoff question on the commitment of the trainee.01:37:07
Ms. Tidball-Zeltinger said the trainee would be affiliated with a clinic, a tribal health care provider or part of a broader network.01:37:29
Senator Cronin question on the $873,808 in Shared Savings.01:38:12
Ms. Tidball-Zeltinger said it was an estimate of payments to providers and IHS based on the current expenditure data. This would be an annual payment to the provider in the latter half of FY19.01:38:33
Senator Cronin asked why this wasn't a backfilled payment. Ms. Tidball-Zeltinger said the department wanted the authority for federal funding needed to make the payment and will leverage federal Medicaid match for non-IHS payments. The department anticipates making an annual payment to the providers. This would become part of the operating budget and any funding changes would come before the Appropriations Committee. 01:39:33
Representative Anderson asked if there was a cap for the dollar amount that will be shared once the program is implemented. Mr. Snyder said there is not a dollar cap today, however, as a practical manner there are limits depending on the nature of the work of the provider. 01:41:28
Senator Partridge suggested this topic be on the agenda for the Health Care Coalition.01:47:19
Senator Peters question on time of payment. Ms. Tidball-Zeltinger said the payment in FY19 will be for the prior 12 months, and possibly made in May or June.01:47:32
Representative Bartels requested the department bring an updated slide on IHS savings.01:48:30
Page 23 - No. 5 - Discretionary Provider Inflation: The department requests an increase of $2,632,856 in general funds and an increase of $3,821,503 in federal fund expenditure authority for a 1.8% inflationary increase. The Governor did not recommend this increase.01:49:33
Page 24 - No. 6 - Provider Rate Adjustment (Governor's 3-Year Plan): The Governor recommends an increase of $876,681 in general funds and an increase of $1,132,676 in federal fund expenditure authority to raise the reimbursement of providers to 90% of allowable costs.01:49:45
Page 27/28 - Children's Services: The FY19 Governor's recommended budget includes $47,345,104 in general funds, $48,457,828 in federal fund expenditure authority and $4,800,143 in other fund expenditure authority for a total of $100,603,075 and 359.8 FTE. This is an increase of $2,222,357 in general funds and $655,410 in federal fund expenditure authority for a total of $2,877,767.01:50:45
Page 29 - Child Support Enforcement budget totals $8,976,639 and 83 FTE.01:52:10
Page 30 - Child Protection Services budget totals $69,239,834 and 251.8 FTE.01:52:30
Page 31 - Child Care Services budget totals $22,386,602 and 25.0 FTE.01:52:43
Page 33 - A. FMAP: A decrease of $383,314 in general funds and a corresponding increase of $383,314 in federal fund expenditure authority due to the change in the FMAP.01:53:05
Page 33 - B. Eligibles and Utilization: The department requests an increase of $1,251,538 in general funds and an increase of $149,712 in federal fund expenditure authority due to caseload growth.01:53:23
Senator Partridge question on caseload growth.01:54:00
Virgena Wieseler, Director of Child Protection Services, said the growth is primarily in foster care because of more children requiring placement due to the meth epidemic.01:54:35
Page 33 - No. 1: Subsidized Guardianships: The department requests an increase of $154,964 in general funds and an increase of $4,402 in federal fund expenditure authority to fund projected growth of 24 additional subsidized guardianships.01:55:16
Representative Hunhoff question on the growth of 24 additional subsidized guardianships.01:55:54
Ms. Wieseler said when the children are placed with an individual, and they become the guardian of that child, the child remains with that family until the age of majority.01:56:02
Representative Hunhoff asked for data on the number of children in the program and those that leave the program. Ms. Wieseler agreed to provide additional information and told the Committee there are currently over 300 children on subsidized guardianship.01:56:30
Senator Partridge question on which area under Children's Services is seeing the increase.01:57:02
Ms. Wieseler said Basic Foster Care has the largest increase; however, there was a slight increase in Specialized and Treatment foster care as well as Group care.01:57:45
Page 34 - No. 2: Subsidized Adoptions: The department requests an increase of $268,759 in general funds and an increase of $117,982 in federal fund expenditure authority to fund projected growth of 37 additional subsidized adoptions.01:59:18
Page 34 - No. 3: Child Care Direct Assistance: The department requests an increase of $694,857 in general funds for an increase in direct assistance of 4.68% based on the biennial market rate survey of provider costs.01:59:45
Representative Hunhoff question on reversion of child care funds in FY17.02:00:28
Secretary Valenti said the $1.2 million reversion in FY17 was in child care assistance and was a onetime reduction. There was also a onetime base reduction in FY18.02:01:00
Senator Peters question on how many providers will receive an increase in child care direct assistance. Secretary Valenti said the monthly average of families served in FY16 was 2,132, and 1,960 in FY17. The estimate for FY18 was 2,004 and 2,049 for FY19.02:01:45
Representative Hunhoff question on Revenues: Direct from Noncustodial Parents. Secretary Valenti explained it was child support collected from noncustodial parents. The department collects child support payments on approximately 67% of all active cases. Secretary Valenti will provide additional information on the amount of child support owed and the amount collected.02:05:11
Representative Anderson question regarding the Obligation Recovery Program. Secretary Valenti explained the department does not use the Obligation Recovery system to collect child support; however, they collected $115 million in 2017 involving 59,800 cases. They were ranked No. 2 in the nation in 2016 and received $2 million in incentive payments. The department has been in the Top 3 in the nation for the past 15 years.02:08:25
Senator Cronin question on the tools used for collecting child support. Secretary Valenti said the department uses a variety of tools to collect child support. Withholding orders is significant as well as withholding driver's licenses. This is all done after notifying the owing parent and giving them the opportunity to enter into a payment agreement. 02:10:30
Page 34 - No. 4: Discretionary Provider Inflation: The department requested an increase of $437,037 in general funds, an increase of $213,580 in federal fund expenditure authority and an increase of $4,530 in other fund expenditure authority for a 1.8% inflationary increase to provider rates. The Governor did not recommend this.02:11:50
Page 35 - No. 5: Provider Rate Adjustment (Governor's 3-year plan): The Governor recommends an increase of $235,553 in general funds to raise reimbursement of group care providers to 90% of allowable costs.02:12:02
Page 38 and 39 - Behavioral Health: The FY19 Governor's recommended budget includes $83,651,845 in general funds, $37,436,364 in federal fund expenditure authority and $3,418,359 in other fund expenditure authority for a total of $124,506,568 and 636.0 FTE. This is an increase of $2,832,719 in general funds, $98,264 in federal fund expenditure authority and $270,650 in other fund expenditure authority for a total increase of $3,201,633.02:12:30
Page 40 - Human Services Center budget totals $50,757,402 and 556.0 FTE.02:13:54
Page 41 - Community Behavioral Health budget totals $69,540,754 and 23.0 FTE.02:14:06
Page 42 - Correctional Behavioral Health budget totals $4,208,412 and 57.0 FTE.02:14:18
Page 45 - A. Operating Expense Inflation: The department had requested $370,830 in general funds and the Governor recommended $324,328 in general funds. The difference is $46,502 in general funds for a discretionary 1.8% inflation increase.02:14:35
Page 45 - B. FMAP: A decrease of $368,662 in general funds and a corresponding increase of $368,662 in federal fund expenditure authority due to the change in FMAP.02:15:19
Page 45 - C. Mandatory Provider Inflation: The department requests an increase of $90,036 in general funds for mandatory provider inflation of 4.8% for prescription drugs based on prescription drug CPI.02:15:33
Senator Cronin question on the increase in prescription drugs.02:15:50
Amy Iverson-Pollreisz, Deputy Secretary said the increase referenced here was for drugs purchased for patients at the Human Services Center.02:16:12
Page 46 - D. Transfers Between Programs: The Governor recommends an increase of $270,650 in other fund expenditure authority and an increase of 3.0 FTE for three pharmacy contracts that will now be budgeted in the Department of Social Services HSC budget.02:16:49
Senator Partridge question on the transfers. Mr. Simmons said it was the same dollar amount; however, the 3.0 FTE are the contract employees that will now become state employees.02:17:20
Page 46 - E. Fund Shift (Swap): The department requests an increase of $1,296,870 in general funds and a corresponding decrease in federal fund expenditure authority due to fewer Medicare eligible residents at the Human Services Center.02:17:45
Representative Hunhoff question on what Medicare covers at HSC.02:18:10
Ms. Iverson-Pollreisz said Medicare would cover some of the costs on the acute units; however, there is a decline in people who have Medicare coming to HSC. In relation to geriatics, Medicare would cover Part A hospital portion.02:18:18
Senator Partridge question on the $1,296,870 fund swap. Ms. Iverson-Pollreisz said it was federal funds for Medicare that are not available because of the clients coming to the HSC do not have that revenue stream. These are individuals that are coming to the HSC on involuntary mental illness commitment and the state is responsible for providing care for these individuals.02:19:35
Senator Partridge asked why these individuals are not eligible for Medicare. Ms. Iverson-Pollreisz said they are seeing a change in the population coming to HSC, individuals who are not eligible for Medicare to begin with, a younger population.02:20:55
Senator Cronin question on the mix of people coming into the HSC. Ms. Iverson-Pollreisz said it is primarily those that are indigent and non-Medicaid eligible. 02:23:00
Page 46 - No. 1: Contract Providers for HSC Geriatric: The department requests an increase of $495,984 in general funds to cover the costs of contracting for difficult to fill aide positions at the HSC.02:24:33
Representative Hunhoff question on where these positions are located. Ms. Iverson-Pollreisz said it is in the nursing home acute units in the non-geriatric units. The HSC still has RN vacancies but is using contracts only for aides.02:24:54
Page 47 - No. 3: HSC Weekend Pay Differential: The department requested an increase of $393,981 in general funds. The Governor did not recommend this increase.02:26:00
Senator Peters requested the department provide information on overtime for the HSC.02:26:45
Ms. Iverson-Pollreisz reported overtime in FY17 was $1.5 million and in FY16 it was $1.4 million. Overtime remains fairly consistent. 02:27:50
Representative Hunhoff question on the pilot program for overtime paid over the holiday. Ms. Iverson-Pollreisz said they would have paid the overtime regardless, the program provided an incentive to work the overtime sooner.02:28:58
Senator Partridge commented on increased salaries for staff at the HSC. 02:29:39
Page 47 - No. 4: HSC Staffing Alignment: The department requests a decrease of $17,242 in general funds, a decrease of $101,323 in federal fund expenditure authority, and a decrease of 3.0 FTE to remove difficult to fill aid positions from the budget.02:30:38
Senator Peters question on the elimination of the 3 aide positions. Ms. Iverson-Pollreisz said aide positions continue to be difficult to fill and while contract employees cost more, it would be a significant budget impact to increase the salaries of all aides.02:31:06
Page 46 - No. 2: Mental Health Court: The department requests an increase of $138,500 in general funds for funding for one-half of a year of treatment services for individuals referred to by the department by Unified Jucicial System's Mental Health Court initiative.02:32:59
Representative Hunhoff asked for more information. Ms. Iverson-Pollreisz said it is mental health services for people involved with the mental health court project. Representative Hunhoff asked if the funding would go to the IMPACT programs. Ms. Iverson-Pollreisz said it is targeted for the mental health court pilot project UJS is doing in Rapid City. 02:33:25
Page 47 - No. 5: Expand Medicaid Coverage for Substance Use Treatment: The Governor recommends an increase of $872,905 in general funds and an increase of $1,127,795 in federal fund expenditure authority to implement the Health Care Solutions Coalition recommendation.02:34:35
Senator Peters question are we opening more slots. Ms. Iverson-Pollreisz said it was substance abuse treatment services for those that are already Medicaid eligible. It is for expanding servcies, not increasing people.02:35:10
Representative Hunhoff asked for clarification. Secretary Valenti said today 69% of the people on Medicaid are children, 20% are elderly disabled adults. If this is funded, the 20% of elderly disabled adults as well as low-income parent group would now be eligible for substance abuse treatment.02:36:12
Senator Partridge asked if this service was mandated by the state and who will provide this service. Secretary Valenti said it is not mandated; however, most state do provide substance abuse services to their adult population. There are currently 39 providers and most services are provided on an out-patient basis. Ms. Iverson-Pollreisz said most people who complete substance abuse treatment are more likely to be employed and sustain themselves and not be on other state programs. 02:37:29
Representative Hunhoff asked if general funds could be matched with federal funds for the weekend pay differential at the HSC. Ms. Iverson-Pollreisz said it depends on the payer mix and with the new population, it is more general funds. Representative Hunhoff asked what the assessment fee is today. Ms. Iverson-Pollreisz said it remains at $600.00.02:42:00
Senator Partridge question is there potential for setting up an HSC in west river South Dakota. Ms. Iverson-Pollreisz said there are not enough admissions from west river to fund an additional facility. 02:43:18
Page 47 - No. 6: Discretionary Provider Inflation: The department requested an increase of $798,499 in general funds, an increase of $250,464 in federal fund expenditure authority and an increase of $6,330 in other fund expenditure authority for a 1.8% inflationary increase to provider rates. The Governor did not recommend this incirease.02:44:43
Page 52 - Board of Counselor Examiners: FY19 Governor's recommended budget is $93,151 in other fund expenditure authority.02:45:48
Page 55 - Board of Psychology Examiners: The FY19 Governor's recommended budget is $77,126 in other fund expenditure authority.02:46:16
Page 58 - Board of Social Work Examiners: The FY19 Governor's recommended budget is $101,882 in other fund expenditure authority.02:46:34
Page 61 - Board of Addiction and Prevention Professionals: The FY19 Governor's recommended budget is $170,430 in other fund expenditure authority and 1.3 FTE. 02:46:56

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