Department of Human Resources

1

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

2
Governors 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
3
Division of Aging ServicesFY2008 Budget
Program/Subprogram  Program/Subprogram    State Federal Total Notes
Elder Abuse and Fraud Prevention Elder Abuse and Fraud Prevention Elder Abuse and Fraud Prevention        
  Adult Protective Services Adult Protective Services 8,868,694 3,107,602 11,976,296 Federal Cuts, FY08/09 (TCM)
  Elder Abuse and Fraud Prevention Elder Abuse and Fraud Prevention 4,744 95,389 100,133 Match
  Elderly Legal Assistance Elderly Legal Assistance 103,999 52,886 156,885 Match
  Long Term Care Ombudsman Long Term Care Ombudsman 1,222,828 443,400 1,666,228 MOE/Match
Elder Community Living Services Elder Community Living Services Elder Community Living Services        
  Community Care Services Program Community Care Services Program 56,295,474 15,981,891 72,277,365 Match
  Home and Community Based Services Home and Community Based Services 18,205,774 23,872,236 42,078,010 MOE/Match, Federal Cuts (NSIP)
Elder Support Services Elder Support Services Elder Support Services        
  Senior Community Services Employment Senior Community Services Employment 50,804 1,948,122 1,998,926 Match
  GeorgiaCares GeorgiaCares 979,831 3,197,631 4,177,462  
  Senior Nutrition Senior Nutrition - 2,360,173 2,360,173 No State Funds
  Health Promotion (Wellness) Health Promotion (Wellness) - 491,367 491,367 No State Funds
  Other Support Services (NORC, ADRC) Other Support Services (NORC, ADRC)        
Program Administration Program Administration Program Administration 2,130,059 4,432,927 6,562,986  
Georgia Council on Aging   Georgia Council on Aging   Georgia Council on Aging   193,064 - 193,064 Admin. Attached Only
TOTAL FY 2008 Budget TOTAL FY 2008 Budget TOTAL FY 2008 Budget 88,055,271 55,983,624 144,038,895
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.
4
Division of Aging ServicesFY2009 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
5
Division of Aging ServicesFY2009 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
6
Division of Aging ServicesFY2009 Reductions
(continued)
Program Reduction Affected Community
Division of Aging Services/All Programs 50,000 Statewide Reduction in Training
Division of Aging Services/All Programs 350,000 Statewide Reduction in Force, To Be Achieved Through Attrition
Total 1,760,000
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Division of Aging ServicesFY2009 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
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Division of Aging ServicesFY2008 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 3,500,000
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Division of Aging ServicesFY2008 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.

10
Division of Family Children ServicesFY2008
Budget
Program Program Program Program State Federal Total Notes
Child Welfare Services Child Welfare Services Child Welfare Services Child Welfare Services 73,149,559 178,048,003 251,197,562 MOE Match
Out of Home Care Out of Home Care Out of Home Care Out of Home Care 113,680,260 84,479,837 198,160,097 Match
Afterschool Care Afterschool Care Afterschool Care Afterschool Care 0 14,000,000 14,000,000 No State Funds
Childcare Childcare Childcare Childcare 58,398,695 175,018,410 233,417,105 Match
Energy Assistance Energy Assistance Energy Assistance Energy Assistance 0 18,623,684 18,623,684 No State Funds
Food Stamp Eligibility Food Stamp Eligibility Food Stamp Eligibility Food Stamp Eligibility 25,547,915 29,693,546 55,241,461 Match at 50/50
Eligibility Determination (Medicaid) Eligibility Determination (Medicaid) Eligibility Determination (Medicaid) Eligibility Determination (Medicaid) 26,942,155 24,377,800 51,319,955 Match at 50/50
Refugee Services Refugee Services Refugee Services Refugee Services 0 3,184,000 3,184,000 No State Funds
Support for Needy Families-Basic Support for Needy Families-Basic Support for Needy Families-Basic Support for Needy Families-Basic 10,315,527 77,652,812 87,968,339 MOE Match
Support for Needy Families-Family Support for Needy Families-Family Support for Needy Families-Family Support for Needy Families-Family 19,744,139 67,342,945 87,087,084 MOE Match
Support for Needy Families-Work Support for Needy Families-Work Support for Needy Families-Work Support for Needy Families-Work 26,000,000 40,587,281 66,587,281 MOE
Adoption Services Adoption Services Adoption Services Adoption Services 33,139,326 36,632,278 69,771,604 Match
Family Violence Family Violence Family Violence Family Violence 4,701,950 5,849,430 10,551,380 MOE
               
Total Total Total Total 391,619,526 755,490,026 1,147,109,552  
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Division of Family Children ServicesFY2009
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
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Division of Family Children ServicesFY2009
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
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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.

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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 MOE Match
Adult Nursing Home 2,383,183 1,547,242 3,930,425
CA Addictive Diseases 10,864,229 17,217,170 28,081,399 MOE
CA Developmental Disabilities 17,589,662 6,331,470 23,921,132 Waiver Match
CA Forensic 3,038,424 0 3,038,424
CA Mental Health 105,062,036 56, 622,457 161,684,493 MOE Match
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 Match
TOTAL 727,952,809 299,592,034 1,084,167,300
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DMHDDAD FY2009 Reductions
Program Reductions Affected Community
Statewide core community clinical services (Adult and CA 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.
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DMHDDAD FY2009 Enhancements
Program Enhancement Affected Community
Community-based pharmacy and lab services for Adult and CA 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
17
DMHDDAD FY2008 Supplemental Budget Request
Program Supplement Affected Community
Emergency hospital funding (Adult Forensic, Adult Nursing Home, Direct Care Support Services, Adult CA 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 12,000,000
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Division of Public HealthFY2008 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 MOE
Epidemiology 6,000,648 487,988 6,488,636 11 Match
Immunization 11,725,931 8,817,897 20,543,828 MOE
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 MOE Match
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Division of Public HealthFY2008 Budget
Program State Federal Total Notes
Infectious Disease Control 39,203,771 11,294,644 50,498,415 21 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 31 Match
Total 171,823,575 177,689,208 349,512,783
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Division of Public HealthFY2009 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
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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
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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

23
Office of Child Support Services FY2008 Budget
Program State Federal Total Notes
Child Support 24,358,230 51,081,316 75,439,546 21 match
Includes 2,841,500 in fees
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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
25
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
26
Office of Regulatory ServicesFY2008 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 0 8,347,158 632,762 State Medicaid match (75/25)
Residential Child Care 1,365,334 0 0 1,365,334
ORS Administration 747,442 292,233 70,000 1,109,675
Totals 8,742,633 6,925,034 70,000 15,737,667
FY08 Fiscal Affairs- pending approval of
moving ORS Admin from DHR Admin to Facility and
Provider Regulation
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Office of Regulatory ServicesFY2009 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
28
Office of Regulatory ServicesFY2009 Enhancements
Program Enhancement Affected Community
Health Care Section 225,000 Statewide (monitoring serious self-reportshospitals, hospices)
Residential Child Care 232,853 (174,853 through redirect) Statewide (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
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Reductions Summary
Division/Office Program Reduction
Various Departmental Administration -2,975,410
Child Support Services Child Support Services - 433,374
Aging Services Elder Abuse Investigations Prevention -160,000
Aging Services Elder Community Living -760,000
Aging Services Elder Support Services -690,000
DFCS Out of Home Care -7,800,000
MHDDAD Adult Mental Health Services -6,457,310
MHDDAD Adult Addictive Diseases -527,067
MHDDAD Child Adolescent Mental Health Svcs -2,373,604
MHDDAD 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
Division of Public Health Adult Essential Health Treatment Services -115,000
Division of Public Health Emergency Preparedness -200,000
Division of Public Health Infant Child Essential Health Treatment -435,000
Division of Public Health Immunization -25,000
Division of Public Health Infant Child Health Promotion -625,000
Division of Public Health Infectious Disease Control -770,000
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Enhancement Summary
Division/Office Program Enhancement
Various Departmental Administration 2,395,410
Aging Services DAS Admin. (for Transportation) 120,000
Child Support Services Child Support Services 433,374
Aging Services Elder Community Living 1,140,000
Aging Services Elder Support Services 500,000
DFCS Child Welfare Services 2,100,000
DFCS Out of Home Care 1,100,000
DFCS Adoption Services 4,500,000
DFCS Family Violence Services 150,000
MHDDAD Adult Mental Health Services 6,457,310
MHDDAD Adult Addictive Diseases 527,067
MHDDAD Child Adolescent Mental Health Svcs 2,373,604
MHDDAD 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
Division of Public Health Epidemiology 400,000
Division of Public Health Infant Child Essential Health Treatment 1,800,000
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DHR Concept Papers
32
Concept Paper FY 09Division of Family Children
ServicesRoom, 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, 2007. 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.

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Concept Paper FY 09MHDDAD
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 CA 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 CA MH / AD) 7,200,000 Statewide
TOTAL 19,790,000
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Concept Paper FY 09MHDDAD DD Waivers
Program Enhancement Affected Community
1,500 DD Waiver service slots (Adult CA) 16,657,454 Statewide
Rate increase for DD community providers 2,015,357 Statewide
TOTAL 18,672,811
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Concept Paper FY 09MHDDAD 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.

36
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

37
MHDDAD Concept Paper FY 09Basic 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 MHDDADs
  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).

38
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

39
MHDDAD Concept Paper FY 091,500 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 Georgias 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.

40
MHDDAD Concept PaperDD 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 FY94 (based on FY93 Medicaid cost
  reports). There have been two increases in DD
  waiver services since FY04 - a 4 DD increase in
  FY02, and a 4.5 increase in FY06. 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
  Georgias 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 FY09. Although a
  7 increase will not reconcile the difference
  between rate increases since FY94 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.

41
Concept Paper FY 09Division of Public
HealthGrant 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

42
Concept Paper FY 09Coordinated 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

43
Concept Paper FY 09Coordinated Transportation
DIVISION/ OFFICE FY 09 REQUEST (State) AFFECTED COMMUNITY PROJECTED Total FY09 FY12 (State)
Aging 1,200,000 Elderly Georgians 6,300,000
MHDDAD 1,200,000 Funds for developmentally disabled self-directed care clients. 7,100,000
OCSS 250,000 Fatherhood transportation 350,000
Technology 100,000 Technology improvements to system. All clients. 150,000
OFSS FTA 5317 GRANT 1,000,000 Matching funds for new FTA Grant. Aging and developmentally disabled clients. 1,000,000
Demo Grants 600,000 Voucher and volunteer programs for Aging / MHDDAD clients. 2,400,000
Total 4,350,000   17,300,000
44
Concept Paper FY 09DHR 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.

45
Concept Paper FY 09Office of Regulatory
ServicesLicensing 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.)