DHFAC Meeting Minutes
April 7, 2000
Attending:
- Patricia Blevins
- Joseph DiPinto
- Tom Grabowski
- Joseph Lieberman
- Gregg Sylvester
Absent:
- Deborah Capano
- Vivian Longo
- David McBride
- Charles Reinhardt
- Dennis Rochford
- Charles Simpson
- Calvin Wilson
Welcome and Introductions
Gregg Sylvester welcomed the Committee members and the public. Introductions followed.
Review and Approval of Minutes
Minutes were reviewed. No corrections were offered but approval was deferred until quorum is present.
Tobacco Issues - Update
Gregg Sylvester reiterated that the next tobacco settlement payment is expected to be made on April 17 and that a reduction is expected. The $15.5 million projected is now expected to be $13 million.
Dr. Sylvester also reported that the Controller General has requested that the HFAC report to the Joint Finance Committee on May 4, 2000. The hearing is scheduled for 10:30am.
Old Business
HFAC Discussion: Funding Amounts, Criteria and Oversight
- Recommendations Worksheet
Dr. Sylvester reviewed the recommendations worksheet as revised on March 17. Specifically, Dr. Sylvester noted the areas of agreement: strategic reserve, prescription assistance, and automatic external defibrillators. Dr. Sylvester reminded the Committee that more information had been requested on Tobacco prevention, the uninsured, testing regimens and transitional housing for recovering substance abusers.
- Tobacco Control and Prevention
Tom Grabowski, Sr. reported to the Committee the progress made at the HFAC meeting on the Tobacco Prevention and Control Plan and Budget. Specifically, Mr. Grabowski reported the areas of consensus about the plan as: its comprehensiveness, community based focus, youth-orientation and school-based initiatives; and inclusion of evaluation components. Significant areas of concern about the plan were revealed as concerns about: funding levels, allocation of funds to governmental agencies v. community organizations, and duplication of existing programs/services. Mr. Grabowski reported that through the discussion during this meeting, it was requested that the Division of Public Health provide additional information on how funds will flow through Public Health to community organizations. Moreover, it was requested during that meeting that Public Health provide the Committee with more information about the FTE's included in the plan. Finally, it was reported that the Supreme Court ruled that the FDA does not have jurisdiction to regulate tobacco, thereby eliminating FDA funding to states for tobacco control. Given this, the tobacco control and prevention plan has been revised to include additional funding requests from the Department of Public Safety for these purposes.
Ulder Tillman, Director of Public Health, DHSS, satisfied the forementioned request of information regarding the flow of money and function of FTE's. Specifically, Dr. Tillman explained that of the total budget ($2.8 million), $313,000 would be disbursed to the Department of Public Safety, $144,000 to the Department of Justice, $300,000 to the Department of Education and $2.2 million to DHSS. Of that $2.2 million, 79% would be directed to community organizations. Twenty-one percent would be utilized by DHSS to manage the initiative and to implement a chronic disease and cancer program targeting tobacco-related illnesses. Questions were raised about the community groups to whom the funds would be disbursed (Blevins) and about the FTE's and salary costs (Grabowski). Specifically, questions were raised about the salary costs in the Department of Education and the Department of Justice. Joseph DiPinto stated that the salary costs in the Department of Justice reflected contractual fees, not FTE salaries and OEC's. Ms. Janet Arns, Department of Justice, reviewed the Department of Education's positions and costs. $230,000 of the $300,000 request will be for positions: a school health coordinator, and two field agents. DHSS' positions were described as a chronic disease manager, a comprehensive cancer program manager, and two community health promotion specialists. Finally, Jeffrey Taschner, DPS, stated that Public Safety is requesting four positions: three DABC agents and one administrative assistant.
HFAC members (Blevins and DiPinto) asked to hear from anti-tobacco advocates regarding this plan. Chris Manning, American Heart Association, and Deborah Brown, Tobacco Free Delaware (ALADE), stated that more funds should be directed to countermarketing and public education. Rob Simmons, Christiana Care, stated that more funds for cessation should be considered.
Patricia Blevins stated her concerns with the budget, objecting to $150,000 proposed for recreational alternatives to substance abuse. Moreover, Sen. Blevins stated that she would like to see the plan mirror more closely the funding goals stated by the IMPACT Coalition.
Rep. DiPinto stated that he would need more time to review the flow of funds and the role of DPH and FTE's in the plan. Rep. DiPinto suggested that an additional meeting be held specifically on the tobacco control plan and budget.
- Uninsured
Dr. Sylvester reminded the Committee that it had previously discussed funding Medicaid benefits for persons who lose coverage due to SSDI, and that the original projection for this project was $1.5 million. Dr. Sylvester reported, however, that the $1.5 projection was based on the goal of matching federal funds. The full cost of the first year of this program is in effect $2.97 million (300 persons at a cost of $825 PMPM). To receive the federal match , DHSS has since learned, requires a HCFA 1115 waiver, which, as stated by Phil Soule, Director of Medicaid, DHSS, can take from 6 to 24 months. Dr. Sylvester suggested that the $1.5 million originally allotted to this initiative would provide medical coverage for the intended population (300 persons) if the program were started mid-year. Sen. Blevins suggested that mid-year implementation would be effective and provide the opportunity for DHSS to pursue the waiver. Mid-year implementation and conditional on pursuit of waiver were recorded as "criteria" in the draft recommendations.
The second initiative related to the uninsured discussed at the March 17th meeting was the DHCC's proposal to spend $1 million to coordinate existing resources and programs to better serve the uninsured. At that meeting, it was requested that the DHCC provide HFAC with a detailed plan and budget. Ms. Paula Roy, Director of DHCC explained that $1.0 would provide the necessary support to an implementation plan to turn the Commission's research into action on the uninsured. The Committee members discussed including this recommendation, with the criteria that action and implementation be maximized.
- Testing Regimens
Joseph Lieberman reported that the Testing Regimens subcommittee met and is requesting that $150,000 be recommended for this initiative. Specifically, the $150,000 will be used to provide staff and research support in a variety of activities that will pursue definitions of "lesser-known illnesses", and recommendations to implement regimens for their detection and prevention. The committee members discussed including this recommendation, suggesting that the funds be directed to DHCC and that the criteria for the program include the development of registries.
- Transitional Housing for Substance Abuse
During the March 17th meeting, Sen. Blevins requested that the issue of infrastructure needs for substance abuse placement be considered by HFAC. Renata Henry, Director of DADAMH, DHSS presented a program proposal to provide transitional housing to persons who have completed detoxification for alcohol and/or other substances. Specifically the goal of this program would be to provide safe and sober post-treatment housing and to provide some supportive services such as linkage with social services, transportation, etc. The annual cost of such a program would run $400,000, however, Ms. Henry suggested that the program be implemented to require a 50/50 match from a contract provider. Specifically, Ms. Henry requested a one-time allocation of $600,000 which would cover DADAMH's 50% of the costs over a three year period. Dr. Lieberman raised the question of how many people would be served in this program. Ms. Henry reported that roughly fifteen people would be served per year, totaling 45 people in the three year period. The committee suggested that the FY01 recommendations include $200,000 for the first year of this program.
Finally, the need to re-address any recommendations regarding chronic diseases was discussed. Ms. Roy suggested that diabetes be discussed. The issue was deferred until the next meeting.
Summary of Old Business
Dr. Sylvester suggested that with the recommendations discussed, it was likely that programs costs have exceeded the $10 million limit to which the Committee had agreed.It was suggested that the strategic reserve be reduced to $15 million to accommodate these programs. Therefore, the recommendations to date are:
- Strategic Reserve: $15 million
- DPAP: $7.5 million ($2 million already expended, $5 million recommended for FY01)
- Tobacco Control and Prevention: $2.9 million
- Public Access Defibrillation: $750,000
- Uninsured: $2.5 million
- Lesser-Known Illnesses: Testing Regimens: $150,000
- Substance Abuse: Transitional Housing: $200,000
Next Meeting date was discussed. Suggestion was made to hold the meeting on April 27. Date will be determined and communicated week of April 10.
Public Comment
Chris Manning, American Heart Association: Informed HFAC and public that the AHA was hosting AED awareness day on April 13, in conjunction with EMS and the American Red Cross.
Dr. Robert Frelick: Commended HFAC for decisions made and advocated that an excise tax on cigarettes would help to not only reduce tobacco use but also to improve indoor air and reduce disease.
Rita Marroco: DELARF: Commended HFAC for including substance abuse issues in recommendations, however, reminded HFAC that additional issues related to substance are currently underfunded.
Meeting was adjourned at 2:40pm.
