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DPH presents FY18-20 budget preview, flags EHR and Medi-Cal 340B risks
Summary
Department of Public Health presented a two-year budget overview and a set of initiatives including a behavioral health engagement team, Drug Medi-Cal organized delivery rollout and corrections for hospital staffing and UCSF affiliation costs; staff said the final budget will be before the commission for a vote on Feb. 20.
The San Francisco Department of Public Health presented an FY18-20 budget preview outlining revenue, expenditure and initiative plans and cautioned commissioners about out-year pressures tied to the department's electronic health record (EHR) project and potential changes to Medi-Cal reimbursement.
Jenny Louie, DPH budget manager, said the department's overall budget is approximately $2.2 billion and described a new budgeting presentation that groups services into Behavioral Health, Population Health, the San Francisco Health Network and Public Health Administration. Louie said the packet includes baseline revenue growth and identified losses of federal and state grants for population health (including STD, TB and some preparedness grants) that the department is working to backfill.
Proposed initiatives highlighted in the presentation include an added behavioral health engagement team to increase street outreach (budget-neutral by leveraging coordinated whole-person care payments), a phased Drug Medi-Cal organized delivery system rollout, and targeted contract increases for providers. Louie said revenue assumptions would support about $50 million in additional funding to meet mayoral general-fund reduction targets and that some rebalancing will be required in the second year.
Commissioners asked whether five-year financial projections and the governor's May revise would affect DPH budgets. Staff said the single biggest outside risk is a governor's proposal affecting the 340B Medi-Cal pricing program and that the department is tracking the issue. The presentation also described a proposal to provide a $6.6 million contingency pool San Francisco General could access if its census exceeds budgeted staffing and an increase in the affiliation agreement funding for UCSF services tied to EHR implementation timelines.
Louie and other staff said the packet included a $3.3 million increase in contracts for behavioral health providers offset by approximately $2.2 million in billable revenue (net general-fund impact roughly $1 million) and that additional balancing measures would be presented at the next hearing ahead of a Feb. 20 vote.
Staff committed to follow-up on lines of questioning about tuberculosis surveillance resources, EHR funding impacts and methods to smooth costs over the two-year planning horizon. The commission will consider the proposed budget initiatives and vote on the final budget at its Feb. 20 meeting.
