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1 Issue Docket Conference Committee on Bill 1 General Appropriations Bill Article II - Health and Human Services Page 1 of 45

2 530 DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES II-1 Biennial Difference II-1 Decision #1 - Increase Preparation for Adult Living (PAL) Purchased Services Decision #2 - Increase Finance Staff Decision #3 - Increase Child Protective Services (CPS) Caseworkers Decision #4 - Increase Statewide Intake (SWI) Staff Decision #5 - Create New Data Analysis Unit Decision #6 - Expand Foster Care Redesign Decision #7 - Create New Capacity Portal for Data Sharing 1,832,024-1,832,024-1,248,561 1,248,561 55,241, ,361,111 88,120,008-5,868,537 5,868,537 1,070,115-1,070,115 7,132,207 3,566,104 3,566,103 5,300,000-5,300,000 increases 1,832,024 in General Revenue to support agency-projected need for Preparation for Adult Living (PAL) services. See also Rider 32, page II-15. increases 1,138,089 in General Revenue, 110,472 in Federal Funds, and 9.0 FTEs to fund additional finance staff to support agency operations. increases 43,826,055 in General Revenue, 6,165,025 in Federal Funds, FTEs in fiscal year 2018, and FTEs in fiscal year 2019 to support additional CPS caseworkers. Funding of 5,726,332 in General Revenue and 636,260 in Federal Funds is contingent on Bill 11. See also Rider 33, page II-15. increases 95,212,940 in General Revenue, 10,648,149 in Federal Funds, FTEs in fiscal year 2018, and FTEs in fiscal year 2019 to support additional CPS caseworkers. funding includes 32,250,000 in General Revenue appropriated in rider. See also Rider 34, page II-16 and Rider 35, page II-16. increases 5,746,464 in General Revenue, 122,073 in Federal Funds, 46.7 FTEs in fiscal year 2018, and 52.5 FTEs in fiscal year 2019 to fund additional SWI staff. increases 1,049,017 in General Revenue, 21,098 in Federal Funds, and 8.9 FTEs to fund a new data analysis unit specializing in providing additional analysis when a caseworker first receives an assignment. increases 5,102,237 in General Revenue, 2,029,970 in Federal Funds, and 11.0 FTEs to expand Foster Care Redesign to four new catchment areas. increases 2,551,119 in General Revenue, 1,014,985 in Federal Funds, and 5.5 FTEs to expand Foster Care Redesign to two new catchment areas. increases 4,600,000 in General Revenue, 700,000 in Federal Funds, and 11.0 FTEs to create a new capacity portal to allow for automatic data sharing with foster care service providers. 530 DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 2 of 45

3 Decision #8 - Continue the Safe Signal Initiative Decision #9 - Enhance Community Engagement Decision #10 - Increase Prevention and Early Intervention (PEI) Program Staff Decision #11 - Expand PEI Services Decision #12 - Provide Certain CPS Salary Increases Decision #13 - Reallocate Indirect Administration Decision #14 - Continue Permanency Care Assistance Decision #15 - Increase Adult Protective Services (APS) Caseworkers Biennial Difference - 611, , , , , , ,279-21,690,090 21,690,090-2,327,990 2,327, ,138,404-8,138,404-10,750,000 10,750,000 increases 557,108 in General Revenue and 54,076 in Federal Funds to continue the Safe Signal initiative. increases 527,710 in General Revenue, 51,350 in Federal Funds, and 3.6 FTEs to support increased community engagement through enhanced volunteer and community partnerships. increases 791,588 in General Revenue, 77,003 in Federal Funds, and 5.4 FTEs to support increased community engagement through enhanced volunteer and community partnerships. increases 307,787 in General Revenue, 9,492 in Federal Funds, and 2.0 FTEs to increase PEI support staff in PEI Research, Evaluation, and Quality Monitoring, and the Office of Child Safety for Child Maltreatment. See also Rider 36, page II-15. increases 21,685,654 in General Revenue and 4,436 in Federal Funds to expand PEI services in the following areas: - Services At-Risk Youth (STAR) (13.4 million); - Project Helping through Intervention and Prevention (HIP) (1.6 million); - Community Youth Development (CYD) (1.7 million); - Project Healthy Outcomes through Prevention and Early Support (HOPES) (3.6 million); and - Texas Home Visiting Program (0.8 million). increases 2,087,252 in General Revenue and 240,738 in Federal Funds to provide salary increases for certain CPS caseworkers. reallocates funding and FTEs within multiple programs in order to better align with the agency's cost allocation plan. Reallocation results in a net zero cost to the agency. increases 5,155,896 in General Revenue and 2,982,508 in Federal Funds to continue the Permanency Care Assistance Program, contingent on passage of SB 203. See also Rider 38, page II-16. increases 10,750,000 in General Revenue, appropriated in rider, to support additional APS staff. See also Rider 35, page II DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 3 of 45

4 Decision #16 - Increase Capital Budget Authority Biennial Difference increases capital budget authority of 5,848,107 to complete the second half of the agency-requested capacity portal which would serve as a case management system for placement staff. Decision #17 - Fund Foster Care Rates with TANF Federal Funds 94,301,444 94,301,444 - funding for the CPS foster care provider rate increase includes a Method of Finance swap to use 66,000,000 in TANF Federal Funds instead of General Revenue. See also Rider 44, page II-16. Decision #18 - Expand Relative Caregiver Payments Decision #19 - Upgrade and Modernize Information Management Projecting Adults and Children in Texas (IMPACT) 32,543,356 32,543,356 3,446,400 3,446,400 increases 32,543,356 in Economic Stabilization Funds to expand Relative Caregiver Payments contingent upon enactment of Bill 4, or similar legislation. increases 3,446,400 in Economic Stabilization Funds to upgrade and modernize the agency's IMPACT database. Number of Full-Time-Equivalents (FTEs) 12, ,166.0 a. increases 9.0 FTEs to support an increase in finance staff. See Decision #2. b. increases FTEs in fiscal year 2018 and FTEs in fiscal year 2019 to support additional Child Protective Services (CPS) staff. See Decision #3. increases FTEs in fiscal year 2018 and FTEs in fiscal year 2019 to support additional CPS staff. Amounts include 73.6 FTEs appropriated in rider. See Decision #3. c. increases 46.7 FTEs in fiscal year 2018 and 52.5 FTEs in fiscal year 2019 to support an increase in SWI staff. See Decision #4. d. increases 8.9 FTEs to create a new data analysis unit. See Decision #5. e. increases 11.0 FTEs to expand Foster Care Redesign. See Decision #6. increases 5.5 FTEs to expand Foster Care Redesign. See Decision # DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 4 of 45

5 Biennial Difference f. increases 11.0 FTEs to create a new capacity portal for data sharing. See Decision #7. g. increases 3.6 FTEs to enhance community engagement. See Decision #9. increases 5.4 FTEs to enhance community engagement. See Decision #9. h. increases 2.0 FTEs to increase PEI support staff. See Decision #10. i. increases 84.0 FTEs, appropriated in rider, to increase APS caseworkers. See Decision #15. Administrative and IT Indirect Administration 77,899,366 Information Technology Program Support 83,391,853 Child Protective Services Adoption Purchased Services 21,352,247 Adoption Subsidy Payments 540,406,480 CPS Direct Delivery Staff 1,519,824,352 CPS Program Support 67,659,406 a. See Decision #5 - Create New Data Analysis Unit b. See Decision #9 - Enhance Community Engagement c. See Decision #13 - Reallocate Indirect Administration a. See Decision #5 - Create New Data Analysis Unit b. See Decision #7 - Create New Capacity Portal c. See Decision #9 - Enhance Community Engagement d. See Decision #13 - Reallocate Indirect Administration a. See Decision #3 - Increase CPS Caseworkers b. See Decision #5 - Create New Data Analysis Unit c. See Decision #9 - Enhance Community Engagement d. See Decision #13 - Reallocate Indirect Administration a. See Decision #5 - Create New Data Analysis Unit b. See Decision #6 - Expand Foster Care Redesign c. See Decision #7 - Create New Capacity Portal d. See Decision #9 - Enhance Community Engagement e. See Decision #13 - Reallocate Indirect Administration 530 DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 5 of 45

6 Foster Care Payments 968,362,178 Other CPS Purchased Services 83,709,369 Permanency Care Assistance Payments 42,660,496 Post-Adoption/Post-Permanency Purchased Services Preparation for Adult Living (PAL) Purchased Services 7,407,298 32,628,491 Relative Caregiver Monetary Assistance 24,708,910 Payments Substance Abuse Purchased Services 18,213,439 TWC Contracted Day Care Purchased Services 139,637,252 Prevention Services At-Risk Prevention Program Support 2,058,203 Child Abuse Prevention Grants 7,932,633 Community Youth Development (CYD) 18,476,978 Program Community-Based At-Risk Family Services 1,487,449 Nurse Family Partnership 26,281,024 Preventive Services for Veterans and Military 6,405,762 Families (MVFP) Project Healthy Outcomes through Prevention 45,608,019 and Early Support (HOPES) Project Helping through Intervention and 1,888,479 Prevention (HIP) Runaway and Youth Hotline 630,283 Safe Baby Campaigns 1,783,130 Services to At-Risk Youth (STAR) 41,559,930 Statewide Youth Services Network (SYSN) 3,278,360 Texas Families: Together and Safe 5,651,796 Biennial Difference a. See Decision #6 - Expand Foster Care Redesign b. See Decision #17 - Fund Foster Care Rates with TANF Federal Funds See Decision #14 - Continue Permanency Care Assistance See Decision #1 - Increase PAL Purchased Services a. See Decision #10 - Increase PEI Program Staff b. See Decision #13 - Reallocate Indirect Administration 530 DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 6 of 45

7 Texas Home Visiting Program 34,961,034 Universal Prevention Services 3,314,586 Biennial Difference Regulatory & Enforcement APS In-Home Direct Delivery Staff 98,376,035 APS Program Support 8,695,396 APS Purchased Emergency Client Services 20,432,195 See Decision #13 - Reallocate Indirect Administration See Decision #13 - Reallocate Indirect Administration Statewide Intake Services Statewide Intake Services (SWI) 46,272,838 a. See Decision #5 - Create New Data Analysis Unit b. See Decision #13 - Reallocate Indirect Administration A.1.1 STATEWIDE INTAKE SERVICES B.1.1 CPS DIRECT DELIVERY STAFF B.1.2 CPS PROGRAM SUPPORT B.1.3 TWC CONTRACTED DAY CARE B.1.4 ADOPTION PURCHASED SERVICES B.1.5 POST - ADOPTION/POST - PERMANENCY B.1.6 PAL PURCHASED SERVICES B.1.7 SUBSTANCE ABUSE PURCHASED SERVICES B.1.8 OTHER CPS PURCHASED SERVICES B.1.9 FOSTER CARE PAYMENTS 49,341,745 1,534,266, ,251, ,348,471 20,130,624 6,976,442 18,330,466 17,136,828 78,305, ,931,004 a. See Decision #4 - Increase SWI Staff b. See Decision #11 - Expand PEI Services a. See Decision #3 - Increase CPS Caseworkers b. See Decision #4 - Increase SWI Staff c. See Decision #9 - Enhance Community Engagement d. See Decision #12 - Provide Certain CPS Salary Increases a. See Decision #4 - Increase SWI Staff b. See Decision #6 - Expand Foster Care Redesign a. See Decision #6 - Expand Foster Care Redesign b. See Decision #17 - Fund Foster Care Rates with TANF Federal Funds 530 DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 7 of 45

8 Biennial Difference B.1.10 ADOPTION/PCA PAYMENTS B.1.11 RELATIVE CAREGIVER PAYMENTS C.1.1 STAR PROGRAM C.1.2 CYD PROGRAM C.1.3 CHILD ABUSE PREVENTION GRANTS C.1.4 OTHER AT-RISK PREVENTION PROGRAMS C.1.5 HOME VISITING PROGRAMS C.1.6 AT-RISK PREVENTION PROGRAM SUPPORT D.1.1 APS DIRECT DELIVERY STAFF D.1.2 APS PROGRAM SUPPORT D.1.3 APS PURCHASED EMERGENCY CLIENT SVCS E.1.1 CENTRAL ADMINISTRATION E.1.2 OTHER SUPPORT SERVICES E.1.3 REGIONAL ADMINISTRATION E.1.4 IT PROGRAM SUPPORT 573,428,122 57,252,266 60,626,107 18,577,185 7,214,315 62,779,694 57,980,268 15,164,632 95,530,998 11,367,361 18,799,637 42,766,120 20,495,148 1,861,486 84,827,188 See Decision #18 - Expand Relative Caregiver Payments See Decision #11 - Expand PEI Services See Decision #11 - Expand PEI Services See Decision #11 - Expand PEI Services See Decision #11 - Expand PEI Services See Decision #11 - Expand PEI Services a. See Decision #4 - Increase SWI Staff b. See Decision #15 - Increase APS Caseworkers a. See Decision #2 - Increase Finance Staff b. See Decision #4 - Increase SWI Staff c. See Decision #9 - Enhance Community Engagement d. See Decision #11 - Expand PEI Services a. See Decision #4 - Increase SWI Staff a. See Decision #2 - Increase Finance Staff b. See Decision #4 - Increase SWI Staff c. See Decision #8 - Continue the Safe Signal Initiative d. See Decision #9 - Enhance Community Engagement e. See Decision #11 - Expand PEI Services 530 DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 8 of 45

9 Biennial Difference F.1.1 AGENCY-WIDE AUTOMATED SYSTEMS 60,937,592 a. See Decision #2 - Increase Finance Staff b. See Decision #4 - Increase SWI Staff c. See Decision #9 - Enhance Community Engagement d. See Decision #11 - Expand PEI Services e. See Decision #19 - Upgrade and Modernize IMPACT Other Reporting Requirements II-6, Rider 7 Rider Packet, page II-1 II-6, Rider 7 Rider Packet, page II-1 requires DFPS to report on litigation involving child welfare service providers. Limitation on Expenditures for Administrative Overhead II-7, Rider 8 Rider Packet, page II-3 II-8, Rider 8 Rider Packet, page II-3 outlines the funding for direct delivery of the TWC Contracted Day Care Purchased Services Program that is subject to the limitations included in the rider. Limitation on Appropriations for Day Care Services II-11, Rider 20 Rider Packet, page II-4 II-12, Rider 20 Rider Packet, page II-4 outlines the funding for direct delivery of the TWC Contracted Day Care Purchased Services Program that is subject to the limitations included in the rider. Foster Care Redesign II-11, Rider 21 Rider Packet, page II-5 II-12, Rider 21 Rider Packet, page II-5 adds any standing Joint Legislative Oversight Committees, as appropriate, to the list of recipients who are required to receive the Foster Care Redesign performance report. Family Finding Collaboration II-13, Rider 26 Rider Packet, page II-7 II-14, Rider 26 Rider Packet, page II-7 1) allows family finding collaboration funding to be used with single source continuum contractors; and 2) adds a reporting requirement related to the use of these funds. Texas Home Visiting Program and Nurse Family Partnership Program II-14, Rider 31 Rider Packet, page II-7 II-15, Rider 31 Rider Packet, page II-7 prohibits funding for the support costs to implement the home visiting programs to exceed 20 percent of the total direct delivery costs for these programs. Preparation for Adult Living (PAL) Purchased Services II-15, Rider 32 Rider Packet, page II-8 restricts the use of appropriations provided to expand the Preparation for Adult Living (PAL) Purchased Services to this purpose. 530 DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 9 of 45

10 Cash Flow Contingency Biennial Difference II-15, Rider 32 Rider Packet, page II-8 allows the agency restricted cash flow flexibility to temporarily utilize General Revenue pending the receipt of federal reimbursements. Contingency for Bill 11 II-15, Rider 33 Rider Packet, page II-9 identifies appropriations for the oversight of case management services contingent upon the enactment of Bill 11, or similar legislation. Child Protective Services Special Investigators II-15, Rider 34 Rider Packet, page II-10 allows DFPS to use CPS Special Investigators to assist dedicated Information Analysts by providing additional up-to-date background information on households currently under DFPS investigation. See Decision #5 - Create New Data Analysis Unit. Additional Funding for Improvements to Foster Care Services II-15, Rider 34 Rider Packet, page II-10 appropriates 21.5 million in General Revenue to improve foster care services. Additional Appropriation II-16, Rider 35 Rider Packet, page II-10 appropriates 10.8 million in General Revenue for CPS Direct Delivery Staff and 10.8 million in General Revenue for APS Direct Delivery Staff. Contingency for Community-based Foster Care Appropriations II-15, Rider 35 Rider Packet, page II-10 makes the fiscal year 2019 funding for Foster Care Redesign expansion contingent upon Legislative Budget Board approval (LBB). Approval is further contingent upon DFPS executing a contract to expand into one region and meeting all related reporting requirements. Prevention and Early Intervention Full-time Equivalents II-15, Rider 36 Rider Packet, page II-11 restricts the use of appropriations provided to increase staff support in PEI by 1.0 FTE in PEI Research, Evaluation, and Quality Monitoring, and 1.0 FTE in the Office of Child Safety for Child Maltreatment for this purpose. Study on Provision of Services to Victims of Sex Trafficking in Foster Care II-16, Rider 36 Rider Packet, page II-11 requires DFPS to conduct a study to 1) develop department standards for placement capacity to provide services to children who are victims of sex trafficking; and 2) make related recommendations. Utilization of Appropriate Levels of Care in Foster Care; Reporting Requirements II-15, Rider 37 Rider Packet, page II-12 requires DFPS to submit a plan to 1) ensure that foster children are placed in the most appropriate level of care; and 2) reduce the utilization of child-specific contracts. 530 DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 10 of 45

11 Biennial Difference Contingency for Bill 203 Faith and Community Based Partner Coordination Office of the Ombudsman II-16, Rider 38 Rider Packet, page II-13 II-16, Rider 39 Rider Packet, page II-13 II-16, Rider 40 Rider Packet, page II-13 provides appropriations for the continuation of the Permanency Care Assistance Program contingent upon the enactment of Bill 203, or similar legislation. directs DFPS, to the extent allowable, to use PEI appropriations to develop and implement a strategy for engaging and collaborating with faith and community based partners. requires the agency to allocate 3.0 FTEs for use in the agency's Office of the Ombudsman. Youth Homelessness II-16, Rider 41 Rider Packet, page II-13 allows DFPS to use STAR Program funding to assist in providing services to homeless youth, including services such as case management and transitional living. Federal Funds Maximization Rate Increases for Foster Care Providers II-16, Rider 43 Rider Packet, page II-14 II-16, Rider 44 Rider Packet, page II-14 requires DFPS to contract with a cost-allocation expert to identify and report on what agency services can be funded through Medicaid and Title IV-E Federal Funds. outlines the CPS foster care service provider rate increases included the additional funding appropriated for this purpose. TWC Day Care Purchased Services Eligibility II-16, Rider 45 Rider Packet, page II-16 allows DFPS to use TWC Contracted Day Care Purchased Service appropriations to provide day care services to any caregivers working at least 30 hours per week. See also Article IX Page IX-84 provides Economic Stabilization Funds for the following: a. Relative Caregiver Payments See Decision #18 b. Information Management Protecting Adults and Children in Texas (IMPACT) See Decision #19 See also Article XI Page XI-1 Page XI DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 11 of 45

12 537 DEPARTMENT OF STATE HEALTH SERVICES II-17 Biennial Difference II-16 Cross-Strategy Issue #1 - Funding for indirect administration. provides 70.8 million in All Funds (54.0 million in General Revenue- Related Funds) and FTEs for indirect administration, which is a decrease of 21.0 million in All Funds (9.5 million in General Revenue-Related Funds) and 79.6 FTEs. provides 43.9 million in All Funds (27.1 million in General Revenue- Related Funds) and 90.0 FTEs for the same purpose, which is a decrease of 47.8 million in All Funds (36.3 million in General Revenue-Related Funds) and FTEs. Cross-Strategy Issue #2 - Funding for ASH Campus Repair & Renovations decreases 1.0 million in All Funds in the following strategies, eliminating funding for the project: - Strategy A million in General Revenue and 30,000 in Federal Funds; - Strategy A million in General Revenue; and - Strategy A million in General Revenue. decreases 1.0 million in General Revenue and increases Economic Stabilization Funds by a like amount in the following strategies, fully funding the project: - Strategy A.1.1, decreases 0.9 million in General Revenue and increases 0.3 million in Economic Stabilization Funds; -Strategy A.2.2, increases 0.6 million in Economic Stabilization Funds; and -Strategy A.2.4, decreases 0.1 million in General Revenue and increases 0.1 million in Economic Stabilization Funds. 537 DEPARTMENT OF STATE HEALTH SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 12 of 45

13 Biennial Difference Number of Full-Time-Equivalents (FTEs) 3, , a. provides FTEs each fiscal year in Strategy A.2.1, Immunize Children & Adults in Texas, which is a decrease of 14.0 FTEs. maintains fiscal year 2017 FTE level for Strategy A.2.1, Immunize Children & Adults in Texas. b. provides 74.9 FTEs each fiscal year in Strategy A.3.3, Children with Special Needs, which is a decrease of 8.3 FTEs. provides 80.9 FTEs each fiscal year in Strategy A.3.3, Children with Special Needs, which is a decrease of 2.3 FTEs. c. provides 7.0 FTEs in fiscal year 2018 only in Strategy C.1.4 to support the interagency agreement between DSHS and TDLR regarding regulation of certain health care professionals, which are slated to transfer from DSHS to TDLR during the biennium pursuant to Bill 202, Eighty-fourth Legislature, provides 0.0 FTEs in Strategy C.1.4, Health Care Professionals for this purpose. See also Rider 34, page II-30. d. See Cross-Agency Issue: provides FTEs each fiscal year for all strategies in Goal E, Indirect Administration, which is a decrease of 79.6 FTEs. provides 90.0 FTEs each fiscal year for all strategies in Goal E, Indirect Administration, which is a decrease of FTEs. 537 DEPARTMENT OF STATE HEALTH SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 13 of 45

14 Biennial Difference A.1.1 PUBLIC HEALTH PREP. & COORD. SVCS/ HOUSE ARTICLE IX, SEC ,098, ,573, ,552 a. provides 0.2 million more in Federal Funds for Local Health Department Contracts. b. See Cross-Strategy Issue #2. A.1.2 VITAL STATISTICS 29,303,717 30,901,435 1,597,718 provides 4.1 million in Appropriated Receipts (Other Funds) from unexpended balances in fiscal year 2017 and corresponding capital budget authority for the following capital budget projects: a. Vital Records Project (TxEver): 2.6 million See also Rider 23, page II-27 and Rider 38, page II-30. b. Controlled Access and Surveillance - Vital Statistics: 0.6 million; c. Vital Records Preservation: 0.8 million; and d. Microfilming Equipment - Vital Statistics: 0.1 million See also Rider 23, page II-27. provides 2.5 million in Appropriated Receipts (Other Funds) from unexpended balances in fiscal year 2017 and corresponding capital budget authority for the Vital Records Project (TxEver). A.1.5 HEALTH DATA AND STATISTICS 7,623,080 7,643,080 20,000 reduces 20,000 in General Revenue for Statewide Health Coordinating Council travel reimbursement, which eliminates funding for this purpose. maintains spending levels for the Statewide Health Coordinating Council travel reimbursement. See also Rider 27, page II DEPARTMENT OF STATE HEALTH SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 14 of 45

15 Biennial Difference A.2.1 IMMUNIZE CHILDREN & ADULTS IN TEXAS 179,540, ,692,895 11,152,724 provides a decrease of 11.6 million in All Funds (9.7 million in General Revenue-Related Funds) and a decrease 14.0 FTEs from spending levels for immunization programs. provides decrease of 0.5 million in All Funds and an increase of 1.5 million in General Revenue-Related Funds from spending levels for the same purpose. maintains 2017 FTE levels of FTEs. A.2.2 HIV/STD PREVENTION/ HOUSE ARTICLE IX, SEC ,401, ,291,906 1,890,031 a. implements agency's ten percent reduction option of 1.2 million in General Revenue for HIV medications. b. provides 0.1 million in Appropriated Receipts (Other Funds) for Wi- Fi and Video Teleconferencing Equipment. provides 0.1 million in General Revenue for the same purpose. c. reduces 0.5 million in General Revenue for HIV/STD screenings. See also Rider 16, page II-25. d. See Cross-Strategy Issue #2. A.2.3 INFECTIOUS DISEASE PREV/EPI/SURV 23,970,861 25,972,235 2,001,374 a. implements agency's ten percent reduction option of 1.5 million in General Revenue for skunk rabies abatement. b. provides 0.5 million in General Revenue for Zika virus preparedness and prevention, which is new funding for the biennium. See also Rider 37, page II DEPARTMENT OF STATE HEALTH SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 15 of 45

16 Biennial Difference A.2.4 TB SURVEILLANCE & PREVENTION/ 55,349,592 55,469, ,000 HOUSE ARTICLE IX, SEC See Cross-Strategy Issue #2. A.3.1 CHRONIC DISEASE PREVENTION 18,708,015 17,263,415 1,444,600 a. maintains funding for the Lone Star Stroke program at spending levels. transfers 1.5 million in General Revenue for the Lone Star Stroke program to the UT System. See also DSHS Rider 13, page II-23; DSHS Rider 13, page II- 24; and University of Texas System Administration Rider 5, page III- 59. b. reduces 55,400 in General Revenue for advisory council travel reimbursement for Texas Council on Alzheimer's Disease and Related Disorders (7,000), Texas Council on Cardiovascular Disease and Stroke (10,000), and the Texas Diabetes Council (38,400), which eliminates funding for this purpose. maintains spending levels for advisory council travel reimbursement. See also Rider 27, page II-28. A.3.3 CHILDREN WITH SPECIAL NEEDS 18,846,934 20,132,438 1,285,504 implements agency's ten percent reduction option of 1.3 million in General Revenue and 6.0 FTEs for eligibility determination, case management, and community-based infrastructure support for families seeking health benefits through the Children with Special Health Care Needs program. 537 DEPARTMENT OF STATE HEALTH SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 16 of 45

17 Biennial Difference A.4.1 LABORATORY SERVICES/ HOUSE ARTICLE IX, SEC ,331,709 84,931,709 1,600,000 provides 1.6 million in Economic Stabilization Funds in Article IX for the following purposes: a. To add testing for X-linked adrenoleukodystrophy (X-ALD) to the newborn screening panel (1.2 million); and b. Laboratory deferred maintenance (0.4 million). C.1.1 FOOD (MEAT) AND DRUG SAFETY 49,866,435 50,152, ,000 reduces 0.3 million in General Revenue-Dedicated Account No. 5022, Oyster Sales to align with the Biennial Revenue Estimate (BRE), which is a decrease of 0.3 million from spending levels. maintains funding from Account No at spending levels of 0.5 million. Note: provides 0.2 in General Revenue-Dedicated Account No. 5022, Oyster Sales, to Texas A&M University at Galveston. provides no funding from Account No to Texas A&M Galveston. According to the Biennial Revenue Estimate, estimated revenue to Account No is 109,000 each fiscal year. E.1.1 CENTRAL ADMINISTRATION 26,428,073 16,622,193 9,805,880 See Cross-Strategy Issue #1. E.1.2 IT PROGRAM SUPPORT 36,336,277 21,799,348 14,536,929 See Cross-Strategy Issue #1. E.1.3 OTHER SUPPORT SERVICES 5,214,050 3,718,250 1,495,800 See Cross-Strategy Issue #1. E.1.4 REGIONAL ADMINISTRATION 2,778,893 1,805, ,086 See Cross-Strategy Issue # DEPARTMENT OF STATE HEALTH SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 17 of 45

18 Biennial Difference Cardiovascular Disease and Stroke Projects II-24 Rider 13 Rider Packet, page II-17 II-23 Rider 13 Rider Packet, page II-17 requires DSHS to allocate 1.5 million in General Revenue to the University of Texas System for the Lone Star Stroke program and allows for DSHS to expend funds for cardiovascular disease and stroke projects. Note: transfers the Lone Star Stroke program and corresponding funding to the UT System. See also University of Texas System Administration Rider 5, page III-59. HIV/STD Screenings II-25 Rider 16 Rider Packet, page II-17 requires the agency to allocate 0.5 million in General Revenue for HIV/STD screening during routine checkups to residents in metropolitan statistical areas with the highest rate or instance of HIV/STD cases. Note: There is insufficient General Revenue not used for federal match or maintenance of effort requirements in Strategy A.2.2, HIV/STD Prevention in CSSB1 to support rider requirements. Unexpended Balances: Credit Card and Electronic Services Related Fees II-28 Rider 24 Rider Packet, page II-17 II-27 Rider 23 Rider Packet, page II-17 identifies 4.1 million in Appropriated Receipts (Other Funds) from unexpended balances in fiscal year 2017 and corresponding capital budget authority for the following capital budget projects: a. Vital Records Project (TxEver): 2.6 million; b. Controlled Access and Surveillance - Vital Statistics: 0.6 million; c. Vital Records Preservation: 0.8 million; and d. Microfilming Equipment - Vital Statistics: 0.1 million requires DSHS to report to LBB the amount of unexpended balances and the amount expended on each of the projects listed above. identifies 2.5 million from the same funding sources for the Vital Records Project (TxEver). Reimbursement of Advisory Committee Members II-29 Rider 28 Rider Packet, page II-18 II-28 Rider 27 Rider Packet, page II-18 authorizes DSHS to provide travel reimbursement for members of the Statewide Health Coordinating Council, Texas Council on Alzheimer's Disease and Related Disorders, Texas Council on Cardiovascular Disease and Stroke, and the Texas Diabetes Council. 537 DEPARTMENT OF STATE HEALTH SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 18 of 45

19 Biennial Difference Emerging and Neglected Tropic Diseases Sentinel Surveillance II-29 Rider 31 Rider Packet, page II-19 requires the agency to implement a sentinel surveillance program to monitor emerging and neglected tropical diseases as outlined in Health and Safety Code, Chapter 100 and provide to the LBB quarterly reports outlining program implementation and performances. If the program is not implemented, the LBB may direct the Comptroller of Public Accounts to reduce DSHS appropriations for Central Administration. Immunization Programs Improvement II-30 Rider 32 Rider Packet, page II-19 requires the agency to identify and report on efficiencies and program improvements for the Vaccines for Children and Adult Safety Net programs. Tobacco Prevention Programs for Youth/Tobacco Prevention Funding II-30 Rider 33 Rider Packet, page II-20 II-29 Rider 33 Rider Packet, page II-20 a. requires the agency to expend funds appropriated for youth tobacco prevention on evidence-based and promising practices. b. prohibits the agency to expend any funding appropriated for tobacco prevention on paid media activities. Cause of Death Data Improvement II-29 Rider 34 Rider Packet, page II-20 requires the agency to study the quality of cause of death data on death certificates and submit a report including findings, potential program improvements, and any recommended statutory changes to the Lieutenant Governor, Speaker, LBB, and certain legislative committees. Newborn Screening Payment II-30 Rider 35 Rider Packet, page II-21 requires the agency to study the most effective way to bill private insurers for newborn screening kits and submit a report including findings and recommendations to the LBB and certain legislative committees. 537 DEPARTMENT OF STATE HEALTH SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 19 of 45

20 Local Health Department Performance Measures II-30 Rider 35 Rider Packet, page II-21 Biennial Difference requires the agency to develop high priority performance measures for local health departments (LHDs) who receive state-funded grants and submit a report including the performance measures and plans to utilize them to the LBB and members of the Finance Committee. Regional Advisory Council Funding: Information Listing II-30 Rider 36 Rider Packet, page II-21 provides an informational listing regarding Regional Advisory Council (RAC) funding. Evaluation of Immunization Programs II-30 Rider 36 Rider Packet, page II-22 requires the agency to assess the Vaccines for Children and Adult Safety Net programs and submit a report outlining any identified efficiency and program improvements to the LBB and certain legislative committees. Zika Virus Preparedness and Prevention II-30 Rider 37 Rider Packet, page II-23 requires the agency to expend at least 0.5 million during the biennium on Zika virus preparedness and prevention in the Texas-Mexico border region. Accuracy of Death Certificate of Pregnant Person or Person Recently Pregnant II-30 Rider 38 Rider Packet, page II-23 requires the agency to develop and implement an electronic process within TxEver for determining in real time whether a person was pregnant at the time of death or was pregnant at any time in the year preceding the person's death and use 0.1 million in Appropriated Receipts (Other Funds) from unexpended balances in fiscal year 2017 for this purpose. Report on Compounding Outsourcing Facilities II-30 Rider 39 Rider Packet, page II-23 requires the agency to review rules, regulations and licensing procedures for compounding outsourcing facilities and report findings and recommendations to the legislature. 537 DEPARTMENT OF STATE HEALTH SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 20 of 45

21 Biennial Difference See also Article IX Page IX-84 provides Economic Stabilization Funds for the following: - Adding testing for X-linked adrenoleukodystrophy (X-ALD) to the newborn screening panel (1.2 million); - State Laboratory deferred maintenance (0.4 million); and - Other agency facility deferred maintenance (1.0 million). See also Article XI Page XI-1 Page XI DEPARTMENT OF STATE HEALTH SERVICES Conf Com on SB1 : 4/25/2017 5:07 PM Page 21 of 45

22 529 HEALTH AND HUMAN SERVICES COMMISSION (Non-Medicaid) Biennial Difference II-32 II-32 Technical Adjustment #1 II-35 II-35 In Strategy E.1.2, Provide WIC Services, reclassify General Revenue-Dedicated WIC Rebates Account No to Other Funds, to reflect the method of finance category used in the Comptroller's Biennial Revenue Estimate (BRE). NOTE: This would not generate a savings to the bill. Technical Adjustment #2 II-35 In the 's bill pattern for Strategy H.1.1, Facility/Community-based Regulation, decrease General Revenue by 5.4 million and increase General Revenue-Match for Medicaid No. 758 by a like amount to align the method of finance with previous funding decisions regarding Strategy H.1.1, Facility/Community-based Regulation. Technical Adjustment #3 II-69 II-71 Technical Adjustment #4 II-89 II-90 In Rider 107/111, Vendor Drug Rebates and Report, amend the rider to align appropriation authority for the Children with Special Health Care Needs (CSHCN) program and the Kidney Health Care program. In Rider 149/153, Reimbursement of Advisory Committee Members, amend the rider to correct the listing of advisory committee members eligible to receive reimbursement. Cross-Strategy Issue #1- Funding to maintain fiscal year 2017 staffing levels at the State Supported Living Centers (SSLCs) in fiscal year 2018 and to transition residents to a long-term community care program. provides 35,127,562 in All Funds (15,145,947 in General Revenue and 19,981,615 in Federal Funds) in fiscal year 2018 across three strategies to maintain additional SSLC staffing in fiscal year 2018 and to transition an estimated 200 residents per fiscal year into a long-term community care program. provides 23,075,735 in All Funds (9,992,148 in General Revenue and 13,083,587 in Federal Funds) in fiscal year 2018 across three strategies for the same purpose. 529 HEALTH AND HUMAN SERVICES COMMISSION Conf Com on SB1 : 4/25/2017 5:08 PM Page 22 of 45

23 Cross-Strategy Issue #2 - Continue funding for the Legacy Department of Assistive and Rehabilitative Services (DARS) Programs, as provided in fiscal year 2017 in Special Provisions 57, Contingency for Bill 208, GAA. Biennial Difference HHSC was provided 9,169,077 in General Revenue in contingency funding for legacy DARS Programs in fiscal year 2017 only, including 5,031,368 to support HHSC's cost allocation plan, 2,024,328 to maintain services in the Deaf and Hard of Hearing Services program, and 2,113,381 to provide field support staff (33.0 FTEs) for Comprehensive Rehabilitation Services, Children's Blindness Services, and Independent Living Services. provides an increase of 4,137,709 in General Revenue in contingency funding for legacy DARS Programs: 13,306,786 in General Revenue is included for the biennium for this purpose, including 5,031,368 to support HHSC's cost allocation plan, 4,137,709 to support the Deaf and Hard of Hearing Services program, and 4,226,762 to support current field staff. maintains 2017 spending levels for this purpose. Cross-Strategy Issue #3 - Funding to eliminate the current and projected waiting lists for community mental health services for adults and children. provides 62,673,000 (54,786,571 in General Revenue and 7,885,974 in Federal Funds) across two strategies to eliminate the current and projected waiting lists for community mental health services. provides 62,673,000 million in General Revenue across two strategies for the same purpose. Number of Full-Time-Equivalents (FTEs) 39, , Appropriations Made in Riders 5,000,000-5,000,000 provides 5,000,000 in General Revenue-Dedicated Hospital Perpetual Care Account No. 8146, contingent on passage of Bill HEALTH AND HUMAN SERVICES COMMISSION Conf Com on SB1 : 4/25/2017 5:08 PM Page 23 of 45

24 Biennial Difference D.1.1 WOMEN'S HEALTH PROGRAM 284,644, ,600,115 9,955,681 provides an increase of 30,897,728 in All Funds for Women's Health programs: 284,644,434 in All Funds is included for programs for the biennium, including 80,915,378 in General Revenue Related Funds and 203,529,056 in Federal Funds. The assumes more federal funding than the for the Healthy Texas Women program. provides an increase of 40,853,409 in All Funds for Women's Health programs: 294,600,115 in All Funds is included for programs for the biennium, including 260,915,378 in General Revenue Related Funds and 23,529,056 in Federal Funds. This includes 9,955,681 in General Revenue for marketing and outreach. The annual split for the 9,955,681 is: 2018: 7,797,679; 2019: 2,158,002. D.1.2 ALTERNATIVES TO ABORTION 18,300,000 38,300,000 20,000,000 D.1.5 CHILDREN'S BLINDNESS SERVICES 11,691,761 11,586, ,299 D.1.6 AUTISM PROGRAM 14,248,197 14,239,310 8,887 See also Rider 184, page II-96. maintains level funding for the Alternatives to Abortion program. provides an increase of 20,000,000 in General Revenue for the Alternatives to Abortion program. See Cross-Strategy Issue #2. See Cross-Strategy Issue # HEALTH AND HUMAN SERVICES COMMISSION Conf Com on SB1 : 4/25/2017 5:08 PM Page 24 of 45

25 Biennial Difference D.2.1 COMMUNITY MENTAL HEALTH SVCS-ADULTS 703,362, ,362,864 3 D.2.2 COMMUNITY MENTAL HLTH SVCS-CHILDREN 168,322, ,973,576 5,348,862 See Cross-Strategy Issue #3. See also Highlights of Behavioral Health Related Decisions. a. See Cross-Strategy Issue #3. b. provides an increase of 2,848,862 in General Revenue for Mental Health Block Grant for the Relinquishment Prevention program to fund an additional 15 residential treatment center beds for youth who are at risk of parental relinquishment. maintains level funding for 20 beds. c. provides 2,500,000 in General Revenue in fiscal year 2018 to establish a one-time grant program for local mental health authorities (LMHAs) to expand targeted case management and rehabilitative services for highneeds children in the foster care system. See also Rider 199, page II-98. D.2.3 COMMUNITY MENTAL HEALTH CRISIS SVCS 257,930, ,930, ,000,000 See also Highlights of Behavioral Health Related Decisions. a. provides 105,000,000 in General Revenue related to increasing access to behavioral health and substance abuse services, contingent on the enactment of Bill 10, Bill 12, Bill 13, and Bill See also Rider 187, page II-98, Rider 188, page II-98, Rider 189, page II-98, and Rider 190, page II-98. See also Highlights of Behavioral Health Related Decisions. 529 HEALTH AND HUMAN SERVICES COMMISSION Conf Com on SB1 : 4/25/2017 5:08 PM Page 25 of 45

26 Biennial Difference D.2.4 SUBSTANCE ABUSE PREV/INTERV/TREAT 380,964, ,160, ,856 provides an increase of 803,856 in General Revenue for health care services, products, and community-based activities to reduce the incidence, severity, and costs associated with neonatal abstinence syndrome. maintains level funding for the same purpose. F.1.1 GUARDIANSHIP 18,414,613 17,644, ,063 See also Highlights of Behavioral Health Related Decisions. provides an increase of 1,118,725 in General Revenue for the biennium and an additional 4.0 FTEs in each fiscal year of the biennium to provide additional legal support for Guardianship program. F.2.1 INDEPENDENT LIVING SERVICES 29,370,940 28,113,404 1,257,536 F.2.2 BEST PROGRAM 875, ,526 87,526 F.2.3 COMPREHENSIVE REHABILITATION (CRS) 48,271,055 47,810, ,063 F.2.4 DEAF AND HARD OF HEARING SERVICES 11,538,694 9,320,296 2,218,398 F.3.1 FAMILY VIOLENCE SERVICES 56,725,756 57,725,756 1,000,000 provides an increase of 348,662 in General Revenue for the biennium for the Guardianship program. See Cross-Strategy Issue #2. See Cross-Strategy Issue #2. See Cross-Strategy Issue #2. See Cross-Strategy Issue #2. maintains level funding for the Family Violence program. provides an increase of 1,000,000 in General Revenue for the Family Violence program to provide enhanced legal and mental health services to survivors currently served in the program. 529 HEALTH AND HUMAN SERVICES COMMISSION Conf Com on SB1 : 4/25/2017 5:08 PM Page 26 of 45

27 Biennial Difference F.3.2 CHILD ADVOCACY PROGRAMS 52,647,006 56,647,006 4,000,000 maintains level funding for Court Appointed Special Advocates (CASA) and Child Advocacy Centers (CAC). provides an increase of 4,000,000 in General Revenue for CASAs and CACs to increase capacity for children served and volunteer supports. The total for CASA programs is 27,949,000, a 2,000,000 increase above spending levels. The total for CAC programs is 28,698,006, a 2,000,000 increase above spending levels. F.3.3 ADDITIONAL ADVOCACY PROGRAMS 1,938,605 9,157,417 7,218,812 G.1.1 STATE SUPPORTED LIVING CENTERS 1,327,865,640 1,316,112,345 11,753,295 a. reduces 4,223,886 in All Funds for the biennium and 25.9 FTEs in each fiscal year, eliminating funding for the Center for the Elimination of Disproportionality and Disparities. The annual split is: 2018: 394,037 in General Revenue, 629,476 in Federal Funds, 1,093,295 in Other Funds, and a reduction of 25.9 FTEs. 2019: 384,573 in General Revenue, 629,210 in Federal Funds, 1,093,295 in Other Funds, and a reduction of 25.9 FTEs. b. includes 2,994,926 in General Revenue to establish a grant program designed to assist victims of trafficking, which is new funding for the biennium. a. See Cross-Strategy Issue #1. b. provides an FTE cap of 13,591.0 FTEs in fiscal year 2018, FTEs more than the. 529 HEALTH AND HUMAN SERVICES COMMISSION Conf Com on SB1 : 4/25/2017 5:08 PM Page 27 of 45

28 G.2.1 MENTAL HEALTH STATE HOSPITALS / ARTICLE IX SECTION Biennial Difference 874,580, ,456,230 9,875,680 a. provides 3,044,180 in General Revenue and 6,088,360 in capital budget authority to maintain the Avatar electronic health record system at the mental health state hospitals. b. provides 24,800,000 in General Revenue to maintain fiscal year 2017 mental health state hospital service levels. c. provides 10,280,142 in General Revenue for the biennium and an additional FTEs in each fiscal year of the biennium to increase maximum security bed capacity at North Texas State Hospital - Vernon Campus by 24 beds. d. provides 2,000,000 in General Revenue to upgrade the hospital video conferencing system to support the provision of telemedicine services. G.2.2 MENTAL HEALTH COMMUNITY HOSPITALS 223,097, ,943,241 13,154,123 e. provides 50,000,000 from the Economic Stabilization Fund for increased forensic bed capacity at the state hospitals. See also Highlights of Behavioral Health Related Decisions. a. provides 3,154,123 in General Revenue to increase contracted rates for community and private psychiatric hospital beds. G.4.2 FACILITY CAPITAL REPAIRS & RENOV / ARTICLE IX SECTION ,910, ,519, ,609,263 See also Rider 197, page II-98. b. provides 10,000,000 in General Revenue to maintain level funding for fiscal year 2017 purchased psychiatric hospital beds. See also Highlights of Behavioral Health Related Decisions. provides 188,609,263 from the Economic Stabilization Fund for critical life and safety needs at the state hospitals and the State Supported Living Centers. reduces 4,542,844 in General Revenue in the Health and Human Services Commission (HHSC) bill pattern related to deferred maintenance at HHSC facilities and replaces it with the same amount from the Economic Stabilization Fund. See also Article IX, page IX-84. See also Highlights of Behavioral Health Related Decisions. 529 HEALTH AND HUMAN SERVICES COMMISSION Conf Com on SB1 : 4/25/2017 5:08 PM Page 28 of 45

29 Biennial Difference I.2.1 LONG-TERM CARE INTAKE & ACCESS 557,784, ,784,146 - provides an additional 2.4 FTEs to support an additional 276 Home and Community-based waiver slots for foster children aging out of the foster care system. Funding associated with this item is reflected in Goal A, Medicaid Client Services. The annual split for the FTEs is: 2018: 0.8 FTEs 2019: 2.4 FTEs K.1.1 CLIENT AND PROVIDER ACCOUNTABILITY 128,749, ,381,697 4,367,521 a. provides an increase of 4,367,521 in All Funds for the Office of Inspector General including 1,250,000 in General Revenue, 3,750,000 in Federal Funds, and 10,000,000 in capital budget authority to support a new procurement for the Medicaid Fraud and Detection System (MFADS) and 1,250,000 in General Revenue, 1,250,000 in Federal Funds, and 5,000,000 in capital budget authority to support the design, development, and implementation of a new integrated case management system. b. maintains level funding for the Office of Inspector General including 3,132,479 in General Revenue with rider requiring the IG to recover the same amount in the biennium. See also Rider 199, page II-100. L.1.1 HHS SYSTEM SUPPORTS 207,998, ,450,275 1,548,531 a. See Cross-Strategy Issue #1. b. provides 1,250,000 in General Revenue and an additional 4.0 FTEs for additional legal assistance through an interagency contract with the Office of the Attorney General regarding the Steward v. Abbott lawsuit. does not include funding for this purpose. 529 HEALTH AND HUMAN SERVICES COMMISSION Conf Com on SB1 : 4/25/2017 5:08 PM Page 29 of 45

30 Biennial Difference L.1.2 IT OVERSIGHT & PROGRAM SUPPORT 406,229, ,218,343 11,400 M.1.1 TEXAS CIVIL COMMITMENT OFFICE 33,360,483 33,086, ,938 a. See Cross-Strategy Issue #1. b. provides capital budget authority of 7,146,845 for the Social Security Number Removal Initiative. No additional funding provided. a. provides 834,938 in General Revenue to support offsite medical care for sexually violent predators (SVPs) civilly committed to the Texas Civil Commitment Center (TCCC). b. provides 561,000 in General Revenue in fiscal year 2018 to provide Hepatitis C treatment for SVPs committed to the TCCC. See also Rider 184, page II-97. Hospital Uncompensated Care. II-47, Rider 10 Rider Packet, page II-25 II-47, Rider 10 Rider Packet, page II-25 requires HHSC to include in its report an assessment of which funding streams that offset uncompensated care might be redirected. Health and Human Services Cost Containment. / Medicaid Funding Reduction and Cost Containment. II-54, Rider 36 Rider Packet, page II-25 II-53, Rider 36 Rider Packet, page II-25 directs HHSC to achieve savings of million in General Revenue and million in Federal Funds. requires an analysis to be provided of initiatives determined not to be costeffective. HHSC may also achieve these savings through initiatives identified in Rider 178, Managed Care Risk Margin, Rider 182, Managed Care Contract Procurement, Rider 196, Contingency for Bill 1787, and Rider 192, Prescription Drug Savings. directs HHSC to achieve savings of million in General Revenue and million in Federal Funds. includes nine initiatives, while includes 16. Healthy Community Collaboratives. II-56, Rider 48 Rider Packet, page II-27 Mental Health Peer Support Re-entry Pilot. II-57, Rider 49 Rider Packet, page II-28 II-57, Rider 49 Rider Packet, page II-27 II-57, Rider 50 Rider Packet, page II-28 permits 10.0 million of the 25.0 million available to be allocated to rural areas. allocates 1.0 million for a mental health peer support re-entry program. allocates 5.0 million for a mental health peer support re-entry program and to improve statewide capacity for peer certification. requires a report due December 1, HEALTH AND HUMAN SERVICES COMMISSION Conf Com on SB1 : 4/25/2017 5:08 PM Page 30 of 45

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