Budget Highlights for the Department of State Hospitals (DSH) in FY 2021-22, Exams of Construction

Download Budget Highlights for the Department of State Hospitals (DSH) in FY 2021-22 and more Exams Construction in PDF only on Docsity! 2021-22 May Revision Highlights: May 14th, 2021 Page 1 of 13 The Department of State Hospital’s (DSH) proposed budget for fiscal year (FY) 2021-22 totals $2.5 billion – a decrease of $41 million (a decrease of two percent) from the 2021-22 Governor’s Budget - with 165.2 proposed positions in the budget year (BY). The proposed budget includes investments in community and jail-based programs to continue DSH’s efforts towards meeting the increased demand for services for individuals deemed Incompetent to Stand Trial (IST), improving the departments operations and delivery of services, and state hospital facility repairs and improvements. SUPPORT COMPARISON FY 2021-22 Governor's Budget vs. FY 2021-22 May Revision (Dollars in Thousands) FUNDING SOURCE FY 2021-22 Governor's Budget FY 2021-22 May Revision Difference % Change General Fund (0001) $2,301,880 $2,308,891 $7,011 0% Lease Revenue Bond (Ref 003) $40,631 $40,631 $0 0% State Hospitals $40,631 $40,631 $0 0% Support Funds (Ref 011) $2,206,790 $2,196,095 ($10,695) 0% Administration $176,134 $206,087 $29,953 17% State Hospitals $1,557,868 $1,685,840 $127,972 8% CONREP $65,693 $69,457 $3,764 6% Contracted Patient Services $384,068 $198,871 ($185,197) -48% Evaluation & Forensic Services $23,027 $35,840 $12,813 56% Support HIPAA (Ref 017) $1,377 $1,857 $480 35% Administration $1,377 $1,857 $480 35% Support COVID-19 (Ref 021) $51,982 $69,208 $17,226 33% Administration $4,148 $475 ($3,673) -89% State Hospitals $47,634 $68,731 $21,097 44% Contracted Patient Services $200 $0 ($200) -100% Evaluation & Forensic Services $0 $2 $2 100% Non- Budget Act (Ref 502) $1,100 $1,100 $0 0% Medicare- State Hospital $1,100 $1,100 $0 0% Lottery Fund (0814) $27 $27 $0 0% State Hospitals $27 $27 $0 0% Reimbursements (Ref 511) $183,684 $158,980 ($24,704) -13% Administration $252 $176 ($76) -30% State Hospitals $183,432 $158,804 ($24,628) -13% TOTALS $2,485,591 $2,467,898 ($17,693) -1% 2021-22 May Revision Highlights: May 14th, 2021 Page 2 of 13 CAPITAL OUTLAY COMPARISON FY 2021-22 Governor's Budge vs. FY 2021-22 May Revision (Dollars in Thousands) FUNDING SOURCE FY 2021-22 Governor's Budget FY 2021-22 May Revision Difference % Change General Fund (0001) $54,320 $31,480 ($22,840) -42% Capital Outlay $54,320 $31,480 ($22,840) -42% Public Bldg Construction (0660) $22,024 $22,024 $0 0% Capital Outlay $22,024 $22,024 $0 0% TOTALS $76,344 $53,504 ($22,840) -30% TOTAL State Hospitals FY 2021-22 Governor's Budge vs. FY 2021-22 May Revision (Dollars in Thousands) FUNDING SOURCE FY 2021-22 Governor's Budget FY 2021-22 May Revision Difference % Change State Operations $2,485,591 $2,467,898 ($17,693) -1% Capital Outlay $76,344 $53,504 ($22,840) 0% TOTALS $2,561,935 $2,521,402 ($40,533) -2% SUPPORT BUDGET The FY 2021-22 May Revision reflects a net decrease of $24.7 million in General Fund in FY 2020-21 and a net increase of $7 million in General Fund in FY 2021-22. Also reflected is a net decrease of $24.7 million in Reimbursement Authority in FY 2021-22. The following provides specific detail of proposed budget adjustments. SPRING FINANCE LETTERS AND BUDGET CHANGE PROPOSALS Spring Finance Letters ($3.6 million and 2.0 positions in FY 2021-22) o Relocation to the Clifford L. Allenby Building – Phase 3 ($3.3 million and 2.0 positions in FY 2021-22) DSH proposes 2.0 positions (authority only) and $3.3 million in FY 2021-22 and ongoing to support increased rent cost associated with the relocation of DSH-Sacramento to the Clifford L. Allenby Building. The $3.3 million supports DSH’s portion of the increased rent cost. Building occupancy is expected to begin in June 2021. The requested staffing will be providing technology support to California Health and Human Services (CHHSA). 2021-22 May Revision Highlights: May 14th, 2021 Page 5 of 13 o DSH-Metropolitan Increase Secured Bed Capacity ($17,000 and -1.2 position authority in FY 2021-22) The 2020 Budget Act provided funding for DSH to activate the remaining three units of a five-unit secured bed capacity expansion to provide additional bed capacity to treat individuals committed to DSH as IST. Due to COVID-19, DSH is experiencing a two-month delay in the activation of the three remaining units for this purpose. The three remaining units are projected to be activated in September 2021. The Continuing Treatment East Fire Alarm Upgrade installation is projected to be completed in August or September 2021 pending no further delays. DSH-Metropolitan prioritized using the three inactive units for its COVID-19 response. One unit has been utilized for isolation of patients testing positive for COVID- 19 and the other two units are being used as Admission Observation Units (AOUs). Additionally, as DSH is finalizing the position phase associated with the bed activations, a position authority and funding calculation error was observed. DSH has corrected the position authority and funding calculation error to reflect a permanent reduction of 1.2 position authority and $17,000 in FY 2021-22 and ongoing. o Enhanced Treatment Program (ETP) (-$3.7 million and -23.0 positions in FY 2020-21; $329,000 and - 8.2 positions in FY 2021-22) ETP is an enhanced level of care designed to treat patients who are at the highest risk of violence and who cannot be safely treated in a standard treatment environment. These units will provide improved treatment in a heightened secure setting to patients with a demonstrated and sustained risk of aggressive, violent behavior toward other patients and staff. DSH anticipates additional activation delays in all four units. The continued delays are due to existing site conditions, code issues, unforeseen conditions such as unknown regular and low voltage electrical conduits, materials damage, unexpected ductwork, and the uncertainties related to COVID-19. As a result, DSH will yield an additional one-time savings of $3.7 million and 23.0 positions in FY 2020-21, a one-time savings of $686,000 and 8.2 positions in FY 2021-22, and an ongoing request of $1.0 million in 2021-22, for a total May Revision request of $329,000 in FY 2021-22 and $1.0 million in FY 2022-23 ongoing. o Vocational Services and Patient Minimum Wage Caseload (-$625,000 in FY 2020-21) Due to COVID-19, DSH patient vocational referrals continue to be low, mostly due to the fact many job sites cannot host patient workers at this time because of restrictions on patient movement around the hospital. DSH will yield a one-time savings of $625,000 in FY 2020-21 as a result of lower participation in the vocational services program due to COVID-19. DSH is projecting the program to resume standard operations January 2022. An update will be provided in the FY 2022-23 Governor’s Budget. o Mission Based Review - Court Evaluations and Reports (-$2.7 million and -13.7 positions in FY 2020-21; $222,000 and in FY 2021-22) This staffing standard establishes population-driven methods for calculating staffing needs for the following forensic functions: Evaluations, Court Reports and Testimony, Forensic Case Management and Data Tracking, and Neuropsychological Services (Neuropsychological Assessments and Cognitive Remediation Pilot Program). The 2019 Budget Act included 94.6 permanent full-time positions and $40.3 million, phased-in over a three-year period, to implement a staffing standard to support the forensic services workload associated with court-directed patient treatment. In response to the economic impact of the COVID-19 pandemic, the 2020 Budget Act revised the implementation of this staffing standard to phase-in across a four-year period. As of March 1, 2021, 59.8 positions have been established and 41.0 have been filled. 27.2 positions approved in the 2019 Budget Act are scheduled to be phased in in FY 2021-22. DSH also recognized an oversight in the position phase-in process; the positions phased-in during BY+2 and ongoing were underfunded. Due to ongoing delays in hiring, DSH is reporting a one- time savings of 13.7 positions and $2.7 million in FY 2020-21, and requests $222,000 in FY 2021-22 and ongoing to account for the underfunded phased-in positions. 2021-22 May Revision Highlights: May 14th, 2021 Page 6 of 13 o Mission Based Review - Direct Care Nursing (-$4.4 million and -39.1 positions in FY 2020-21; $434,000 in FY 2021-22) This staffing standard examined nurse-to-patient ratios for providing nursing care and the components available to achieve these ratios. This analysis included internal registries, overtime, and position movements among facilities. It also included staffing methodologies for the administration of medication and the afterhours nursing supervisory structure. The 2019 Budget Act included a total of 379.5 positions and $46 million, phased-in over a three-year period, to support the workload of providing 24-hour care nursing services at the hospitals. In response to the economic impacts of the COVID-19 pandemic, the 2020 Budget Act revised the implementation of this staffing standard to phase-in across a four-year period. As of March 1, 2021, 104.5 positions have been established and 72.3 have been filled. 135.5 positions approved in the 2019 Budget Act are scheduled to be phased in in FY 2021-22. Recruitment for the positions phased-in as of April 1, 2021 is in progress at the hospitals. Additionally, DSH recognized an oversight in the position phase-in process; the positions phased-in during BY+2 and ongoing were underfunded. Due to ongoing delays in hiring, DSH is reporting a one-time savings of 39.1 positions and $4.4 million in FY 2020-21, and requests $434,000 in FY 2021-22 and ongoing to account for the underfunded phased-in positions. o Mission Based Review - Workforce Development (-$203,000 and -1.2 positions in FY 2020-21; -$40,000 in FY 2021-22) The 2019 Budget Act included resources to support the development and implementation of a Psychiatric Residency Program and expand resources for Nursing Recruitment to meet the mission of providing mental health services to patients and reduce vacancy rates for mental health providers. As of the 2021- 22 May Revision, the Psychiatric Residency Program is currently anticipating holding the first cohort in July 2021. For the Psychiatric Technician Program, DSH-Atascadero and DSH-Napa have expanded their cohorts. DSH-Coalinga is no longer moving forward with the West Hills College contract to expand the Psychiatric Technician Program. As a result, DSH will redirect the allocated Nurse Instructor to the DSH-Sacramento Recruitment Unit and reclass to an Associate Governmental Program Analyst (AGPA) to work as a Recruitment Outreach Specialist. Due to ongoing delays in hiring, DSH is reporting a one- time savings of 1.2 positions and $203,000 in FY 2020-21 and an ongoing savings of $40,000 in FY 2021-22. o Mission Based Review - Treatment Team and Primary Care (-$4.4 million and -13.4 positions in FY 2020- 21; $22.8 million and 44.3 positions in FY 2021-22) This staffing standard uses data-informed methodologies for standardizing caseload for DSH’s interdisciplinary treatment team and primary care, resulting in an increase in the number of treatment teams and primary care physicians in the state hospitals. This will improve patient outcomes, result in shorter lengths of stay, and reduce patient violence and staff injuries. In the 2020 Budget Act, due to COVID-19, the Legislature approved the methodologies contained in the BCP but were only able to provide funding and resources of $5 million and 12.5 positions in FY 2020-21 and $10 million and 30.0 positions in FY 2021-22 and ongoing for both the MBR-Treatment Team and Primary Care and MBR- Protective Services proposals. DSH prioritized the funding and resources be allocated to this proposal. As of the FY 2021-22 May Revision, DSH requests the funding and position authority for full implementation of the BCP to be phased in over five years in alignment with the methodology previously approved. DSH yields one-time savings in FY 2020-21 of $4.4 million and 13.4 positions due to hiring delays. DSH requests $12.2 million one-time funding, $10.6 million and 44.3 positions in FY 2021-22, $28 million and 113.0 positions in FY 2022-23, $39.8 million and 161.7 positions in FY 2023-24, $47.5 million and 191.7 positions in FY 2024-25 and $54.1 million and 213.3 positions in FY 2025-26 and ongoing. 2021-22 May Revision Highlights: May 14th, 2021 Page 7 of 13 o Mission Based Review - Protective Services ($6.5 million and 35.8 positions in FY 2021-22) This staffing standard identifies protective service posts and establishes workload-driven staffing methodologies to allocate adequate resources for essential police functions and reduce overtime usage. In the 2020 Budget Act, due to COVID-19, the Legislature approved the methodologies contained in the BCP but were only able to provide funding and resources of $5 million and 12.5 positions in FY 2020-21 and $10 million and 30.0 positions in FY 2021-22 and ongoing for both the MBR-Treatment Team and Primary Care and MBR-Protective Services. DSH prioritized the funding and resources to be allocated for the MBR-Treatment Team and Primary Care. Subsequently, the Department of Finance approved DSH to utilize the overtime budget for off-grounds custody, and DSH administratively established 12.0 Hospital Police Officer positions in FY 2020-21. As of the 2021-22 May Revision, DSH requests the funding and position authority for full implementation of the BCP to be phased in over two years in alignment with the methodology previously approved. DSH requests $6.5 million and 35.8 positions in FY 2021-22 and $11.3 million and 71.3 positions in FY 2022-23 and ongoing. o COVID-19 Informational Only (No position authority or dollar change) COVID-19 has been a rapidly evolving event and DSH has and continues to actively plan and prepare for COVID-19 across the DSH system, following guidance issued from the California Department of Public Health (CDPH), the Centers for Disease Control and Prevention (CDC), and other state and local partners. Changes are made to the DSH system on an ongoing basis in order to be responsive to COVID- 19 and overcome challenges this pandemic presents. DSH has implemented its vaccine campaign, and vaccinations have been made available to all employees and patients at each state hospital. As of March 30, 2021, DSH performed 64,134 tests on a cumulative total of 7,203 patients across all five hospitals, with a total of 1,885 patients testing positive. DSH also performed 86,985 staff tests statewide and with a total of 1,988 testing positive. DSH has administered a total of 8,502 vaccinations to patients and 14,400 to employees as of March 30, 2021. o Telepsychiatry Resources (-$635,000 and -4.7 positions in FY 2020-21) In the 2019 Budget Act, DSH added clinical oversight and supervision, telepsychiatry coordinators, and information technology (IT) equipment and resources to support the Telepsychiatry program. As of January 1, 2021, the 7.0 coordinator positions allocated to DSH-Atascadero were transferred to DSH- Coalinga, and recruitment has begun. Due to the delay in hiring, DSH will yield an additional one-time savings of $635,000 and 4.7 positions in FY 2020-21. 2021-22 May Revision Highlights: May 14th, 2021 Page 10 of 13 o Community-Based Restoration (CBR) Program (-$4.9 million in FY 2020-21; $28.3 million and 4.5 positions in FY 2021-22) To support the development of a comprehensive continuum of care for felony ISTs, DSH reflects a savings of $4.9 million FY 2020-21, requests $28.3 million in FY 2021-22, $54.9 million in FY 2022-23, $51.3 million in FY 2023-24, $49.8 million in FY 2024-25 and ongoing. DSH requests 4.5 permanent fulltime positions in FY 2021-22 and ongoing. This funding will cover the costs of expanding the Los Angeles (LA) community-based treatment program and to establish new programs in additional counties. DSH is requesting ongoing funding for the 200-bed expansion presented in the 2021-22 Governor’s Budget. DSH is also requesting funding for an additional 100 LA County beds to be activated by September 2021. DSH is requesting an additional 202 new beds in 17 additional counties activated over a three-year period. This will total an additional 300 beds in LA County and 252 beds for additional counties. o Statewide Incompetent to Stand Trial Off-Ramp (SISTOR) Program (No position authority or dollar change) DSH anticipates a slight delay in selecting a provider in mid-spring 2021, resulting in a one-time FY 2020- 21 savings of $293,000. The implementation delay is due to unanticipated challenges in the contracting process which resulted in an unsuccessful first round of competitive bidding. DSH is utilizing this one- time CY savings to offset costs associated with the IST evaluation caseload until the SISTOR program is implemented. DSH is utilizing forensically trained DSH evaluators (Consulting Psychologists) who conduct Offender with Mental Health Disorder (OMD) forensic evaluations, to temporarily provide the SISTOR evaluations. With focused IST evaluation training, the OMD evaluators perform competency evaluations of ISTs and off-ramp defendants from the IST pending placement list who may have already regained competency. DSH estimates that the final annual cost of the SISTOR contract to be executed will be approximately $1 million and therefore proposes to redirect the remaining $1 million of SISTOR funding to support the Re-Evaluation Services for Felony IST proposal in BY and ongoing. Evaluation and Forensic Services Estimate (-$520,000 in FY 2020-21; $12.7 million and 15.5 positions in FY 2021-22) o Sex Offender Commitment Program (SOCP) and Offender with a Mental Health Disorder (OMD) Pre- Commitment Program: Caseload Update (-$520,000 in FY 2020-21) In response to the COVID-19 pandemic, the California Department of Corrections and Rehabilitation (CDCR) reduced its population in order to reduce the risk of transmission of COVID-19 within its facilities. As a result, CDCR has been pursuing a series of accelerated release efforts and DSH has seen an increase in rush referrals. However, overall referral totals have trended downward in recent months and OMD evaluators were able to perform tele-evaluations in lieu of traveling to perform evaluations in person. This created a one-time savings of $520,000 in FY 2020-21. This downward trend has allowed for the temporary assignment of critical IST evaluation workload to OMD evaluators. Utilizing the SISTOR program’s one-time CY savings, DSH will be utilizing 13.0 OMD evaluators to assist in performing IST evaluations for three months. 2021-22 May Revision Highlights: May 14th, 2021 Page 11 of 13 o Re-Evaluation Services for Felony ISTs ($12.7 million and 15.5 positions in FY 2021-22) DSH proposes to establish the Re-Evaluation Services for Felony IST program on a four-year limited- term basis beginning in FY 2021-22. This program will allow DSH to re-evaluate individuals deemed IST on a felony charge who have been waiting in jail for 60 days or more pending transfer to a DSH restoration of competency program. The workload and costs for this proposal fall into three main categories (1) DSH contracted forensic evaluators and associated travel support when necessary to provide in person services; (2) DSH clinical, administrative, and operational staff to support coordination of service delivery; and (3) Reimbursement of jail IT costs (including laptops and licenses) to facilitate the tele-evaluations and a flat reimbursement rate per each IST defendant evaluated available for payment to the Sheriff to cover the jail staff time to provide support and escort the patient for the evaluation. Including the redirection of $1.0 million from the SISTOR program, DSH requests $12.7 million in FY 2021-22, $11.0 million in FY 2022-23, and $10.2 million in FY 2023-24 and FY 2024-25 to implement the Re-Evaluation Services program. DSH also requests 15.5 positions beginning in FY 2021-22 to assist with clinical, operational, and administrative oversight. After the third year of program implementation, DSH will assess the need to extend all or a portion of the resources on an ongoing basis and, if necessary, submit a new budget request for the FY 2025-26 budget cycle. DSH Technical Adjustment (No position authority or dollar change) o DSH is proposing a net-zero technical adjustment to realign resources in FY 2021-22 and ongoing. This adjustment is needed to properly align budget and position authority within existing resources to where expenditure will occur. This request does not adjust DSH’s funding levels. CAPITAL OUTLAY BUDGET The FY 2021-22 May Revision reflects a net decrease of $229,000 in General Fund in FY 2020-21 and a net decrease of $22.8 million in General Fund in FY 2021-22. SPRING FINANCE LETTERS AND CAPITAL OUTLAY BUDGET CHANGE PROPOSALS Spring Finance Letters (-$229,000 in FY 2020-21; -$22.8 million in FY 2021-22) o Coalinga: Hydronic Loop Replacement (-$23.1 million in FY 2021-22) DSH requests a decrease of $23.1 million for the DSH-Coalinga Hydronic Loop Replacement project based on the Department of General Services (DGS) updated cost estimate. The total request, for all phases, will be $27,463,000 with $539,000 for preliminary plans, $744,000 for working drawings, and $26,180,000 for construction. This project replaces the severely corroded and deteriorated hydronic loop piping system with a completely new hydronic loop piping system which will efficiently provide hot water and heating to the facilities including patient occupied buildings. DSH and DGS evaluated alternative system options for the project and selected a specialized hydronic loop plastic piping system which reduced the construction costs in both labor and material. This system will deliver the required protection from the corrosive soil thereby providing both longevity of the product and is a cost-effective solution. Provisional language is also requested regarding the availability of funds allowing for the completion of working drawings and construction. 2021-22 May Revision Highlights: May 14th, 2021 Page 12 of 13 o Atascadero: Potable Water Booster Pump System (-$229,000 in FY 2020-21 and $229,000 in FY 2021- 22) DSH requests a re-appropriation of $229,000 for Working Drawings of the Atascadero: Potable Water Booster System. The re-appropriation is necessary to address project delays such as completing the real estate due diligence during the preliminary plans phase driven by the COVID-19 Pandemic. This re- appropriation will allow DSH to complete the working drawings phase of the project and proceed to construction in fiscal year 2022-23. The project includes installing a potable water booster pump system to serve DSH-Atascadero to address water line pressure issues that support the main fire sprinkler system and domestic water operations (i.e. patient showers, sinks, toilets).