Intro to Public Health Admin, Grants & Reports

1. Intro to Public Health Admin, Grants & Reports Presentation to the AMSSA Conference June 24, 2014 Dave Greeman, Budget Director

2. To protect, maintain and improve the health of all Minnesotans Health Protection Health Improvement Health Care Reform MDH Mission

3. Health Improvement Bureau Community and Family Health Health Promotion and Chronic Disease Center for Health Equity Office of Statewide Health Improvement Policy, Quality and Compliance Bureau Compliance Monitoring Health Policy Departmental Program Structure Health Protection Bureau • Environmental Health • Infectious Disease Epid., Prevention and Control • Public Health Laboratory • Office of Emergency Preparedness Administrative Services • Finance and Facilities Mgmt • Human Resources • Internal Audits • Information Technology

4. MDH Budget by Funding Source

5. How Sources of Funding Have Changed

6. Largest Sources of Federal Funding2014-15

7. MDH Sections Most Reliant on Federal Funds

8. Total FY 2014 Budget of $595 billion Grants: $393 million (66%) Payroll: $113 million (19%) Non-payroll Operating: $89 million (15%) Staffing Base FY 2014-15 MDH Staffing Levels Total FTEs: 1,264 General Fund FTEs: 135 (10.7%) How Funds Are Spent

9. Health ImprovementCommunity and Family Health • Manages and oversees programs to support families and young children, including WIC and family home visiting • Provides grants and technical assistance for pre-pregnancy family planning • Works with providers and local agencies to improve health and development screenings and follow-up services for children

10. Health ImprovementHealth Promotion and Chronic Disease • Works to improve prevention and treatment of conditions such stroke, diabetes, asthma, arthritis, etc. • Operates breast and cervical cancer screening programs for low-income women • Provides grants for services that improve and protect health including dental sealants, poison control and asthma treatment • Operates a statewide cancer registry

11. Health ImprovementCenter for Health Equity • Collects racial, ethnic, and language data to inform policy makers about the health of populations of color and develops appropriate indicators to measure progress. • Administers the Eliminating Health Disparities Initiative (EHDI) grant program • Connects populations of color with MDH and local public health experts to identify and address actions essential to eliminating heath disparities.

12. Health ImprovementStatewide Health Improvement • Supports all Minnesotans in leading healthier lives, raising healthier families and building healthier communities by preventing disease well before it starts. • Operates programs that address the leading causes of chronic disease, including tobacco use, poor nutrition and lack of physical activity • Operates tobacco cessation programs throughout the state

13. Policy, Quality and ComplianceCompliance Monitoring • Regulates approximately 870 health and long-term care facilities in the state, including hospitals and nursing homes • Regulates health-related professionals. • Investigates reports of maltreatment under the Vulnerable Adults Act • Regulates HMOs and county-based purchasing plans in the state

14. Policy, Quality and ComplianceHealth Policy • Performs research to monitor and understand health care access and quality, market conditions, and care spending. • Develops and leads health reform efforts • Sets standards for primary care clinics and certifies health care homes • Oversees a secure, web-based system for registering all Minnesota births and deaths and issuing certified birth/death records • Supports rural and primary healthcare facilities and providers through technical assistance, grants and workforce support

15. Health ProtectionEnvironmental Health • Monitors the quality of drinking water and prevents contamination • Protects indoor air quality from risks associated with lead, asbestos, radon and tobacco smoke • Protects the safety of food served in commercial establishments • Identifies and responds to emerging environmental health risks

16. Health ProtectionInfectious Disease Epid., Prev. and Control • Detects, investigates and mitigates infectious disease threats and outbreaks using 24/7 response capability • Promotes vaccination to prevent disease and provides vaccines for low-income children • Prevents the spread of disease through HIV prevention grants, providing medications for TB and coordinating health screenings • Prevents and investigates foodborne disease outbreaks

17. Health ProtectionPublic Health Lab • Screens newborns for over 50 serious congenital conditions • Analyzes a wide variety of environmental samples to identify contaminants of emerging concern • Performs tests on patient specimens to determine the presence or absence of disease- causing agents • Trains a network of microbiology laboratories in rapid identification, notification and referral of potential agents of bioterrorism

18. Health ProtectionOffice of Emergency Preparedness • Coordinates state response to public health emergencies caused by infectious disease outbreaks, natural disasters and criminal activities • Maintains communication systems to provide timely information to providers, local governments and the public • Plans and oversees the inventory and distribution systems to disseminate medications and medical supplies in a public health emergency

19. Administrative Services • Manages the MDH budget to ensure that resources are properly tracked, budgets are well-planned, and financial activities meet standards set by federal, state and private funders • Manages facilities space in five metro and eight Greater Minnesota locations • Collects and analyzes data to measure performance of MDH in meeting statewide goals • Operates an internal audit section • Provides legal and internal audit services to the department

20. Under Minnesota’s Local Public Health Act, “a community health board [CHB] has the general responsibility for development and maintenance of a system of community health services under local administration and within a system of state guidelines and standards.” Minn. Stat. §145A.04, subdivision 1 State Public Health System

21. A CHB is the governing body for local public health in Minnesota. A CHB may be comprised of a single county, multiple contiguous counties, or in a limited number of cases, a single city. The powers and duties of a CHB can be assigned to human services board. State Public Health System

22. CHBS are responsible for addressing areas of public health responsibility, which include: (1) assuring an adequate local public health infrastructure;(2) promoting healthy communities and healthy behaviors;(3) preventing the spread of communicable disease;(4) protecting against environmental health hazards; and(5) preparing for and responding to emergencies. State Public Health System

23. MDH operates approximately 100 grant programs to address public health needs in the state. Funding for the programs comes from state and federal sources. Requirements for the programs are set by the Legislature, Congress, and state and federal rules related to budgeting and accounting Grants are awarded to CHBs, local government units and non-profits depending on the requirements Public Health Grants

24. Grants are awarded either competitively or through a formula. • Examples of competitive grants include • Family Planning Special Project • Tobacco Use Prevention • Examples of Formula Grants • Maternal and Child Health Block Grants • Local Public Health Grants • Examples of Grants that combined aspects of both a formula and competition • Statewide Health Improvement Program • Medical Education and Research Types of Public Health Grants

25. Timing of federal grants and reporting cycles are generally driven by: • The budgeting period established by the funding agency • The timing of obtaining legislative approval to spend federal funds. • Many federal grants do not coincide with fiscal or calendar year periods. • MDH must award grants on the cycles dictated by funders in order to ensure that the funds are expended within the grant cycle. Timing of Grants and Grant Cycles

26. The Office of Grants Management has established a grants management policy for all state executive branch agencies. The most recent update of the policy finds that cost reimbursement is the preferred method for making grant payments. Since January 1, 2013, a number of public health grants, including the Local Public Health Act grant and the Maternal and Child Health Block grant have been distributed through a cost reimbursement system. Public Health Grant Payments

27. Advance payments may be allowed if an agency believes that a grantee will account for the grant funds and abide by the terms of the agreement. In order to make advance payments, agencies must prepare a written justification. Public Health Grant Payments

28. State agencies must conduct one monitoring visit per grant period for each grant over $50,000 and once per year for grants over $250,000. State agencies must also conduct financial reconciliation of grantees’ expenditures at least once during the grant period on grants over $50,000. Public Health Grant Monitoring

29. Generally local government grantees that do not have a federally approved indirect cost rate may use an indirect cost rate equal to 10% of modified total direct costs Local grantees may account for staffing costs as direct expenditures if those costs can be directly attributed to the program. Reporting and Claiming Administrative Costs

30. CHBs that comply with the LPHA are eligible for funding through the LPHA Grant LPHA grant funds awarded in CY 2014 totaled $32.9 million LPHA grants include state General Funds, Federal TANF funds and Federal Title V funds Each CHBs allocation is based on 2003 allocations for a number of categorical grants. Local Public Health Grant

31. CHBs must provide a 75% match for state funds received through the LPHA grant. Funds eligible for the local match include property taxes, reimbursements from third parties, fees, other local funds, and donations or non-federal grants used to address public health activities. CHBs may use LPHA grants to address areas of public health responsibility and local priorities developed through a community health assessment and community health improvement planning process. Local Public Health Grant

32. Dave Greeman Budget Director Minnesota Department of Health Phone: 651 201-5235 E-mail: dave.greeman@state.mn.us Contact Information