1996 annual report

1996 Annual Report from the Budgetary Responsibility Oversight Committee
1996 BROC Annual Report
This document, linked to the homepage of the Budgetary Responsibility Oversight Committee (BROC) of the Georgia General Assembly, is the Web version of the BROC Committee's 1996 Annual Report. It describes the Committee, its Research Office, and its duties and reports. Contained also are summaries of reports presented to and acted upon by BROC.
BROC
BUDGETARY RESPONSIBILITY OVERSIGHT COMMITTEE
1996 ANNUAL REPORT
THE GENERAL ASSEMBLY
STATE OF GEORGIA
ORDER OF CONTENTS
Chairman's Report to the Governor and the General Assembly
Budgetary Responsibility Oversight Committee
BROC Vision, Mission, and Beliefs
Reports to BROC
Summaries
q Construction Management Process q Contracted Computer Personnel q Parolee Supervision q DOAS Workers' Compensation q Railroad Acquisition and Rehabilitation q Length of Stay in Foster Care
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1996 Annual Report from the Budgetary Responsibility Oversight Committee
q HIV/AIDS Prevention q Georgia Cancer Registry q Multi-Agency Team for Children (MATCH) q Children's Trust Fund Commission q Georgia Child Care Council q Dental Treatment and Sealant Program
Chairman's Report To the Governor and the General Assembly
January 1997
In accordance with O.C.G.A. 28-5-5(f), the Budgetary Responsibility Oversight Committee submits this annual report of committee activities. Included are summaries of the evaluative findings, agency responses, and committee recommendations for programs we reviewed in calendar year 1996.
Budgetary responsibility in Georgia state government is firmly established upon a widely shared conviction that Georgia's Legislature, the Governor, and state agency leadership should use a deliberative process to develop an increasingly clear idea of preferred future organizational directions and missions. It is crucial that state activities be coordinated among the agencies by their adherence to a common vision. During 1996, the Budgetary Responsibility Oversight Committee (BROC) welcomed the completion and publication of the state's first formal strategic plan by the Governor's office. For each coming year, the General Assembly can look forward to receiving annual updates from the Governor, as required by O.C.G.A. 45-12-177(b).
That agency programs should have goals and objectives, together with indicators of achievement and performance, has been a recurring refrain throughout the past year as BROC examined state endeavors. Legislation passed and signed into law as the Budget Accountability and Planning Act of 1993 requires that all agencies develop strategic plans, and that goals, objectives, and performance measures be established at the programmatic level. In balance with the need for the executive branch to establish state agency strategic planning is the need for the legislative branch to evaluate the performance of agencies' programs. We are confident that these efforts will place both legislators and executive branch personnel in better positions to make budgeting decisions in the future.
In order to ensure that agencies are providing services to the citizens of Georgia in the most effective and efficient manner, state agency program managers and policy makers must have access to accurate and relevant data about services provided. Several of the reports heard by BROC this year on such programs as Foster Care, HIV/AIDS, the Cancer Registry, MATCH, the Children's Trust Fund Commission,
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1996 Annual Report from the Budgetary Responsibility Oversight Committee
Parolee Supervision, and the Management of Construction Projects showed disturbingly that some programs still lack reliable data necessary for the best program management. We continue to expect state agencies to cooperate with the Information Technology Policy Council as it seeks to establish policies promoting more effective and efficient use of information technology, and that the data problems addressed in the program evaluations presented to BROC in 1996 will be resolved in the near future.
Privatization, or outsourcing, is an option that we are all considering more frequently for program operation and service acquisition. During the past year, BROC heard about outsourcing applied to some parts of DOAS's Workers Compensation program, to the design and construction of state facilities, to inmate health care, and for many computer-related services. While privatization is certainly an option that may be advanced if it results in agency personnel being better stewards of taxpayers' dollars, it is necessary to be sure that the citizens of Georgia are getting a better deal with newly privatized services. BROC's program evaluation efforts constitute an important ongoing review of privatization on behalf of the legislative branch.
We hope the readers of this document will find the information in it useful.
Sincerely,
Terry L. Coleman Representative, House District 142 1996 Chairman, Budgetary Responsibility Oversight Committee
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Budgetary Responsibility Oversight Committee
The Budget Accountability and Planning Act of 1993 established the Budgetary Responsibility Oversight Committee (BROC) to evaluate and report on the efficiency and effectiveness of state operations.
Among BROC's duties is to consult with the Governor and OPB concerning the development and implementation of the strategic planning process, the development of outcome measures for program evaluation, and the implementation of related actions. In addition, the members of the committee review and evaluate: strategic plans submitted by OPB, program evaluation reports, the continuation budget report, information on new programs, information on reports submitted to OPB identifying dollars received of expended where not contemplated by the Appropriations Act, and other information and reports.
Programs and activities of Georgia's state government now cost over eleven billion dollars each year.
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Legislators and administrators are under intense pressure to allocate state taxpayers' money effectively and to make government work more efficiently.
In line with a majority of the other states, BROC's authorizing legislation redirects the focus of program budgeting away from simple continuation of established line item expenditures to funding based on outcomes and achievement of agreed upon goals and objectives.
BROC determines the programs or policies to be evaluated in consultation with the leadership of the General Assembly and the Governor. Legislators or others who want a particular topic to be reviewed by BROC should submit a formal written request to the chair of the Budgetary Responsibility Oversight Committee.
1996 Members of the Budgetary Responsibility Oversight Committee
q Representative Terry L. Coleman, Chair and Chair of House Appropriations Committee q Representative Thomas B. Buck III, Chair of House Ways and Means Committee q Representative Bill Lee, Chair of House Rules Committee q Representative Larry J. "Butch" Parrish, Vice-Chair of House Appropriations Committee q Representative Calvin Smyre, Chair of University System of Georgia Committee q Representative Larry Walker, Majority Leader
q Senator George Hooks, Vice-Chair and Chair of Senate Appropriations Committee q Senator Arthur B. "Skin" Edge IV, Minority Leader (now retired) q Senator Sonny Perdue, Majority Leader q Senator David Scott, Chair of Senate Rules Committee q Senator Terrell Starr, Chair of Senate Finance and Public Utilities Committee q Senator Charles W. Walker, Chair of Senate Health and Human Services Comm.
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1996 BROC Research Office Staff
q Kevin Fillion, M.A., M.B.A., Director q Marion Y. Throckmorton, M.B.A., Deputy Director (now retired) q Kevin Fillion, M.P.A., Deputy Director (formerly senior analyst) q Hilda L. Jackson, M.P.A., Program Analyst II q E. Lee McElhannon, M.B.A., Program Analyst II q Glynnell Lewis, Office Manager
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BROC Vision, Mission, and Beliefs
The joint Budgetary Responsibility Oversight Committee evaluates itself in light of its own Vision, Mission, and Beliefs:
Vision
The Budgetary Responsibility Oversight Committee shall be the principal state program review arm of the Georgia General Assembly, measuring program performance against commonsense standards of efficiency while comparing program goals with legislative intent.
Mission
The mission of the Budgetary Responsibility Oversight Committee is to follow the intent of the General Assembly that taxpayer dollars be spent in the most effective and efficient manner possible. We will recommend that the General Assembly deny resources to unworthy or redundant programs. We will recommend improvements for worthy programs to allow them to become effective and efficient. We will, further, advise the General Assembly whether the strategic plans of individual agencies are consistent with the intent of the legislature and with the state strategic plan.
Beliefs
The members of the Budgetary Responsibility Oversight Committee believe that . . .
1. The General Assembly has the responsibility to decide which, out of the many needs and wants of human existence, are the appropriate social problems to be addressed by legislation and the expenditure of tax dollars in state programs.
2. Legislative responsibility properly pertains to the recognition of a social problem to be addressed by state action. Such legislative responsibility is not discharged merely by funding wellintentioned programs, but includes oversight of the programs themselves through evaluations of their functions and performance.
3. Social problems recognized as properly in the domain of government intervention should be addressed in a coordinated manner by relevant state agencies.
4. The people of Georgia deserve assurance that their elected representatives are engaged in an ongoing review of expenditures by state agencies.
5. A vigilant effort to determine if tax money is actually being put to use according to legislative
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intent is the proper duty of the Budgetary Responsibility Oversight Committee. 6. Sound advice based on objective and impartial research is the product we are constituted to give to
the General Assembly of the State of Georgia.
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Reports to BROC
Evaluation Reports
Program evaluations examine how well a program is operating or whether a program is achieving the results the Legislature intended. Such evaluations help legislators in their decisions about whether to continue, expand, or eliminate particular programs.
The Budgetary Responsibility Oversight Committee has decided that it can improve its own effectiveness in the future by focusing program evaluation efforts each year on a specific theme around an issue that is of particular significance. Although not in effect in 1996, for calendar year 1997, the theme is "Economic Development through Workforce Preparedness." Professional evaluation staff are currently working on the state's programs that are related to this theme. The next annual report will deal more specifically with the state's policy on workforce issues.
During calendar year 1996, professional evaluators from the Georgia Department of Audits and Accounts, the Governor's Office of Planning and Budget, and from the BROC Research Office conducted 13 program evaluations in the areas of Criminal Justice, General Government, and Human Development. The following is a listing of evaluations along with their month of publication and shortcuts to the report summaries:
Criminal Justice r Parolee Supervision (October)
General Government r DOAS's Workers compensation Program for State Employees (May) r Construction Management Process (June) r Contracted Computer Personnel (June) r Contracted Legal Services (June) r DOT Railroad Acquisition and Rehabilitation Program (November)
Human Development r DHR Foster Care Program (June) r DHR HIV/AIDS Treatment Program (June)
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r DHR Cancer Control Program: Registry (August) r MATCH (Troubled Children) Program (August) r Children's Trust Fund Commission (October) r Georgia Child Care Council (November) r DHR Dental Treatment and Sealant Program (November)
Three issues emerged repeatedly during 1996 from the evaluations conducted:
1. Agencies and their programs have yet to establish adequately their goals, objectives, and performance measures for use in assessing the effectiveness of the services they provide;
2. Many agencies do not have complete and accurate data necessary to manage their programs effectively and assure the proper use of state funding; and
3. As programs and services are privatized through outsourcing or other means, the state has a vital interest in diligent oversight of the privatized provision of services.
The Budgetary Responsibility Oversight Committee commends the services of staff from the Performance Audit Operations Division of the Department of Audits, and from the Program Evaluation Division of the Office of Planning and Budget, for their invaluable aid to the committee during 1996.
Follow-Up Reports
Follow-up reports revisit programs that have already undergone formal evaluation review. The follow-up process is designed to examine the progress of program performance during an appropriate intervening period. The objective of follow-up evaluations is to see if state government has improved. The follow-up evaluation will determine what agencies have done to address findings of the original evaluation and whether the initiatives taken had their intended effect.
The BROC Research Office completed a follow up review to the 1994 evaluation of the Inmate Physical Health Care Program within the Department of Corrections to determine what improvements had been made since the time of the evaluation. Copies of this BROC Follow-Up report are available from the BROC Research Office.
Continuation Reports
Continuation reports are prepared by policy analysts from the Governor's Office of Planning and Budget. These reports give a general background and operational description of currently funded state government programs. BROC received seven continuation reports in 1996:
q Department of Industry, Trade and Tourism (June) q Department of Natural Resources, Coastal Resources Division (June) q University System of Georgia, Advanced Technology Development Center (May)
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q University System of Georgia, Center for Rehabilitation Technology (April) q University System of Georgia, Education Extension Service (May) q University System of Georgia, Forestry Research Program (April) q University System of Georgia, Regents' Scholarships and Regents' Opportunity Grants (April)
Strategic Planning
The BROC Research Office staff work cooperatively with the Office of Planning and Budget's Strategic Planning Division to review agency planning efforts. The Budgetary Responsibility Oversight Committee's primary interest in overseeing this important process in state government is to promote consistent and compatible strategic directions among state agencies. According to personnel from OPB, all state agencies have at least initiated the strategic planning process and many state agencies have completed at least one version of their strategic plans. Realizing that strategic planning is an ongoing process, BROC, on behalf of the General Assembly, sponsors an annual strategic planning conference each January to highlight some of the strategic directions of the state. The Governor's Office of Planning and Budget provided a draft copy of the state's strategic plan to BROC in December 1996; OPB has now published the final version.
Results Based Budgeting
As a continuation of the phased-in approach to the new results based budgeting system, required under the Budget Accountability and Planning Act of 1993, OPB asked all agencies to provide descriptive information for each of their programs in their 1998 budget requests. This information includes program purpose, goals, objectives, and performance measures for all programs identified. At the end of 1996, OPB continued to compile a master list of all state government programs.
According to their results based budgeting implementation calendar, OPB plans for agencies to have program descriptions and performance measures finalized in the FY99 budget. With help from the Legislative Budget Office and the Governor's Office of Planning and Budget, the BROC Research Office is developing an inventory of all state programs along with their purpose, goals, objectives and performance measures to be used for evaluation purposes.
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Summary of Findings and Agency Responses
Construction Management Process Evaluated: June 1996 by BROC Research Office
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Each year, over $500 million are appropriated for capital outlay projects needed by state agencies in Georgia; most of these funds are used for the construction of new facilities. This evaluation focused on a sample of new facilities that were funded during the last five fiscal years, 1991 through 1995, to determine whether the state's construction management process was effective at providing agencies with the facilities they need on time and within budget. At the conclusion of their evaluation of the state's construction management process, staff from the BROC Research Office reported (with Current Status in italics) that:
1. Facilities are generally not completed within original budgets; total actual construction costs for 60 projects were 11 percent greater than original construction budgets. r There is broad agreement--within state government and without--that original budgets are exceeded largely because the original budgets were not based on solid predesign studies that would develop essential information, including cost estimates, to support and advance the decision making process prior to the design and implementation phases of construction. Predesign means that phase of construction activity where requirements programming, site analysis, and other appropriate studies are conducted.
2. Almost half of the completed facilities reviewed were not completed within the time given for construction. r Lacking predesign studies, original estimates for construction time are as faulty as original budget estimates. Delays for unanticipated complications and change orders result.
3. Completed facilities generally do meet the need of the program or agency for which the facility was built although owners did report some problems with construction. r Predesign studies will cover more systematically the requirements programming necessary for owners to express their needs and for professionals subsequently to translate these expressions into a functional product.
4. No single entity is accountable for the expenditure of capital outlay dollars; the capital budgeting process does not always ensure that funds are available to have a facility constructed when it is needed; and project accounts are not always "closed out" in a timely manner. r The status on this finding is not changed. BROC has pledges from OPB and the Georgia Financing and Investment Commission (GSFIC) to address this criticism.
Roundtable Discussions: During the month of August 1996, the BROC Research Office hosted two roundtable discussions with state agency representatives and industry representatives to discuss the findings of the evaluation and identify possible ways of improving the effectiveness of the design and construction process in Georgia. State agency and industry representatives have made several formal responses to the evaluation and are working in a highly positive fashion to suggest improvements in the state's construction process.
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1996 Annual Report from the Budgetary Responsibility Oversight Committee
The BROC Research Office has made some preliminary recommendations to the Budgetary Responsibility Oversight Committee and the involved stakeholders for further discussions that are intended to lead to enabling legislative action during the 1998 Session of the Georgia General Assembly. The preliminary recommendations are as follows:
q Require the Governor's Office of Planning and Budget (OPB) to implement a pre-design requirement for all capital outlay projects. In addition, OPB should hire an engineer to work with the architect currently employed at OPB in order to take a more active role in reviewing and approving pre-designs and designs for capital outlay projects to ensure that facilities are built utilizing the most efficient and effective designs. Design review can be modeled after Washington State's BEST Study Process which is deriving a $10 savings for every $1 spent on the review process.
q Assign a single entity the responsibility of establishing and keeping current the policies and guidelines governing all elements of the construction process in Georgia.
q Require OPB to use a pricing index tied to the construction industry to ensure that cost estimates used in construction budgets are updated as necessary.
q Require that a pre-qualification process be established for hiring construction contractors. q Request that OPB establish a fee schedule to be used by all agencies who hire architects under
contract and that fees are changed from the current percentage fee to a negotiated lump sum fee.
Postscript In direct response to BROC's work, State agency representatives have formed the Georgia Association of State Facilities Administrators (GASFA) and are meeting regularly to open channels of communication among state agencies regarding construction and facility maintenance and renovation. Conversations between GASFA, professional services providers, and legislators are ongoing. These talks have produced proposed legislation introduced in the 1998 Session (Senate Bill 437) that will begin to address some of the recognized problems.
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Contracted Computer Personnel Evaluated: April 1996 by BROC Research Office
Contracting for computer personnel is a mechanism state agencies have used for many years to obtain new skills and expertise that are crucial in the rapidly changing world of information technology. However, recent reductions in force and personnel hiring limits have forced many agency information technology divisions to use contractors as full-time substitutes for state employees. The state uses three types of information technology contractors: the technician, the product specialist/consultant, and the programmer/analyst. During fiscal year 1995, the state used 360 contractors at a cost of $18 million; nearly 80 percent of that expenditure was for programmer/analyst contractors. At the conclusion of this evaluation checking for differences in contractor compensation between agencies and assessing the cost
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effectiveness of using contracted computer personnel, staff from the BROC Research Office reported that:
1. The hourly rates paid for the services of a programmer/analyst contractor are not significantly different between agencies.
2. On average, the DOAS Statewide Information Technology RFP secures a lower hourly rate than does an agency or sole-source contract.
3. Full-time "general skills" programmer/analyst contractors are not cost effective because the state paid between 32 and 57 percent more for these contractors than for similarly skilled classified state employees, and because surveys indicate that there is no significant difference in job-related ratings between contractors and state employees.
Evaluation recommendations:
1. State agencies should curtail the use of full-time programmer/analyst contractors as a way to solve personnel problems and give priority to spending contract funds to acquire special skills for the short-term. Agencies need the funding and administrative latitude to hire unclassified state employees to replace full-time programmer/analyst contractors.
2. If a general skills programmer/analyst contractor is needed, the DOAS Statewide Information Technology RFP should be used.
3. The opinion of the state's attorney general is needed to specify the legal risks of using contractors. 4. Agencies using contractors should conduct cost effectiveness analyses and track performance
measures of their use. 5. Penalty-days provisions should be included in all contracts for computer personnel and should be
enforced.
Exhibit 1: Agency Responses to Contracted Computer Personnel Evaluation
q DOAS (Administrative Services): DOAS has concern over the cost differences shown in the BROC report and about how they were calculated. DOAS preferred its own analysis that showed no significant difference in hourly rates if billable hours are used instead of full-time hours. DOAS thinks that application training costs and recruitment costs were not properly included. DOAS does, however, generally concur with a significant portion of the report. They are testing hiring LAN engineers under the new Merit System changes.
q ITPC (Information Technology Policy Council): ITPC asserts that the BROC study does not account for the quality of work differences between mainframe personnel and LAN support, and client/server development. The issue of including training costs could significantly narrow the savings gap between permanent and contract personnel. ITPC does support the agency-level cost effectiveness analysis recommendation.
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q DOC (Corrections): The Department of Corrections concludes that recruiting costs for employees were not properly considered. DOC strongly disagrees with requiring an agency-level cost effectiveness analysis. Until the personnel position allowance is changed, DOC affirmed its intention to continue to operate as they have in the past regarding contracted computer personnel.
q DHR (Human Resources): Concurs without qualifications.
q SFC (Student Finance): Agrees with the report.
q DOR (Revenue): The Department of Revenue disagrees with the report. Computer contractors provide the State with a valuable and appropriate cost benefit tool for managing short term projects without long term obligations to full time employees, they wrote. Revenue reported that it is unable to fill vacancies because of current salary structures.
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Georgia Board of Pardons and Paroles: Parolee Supervision Evaluated: October 1996 by Department of Audits
The Georgia State Board of Pardons and Paroles is charged with supervising all prisoners placed on parole. The Board's parolee supervision activities seek to provide a cost effective alternative to incarceration, to take steps quickly to remove from parole any offender who becomes a threat to the public and to help offenders successfully reintegrate into society. During fiscal year 1996, 365 parole officers were responsible for supervising an average of 17,337 parolees. At the conclusion of this evaluation, staff from the Department of Audits reported the following (with Board responses in italics):
1. Benefits and Costs of Parolee Supervision Activities : Parolee supervision provides significant cost savings as compared to incarcerating inmates for their full sentence. (Estimated annual operating cost savings are approximately $272 million and estimated one time prison construction cost savings are approximately $607 million.). Parolees also make payments for supervision, victim compensation, and victim restitution. During fiscal year 1996, parolees paid $749,387 in supervision fees. The supervision fees collected were remitted to the State's General Fund, offsetting a small portion (approximately 2%) of parolee supervision costs. Parolees paid an additional $184,211 to the Victims Compensation Fund and $199,262 of Restitution Fees to property owners victimized by crime. r The Board accepts this finding.
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2. Protection of the Public: Parole officers are protecting the public by monitoring parolees and informing the Board about parolees who do not abide by their conditions of parole. Board personnel need to compile more information on crimes committed by parolees to evaluate better its performance as related to its mission of protecting the public. r The Board agrees with this finding. Over the past year, the Research and Evaluation Unit began developing mechanisms to track crimes committed by parolees.
3. Reintegration of Parolees into Society: Current parole supervision activities include elements that encourage reintegration of parolees into society; however the Board needs to monitor and track parolees better after their release to evaluate the effectiveness of their reintegration efforts. r The Board accepts this finding. The Board does feel, however, it is difficult to continue the monitoring process after parolees have completed their sentence and are released from supervision. However, the Board will take additional steps to conduct studies of released offenders in order to better evaluate and assess their success in the reintegration of parolees back into society.
4. Fee Collection Methods and Controls: Board personnel need to monitor better the collection of Supervision, Compensation and Restitution Fees. Back payments reports identified $362,444 of Supervision and Victim Compensation Fees in arrears from active parolees as of June 1996. However, information was not available in the amount of Restitution Fees in arrears, "write offs" of uncollectable restitution fees from prior periods, the length of time amounts in arrears were overdue (an aging schedule) or the overall percentage of collections as compared to fees due (collections ratio). r The Board accepts this finding. The Agency will make efforts to address some of the issues regarding non-collection of fees. While it is true that a parolee not paying his fees but complying with the other conditions of parole may not be revoked to prison, the parole officers do employ a number of lesser sanctions to gain compliance.
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DOAS Workers' Compensation Program Evaluated: May 1996 by Governor's Office of Planning and Budget
Georgia Workers' Compensation Law requires private and public employers with three or more employees to either self-insure or purchase insurance to pay medical expenses and disability expenses for workers who are injured at work. As an employer, the state has chosen to self-insure; the Department of Administrative Services (DOAS) administers the Workers' Compensation Program for state employees. Each individual state agency is assessed an annual premium to cover (1): the costs of medical and disability expenses for workers who are injured at work and, (2): administrative and management expenses incurred by DOAS. DOAS staff perform most claims management and processing functions,
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but contract out for other functions such as actuarial and computer services. In FY95, total premiums charged were $62.9 million with $42.2 million going to claims paid out and $3.3 million for operating expenses. At the conclusion of their evaluation assessing the costs of the state's Workers' Compensation Program, controls to ensure accurate and expeditious claims processing, cost-containment measures, and options for privatization, staff from the Governor's Office of Planning and Budget reported the following (with Agency Response in italics):
1. State workers' costs can be reduced by strong injury prevention and return-to-work programs. r DOAS has developed a new Return to Work Program with training conferences to be conducted in February 1997.
2. The DOAS Worker's Compensation Unit needs to improve relations with other state agencies. r Staffing realignments are being made so the DOAS claims management employees work with cases on an account team basis, by agency, allowing agencies a more efficient customer account team to process claims. Customer service and telephone skills training has been scheduled for all Workers' Compensation Unit employees.
3. The Program should develop outcome-based goals, measurable objectives, and performance measures. r DOAS has improved its filings to the State Board of Workers' Compensation (18.4% in August 1996, down from the 1991-1995 average of 42%).
4. The Unit should improve management reporting, efficiency, and quality assurance efforts. r DOAS has taken action to improve the reporting and performance of its claims processing contractor; these efforts now provide data routinely on internal performance, costs and employee performance. Management reports have been redesigned to gather additional information, including data on lost work days and an extensive number of medical cost containment reports. Training sessions have been held to assist employees in their professional development and to target specific program areas.
5. The Unit uses cost containment strategies, but it can reduce costs more by expanding current strategies and monitoring results more closely. r A new vendor contract for a managed care organization to provide medical case management for injured state employees should be awarded by April 30, 1997. The Returnto-Work effort will bring all state agencies into the effort of cost containment, management of the injured worker, and active participation in the return to wellness of the specific injured employee.
6. DOAS should be commended for initiating privatization efforts that should result in a more coordinated, cost effective program. r The Managed Care and Return to Work Programs will represent significant effort towards involving private health care and worker's compensation firms with the ability to assist the
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State. Many of the Worker's Compensation functions and processes now used by DOAS in the operation of the Program--including medical cost containment strategies, fee schedule auditing, medical payment claims processing, selection of health care providers, and system accounting--will, in the future, become the responsibility of private firms.
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Department of Transportation: Railroad Acquisition and Rehabilitation Program Evaluated: November 1996 by Governor's Office of Planning and Budget
The purpose of the Railroad Acquisition and Rehabilitation Program is to provide financial assistance for capital projects to preserve and improve local rail freight service. Since deregulation of the railroad industry in the 1970s, the largest rail carriers have been restructuring and downsizing their systems. Smaller railroad companies often buy or lease the more viable lines from the larger railroad companies allowing rail service to be continued in some communities. However, these smaller railroad companies often lack the financial resources to rehabilitate or acquire rail lines; thus, they depend on financial assistance from the Program. At the conclusion of their evaluation assessing whether the Program is effective in preserving and improving rail service on those lines assisted by the Program, whether the Program has been cost effective, and whether the Program's process for evaluating rail lines' needs and providing financial assistance is well defined and consistent, the Governor's Office of Planning and Budget reported the following:
1. The Program has been able to meet its objectives of preserving service, improving service, or banking all rail corridors for which it has initiated projects. While the Program is seeking to reestablish service on the banked rail corridors (which are not presently operating), the cost effectiveness of such action has not been demonstrated. r The Department has completed eight rail line rehabilitation projects and has acquired five rail lines. Rail service has been abandoned by the owning rail carrier on only three of the projects. All three were in operation for a period of time which exceeded the payback period as determined by benefit/cost analyses prepared for the project justification. For these lines service was continued for eight to twelve more years due to the rehabilitation projects. The five rail lines which were acquired are strategic links in the state rail transportation system.
2. The Program needs to reassess its current goals and develop measurable objectives and performance criteria. r The goals and objectives of the program are reevaluated as part of the periodic updating
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of the State Rail Plan. But because of general fund budgetary limits the plan has not been updated since FY89. Goals, objectives, and performance measures have been reassessed and revised though, as part of the FY97 and FY98 Results-Based Budgeting process.
3. The Program should develop a process and collect related information to determine the overall cost effectiveness of all projects. r There is an established process that meets Federal Rail Administration requirements. The Program uses the process of updating the State Rail Plan to analyze new projects and assess completed projects.
4. Several key components in the planning process were missing, including updated comprehensive plans, policies, and procedures, and better coordination of efforts with other economic development organizations. r The State Rail Plan has not been updated since FY89 due to the limited funding available. State general funds have been requested each year since FY94 ($500,000 requested in FY98). Those funds have not been appropriated.
5. The Department appears to do a good job monitoring the progress of rehabilitation projects. However, the Program can be more effective in monitoring assisted lines after project completion, in obtaining available federal funds, in maintaining records, and in cross-training its staff with other Office of Intermodal Program staff. r One of the most effective ways to monitor rail lines receiving rehabilitation assistance is to systematically collect data as part of the rail planning process. The Update of the State Rail Plan will include establishing performance monitoring as an integral component.
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Department of Human Resources: Length of Stay in Foster Care Evaluated: June 1996 by Department of Audits
The Foster Care Program provides temporary out-of-home placement for children who are not receiving a sufficient level of care and whose families or environment creates a serious threat to their safety and welfare. The Program was responsible for 16,002 children in foster care (as of the end of fiscal year 1995), and the average length of stay for children leaving foster care during fiscal year 1995 was approximately 14 months. At the conclusion of their evaluation focusing exclusively on the length of stay in foster care, staff from the Department of Audits identified the following needs (with Agency Response in italics):
1. Goals and measurable objectives regarding length of stay in foster care are needed. The
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department also needs to provide more Program monitoring to help local foster care workers minimize children's stays in foster care while continuing to ensure their safety. While Georgia's reported average length of stay in foster care compares favorably with figures reported by other southeastern states (national benchmarks do not exist), the evaluation team believes that room for improvement still exists. The amount of improvement that is possible cannot be predicted; however, a directed effort to identify and address problems that hinder the permanent placement of children in foster care should ultimately result in a reduced average length of stay.
r A goal to reduce the length of stay in foster care is not an outcome in and of itself, however, it is an indicator when safety issues or barriers to achieving permanency have been removed. The philosophy of the Department of Human Resources is Child First, with a strategy of First Placement, Best Placement. The goal of the First Placement, Best Placement strategy is to improve service delivery by involving multi-disciplinary public and private agency teams with children's families, and the Department to assure safety, develop and monitor a permanent plan for each child placed in foster care.
2. Computerized data needed to monitor adequately the length of stay in foster care are not available. More information is needed on children's previous stays in foster care, the time children spend in smaller component parts of the overall foster care process, the status of children available for adoption, and children whose permanent placement has been identified as long-term foster care. The existing database, Interim Data System (IDS), includes significant, obvious errors, and lengths of stay data in the system do not match information in case files. r A new computerized social services data system, called the Family and Children Electronic Tracking System (FACETS), which will provide the needed information, is being developed. FACETS-1, the first phase of the project, is forecast to cost $26 million; funding sources of approximately $19 million have been secured. The final implementation date is June 1999. FACETS-1 includes functionality to track and monitor caseload assignments and case activity as an approach to reduce the length of stay in foster care. This feature will allow program managers to take timely action on cases. To validate and improve the accuracy of data and reliability of the information currently in the Interim Data System, information correction templates have been developed for monthly distribution to county departments. The templates will summarize the data from each county, require counties to correct discrepancies and provide a temporary solution until FACETS-1 is operational. Quality Assurance staff will monitor computer forms during onsite county reviews of case records to verify that the data in the record are consistent with information in the Interim Data System.
3. More study is needed to determine if local foster care workers' caseloads have an impact on the average length of stay of children in foster care. r Improved data collection will help to determine the impact of caseload size on the length of stay. FACETS will capture data to assist county directors in weighing caseload duties and making caseload assignments.
4. Program personnel need thoroughly to analyze and quantify problems that may affect children's
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length of stay in foster care (such as lack of parental responsibility, problems with scheduling parents for treatment, and problems with severing parental rights).
r The case plan, as developed with the case manager and the parents, will generate compliance data concerning the requirements placed on the parents. These data will be captured and analyzed when FACETS is operational. The Division plans to increase the number of substance abuse treatment slots for parents with children in foster care. These activities are directed toward the parents so that the children can return home as soon as possible. Implementation of Senate Bill 611 (Reunification Services) and the implementation of some of the recommendations of the Advisory Committee of the Georgia Supreme Court Child Placement Proceedings Project will greatly reduce this problem. The Department will intensify training for local county staff on case preparation for presentation in the Court proceedings to sever parental rights.
POSTSCRIPT: Several initiatives were undertaken to enhance the state's efforts to improve the foster care system. Effective January 1, 1997, the Department of Human Resources created the Office of Adoptions in response to a recommendation by a Senate Study Committee on Foster Care. Additionally, to provide incentives for families to adopt children in state care, HB112 was passed allowing the State to provide financial assistance to families adopting children who are deemed "hard-to-place" due to physical, mental, or emotional disabilities or with other problems for whom it is difficult to find a permanent home.
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Department of Human Resources: HIV/AIDS Program Evaluated: April 1996 by Department of Audits
Administered by the Division of Public Health within the Department of Human Resources, the HIV/AIDS Program is responsible for protecting the public health and welfare by reducing the morbidity and mortality resulting from HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome). Staff from the Department of Audits reported that approximately 22,155 to 50,989 Georgians between the ages of 18 and 59 are infected with HIV. The estimated cost of caring for these people during their lifetime ranges from $2.6 billion to $6.1 billion. At the conclusion of their evaluation, staff from the Department of Audits identified four specific areas for improving the Program's prevention efforts (with Agency Response in italics):
1. Revise Prevention and Education Efforts: HIV/AIDS prevention and education efforts are not uniformly available statewide and are not available in all areas in which there is evidence of widespread, high-risk behavior. Currently, pro-active prevention efforts are not conducted in 45 of the 74 counties in which there is evidence of high-risk behavior (such as high rates of teenage pregnancy, syphilis, and drug usage).
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r Agency response emphasizes multilateral approaches and collaboration with other state and local organizations combating HIV/AIDS. Agency acknowledges that funding from last Session will pay for DHR "AIDS Core Staff" for all Health Districts and pledges to ensure that limited HIV prevention funds are used most effectively.
2. Revise HIV Testing Policies and Reporting Procedures: Approximately 48% of the HIV tests administered by county health departments are anonymous (rather than confidential), preventing public health officials from contacting individuals (or their partners) who do not return for their test results. In addition, test results are not reported to the Department with sufficient identifying information (such as the person's name and address) to eliminate duplicate test results or to pinpoint areas of the state with increasing numbers of positive test results. The Program currently uses aggregate data along with data on sexually transmitted diseases and teenage pregnancy to target its prevention efforts. The authority to require additional demographic data was granted the Department by legislation enacted in 1988. r Agency has agreed to emphasize HIV confidential testing over anonymous testing and is training staff in new techniques.
3. Improve Strategic Planning: The Program does not have a strategic or long range plan for addressing the spread of AIDS throughout the state. The Program's most current five year plan covered the period 1986-1991. In addition, the Department has not implemented performance measures for monitoring the Program's overall effectiveness in reducing the mortality and morbidity from AIDS. r DHR reports that a new HIV/AIDS Prevention five-year plan for 1997 through 2002 is in the final stages of completion.
4. Provide Increased Assistance to Local Health Departments: Although 73% (74) of 102 survey respondents indicated they were satisfied with the assistance provided by the Program, 27% (28) indicated they were not satisfied with the assistance provided. r Management and structure changes in the DHR Epidemiology and Prevention Branch are, in part, intended to enhance and increase DHR leadership in HIV prevention programs at the district and county health office levels.
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Department of Human Resources: Georgia Cancer Registry Evaluated: August 1996 by Department of Audits
The Georgia Cancer Registry, a clearinghouse for cancer incidence data, began in the 1960s as a means for hospitals to compare the effectiveness of treatment methods. In 1977, the Cancer Control Act was
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passed by the General Assembly. The Act expanded the Registry's role to include providing statewide data to enable public health officials to evaluate the nature and extent of cancer incidence in Georgia. At the conclusion of their evaluation, staff from the Department of Audits identified three specific areas for improving the Registry (with Agency Response in italics):
1. Monitor the benefits resulting from the Registry: While there was little indication that Registry information was being used (or that it was generating any significant benefit), DHR continued to collect Registry data at a cost of approximately $100,000 a year after problems with the Registry were identified in 1990. The Registry may eventually realize more "tangible benefits" as the result of an enhancement plan initiated at the end of 1994; however, at this time, there is little indication that Registry data are being used. r The Cancer Control Program will develop more well-defined overall goals, objectives and performance measures for the Comprehensive Cancer Registry as well as a comprehensive system to document and measure performance, outcomes and benefits.
2. Review contract management practices: Since 1991, Emory University has continued to receive approximately $100,000 per year under state contract for compiling Registry data even though Emory no longer has to analyze or disseminate the data. The evaluation team also found that, during the first year of a multi-year project to enhance the Registry, Emory had made little progress towards fulfilling the contractual obligations identified in an approximately $450,000 contract. r The contract should have been modified at that time. All contracts are being reviewed to assure the appropriateness and timeliness of the work scope and the deliverables. Emory is now testing a system with high expectations.
3. Enhancement plans need to be modified: Registry enhancement plans should be modified to provide for complete and accurate data; should include a mechanism to validate data throughout the state (not just in the 26 counties where comparable federal cancer registry data are available); should address problems with duplication of effort and inadequate user awareness of the availability of Registry data; and should address efforts needed to attain a goal of 95% to 100% representation by hospitals, pathology laboratories, and other health care facilities in order to obtain useful information as soon as possible. r The Cancer Registry will develop operational plans that state the department's priorities which are to improve completeness and accuracy of reporting from the large hospitals with cancer registries, to assist large hospitals without cancer registries, large laboratories and large outpatient facilities in developing a system for reporting. The department will then develop a plan for assisting smaller hospitals in developing a system of reporting cancer incidence.
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Department of Human Resources: Multi-Agency Team for Children (MATCH) Program Evaluated: August 1996 by Governor's Office of Planning and Budget
The purpose of the Multi-Agency Team for Children (MATCH) Program is to arrange and fund residential mental health treatment services for severely emotionally disturbed (SED) children and adolescents. MATCH placements are typically used as a last resort instead of institutionalization for those SED children and adolescents who have not been successfully treated through community-based mental health services. As a result, the Program serves the most severe SED cases, many of which have been in and out of various types of treatment for most of their lives. The Program strives to purchase services that, upon completion of treatment, will assist the SED child or adolescent to function at the least restrictive level of care. Residential treatment services are purchased primarily from private providers located throughout the state. The MATCH Committee is composed of representatives from DHR's Division of Family and Children Services and Division of Mental Health, Mental Retardation, and Substance Abuse; the Department of Children and Youth Services; and the Department of Education. The following is a summary of evaluation findings (with Agency Response in italics):
1. The MATCH Program should develop goals and measurable objectives and establish criteria and outcome measures to assess the effectiveness of the Program as well as the effectiveness of each treatment service provider. r The program has developed the MATCH Outcome Project (MOP) to design a system that will gather consistent and measurable data regarding the progress children make in treatment and the results they maintain after discharge from MATCH. MOP is a joint effort of the MATCH staff, the Georgia Association of Homes and Services for Children (GAHSC), service providers, public agencies and other match stakeholders including families of children in MATCH placement and the children themselves.
2. The MATCH Program is securing and funding placements for SED clients in residential treatment programs, thereby avoiding continued placements in institutionalized care. r The program is achieving this informal goal.
3. Upon completion of treatment, MATCH clients are generally being discharged to a less restrictive treatment level of care. r The program is achieving this informal goal.
4. Placements to out-of-state providers have decreased from fiscal year 1990 to fiscal year 1996. r At the time the agency's response was written, there was only one child placed out of state and plans were underway to return that child to Georgia by the end of February. Based upon information available to MATCH, it is likely that Georgia may be the only state in the country (or certainly one of only a very few states) to have developed resources to allow all its children with SED to be served at home.
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5. The Department of Human Resources needs to institute adequate systems and procedures to track the services and expenditures provided to SED diagnosed children and adolescents to allow MATCH Program staff to assess the overall need for services. r MATCH will initiate a discussion with representatives of MHMRSA, Department of Education, and the Department of Juvenile Justice to identify types of data currently being gathered and the capacity of the agencies to share information within existing systems.
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Department of Human Resources: Children's Trust Fund Commission Evaluated: October 1996 by Department of Audits
The Children's Trust Fund Commission is responsible for providing funds for community-based programs designed to prevent child abuse and neglect. The Commission is administratively attached to the Department of Human Resources. At the conclusion of their evaluation of the Commission, staff from the Department of Audits reported the following (with agency responses in italics):
1. The Commission is meeting its statutory mandates by providing funds to local organizations in a fair and equitable manner and by minimizing its administrative expenses. Information obtained from DHR indicates, however, that there is a continuing need to fund prevention programs in the state. From 1992 through 1995, the number of reported cases of child abuse and neglect increased by 12% from 51,225 to 57,118. r Using child abuse reports as the measure for the prevalence of abuse is flawed. Many prevention programs heighten awareness of abuse and can actually lead to an increase in reports as the public learns to recognize the signs of abuse and how to report appropriately. Investigations, however, may fail to confirm abuse. The truer measure of the effectiveness of prevention programs would be tracking the reduction in the number of cases, not in the number of reports. In 1995, there were 57,118 reports, however, there were 34,401 cases where abuse was indicated.
2. The Commission should compile quantitative data for evaluating the effectiveness of the child abuse prevention programs that receive Commission funding. Although the Commission funds a number of different types of prevention programs throughout the state, it does not maintain adequate information formally to evaluate the relative effectiveness of the different programs. r The Children's Trust Fund Commission Application for Funding has been strengthened in the area of required evaluation. Potential grantees are now required to design their programs with an integrated evaluation and state specific methods that will be used to measure both Output (process) and Outcome (results) indicators.
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3. Action should be taken by the Commission to document more fully its funding decisions and to require applicants to submit revised budgets reflecting any differences in grant awards versus amount of funding requested. r The new Approved Program Budget provides documentation of the expectations with regard to the amount of cash and in-kind approved as well. Grantees must request budget changes, including change in cash or in-kind, according to the procedures set forth in Attachment "G", Procedures for Contract Amendments.
4. The Commission should require grant applicants to document fully their compliance with the Commission's matching requirement. By manipulating the value of its local match, an applicant can inflate the total cost of the program and qualify for a larger dollar amount of state funds. r The CTF grant application requires applicants to declare both the amount and the source of the cash that will be applied to the program should the program be recommended for funding. The law prescribes that the Commission approve the amount and types of in-kind services that will be accepted as match. In the 1998 RFP, there will be requirements stating that if occupancy costs are listed as "in-kind" verification of the fair market value must be provided on the letterhead of the donating entity.
5. Although the Commission staff conducts on-site visits to "ensure that public monies are being efficiently and effectively utilized," they do not specifically address financial operations or effectiveness in preventing child abuse. r The protocol for site visits has not yet been formally revised but standards and procedures to comply with recommendations will be incorporated as practicable.
6. The Commission's contracting and reimbursement procedures should be revised to provide for more effective stewardship of state funds. A review of 14 Commission-funded programs indicated cases in which the Commission staff extended contracts after their termination dates and reimbursed grant recipients for expenses that were not fully documented or were not allowed according to the terms of their contracts. r All contract procedures were reviewed and revised during the summer of 1996. The new "Procedures for Contract Amendments" memo was mailed to all active grantees and is now sent with all regular CTF contracts. Requests for Budget Revisions must be received no less than 30 days prior to the proposed effective date of change. Requests for Contract Extensions must be received in writing no less than 30 days prior to the Contract end date.
7. Consideration should be given to streamlining the grant application process by requiring secondand third-year applicants to submit only new information or changes to information already on file. r Action has been taken to change continuation funding requirements to focus on results achieved during the first funding period; changes that have taken place in administration, program services or funding; and obstacles faced and addressed.
8. The Commission should require the "Healthy Families of Rural Georgia" programs to provide a
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specific amount of matching funds as a condition of receiving a grant. r The Commission acted to require year one match requirements for the next renewal applications for the programs funded through the special appropriation for rural Georgia programs and Chatham County. There was legitimate concern that the rural areas would be unlikely to be able to offer the 50% match required of other applicants.
9. New Commission members need to be appointed to fill vacant or expired terms. Of the 15 positions on the Commission, two are vacant and 11 are filled by people serving expired terms. r Since the Program Evaluation was completed, there has been one additional resignation. Current status is 12 members, 11 serving with expired terms. [The CTCF] has been assured that appointments/reappointments will be made by March [1997].
10. The Commission should consider computerizing its record-keeping system for monitoring the status of initial grant awards and for keeping track of reimbursement requests. r The Commission has had a contract with DOAS to design a program for computerized record keeping since June 1996 and the system is still not operational.
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Child Care and Development Block Grant: Georgia Child Care Council Evaluated: November 1996 by Department of Audits
The Georgia Child Care Council is responsible for administering a portion of the federal Child Care and Development Block Grant funds awarded the state. The Council's overall purpose is to make quality child care accessible and affordable for all Georgians. The Council is administratively attached to the Department of Human Resources. At the conclusion of their evaluation of the Council, staff from the Department of Audits reported the following with Council response in italics:
1. Because there is a continuing shortage of child care services in many Georgia counties, the Council's efforts should be more focused on increasing the availability of services in the most under-served areas. Analysis of the contracts awarded to child care providers in federal fiscal year 1996 indicated that most of the Council's funds were awarded to existing child care facilities in urban counties. r The Council can only award funding to organizations that apply for funding. For the 199596 fiscal year, eight child care programs from the 20 least accessible counties, as determined by the auditor, applied to receive CCDBG funding. Of those programs that applied for funding, four were awarded CCDBG funds. The Council did not receive applications from the remaining 20 counties.
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2. The Council should establish specific measurable goals for fulfilling its overall mission and take a more pro-active approach to developing new and expanded child care programs throughout the state. In federal fiscal year 1996, for example, only 24 of the 127 contracts awarded for child care services were for new or expanding programs. r For the 1996-97 program year, the Council awarded $100,000 start-up funds to two early childhood programs and two school-age care programs. The 1997-98 Application Guidelines request proposals for start-up for the next program year. The Council intends to fund qualified applicants in the start-up category.
3. The Council's method of selecting counties to receive funding priority should be revised to comply with federal regulations. The current method does not give first priority to counties with large numbers of low-income children and does not give any priority to counties with low population densities. r The formula was developed by DHR in 1991 and the federal government approved the formula. It is also important to note that the targeted county list has not negatively affected funding decisions for low population counties. The Georgia Child Care Council simply does not get as many applications from those areas.
4. Although the Council should be commended for ensuring that contracts are awarded in a fair and objective manner, it should fully document its reasons for awarding providers less than the amount requested in their applications. r For the 1996-97 program year, more detailed notes were maintained as to why an applicant received less than what they requested.
5. The Council's contracting and reimbursement procedures should be improved. A review of the Council's contracts and reimbursement payments for child care services in federal fiscal year 1996 disclosed a number of internal control weaknesses and other deficiencies that need to be addressed. r The Council is concerned that requiring contractors to submit canceled checks as a backup documentation as suggested by the auditor will delay the reimbursement process, and contractors will be unable to meet the 10th working day contract deadline to submit reimbursement requests.
6. The Council should take steps to ensure that funds awarded for resource and referral services are used in a cost effective manner to improve the quality and availability of child care services. r During the 1996-97 program year, the Georgia Child Care Council is conducting an extensive evaluation of the resource and referral system through an evaluation contract with Save the Children. The final report will be available after March 7, 1997.
7. New Council members need to be appointed to fill vacant and expired terms. Of the 15 voting positions on the Council, only seven are filled by people serving current terms of office. Five of the 15 positions are vacant and three are filled by people whose terms expired in 1995.
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r The Council's chairperson has made extensive efforts to fill vacant Council positions, including meetings with the Governor's board appointment secretary. In late November, the Council was notified that the Governor had made one additional appointment to fill the position representing Head Start.
Postscript: In August 1997, the BROC Research Office issued a BROC Oversight Calendar concerning the lack of benchmarks for determining what is affordable and accessible quality child care. The Research Office will continue to work with the Childhood Care and Education Community in 1998 to clarify and benchmark the state's progress towards achieving affordable and accessible child care.
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Department of Human Resources: Dental Treatment Program Evaluated: November 1996 by Department of Audits
The purpose of the Dental Treatment Program is to make basic dental care accessible to the children of low-income families throughout the state. The Program's overall objective is optimum oral health for each Georgia citizen. The program is administered by the Division of Public Health within the Department of Human Resources. At the conclusion of their evaluation of the Program, staff from the Department of Audits reported (with agency response in italics):
1. As it currently operates, the Program cannot achieve its purpose of making dental care accessible to low income children throughout the state. Currently, Public Health dental services are only available in 45 of the state's 159 counties, leaving approximately 235,000 low-income children in the remaining 114 counties without local access to a Public Health dental clinic. r It is DHR's opinion that the evaluation confirmed that, due to inadequacy of resources, the dental program has not been able to meet the dental needs of medically indigent children throughout the state. State dental funds are to be redirected to more critical and higher priority areas such as teen pregnancy and heart attack prevention.
2. Information obtained from local Public Health officials throughout the state indicates that there is a continued need for the Dental Treatment Program. Of the 33 county Public Health personnel who have a dental clinic in their county and who responded to a questionnaire, 94% (31) indicated that discontinuing the Program would impact the ability of low-income families to obtain dental services for their children. Similarly, 90% (47) of the 52 county and district personnel who do not have a dental clinic in their county or district and who responded to the questionnaire indicated that a dental clinic was needed. r The Department does not disagree with this finding.
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3. The absence of preventive dental care can result in dental problems that are painful, costly to treat, and impact a child's overall health. Although data obtained from the U.S. Public Health Service indicate that dental disease can be easily prevented and controlled at a reasonable cost, the impact of not obtaining preventive dental care can be substantial. r The Department does not disagree with this finding.
4. Under the Program's current organizational structure, no state-level office or section is responsible for exercising managerial control over the Program on a statewide basis. In addition to resulting in a patchwork of Program services, the current system also results in the inefficient use of Program funds. r The finding is correct. The State Dental Director is professionally responsible for dental public health personnel working in health department (e.g. professional supervision, quality of care, etc.). Most districts follow state guidelines they helped establish, but the districts are not required to follow any statewide guidelines unless quality of care is involved.
5. The Department of Human Resources should consider alternative methods, such as the use of portable dental equipment or mobile units, for making dental services more accessible. An alternative service delivery system (developed by Program personnel at the request of the evaluation team) would provide services on a regional basis using portable equipment. Program staff have estimated that implementing the plan would require a one-time expenditure of $700,000 for 46 portable dental units and a $500,000 increase in the Program's current annual operating costs (for 12 new positions, additional travel costs, and additional operating expenses). r If the program is not eliminated and continued at its current level, it will be unable to pursue many of the alternatives proposed in the evaluation. These alternatives are based on increased funding both short term, for the one time expenditures, and in continuation to maintain, upgrade and support these alternatives in the future.
6. The Department of Human Resources should work with the Department of Medical Assistance to increase the number of dentists who participate in the state's Medicaid Program. In fiscal year 1996, only about 28% (866) of the state's 3,124 licensed dentists (with Georgia addresses) provided services to Medicaid-eligible children. According to Public Health staff and the Georgia Dental Association, low Medicaid reimbursement rates and paperwork requirements discourage dentists from serving Medicaid-eligible clients. An analysis of the current Medicaid reimbursement rates verified that they are substantially less than the average private sector rates. r The Department continues to work with DMA to find ways to increase participation of dentists in private practice.
7. The Department of Human Resources should take steps to obtain complete and accurate information for assessing periodically the status of children's oral health throughout the state. Although legislation requiring dental screenings for all children entering school was passed in 1972, DHR has not established procedures for ensuring that the screenings are being conducted or that the results of the dental screenings are accurately reported.
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r A proposed new "Daily Dental Clinic Patient Form" will contain demographic information of patients seen in dental public health facilities. The hard copy of the form or its electronic counterpart will also incorporate the educational and preventive (e.g., screening) activities performed. A screening update will be provided to all dental public health dentists and dental hygienists - "Guidelines for Dental Screening of Patients."
POSTSCRIPT: During the 1997 session of the Georgia General Assembly, legislative action was taken to restore funding for the Department of Human Resources's Dental Treatment Program. In August 1997, the Department of Human Resources's Chronic Disease and Health Promotion Branch, which houses the Oral Health Program, developed a dental treatment plan designed to make dental services available in all 159 Georgia counties. The plan required a funding enhancement of $2.3 million to provide primary prevention services to eight health districts that lack dental programs. Funding for each of the eight districts was proposed to be $180,000, with the other 11 health districts with dental programs receiving $85,000. The revised plan was submitted as part of DHR's FY99 budget submission to the Governor, but was not included in the Governor's final budget. DHR officials are now relying on the proposed 80% increase in Medicaid dental reimbursement rates and the implementation of the Children's Health Insurance Program (CHIP) to address the dental treatment needs of low income children.
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BROC Research Office
206 Legislative Office Building 18 Capitol Square Atlanta, GA 30334 (404) 657-4600
Content by the Budgetary Responsibility Oversight Committee Research Office Kevin Fillion, Director
Return to BROC Index
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