Thursday, December 06, 2012

Council Cuts, Feds to Backfill?

San Angelo City Council drastically cut the Nursing Department budget beginning October 1, requiring the "closure" of the Sexually Transmitted Disease Clinic and reduction in Immunization services.  Below are the city's STD statistics:

A state health department physician testified before Council in September.  She pleaded with Council members not to hack what little remained in the City Health Department.  The Nursing budget was reduced by 47% or $138,000.  Council chose to lecture the good doctor, saying the state wasn't doing its part financially, so the City would do likewise (my interpretation).  It read shakedown. 

The City put out a news release stating immunizations would be drastically curtailed and the STD clinic closed September 28.

However, a nurse told council on December 4th the clinic was still treating STD patients.

"Anyone who is identified as positive by the state can be treated through us."

Might this revelation blow a hole in the City's basis for asking for 1115 waiver money?  A Standard Times piece confirms that services were curtailed but not eliminated:

"If someone has context ... is positive for STD, but can't access treatment, we can still do that (provide STD treatment)," Villarreal said.

The feds don't like paying for services already provided and Weise told council it could not be an "ongoing program."  His presentation included Medicaid waiver goals: 

There was nothing in the presentation delineating how the clinic explicitly meets any of the above goals.  Infrastructure development was underlined several slides later, but this City Council just destroyed that infrastructure to save $138,000.  Restoring that which was eliminated does not seem an improvement.  It's building back what was.

Additional oddities included Rick Weise providing little detail on STD clinic operating costs and stating that the grant had already been submitted.   Also, the packet mentioned buying a building near City Hall to house the clinic, yet Rick would clearly tell any staff their jobs would only be funded for 4-5 years.  Who buys a 30 year asset for a 4 year program?  Also, the grant would fully fund this new location.

The final absurdity came from City Council approving another holiday.  The last time Council did such, adding Veteran's Day, the cost was estimated at $135,000.  That's virtually the same number that eliminated the STD clinic, $138,000.  Apparently, the city had an extra $135,000 laying around.  Funny, they didn't ask about the cost of the extra holiday.

Update 12-7-12:  The Standard Times did a story on the new holiday.

Update 12-10-12:  The grant application posted on Texas Regional Health Plan 13 shows a December 3rd date.  City Council met on December 4th to consider applying for the Section 1115 waiver money.  Oddly, the grant shows incentive payments for certain milestones vs. detailed budget projections.  There were no operating projections in the application, which explains why Rick Weise was stumped by what appeared to be a simple question.

Update 3-5-13:  The State will backfill the void with the assistance of city health department staff. 

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