Information relevant to the economic stimulus and its potential impact on funding available for public health efforts across Oklahoma is provided below. Please note that this represents the best information from numerous sources available to us at this time.

With few exceptions state agencies and programs continue to await additional instructions from federal agencies regarding state specific amounts, timetables and other guidance. In addition the Governor and the Legislature are in discussions regarding their respective roles, appropriations implications for this fiscal year and future fiscal years when the stimulus dollars cease. The main focus of these reports will target funding opportunities for OSDH programs. However we will make an attempt to include relevant information concerning stimulus information on other health related initiatives funded outside the OSDH.

This update will be provided on a weekly basis and as significant information becomes more detailed and available. If you have additional questions or informational needs please we will be pleased to assist.

The stimulus package provides a temporary increase in the Federal Medical Assistance Percentage (FMAP), the federal share of Medical Payments. Benefits directly to the department related to this portion of the stimulus affect October 2008 through December 2010. A total budgetary impact of $2.478 Million is expected across various programs of the department supported in part with Medicaid funding. More details regarding the computation of the relief provided states through this aspect of the stimulus is available on the state web site.

Nationally, the ARRA appropriation totals $500 Million. Additional stimulus funds provided for these programs as follows, $400 Million placed in the Reserve Fund for the Secretary of Agriculture to distribute as deemed necessary and $100 Million to be granted to states for improvements in information management systems.

Currently, Oklahoma anticipates $2 Million in WIC Food monies and $500K for administrative and staff support. For several years the OSDH has undertaken significant planning efforts to prepare for implementation of the more efficient and cost saving Electronic Benefit Card system. The $100m available nationally will greatly improve Oklahoma’s chances for funding such a system.

Part C of PL 99-457 provides services to developmentally delayed infants and toddlers aged 0-3. In Oklahoma the State Department of Education is the statutory lead agency. Statutorily OSDH is the major provider of these services under contractual agreement with the State Department of Education (OSDE). Currently, the federal Department of Education Web site estimate for stimulus dollars available to Oklahoma if approved as listed would be approximately $5.72 Million.

Under the stimulus plan, $2 Billion is set aside for the National Coordinator for Health Information Technology (HIT) to award planning and implementation grants to states or qualified state-designated entities to facilitate and expand electronic health information exchange. The state or state-designated entity must submit a plan describing the activities to be carried out to facilitate HIT exchange. States must contribute a certain portion of matching funds after Fiscal Year 2011 and the American Recovery and Reinvestment Act of 2009: the U.S. Health and Human Services Secretary has the discretion to require such matching funds before then. The Secretary may require annual reports. An annual review by the National Coordinator for HIT is required.

The $50M allocated to states is expected to be assigned as follows:

• Through CDC to states for surveillance, education and outreach intervention work
• To CMS for ambulatory care-related program services
• To AHRQ for research for the development of effective prevention models

HHS will probably use its January 2009 draft HAI Action Plan to help guide the focus of the initiative. (Note: on March 11, 2009, ASTHO corresponded with HHS to strong recommend the use of the Epidemiology and Lab Capacity grant as the mechanism to disburse these funds to states.) Some state health agencies are planning to apply for healthcare-associated infection funds and comparative effectiveness funds.

OSDH’s eligibility for portions of this $50 Million in funding and role in regard to this aspect of the stimulus is unclear at present. Research within this area of the stimulus will continue with updates forthcoming.

CDC's recommended implementation plans for Sec 317 Childhood Immunization Program funds ($300M) were submitted to HHS on Friday, March 13

• Most of the Sec 317 funds will be used for vaccine purchase with the balance authorized for state operations/infrastructure, competitive innovation grants, and CDC program support such as a national communications campaign.
• It is hoped that part of the HIT funds will be eligible for the enhancement of immunization registries and integrate them with electronic medical records.
• In anticipation of 317 funds, some states with universal immunization programs may be facing cuts from their state legislatures. Oklahoma is not a universal immunization state and the state contributes a small amount to children’s immunization funding.

Internal Update & Disclaimer – the following information was provided on a conference call based on a recommended plan submitted by CDC to HHS on March 13, 2009. This information is subject to change.

• Majority of funds will be allocated to vaccine
• Approximately $18 million will be awarded to states through a competitive grant process for demonstration projects focused on adult (non-senior) and school based activities. Projects should be innovative, yet use best practices. Regular data collection must occur and be reported back to CDC, including economic evaluation. Size of the awards is undetermined at this time and guidance is expected in July 2009
• Approximately $50 million in funding will be awarded based on a formula to 64 immunization grantees. The Funding Opportunity Announcement (FOA) is pending a spending analysis at the federal level. Allocations have not been provided to grantees at this point.
• End date of funding in December 2010

Of all the public health stimulus initiatives Wellness and Prevention funding continues to be the least agreed upon by the White House and DHHS. Under the ARRA the Secretary for DHHS has authority to transfer these funds to other areas. In the short term there are several rumored possibilities for actually providing community-based prevention programs. Another possibility is the use of funds for a major health initiative, which may or may not involve funding to state or local public health agencies. No definitive models or funding mechanisms have been adopted and P&W funds may not move as quickly as stimulus dollars in other areas.

The stimulus appropriation is $500 Million in new funding for development, operations and infrastructure improvements. Two weeks ago three new FQHC organizations were approved and funded along with six applications for new FQHC sites in Oklahoma. Additional millions in operational and infrastructure funds for CHCs are being made available. Oklahoma has historically lagged behind most states in development and approval of FQHCs. In recent years the state and federal government has increased their interest in expansions. This is easily the largest gain in new centers since the federal designations began.

As a part of the American Recovery and Reinvestment Act the federal government will provide contributions for amounts states pay to eligible Medicaid providers, $63,750 Per Medicaid Provider, to encourage the adoption of EHR technology, in order to promote health care quality and the exchange of health care information. The contributions can be as much as $21,250 per provider for the first year of payments (which may not be later than 2016), and as much as $8,500 for up to five years thereafter. Providers eligible for both Medicare and Medicaid incentive payments are required to choose one.

OSDH’s eligibility for portions of this funding and potential role in regard to this aspect of the stimulus is unclear at present. At least one state is designating local health departments as Medicaid providers to improve their access to Medicaid HIT improvement stimulus funds. Research within this area of the stimulus will continue with updates forthcoming.

Accountability Measures
Oklahoma has suggested or implemented the following measures to lend transparency and accountability to the expenditure of stimulus monies received by Oklahoma.

• The Governor, via executive order, has established the American Recovery and Reinvestment Act (ARRA) Coordinating Council to help oversee Oklahoma’s use of federal stimulus funds.
• State Auditor and Inspector Steve Burrage has been tasked to review, monitor and audit state stimulus efforts and expenditures
• The Web site recovery.ok.gov provides details on stimulus funds potentially allocated among various public entities and programs in Oklahoma.
• The Treasurer and Office of State Finance are tracking expense of these monies through specifically identifiable financial accounts
• The state legislature proposes agencies be required to submit a “plan” for utilization of these monies prior to expenditure of the funds. Credits and Acknowledgements for this Informational Update

Much of the preceding information was derived from the Association of State and Territorial Health Officials (ASTHO) updates, various other federal and other association Web sites and briefings, discussions with senior OSF staff, Senior legislative staff, OSDH program managers and from the State of Oklahoma through recovery.ok.gov.

Your Questions, Comments or Additional Information are certainly welcome.

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