Department of Health

  Annual FTEs General Fund State Other Funds Total Funds
  (Dollars in Thousands)
Estimated Expenditures 1,823.8 149,285 1,097,397 1,246,682
2019-21 Maintenance Level 1,845.2 133,045 1,083,229 1,216,274
Difference from 2017-19 21.4 (16,240) (14,168) (30,408)
% Change from 2017-19 1.2% (10.9%) (1.3%) (2.4%)

2019-21 Policy Other Changes

Fund Foundational Public Health 0.0 22,000 0 22,000
Reduce Suicide Rates 3.3 1,150 0 1,150
Improve Prescription Drug System 1.8 100 0 100
Create Developmental Screening Tool 1.1 223 0 223
Fruit and Vegetable Incentives 0.0 2,325 0 2,325
Monitor Group B Water Systems 0.0 1,012 0 1,012
Continue Maternal Mortality Reviews 3.4 807 0 807
Conduct Mandated Newborn Screening 3.1 0 1,606 1,606
Modernize Vital Records Law 1.3 0 399 399
End AIDS 9.4 0 18,000 18,000
Align Drinking Water Funding 1.0 0 834 834
Upgrade Profession Licensing System 18.8 0 7,943 7,943
Streamline Marijuana Funding 2.7 0 0 0
Improve License Processing Times 12.8 0 2,010 2,010
Address Newborn Screening Shortfall 0.0 0 332 332
WMC Increased AG Costs 0.0 0 1,123 1,123
WMC Clinical Investigator Costs 1.7 0 1,310 1,310
NCQAC Increased Legal Costs 8.9 0 3,210 3,210
CQAC Increased Legal Costs 0.0 0 500 500
Opioid Package: Fentanyl Test Strip 0.20 101 0 101
2019-21 Policy Other Changes Total 69.5 27,718 37,267 64,985

2019-21 Policy Comp Changes

State Public Employee Benefits Rate 0.0 11 43 54
WFSE General Government 0.0 2,398 11,686 14,084
State Rep Employee Benefits Rate 0.0 33 186 219
Non-Rep General Wage Increase 0.0 752 2,915 3,667
Non-Rep Premium Pay 0.0 152 252 404
Non-Rep Targeted Pay Increases 0.0 34 64 98
SEIU 1199 General Government 0.0 46 516 562
PERS & TRS Plan 1 Benefit Increase 0.0 60 309 369
Non-Rep Salary Schedule Revision 0.0 64 263 327
2019-21 Policy Comp Changes Total 0.0 3,550 16,234 19,784

2019-21 Policy Transfers Changes

Orca Transit Pass Funding Transfer 0.0 (64) (126) (190)
Health Coalition FSA Fund Transfer 0.0 (74) (54) (128)
2019-21 Policy Transfers Changes Total 0.0 (138) (180) (318)

2019-21 Policy Central Services Changes

Electric Vehicle Infrastructure 0.0 2 12 14
Archives/Records Management 0.0 4 22 26
Audit Services 0.0 3 12 15
Legal Services 0.0 129 1,042 1,171
CTS Central Services 0.0 (111) (545) (656)
DES Central Services 0.0 15 101 116
OFM Central Services 0.0 249 1,212 1,461
2019-21 Policy Central Services Changes Total 0.0 291 1,856 2,147
Total Policy Changes 69.5 31,421 55,177 86,598
2019-21 Policy Level 1,914.7 164,466 1,138,406 1,302,872
Difference from 2017-19 90.9 15,181 41,009 56,190
% Change from 2017-19 5.0% 10.2% 3.7% 4.5%

Policy Changes

Fund Foundational Public Health

The department is provided funding for foundational public health services to address the key areas of communicable disease, environmental health, and assessment and support activities for these areas. This investment continues the baseline funding provided in the 2017-19 biennium ($1.2 million for tribes) to reinforce capacity at the local and state levels and address gaps in the key focus areas using innovative service delivery models. The department will prioritize investments that can be combined with other opportunities (federal or other funding) to expand resource capacity, focus on general communicable disease and STDs, and address data consolidation and innovation systems.

Reduce Suicide Rates

Funding is provided for the crisis hotline and text line which provide real-time crisis support and intervention. This will allow the department to continue its partnership with the National Suicide Prevention Lifeline. In doing so, it will also incentivize two additional call centers to become National Suicide Prevention Lifeline-affiliated crisis centers. These call centers will better represent eastern Washington and assist with increased call volumes which will improve Washington’s in-state answer rate.

Improve Prescription Drug System

Washington’s Prescription Monitoring Program (PMP) enables eligible providers to check a patient’s prescription history for opioids, giving providers critical information to guide treatment decisions. The department currently contracts with a vendor for a PMP system. When this contract expires in June 2020, the price is anticipated to increase substantially. Information gathered on the current market indicates there may be lower cost options that offer improved functionality for prescribers. Funding is provided to transition to a new PMP system that provides improved functionality at a competitive price.

Create Developmental Screening Tool

To ensure all children are appropriately screened for developmental delays and receive critical early intervention services, funding is provided to create a statewide data system to track developmental screenings and delays identified in children, and assist with care coordination and early intervention.

Fruit and Vegetable Incentives

The Food Insecurity Nutrition Incentives (FINI) and the WIC Farmers' Market Nutrition Program (FMNP), offer fruit and vegetable incentives to low-income individuals for use at grocery stores and farmers' markets. Federal funds for FINI expire in 2020 and FMNP provides only a very small incentive to clients, which diminishes the participation rate. Funding is provided to maintain these programs at fiscal year 2019 levels.

Monitor Group B Water Systems

Funding is provided for the department to work with local public health entities to ensure the approximately 13,400 Group B public water systems comply with statewide rules and provide safe and reliable drinking water.

Continue Maternal Mortality Reviews

Maternal mortality is on the rise in the United States, with minority communities experiencing disparities compared to the general population. Maternal mortality is also under-reported, leaving Washington without critical data to inform policy recommendations that reduce the rate of occurrence. Ongoing funding is provided to continue the biennial maternal mortality review report and align state policy with national best practices.

Conduct Mandated Newborn Screening

In 2017, the State Board of Health initiated administrative rules to add Pompe disease and MPS-I to the mandatory newborn screening panel. When these rules are adopted, the Department of Health is required to begin testing for both of these heritable conditions. Additional expenditure authority and a fee increase is granted for the Department of Health’s Newborn Screening Laboratory to conduct the required blood sample testing.

Modernize Vital Records Law

Current vital records law does not provide adequate protections against identity theft and fraud. Many parts of the statute have not been updated since 1907, making the law outdated, confusing, and inconsistent with current state and national best practices. Funding is provided to the Department of Health to modernize the vital statistics law (chapter 70.58 RCW) based on a national model law developed by the National Center for Health Statistics and National Association for Public Health Statistics and Information Systems.

End AIDS

Funding is provided to ensure grant compliance with the federal Health Resources and Services Administration. This additional authority will allow the department to continue providing community services and care for people living with HIV/AIDS at a level required by law for core medical services, case management, and support services.

Align Drinking Water Funding

Additional appropriation authority is provided for the Drinking Water Assistance Administrative Account to align funding with staffing costs and provide consolidation grants to successful water utilities to study the feasibility of owning, operating, and maintaining smaller failing water systems within their service areas.

Upgrade Profession Licensing System

Licensing and regulating health care providers, facilities, and educational and training programs are statutory responsibilities of the department that promote patient safety and access to care. Those activities are currently supported by an outdated and aging Integrated Licensing and Regulatory System (ILRS). Funding is provided for a new Healthcare Enforcement and Licensing Modernization Solution (HELMS) to transform licensing and enforcement processes and its interactions with participants and stakeholders. HELMS will improve data security, support electronic records management, and improve access to information.

Streamline Marijuana Funding

The medical marijuana database is financed from the Health Professions Account but reimbursed from the Dedicated Marijuana Account. This item streamlines the administration of the database by moving funding to the Dedicated Marijuana Account.

Improve License Processing Times

This item will continue an increased staffing level originally funded as one-time in the 2018 supplemental budget for credentialing staff in the Health Systems Quality Assurance (HSQA) unit at the Department of Health. These staff reduce wait times and accelerate the licensing process for 85 health professions throughout the state.

Address Newborn Screening Shortfall

The 2017 Legislature authorized an increase in the newborn screening fee by $8.10 per infant to screen for X-linked adrenoleukodystrophy (X-ALD), a deadly genetic disorder that affects about 1 in 17,000 babies. However, current budget forecasts project a shortfall by the end of the 2019-21 biennium. Funding is provided for an additional fee increase of $1.90 to fully support screening for X-ALD.

WMC Increased AG Costs

The Washington Medical Commission (WMC) has experienced an unprecedented upward trend in Attorney General (AGO) billings due to increased discipline activity and increased litigation costs due to defendants retaining more counsel and outside witnesses. Funding is provided to cover the increased AGO billing costs.

WMC Clinical Investigator Costs

The 2017-18 collective bargaining agreement included a new class of investigator, Clinical Health Care Investigator, for the Washington Medical Commission but the 2017-19 budget did not include the needed additional funds to compensate these clinically trained staff. Funding is provided to correct this budget difference.

NCQAC Increased Legal Costs

The Nursing Care Quality Assurance Commission (NCQAC) regulates over 122,000 nurses in Washington State. In the past four years, the number of licensed nurses increased 16.3 percent, and complaints against nurses increased 106 percent. Complaints include patient deaths, serious harm, and abuse. Performance measures and legally mandated timelines are not being met. Funding is provided to NCQAC to address the complaint backlog and to investigate the growing number of complaints received.

CQAC Increased Legal Costs

Funding is provided to the Chiropractic Quality Assurance Commission (CQAC) for a projected increase in costs for legal services. Over the past two years, Office of the Attorney General costs have risen 139 percent.

Opioid Package: Fentanyl Test Strip

This step is part of a multi-agency package to expand treatment and prevention services across the state to prevent opioid-related overdose deaths. Fentanyl is an extremely potent and fast-acting opioid often found in drugs that were not sold as opioids (e.g. methamphetamine, MDMA and cocaine), and education to individuals using these drugs about that possibility is especially critical. Fentanyl test strips have been shown to be highly accurate, correctly detecting the presence of fentanyl and/or fentanyl analogues approximately 98 percent of the time. Data shows that 66 percent of individuals with positive fentanyl test results engaged in overdose risk-reduction behavior. One-time funding and staff support is provided to supply fentanyl test strip kits to distribute to syringe services programs.

State Public Employee Benefits Rate

Health insurance funding is provided for state employees who are not represented by a union, who are covered by a bargaining agreement that is not subject to financial feasibility determination, or who are not part of the coalition of unions for health benefits. The insurance funding rate is $977 per employee per month for fiscal year 2020 and $978 per employee per month for fiscal year 2021.

WFSE General Government

Funding is provided for a collective bargaining agreement with the Washington Federation of State Employees - General Government. The agreement includes a general wage increase of 3 percent, effective July 1, 2019; a general wage increase of 3 percent, effective July 1, 2020; premium, shift, and other special pay changes, and increases in targeted job classifications. Employee insurance included in the agreement is displayed in a separate item.

State Rep Employee Benefits Rate

This provides health insurance funding as part of the master agreements for employees who bargain for health benefits as part of a coalition of unions. The insurance funding rate is $977 per employee per month for fiscal year 2020 and $978 per employee per month for fiscal year 2021.

Non-Rep General Wage Increase

Funding is provided for wage increases for state employees who are not represented by a union or who are covered by a bargaining agreement that is not subject to financial feasibility determination. It is sufficient for a general wage increase of 3 percent, effective July 1, 2019, and a general wage increase of 3 percent, effective July 1, 2020. This item includes both general government and higher education workers.

Non-Rep Premium Pay

Funding is provided for increases in premium pay for state employees who are not represented by a union or who are covered by a bargaining agreement that is not subject to financial feasibility determination. Funding is sufficient to support changes in shift differential, call back and standby pay, as well as a 5 percent increase for employees working in King County.

Non-Rep Targeted Pay Increases

Funding is provided for classified state employees who are not represented by a union for pay increases in specific job classes in alignment with other employees.

SEIU 1199 General Government

Funding is provided for a collective bargaining agreement with the Service Employees’ International Union Local 1199 NW. The agreement includes a general wage increase of 3 percent, effective July 1, 2019; a general wage increase of 3 percent, effective July 1, 2020; premium pay changes; and increases in targeted job classifications. Employee insurance included in the agreement is displayed in a separate item.

PERS & TRS Plan 1 Benefit Increase

For eligible Public Employees' and Teachers' Retirement Systems Plan 1 members, this item provides a one-time, ongoing increase of 3 percent, up to a maximum of $62.50 per month.

Non-Rep Salary Schedule Revision

This funds a revised salary schedule for non-represented employees in information technology jobs, in alignment with other state employees.

Orca Transit Pass Funding Transfer

This moves funding for employee transit passes from agencies to WSDOT, which administers the program. The transfer includes both funding added in 2019-21 for expanded access, as well as funding that was provided in the 2017-19 budget.

Health Coalition FSA Fund Transfer

This moves funding for negotiated medical flexible spending arrangements (FSA) from individual agency budgets. It will be provided to the Health Care Authority, which will administer the benefit.

Electric Vehicle Infrastructure

Agency budgets are adjusted to reflect each agency’s estimated portion of increased fee for service charges from the Department of Enterprise Services to expand electric vehicle infrastructure for the state Motor Pool fleet.

Archives/Records Management

Agency budgets are adjusted to reflect each agency’s allocated share of charges for the state archives and state records center.

Audit Services

Agency budgets are adjusted to reflect each agency’s allocated share of charges for state government audits.

Legal Services

Agency budgets are adjusted to reflect each agency’s anticipated share of legal service charges.

CTS Central Services

Agency budgets are adjusted to reflect each agency’s allocated share of charges from the Consolidated Technology Services Agency (WaTech) for the Office of the Chief Information Officer, Office of Cyber Security, state network, security gateways, and geospatial imaging services.

DES Central Services

Agency budgets are adjusted to reflect each agency’s allocated share of charges from the Department of Enterprise Services (DES) for campus rent, utilities, parking, and contracts; a capital project surcharge; financing cost recovery; public and historic facilities; real estate services; risk management services; personnel service rates; the Perry Street child care center; and the department’s enterprise applications.

OFM Central Services

Agency budgets are adjusted to reflect each agency’s allocated share of charges from the Office of Financial Management (OFM) for the One Washington project and OFM enterprise systems.