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The Senate released its version of the FY25 LHHS appropriation bill on August 1, 2024, with significant changes in proposed public health funding than the House's proposed bill.

Investing in Indiana’s Public Health Infrastructure Through Community-Driven Policy Change public health infrastructure, community driven policy, indiana state health commissioner, public health system, indiana department of health, outpatient facilities, technical assistance, data and information integration, emergency preparedness, child and adolescent health, legislative action, state and local elected officials, health problems, health care, health system, health departments, federal agencies, essential public health services, centers for disease control, state and local levels, health outcomes, health organization, covid-19 pandemic, health infrastructure, promoting health, public health organizations, states public health, federal funding, astho, association of state and territorial health officials Maggie Davis, Keith Coleman Indiana enacts historic public health funding through community engagement and legislative support. In April 2023, Indiana passed bill SB 4, which was a historic investment in the state's public health funding and restructuring its public health system. This case study shares how the Governor's Public Health Commission and the Indiana Department of Health approached community listening sessions, formulated recommendations, and successfully built legislative support to reform the public health system in the state. Get the Report (PDF) website yes

Sustaining DMI: Conditions for Enhanced Funding How state Medicaid agencies can receive enhanced federal funding for certain expenditures. What are the Conditions for Enhanced Funding? Why are they important? The Conditions for Enhanced Funding (CEF) are a series of federal requirements that states must meet to receive federal financial participation. If a state Medicaid agency (SMA) meets the CEF and couples them with measurable outcomes and metrics that improve the Medicaid program, it can receive enhanced funding at the rate of 90% to design, develop, or implement a Medicaid Enterprise Systems (MES) module or at 75% to operate and maintain an MES module. Each state operates an MES to manage its Medicaid data and run its program. Increasingly, SMAs’ MES are composed of independent modules in categories such as eligibility and enrollment and financial management. An SMA that uses these funds can build a strong financial foundation for a data modernization initiative and can secure reliable funding to better sustain the initiative. How can states receive enhancing funding to design, develop, implement, or operate and maintain an MES module? To receive enhanced federal funding, SMAs must collaborate with the federal government from the original implementation of their MES module and throughout its operations and maintenance. Frequently, SMAs begin the MES development journey through a request for planning funds. Planning activities include assessing impact, conducting a Medicaid Information Technology Architecture self-assessment, convening work groups to identify potential system enhancements, and exploring outcomes and metrics. These plans often are converted into requests for design, development, and implementation funding. The 90% funding match for design, development, and implementation could cover the performance of system fixes, establishing connectivity and interfaces, developing business continuity plans, software leasing, configuring off-the-shelf software, and ongoing planning activities. To receive the 75% funding match for operation and maintenance of an MES module, the state must have its module certified by and continuously report operational metrics to the Centers for Medicare & Medicaid Services (CMS). After certification, the SMA can receive enhanced federal funding to support security updates, software leasing or licensing, portal and technology maintenance and operation, and training for personnel engaged in the operation of the MES. Although these eligible activities are diverse, states should ultimately meet seven conditions for enhanced funding (Table 1): Modularity Medicaid Information Technology Architecture (MITA) Industry standards Technology reuse and sharing Business processes Reports Interoperability Table - Resource - Sustaining DMI: Conditions for Enhanced Funding What best practices should states consider when seeking enhanced funding? If an SMA meets the CEF and couples them with measurable outcomes that improve the Medicaid program, it can receive enhanced funding. Public health data modernization initiatives and their ongoing support may be eligible for enhanced federal funding through the Medicaid program. Best practices include: Start the Streamlined Modular Certification early. Certification is a crucial piece of CEF and requires many interrelated activities. States should use the intake form to enter information about MES certification and CMS-required outcomes to develop documentation of their compliance with regulations applicable to their Medicaid-based data modernization initiative, state-specific outcomes, and metrics. The intake form can be used to show that the project is achieving outcomes on a continuous basis. Become familiar with CEF best practices. CMS highlights several best practices for successfully engaging with CEF. States should become familiar with this guidance to help them complete various required forms and documentation, understand connected activities, create realistic timelines, prevent duplication of work, identify efficiencies, and more. Identify outcomes that are feasible to achieve and measure and improve the Medicaid and public health programs. Some outcomes can take years to appear and intensive research and resources to measure. A state should identify outcomes that are feasible to achieve and measure based on its Medicaid-based data modernization initiative, available resources, staff capacity, and other factors. This includes setting measure targets that, when reached in the designated time, collectively provide proof that there is progress toward achieving Medicaid and public health outcomes. website yes

As a truly historic year comes to an end, many public health policy issues received a considerable amount of attention in 2020. Subjects such as the pandemic that will live on in infamy, racial health disparities, and the future of the Affordable Care Act, are just a few of the major health issues that took center stage on Capitol Hill this year.

The second half of Public Health Review's story on the opioid epidemic explores how coalitions in Kentucky are driving prevention efforts, what public health practitioners in West Virginia are doing to identify and care for newborns who have been exposed prenatally to addictive drugs, and how one federal agency is working to ensure that rural communities get access substance abuse and mental health services.

Sustaining DMI: Medicaid Advanced Planning Document Process How state Medicaid agencies can request enhanced federal funding for Medicaid Enterprise Systems and related activities. Why is the Advanced Planning Document process important? Based on information from the Government Accountability Office (GAO), the Centers for Medicare & Medicaid Services (CMS), and the Federal Register, the Advanced Planning Document (APD) process is a procedure through which states develop a plan of action for their Medicaid information technology (Medicaid IT) projects. These plans are for designing, implementing, or operating Medicaid Enterprise Systems (MES) projects. State Medicaid agencies (SMAs) submit completed APDs to CMS—specifically a designated state officer in the Center for Medicaid and Children’s Health Insurance Program (CHIP) Services (CMCS) Data and Systems Group (DSG)—to request federal financial participation for their activities. The state officer reviews APDs to assess whether states’ requests for federal financial participation for designing, developing, implementing, or maintaining MES activities contribute to the economic and efficient operation of Medicaid and meet specific technical and operational criteria defined in statute, regulation, or sub-regulatory guidance. A state that receives federal financial participation can see increased access to stable federal funding to support MES activities. In addition, APDs are used to monitor a state’s project performance and outcomes. What are the three types of APDs? There are three types of APDs: Planning, Implementation, and Operational (Table 1). Table - Resource - Sustaining DMI: Medicaid Advanced Planning Document Process What are the major steps for states in the APD process? To request enhanced federal funding for MES, SMAs must complete the APD template that aligns with where they are in the development of their project (for example, design or maintenance) and submit it to the designated CMCS DSG state officer. The APD process contains five major steps and can take many months to complete: Meet with key state contacts and decision-makers. Based on information from the Public Health Informatics Institute’s information and tip sheets, before developing the APD, the SMA should identify and engage key state contacts and decision makers to solicit their input about the proposed project and secure their and their staff’s collaboration to complete and submit the APD to the CMCS DSG state officer. The state health agency (SHA) should work closely with the SMA during this process to ensure that they provide needed support to the SMA. For example, the SHA may gather information for the SMA to include in the APD or advise on how to complete particular sections of the APD. During this process, the SMA and SHA should consult with their respective agency leadership to discuss the type of technological solutions Public Health maintains, Public Health’s relationship with the state Medicaid program, and the opportunity to align systems to reduce overall state costs and improve state efficiency through the APD process. The SMA and SHA should also engage the MES lead, who can offer critical information about current MES components and component certification needed to complete the APD. In addition, GAO recommends states involve their chief information official in overseeing Medicaid IT projects because they can play a critical role in decision making related to IT budgets, management, and oversight. Next, the SMA and SHA should engage the CMCS DSG state officer to develop a strong understanding of how the APD can support the Medicaid program and serve a public health interest. Coordinating with the state project management office can help integrate the diverse parties and processes needed to develop and submit the APD for approval. It can also help ensure that states develop a comprehensive and flexible timeline for the APD process, stay aware of approaching deadlines, and meet ad hoc requirements. Develop the appropriate APD. Next, based on 45 C.F.R. § 95.610(c), the SMA and SHA should identify which of the three types of APDs to submit to the CMCS DSG state officer. Planning APDs are recommended for large and complex projects, such as statewide projects. However, if a state can identify a clear and easy pathway to integrate a public health information technology system with a current MES procurement or development phase, it can forgo developing a Planning APD and directly develop or update an existing Implementation APD. For example, if a state is looking to integrate its counties’ public health data into its MES at once, it should develop a Planning APD as the project is large and affects all counties in the state. However, if a state already has most of its counties’ public health data in its MES but is looking to add a single county’s data to its MES using the same process it previously and successfully used to add the other counties’ data, it may not need to submit a Planning APD. If a state has already successfully integrated its counties’ public health data into its MES and is looking to make major technology upgrades and improvements, it should submit an Operational APD. Regardless of the type of APD the state submits, the SMA and SHA should work together to ensure the request meets the Conditions for Enhanced Funding (see separate document Conditions for Enhanced Funding: The Basics). Submit the APD for approval and be available for revisions. Based on information from CMS, GAO, and the Office of Child Support and Enforcement, the state should then submit the APD to the designated CMCS DSG state officer. The SMA and SHA should plan to receive questions and revision requests from the CMCS DSG state officer and ensure that the state has staff capacity to answer questions and revise and resubmit. Approval conditions can be found at 45 C.F.R. § 307.15, but approval criteria might vary by Medicaid IT project and other factors. If approved, implement the plan. Next, the state can carry out the plan described in its Planning and Implementation APDs. After the Medicaid IT project has been operating for at least six months, states can request system certification from CMS. According to CMS, certification is required to receive the enhanced 75 percent federal financial participation for operations. The certification process includes states submitting to CMS an intake form, a certification request letter, and supplemental materials with information on its system. CMS may then start its review to assess whether the state’s system meets certification requirements. If approved, monitor and report progress and submit other APDs as needed. Based on 45 C.F.R. § 95.610(c) and 45 C.F.R. § Part 95 Subpart F and information from CMS, CMCS, Office of Child Support and Enforcement, as the state continues with its Medicaid IT project, it should adhere to monitoring and reporting requirements for enhanced federal funding. It also should submit annual APDs as required. If the state wants to make any major changes to the Medicaid IT project in concept, scope, cost allocation approach, timeline, and other key areas, it must develop and submit an as-needed APD. An as-needed APD is due no later than 60 days after the occurrence of the change. State examples: Medicaid Enterprise System projects Based on information from Alvarez & Marsel, state MES projects will vary based on factors such as the maturity of a state’s technology infrastructure, its specific data needs, and its available resources. As such, projects to design, implement, or operate MES can range in size, complexity, and timeline. For example, the Alabama MES Modernization Program, the Wyoming Integrated Next Generation System Project, and the Florida Health Care Connections project all seek to transform their singular Medicaid Management Information Systems (MMIS) into modular, multi-vendor MES, but differ in approach. In addition, Arizonia and Hawaii are collaborating to modernize their shared MES. For more information on state MES projects, see the Medicaid Enterprise System Solution/Module Contract Status Report. This webpage lists states’ MMIS and Eligibility and Enrollment contract information for their MES projects. It also lists contact information for state officers to reach out to learn more about states’ MES projects. website yes

CDC-funded program will accelerate data exchange between healthcare and public health to drive timely, data-informed public health action

Sustaining DMI: A State Health Official’s Guide to Enhanced Funding Sustainable financing strategies for state health officials to support data modernization and Medicaid. What is the relationship between a state’s Medicaid program and its public health data system? Although state implementation of the Medicaid program (Title XIX of the Social Security Act) varies, each state’s program has enrollment and claims data on Medicaid participants, including demographic data on race and ethnicity, age, and service utilization, such as vaccines received. At the same time, a state’s public health system needs to collect, analyze, and report diverse data from public health initiatives and related programs to support its goals to protect and improve the health of individuals and communities by promoting healthy lifestyles, researching and encouraging disease and injury prevention, and detecting, preventing, and responding to infectious diseases. A state’s Medicaid program and public health agency can collaborate to implement a sustained data modernization initiative (DMI) that combines Medicaid and public health data and integrates these data into the state’s health-related data ecosystem. A sustained DMI can yield various improvements to a state’s health-related data ecosystem, such as improved data quality, public health reporting, data storage and resiliency, and analytics to respond to pandemics. It can also set the stage for data sharing with additional data system partners, which can further improve the state’s health-related data ecosystem. Why is sustainable funding necessary to continue DMIs? Sustainable funding to support personnel, processes, and technology is imperative to the continued success of a DMI. Stable funding can increase state Medicaid and public health agencies’ likelihood of recruiting and retaining personnel with advanced degrees, such as biostatisticians and epidemiologists, by enabling the agencies to offer compensation packages that are competitive with job market rates. Stable funding also enables the agencies to maintain and refine new and existing data-sharing processes, and it ensures that technology is maintained and upgraded appropriately to meet evolving needs. Medicaid funding is a potentially large and stable funding stream that can support the personnel, processes, and technology in a DMI that focuses on integrating Medicaid and public health. However, public health funding has historically been an unstable patchwork of federal, state, local, and private funding streams and mechanisms, largely because of changing economic and political priorities and the perceived risk level and severity of major public health threats. What sustainable financing strategies can support the personnel, processes, and technology needed to continue DMIs? State health officials can use the following three strategies when pursuing Medicaid funding to sustain a DMI: Blend and braid funding sources. Optimize existing and potential funding streams by blending or braiding administrative approaches to grow and maintain programs. To blend funding sources, program officials combine funding into a single stream, which results in a loss of award-specific requirements and thus requires statutory authority. In contrast, braiding funds allows program officers to direct funds toward a single strategy or initiative while preserving funding requirements (Box 1). Callout 1 - Resource - Sustaining DMI: A S/THOs Guide to Enhanced Funding Support personnel by using cost allocation through the Advance Planning Document (APD) process or the Administrative Cost Allocation Plan. A DMI team often has people with specialized skills, such as clinical and technical experts, compliance or legal officers, and financial experts. The salary for these people may be cost-allocated via the APD process or the Administrative Cost Allocation Plan described in Social Security Act Section 1903(a)(7) (Box 2). To illustrate, the Administrative Cost Allocation Plan provides 50 percent match for costs that meet a series of requirements to cover personnel costs. In addition to this strategy, state health officials can cover salary costs through blending and braiding approaches. Callout 2 - Resource - Sustaining DMI: A S/THOs Guide to Enhanced Funding Align public health functions with Medicaid business and technical functions. To explore whether a state Medicaid agency could access enhanced federal funding to support public health, a state public health agency must approach the state’s Medicaid program collaboratively and design and implement a DMI that does the following: Meets the Conditions for Enhanced Funding and couples any technical system improvements with measurable outcomes that improve public health and the Medicaid program. Investigates the extent to which the public health technical functions (for example, health care provider enrollment) align with similar Medicaid business functions. Confirms the extent to which the public health functions and Medicaid Enterprise Systems share or could share (that is, reuse) core technical components to support common business functions. Callout 3 - Resource - Sustaining DMI: A S/THOs Guide to Enhanced Funding After this investigation is complete, the state Medicaid agency should explore cost allocation models that apportion costs with the benefits received (Box 3). Box 4 provides examples of public health use cases that successfully acquired enhanced Medicaid funding. Callout 4 - Resource - Sustaining DMI: A S/THOs Guide to Enhanced Funding website yes

Upgrading how public health and healthcare systems share data.

ASTHO Requests $1 Billion in Emergency Supplemental Funding for Opioid Epidemic ARLINGTON, VA—The Association of State and Territorial Health Officials (ASTHO) is requesting that the Administration and Congress provide $1 billion in emergency supplemental funding for the Centers for Disease Control and Prevention (CDC) and state and territorial health departments to address the opioid epidemic. This emergency supplemental funding will allow state and territorial health agencies to allocate additional resources for their top priorities, including: Strengthening public health surveillance to improve our understanding of the epidemic. Expanding opioid misuse and addiction prevention campaigns. Linking electronic health records and prescription drug monitoring programs (PDMPs). Expanding partnerships and collaboration with law enforcement. Expanding access to naloxone and linking patients to medication assisted treatment and other services. “While the Administration has made major federal investments in treatment and recovery, health officials need funding for prevention,” says Michael Fraser, executive director of ASTHO. “We strongly encourage Congress to provide this emergency supplemental funding and address this deadly crisis like any other emergency where the Administration proposes and Congress provides the resources necessary to defeat it.” More needs to be done to provide CDC, states, and territories with investments in prevention to turn the tide on this epidemic. There is an urgent need to prevent opioid misuse through population-based and community-wide public health programs including connecting PDMPs with electronic health records, surveillance, implementation of prescribing guidelines, and prescription drug public awareness campaigns. ASTHO’s request aligns with many recommendations included in the President’s Opioid Commission report and Gov. Chris Christie’s recent call for additional resources to address the opioid crisis. To view ASTHO’s $1 billion opioid emergency supplemental request, click here. Visit my.astho.org/opioids to view ASTHO’s opioid framework, access resources, and learn about promising practices that state and territorial health agencies are undertaking to end the opioid epidemic. ASTHO Press Release Boilerplate website yes

In May 2021, President Biden released full details of the fiscal year 2022 budget. Overall, the budget request combines President Biden's American Jobs Plan, his American Families Plan, and funding priorities for the Pentagon and domestic agencies, for a projected total of $6 trillion. Read more about what the president is proposing in this post.

COVID-19 revealed the dire straits of public health; now, with renewed funding, public health leaders discuss how to use COVID funding to build and maintain sustainable infrastructure.