can’t exceed the amounts expended in fiscal year 2012 and budgeted in fiscal year 2013. Exceptions to the baseline re- quest limitation include amounts neces- sary to “maintain benefits and eligibility in Medicaid entitlement programs, the Children’s Health Insurance Program, the foster care program, the adoption subsidies program, and the permanency care assistance program.”


Agencies also must submit a supple- mental schedule detailing how they would reduce the baseline request by an additional 10 percent. In its Legislative Appropriations Request, DSHS proposes reducing general revenue, in part, by eliminating some full-time administra- tive positions and jobs in some safety net and public health programs. Dr. Lakey says DSHS’s strategy to con- tinue to improve public health in Texas in the face of general revenue reductions involves continuing to use “methods that can provide the greatest return for the dollars we’re entrusted with by focusing on prevention and building partnerships with other organizations at the federal, state, and local levels. In addition to state general revenue, we receive fed- eral funding and will continue to pursue other funding opportunities.” He says different parts of the depart-


ment are also working together to lever- age resources. For instance, the DSHS tobacco program is working with the department’s chronic disease prevention, community health, and substance abuse prevention and treatment programs to reduce tobacco use in Texas. “Return on investment, especially in the state budget, is critical to working with limited resources. We focus on in- terventions that bring the most value for the dollars spent. We use continuous quality improvement to improve our pro- cesses, create efficiencies, and identify effective programs,” Dr. Lakey said. The budget board added that fund-


ing requests for other purposes that ex- ceed the baseline spending level may be submitted as exceptional items. DSHS exceptional items requests total about $352 million for the upcoming biennium. One of the health department’s excep- tional items requests pertains to tobacco cessation and chronic disease preven-


tion. DSHS is asking for $8.57 million for 2014–15 to fund initiatives such as increasing tobacco prevention and ces- sation funding for Quitline counseling services, preventing smokeless tobacco use among children in rural counties, and expanding the department’s efforts to implement chronic disease reduction and prevention efforts in urban areas. DSHS reports that in fiscal year 2011, the Quitline took 26,183 calls and pro- vided 12,113 people with smoking ces- sation counseling and 6,305 people with nicotine replacement therapy. Senator Nelson says she expects fund- ing to pose a major challenge for public health legislation this session. “As a member of the Senate Finance Committee, I will continue to make health and human services a priority and fight for … important programs, in- cluding many public health initiatives,” Senator Nelson said. Dr. Patt, like many physicians, antici-


pates challenges to public health legisla- tion with a fiscal note this session. She encourages physicians to speak out in favor of public health legislation that would cut costs and improve Texans’ health. “As doctors, we need to continue to


tell our story. We need to understand that our policymakers have the best in- tentions to facilitate good health among Texans in a fiscally responsible and au- tonomous way. Sometimes they need our guidance and understanding on how health policy will affect our patients and their constituents. It is our job to help legislators respect our liberties and work together to improve the health of all Tex- ans,” she said. Dr. Terk says physicians can help


overcome challenges to passage of pub- lic health legislation. “We need to broadcast a clear message on these important public health priori- ties and not assume that anything is safe


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February 2013 TEXAS MEDICINE 31


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