The Division of Administrative Services within the Department of Health is responsible for all fiscal management. Division staff uses Edison which is the State of Tennessee's Enterprise Resource Planning (ERP) system for budgeting, collection of revenues and distribution of expenditures. Computer generated cumulative expenditure and receipt plan analysis, transaction listings and spending/receipt plans are available statewide on-line for all MCH programs. This information can be accessed by both central and regional office staff. Financial audits are the responsibility of the Comptroller's Office. All departments, offices and programs within state government are subject to frequent audits. Contract agencies are also audited frequently. MCH program staff provide site visits and program monitoring at contract agencies in order to assure compliance with the contract's scope of services. Fiscal monitoring of contract agencies is the responsibility of the Department of Health's Internal Audit staff.

The Tennessee Department of Health adheres to the policies and procedures developed by the Department of Finance and Administration. These policies can be found on the Department of Finance and Administration website and pertain to the multiple financial functions of the State.

The Tennessee MCH/Title V Program met all legislative requirements in regards to the spending of grant funds.  This includes a maintenance of effort in the amount of $13,125,024 set by the state in 1989.  This figure is based on the amount the state was spending on maternal and child health programs in 1989. The state is required to continue to contribute at least that amount to the program in order to receive this federal grant.  The state met that amount in FY2019.  The state is also required to match the federal dollars 3 to 4.  For every 4 federal dollars the state receives they must contribute 3 dollars.  For FY2019 Tennessee received $11,797,538 federal dollars, therefore the required state match amount was $8,848,153.50.  The state exceeded that match amount in FY2019.  The last requirement is that of the federal allocation states spend at least 30% of federal grant funds on preventive and primary care for children, 30% on children with special health care needs, and no more than 10% on administrative cost.  Tennessee met all of these thresholds during FY2019.  It also should be noted that none of the services paid by the grant were reimbursable by other agencies (namely Medicaid) or providers. This is assured through eligibility determination processes for programs such as CSS as well as regular communication with TennCare regarding the reimbursement services of the MCOs.

During FY2019 federal and state match MCH/Title V Program dollars supported programs across the health domains as illustrated below.  Some of the programs span multiple domains, and therefore are repeated among the domains.

Estimates of the reach of the MCH/Title V program in terms of population served is listed on Form 5a and 5b.  The program has the widest reach among children 1-22 years of age pregnant women and infants less than 1 year old categories through newborn screening and the work of the perinatal centers.  The children 1-22 years of age, CSHCN, and others categories have a much smaller reach.  These numbers are estimates in that deduplication is not possible between programs.

Tennessee state law requires all departments to submit a complete financial plan and base budget request for the ensuing fiscal year that outlines proposed expenditures for the administration, operation and maintenance of programs. Budget guidelines are prepared annually by the Department of Finance and Administration. The Department’s Budget Management Office, in cooperation with all programs, is responsible for the preparation of the budget documents. The base budget request becomes law after it is approved by the General Assembly and signed by the Governor. A work program budget is then developed for each program.

The Department of Health uses a cost allocation system for the local health departments. Costs are allocated using two specific methods, the direct cost allocation method and the resource based relative value method (RBRVS). The direct cost allocation method is used when costs can be directly allocated to one or more programs. Any cost can be directly allocated when coded correctly on the appropriate accounting document. Direct cost allocation is used primarily for costs that arise from administrative support staff in the Department’s central and regional offices and for selected contract expenditures. The RBRVS cost allocation method is used to allocate costs which cannot be directly allocated to one or more programs. These costs arise from the delivery of direct health or patient care services in rural health departments. RBRVS adds weighted encounter activities using relative value units and allocates costs based on the percentage of activity for each program. RBRVS is a federally approved cost allocation method for the Tennessee Department of Health. RBRVS is linked at the service delivery level to AS 400 computers at the regional and central offices.

Program encounter data are entered at local health departments for direct patient care services using Current Procedural Terminology (CPT) codes and program codes. Relative value units assigned to each procedure code allow a proportionate amount of cost to be associated with each procedure. RBRVS provides quarterly cost allocation reports to central and regional office staff. These reports are used to monitor and manage expenditures, determine cost for services provided, and allocate resources as needed.

The maintenance of effort requirement for the Maternal and Child Health Block Grant was established in 1989. This requirement specifies that the state must, at minimum, continue to fund Tennessee MCH/Title V Program efforts through state funds at the level it was in 1989.  At that time Tennessee calculated its maintenance of effort to be $13,125,024.28.  This calculation was based on an analysis of 15 months of expenditures for the program, adjusted for differences between the state and federal fiscal years, as well as adjustments for accrued liabilities. TDH fully supports using state funds to meet the maintenance of effort and match requirements in support of Maternal and Child Health Program activities. TDH monitors its maintenance of effort annually and has exceeded requirements in all reporting years.

Tennessee fully utilizes Maternal and Child Health Block Grant funding within the 24 month allowable timeframe and meets all targeted maintenance and match requirements set forth in the grant regulations. Any unobligated balance noted in the report will be used to support or expand program activities. This funding has typically been used to develop new services or to expand current programs. During recent years funding has been used in teen pregnancy prevention and for breast and cervical screening for reproductive age women. Funding has also supported home visiting services for pregnant women and families with high risk infants and young children as well as care coordination services for families with children with special health care needs.

The Tennessee MCH/Title V Program is not proposing major changes to the reported budget for this year.  The budget will mirror that of the FY2019 expenditures.  This budget aligns with Tennessee's priorities for the grant.  Federal dollars are used to extend the reach of state dollars.  The federal allocation allows Tennessee to serve more of the maternal and child population.

The MCH/Title V director leverages other federal dollars from the programs listed below which are under the director's control.

Other Federal Programs

• Abstinence Education Grant
• Breast and Cervical Cancer Screening Grant
• Childhood Lead Poisoning Prevention
• Commodity Supplemental Food Program (CSFP)
• Family Planning (Title X)
• Injury Surveillance and Prevention
• The Loving Support Peer Counseling Program
• Maternal, Infant, Early Childhood Home Visiting Program
• Preventive Health Services Block Grant
• Rape Prevention and Education
• State Systems Development Initiative
• Sudden Death in the Young Registry
• Tobacco Quitline
• Tobacco Use Prevention and Control
• Traumatic Brain Injury
• Universal Newborn Hearing
• Women, Infants, and Children

The required state match and maintenance of effort is monitored throughout the year by the Division of Administrative Services.  All programs of the TDH must be free from discrimination.  The Department's non-discrimination policy is below.

TDH Non-Discrimination Statement:

Title VI of the Civil Rights Act of 1964 requires that federally assisted programs be free of discrimination.  In accordance with Federal civil rights laws, the Tennessee Department of Health does not tolerate harassment and discrimination based upon any protected class including race, color, national origin, sex, age, disability or reprisal or retaliation, in any program or activity conducted or funded by TDH. Such harassment and discrimination constitutes misconduct which undermines the integrity of the employment relationship and is subject to disciplinary action, up to and including dismissal.