After talking to a few other people at our facility I have a better understanding of how the budget is made.  As I had discussed before, we are a state ran facility so we dont do things as easily.  Our budget is set up by classifications and you cannot take one set of moneys for one classification and put it to another classification.  So, if I have a PRN pool of money I cannot take that money and use it for another full time staff member because that money comes from a separate classification and budget. 

The department director for mental health will lobby and push for moneys to come to our programing in the state, along with many other departments doing the same thig.  A proposal would go to the Office of Administration and be looked at by the Personnel Advisory Board, if approved would then go to the Governor for his/her approval. Once that is approved by the Governor the proposal will go to legislation for a vote.  If the proposal is approved then it goes back to the Department Director who will then divide that up by the various regions of the state based on how he feels it would help those regions.  The Regional Directors would then decide how much of the money would go to each facility and the Chief Operating Officer (COO) would then be able to oversee the budget.  This same process is used in trying to get raises for the workers and any other needs met. 

This system is similar to a global budget where the budget is set for each facility and funded by the state and other payers involved (Sharfstein, Gerovich & Chin, 2017).  Maryland has a global budget for rural hospital networks that also reward facilities for reduction in preventable care and penalized when a patient needs care from another facility.  The biggest difference from Marylands Safety-Net Hospitals that are using this system is our facility does not get rewarded when we reduce cost or penalized if a client has to seek emergency medical attention multiple times for removal of a foreign object repeatedly.