MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:
JANUARY 18, 2005
TABLE OF CONTENTS
Chairperson Stutsman called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 9:00 a.m. Members present were: Pat Harney, Mike Lehman, Terrence Neuzil, Sally Stutsman, and Rod Sullivan.
FISCAL YEAR 2006 PUBLIC SAFETY SERVICE AREA BUDGET
Budget Coordinator Jeff Horne said that there had been a Capital Improvements Plan meeting in December and that the plan will be looked at again before the end of the process. Horne explained that the amount in the General Fund cannot really be exceeded. If they add to the budget then something else has to be taken away.
Horne said there are no ambulances up for replacement this year, but that lifepack monitors need to be purchased, and Ambulance Director Steve Spenler is requesting an additional ambulance. Horne pointed out that there are no new personnel being requested for the Ambulance Department, but there is a payroll adjustment. Horne said that the total increase for the Ambulance Department will be 4%.
The Board discussed the large amount of overtime that the Ambulance Department pays. Stutsman asked if it would be more beneficial to hire another employee rather than pay all of the overtime. Horne reminded the Board that they added two paramedics last year which alleviated some of the costs. Stutsman said part of the problem is that two people have been called up to serve in Iraq. Executive Assistant Mike Sullivan said another problem is that when someone takes sick, vacation, or family medical leave the hours have to be back filled with another paramedic to meet staffing requirements.
Harney asked how many ambulances the department has. M. Sullivan said they have five. Harney said he thought the maintenance fees should be minimal, as two of the ambulances are brand new. M. Sullivan said that the County used to be able to buy maintenance agreements through the Ford dealership when they purchased the vehicles, but that is no longer possible. Stutsman said that he would like to talk to Spenler about the necessity of all twelve lifepacks being purchased at once or if they could spread it out over a couple of years. Neuzil said they should ask Spenler if fewer monitors could be purchased this year while still getting the vehicle rather than getting all of the monitors and no vehicle. Harney said there is still a concern of running the cars in and out of the County so much when they might not have to. Harney pointed out that by having a car available it could become a pay issue because it is a benefit. Horne said it is a tax benefit. Stutsman said she didn’t know there were so many Ambulance people that lived out of County. M. Sullivan said that there isn’t a residency requirement but there is a response time requirement. Stutsman said the Ambulance budget is made up of property tax dollars and she has a hard time with people working for the County and not contributing to the County through property taxes. Horne said they could make a residency requirement. Neuzil suggested they make the topic a future agenda item.
Harney asked who estimates fuel costs. Horne said there isn’t a set policy, but each department sets their own fuel costs. Harney suggested Horne provide the departments with an average increase number so that everyone is using the same numbers to figure their fuel budgets. Horne said that in the future they could centrally allocate fuel like they do postage. Stutsman said that she likes the departments having the fuel in their budgets because it helps to get an accurate picture of the departments’ budgets. Neuzil pointed out that fuel will be a major part of many budgets as costs to rise.
Stutsman asked if budget requests reflect an increase in postage. Horne said that they centrally budget postage, but that there is an increase this year due to the election. The Postal Service is also increasing the price of postage. Neuzil said it would be nice to be able to email people, but they can’t due to statutory guidelines. Horne said that the State requires things to be downloaded from their sites because they don’t want to mail it out.
Horne said he wanted to recap the questions he had from the Board. The Board wants to know about the costs for physicals. R. Sullivan said he wants to know about the breakdown of the overtime and why the field supervisors are averaging 30 hours of it each week. Horne said some of the other questions are how would Spenler be willing to prioritize the monitors versus the vehicle, if he would be willing to get the monitors over two years instead of one, and to get background on revenue and fuel research.
Horne said that the Medical Examiner budget continues to increase due to changes at the University. He said that in the future it seems that it will be difficult to work with anyone else. Stutsman said that now they have to deal with what they created. Harney said that they need to be careful in blaming University Hospitals because the situation could be tied to any hospital. Harney pointed out that the increased requirements of M.E. services has changed and now it would take too much away from a private practice and no doctor would be willing to do it. M. Sullivan said that the model used in Johnson County is similar to that of many other Counties in Iowa, but it is unique because there is a major medical regional center here. M. Sullivan said that about half of the autopsies reviewed of the past couple of years are eligible to be reimbursed. Many residents of Iowa, from Counties other than Johnson, come to the University of Iowa Hospitals and Clinics and die of their afflictions. M. Sullivan said that other Counties are not interested in forming a regional center because the case load is too high here, and other hospitals are not interested in getting involved due to the case load in Johnson County. M. Sullivan said that there were 203 autopsies billed to the County and there were almost 400 cremation permits. This is a bigger volume of cases than some counties that are of similar size or even larger and this is due to the University of Iowa Hospitals and Clinics.
M. Sullivan explained that there is a medical examiner with deputies but all the other employees are on an on-call basis. The workload for the on-call employees has increased dramatically over the years. Harney said there is a management issue now too because too much time is being taken away from the secretaries at University Hospitals and the director at Mercy Hospital. Harney added that those people when forced to make a choice will choose their full time jobs, and that someone needs to be in charge of overseeing operations. Harney pointed out that he doesn’t feel they can ask M. Sullivan to do it because of his workload, so possibly someone needs to be hired. Horne said that the biggest thing requested by the Medical Examiner department was a part time field supervisor. Horne said that Jeff Gauthier has left and that he had been doing a lot of the work for them. M. Sullivan said that when the agreement was negotiated, there was an assumption made that administrative costs would be covered by the University. With Jeff Gauthier gone, two secretaries need to do the administrative paperwork previously done by Gauthier. M. Sullivan said that the University made a decision to not fill the position vacated by Gauthier. The new Doctor running the emergency and pathology departments said that the hospital enjoys doing this, but it cannot cost the departments any money out of their budgets and the County is now going to be responsible for the administrative costs. Horne said he received the letter to that effect before putting together the budget numbers and had meetings with the on-call supervisor to discuss the issue. The cost to have the administrative professionals at the University continue their duties for the County would be $7,500. M. Sullivan said to pull the duties out and have him do them would have a greater cost because he is not physically present in the M. E. Office and it would take him more time to be going back and forth. Neuzil asked if it would make more sense to hire someone else within the County or to keep the work at the Hospital. Harney said that part of the problem is that the person doing the work needs to have an idea as to what the medical jargon is and what the terms mean. M. Sullivan said another problem is that this is not all financial functions.
Neuzil asked where the revenues are and if the County is maxed out as to how much can be asked for. M. Sullivan asked if Neuzil was referring to cremation fees, and if so, then yes, the County is at its limit. Neuzil said that he was surprised that the revenues have gone up over 200%. M. Sullivan said that the cost of the position could be easily tacked onto the bill for the autopsy. Horne said that in FY 03 there was $39,000 in revenue generated. The following year saw just over $82,000 in revenue. Horne said that he is anticipating $14,000 over this year’s revenue for next year. Horne explained that all revenue comes from what is allowed to be billed by the statutes. Harney said that the reason for the sharp increase in autopsies is due to a statutory change that requires autopsies in a variety of new circumstances.
Stutsman clarified that the department wants a new part time assistant to help with administrative duties. M. Sullivan said the person would necessarily have to be new, that the University employees would continue doing the work but they would have to be paid by the County now. Stutsman said that she is wondering why Mike M. Sullivan would be doing any of the work if they were to pay $35-36,000 for a new staff person. M. Sullivan said that his hope is that if the Board approves the position he wouldn’t be doing any of the work. Stutsman asked who would supervise the person. M. Sullivan said the Medical Examiner would. Stutsman asked how they would figure out if the person was being responsible and billing the other Counties and the families. Horne said they would be responsible to the budget for doing so. M. Sullivan explained that one on call employee has been taking vacation time from his regular job and double scheduling himself to get work done with the M.E. The employer wants the employee to continue the program with the M.E., but at the same time they need him to be free to do his full time job. M. Sullivan said hiring a part time accounting position would help alleviate some of the trouble. Horne said the $35,878 includes the position, the additional $7,500 for the administrative position and the part time position as well as the increases in other line items. Stutsman said she doesn’t understand because the gross pay for the part time field supervisor is $18,000. Horne said when the benefits are added in the total compensation is $25,978.79. Stutsman said the extra $10,000 would be for the other line items and the administrative duties.
M. Sullivan said that the autopsy line has been reduced because it was over budgeted before. The costs of medical supplies have increased. R. Sullivan said that perhaps they should talk to the State about the overburden of University Hospitals on the Johnson County M.E. M. Sullivan said that the State also does autopsies for Counties. There are certain autopsies that have to be done by the State Medical Examiner and Counties get billed for that without an opportunity to be reimbursed for them. M. Sullivan said that there were at least five or six that the State performed for the County last year. Stutsman asked if they were all on residents from Johnson County. M. Sullivan said that the County cannot bill other counties when the State does the autopsy. M. Sullivan added that if an out of state resident comes to the University Hospitals and dies the County cannot be reimbursed for their autopsy according to statute. Stutsman wanted to know how many autopsies the County are not reimbursed that the Johnson County taxpayer ends up footing the bill for. M. Sullivan said certain things automatically trigger autopsy like criminal investigations and the death of a child. Stutsman said she doesn’t mind performing the autopsies, but it is not fair to the Johnson County taxpayer that just because the hospital is located here they pay for more than their fair share of autopsies. Horne said that this is a service that will continue and that it could be difficult to find someone to fill the position. M. Sullivan said that between 40 and 48% of the autopsies performed are for out of county residents but that most of them do come from Eastern Iowa counties, however, some do come from Wisconsin and Illinois. Harney said one up side to the University Hospitals is that many bodies do not have to be transferred to the State for autopsies, the procedure can be done here at the hospital. M. Sullivan said that State autopsies performed in Iowa City are not billed to the County, rather only those that have to be performed in Des Moines by the State facilities. Stutsman asked if State cases are outlined in the Code. M. Sullivan said that he isn’t sure of the exact wording, but the State likes to do cases involving criminal prosecution in Des Moines at their facility. Stutsman said that she thought it would be a good topic to bring up at County-A-Day. Stutsman also brought up that another problem is that for a long time University Hospitals was willing to be responsible for a lot of the costs and now they are under a budget crunch and it is no longer feasible for them. Harney pointed out that they could also be billed for prison services and other such items in the future that the County is not currently responsible for.
Recessed at 9:45 a.m.; reconvened at 9:55 a.m.
FISCAL YEAR 2006 MH/DD SERVICE AREA BUDGET
Mental Health/Developmental Disabilities (46)
Horne said that MH/DD is asking for substantial changes this year. Mental Health/Developmental Disabilities Director Elaine Sweet said that looking back at the MH/DD expense budget there have been very large increases in some of the service areas. There have also been many legislative and interpretive changes in the past year regarding MH/DD. Sweet pointed out that MH/DD is actually three departments under one umbrella and that will increase to four with the addition of the Jail Diversion and Mobile Crisis Department.
Sweet said the first decision packet is for a Word Processor III. The department currently has one of these positions and is seeking another. Sweet said this additional position was needed to accommodate targeted case management and billing, provide relief for the front desk, and help will file management. Sweet explained that the targeted case management program has grown tremendously. The revenues from this program have increased 143%, and there has been no additional billing staff added. In FY 04 there were 1,636 MH/DD claims processed and of those 297 were Johnson County network providers. R. Sullivan said that the typical service expected is being done within the network, it is the people taking the vouchers to out of network pharmacies. Sweet said that is true, there is a network of providers, but MH/DD does not maintain a relationship with every pharmacy. Neuzil asked how the data entry has been done in the past, and why they need someone else now. Sweet said that the claims were being processed by Human Services Accountant Kathy Lynch and as of July 1, 2004 it moved to MH/DD. Neuzil said that there was a perception that the Management Information System (MIS) was going to do a lot of the work and it seems that is not true. Sweet said that she was amazed at the volume and that if she had had an idea on the volume probably would have reconsidered dropping the data check position. Stutsman said she doesn’t understand why Lynch is not longer doing the work. Sweet said that she looked in her documents and the change was first brought up in an April 28, 2002 28E Agreement meeting. Sweet said that it has been a great challenge to keep up with all of the paperwork and explained that if they don’t then their providers do not get paid and the Legislature gets inaccurate information when they request statistics from the office. Stutsman asked why they couldn’t just turn the work back over to Lynch. Sweet said that she does not supervise Lynch. Stutsman said that she is not comfortable with adding another position because she feels there might be another way to ease the burden by working within the existing system. Neuzil asked what Sweet thought would happen in the long term. Sweet said that MIS can be developed to help accommodate the load, but there will have to be a cooperative effort with the State to get everyone on the system. Sweet pointed out that claims is only one piece of the request, another big piece is Targeted Case Management billing.
Sweet said the second decision package is for an Account Clerk. Sweet said this position’s duties would include working with legal settlements and coordinating funding for individuals. The estimated increase in expenditures is about $42,000. A conservative estimate of the cost savings is $167,000. Sweet said the savings have been found by further investigating their prescription drug plans. Sweet added that there have been many more people coming to the department that are involved in legal settlements and need assistance to have their situation straightened out. Stutsman asked if there were any questions about the second package. Sweet said that pages 12-18 of chapter 25 of the Administrative Code shows the minimum amount of information that MH/DD is required to gather on every individual involved in the program. Neuzil asked if Sweet thought that the trends would continue as they are. Sweet said that she believes the service demands will continue to grow and Johnson County will continue to be a magnet county for people who need services because of other services present in the County such as the University Hospitals and the Veteran’s Administration Hospital.
Sweet said decision package three is for another Case Manager. Sweet said that ISAC is recommending that the average caseload be about 31 cases. Currently case managers run about 45-50 cases. Sweet explained that ISAC is talking about targeted case management files only. Currently there is a mix of case management and social work cases being assigned. Sweet said that social work cases do not require as much paperwork or case monitoring, but the caseloads are still much higher than any recommended level. Sweet explained that although the number of total cases has remained somewhat steady there has been a change in the balance of social work cases to case management files. It used to be that social work was the majority, but now the more labor-intensive case management files are. Sweet explained that in cases involving commitments, commitments are the responsibility of the county of residence and the payment is the responsibility of the county of legal settlement. This means the county of residence is responsible for doing all of the paperwork and billing the county of legal settlement. Sweet said that out of county commitments have increased as well. Stutsman asked why there has been such an increase. Sweet said that other counties have identified the University Hospitals as having unlimited psyche papers. This means that people can be taken to the UIHC emergency room and the commitment can happen at no cost. Sweet pointed out that this system helps Johnson County as well because they don’t have to pay for admissions. The problem is that there are so many out of county commitments that when an in county commitment comes up there aren’t any beds available. Sweet said this forces the patient to be sent to MHI, and if there is not any room there, the patient ends up in a community hospital in Cedar Rapids and Johnson County has to foot the bill.
Sweet said that Linn County maintains 8-10 CRIS contracts and Johnson County maintains 13. The total number of contracts that Johnson County maintains is about 25. Stutsman asked how this potion is impacted by the shift in claims. Sweet said that when the claims moved over Financial and Statistical Supervisor Deborah Guard lost time to work with the financial statements, the budget, and other things she had been working with. Sweet said that MH/DD services reassigned responsibilities and that there is a sheet describing the responsibilities that moved from Guard. R. Sullivan asked about the way the savings would be achieved. Sweet said that the treatment services and SCL Waiver as well as prescription medications will help curb costs if they can get additional staff to help search out savings. R. Sullivan said a couple of concerns he has is that there might be a chance that when they investigate charges they might find out that they are in fact being undercharged and costs may increase. R. Sullivan pointed out that there is a rate back program that is designed to refund agencies at the end of the year if they have been over charged and he asked if there had been enough rate back to lead them to believe that there is $50,000 in overcharging. Sweet said she thinks at least that much could be recouped from site rates alone. Sweet said that the Waiver service is a mandated service and that the County has increased the number of Waiver slots from 135 to 180 in recent years. The only control MH/DD has over mandated services is the number of slots they allow and whom they choose as providers. Sweet added that the cost of prescriptions for the upcoming year will be close to $9 million dollars.
Sweet said that decision package number five does not have to be in MH/DD. Mobile Crisis and Jail Diversion are not required to be funded out of MH/DD. Sweet said that it would make sense to fund these programs out of MH/DD due to the County structure, but that they could be funded out of a different department. Sweet said the position of Coordinator is being filled. The Mobile Crisis position will be taken care of later. The Jail Diversion staff will actually be two Mobile Crisis Team Members. Sweet said this will require a heavy screening process.
Horne said that Sweet also requested a vehicle and $20,000 in temporary clerical hours. Sweet said that decision package eight involves the vehicle. She said that staff generally use their own vehicles and that they could continue to do that and reimburse staff for mileage. Sweet pointed out that the decision packages are written in order of importance. Stutsman asked how much it would cost to have a vehicle instead of paying mileage. Horne said that he could bring those estimates for the Board. He also pointed out that the mileage rate was probably going to go up so the model would be a bit inaccurate.
Sweet introduced decision package nine for temporary clerical work. Sweet explained that there are strategic goals required by Chapter 25 and they must be improved on and progress reported each year. This clerical time would help with these requirements. Stutsman asked why the State is no longer paying commitments. Sweet said that the State payment program is bankrupt and to save it the Commission recommended that Merit no longer be paid to manage CMI State cases.
FISCAL YEAR 2006 PUBLIC SAFETY SERVICE AREA BUDGET
Emergency Management Block Grants (20)
Horne said that the Emergency Management grant is a levy based on the census. The Sheriff is the administrative head of the Haz-Mat team. There are no changes in funding from FY 2005. Horne said that $78,815 goes to emergency management. This is a levy for the whole County and there is an option to switch to a levy that is separate from the General levy. Horne said that the other block grant is the Haz-Mat grant. Horne said that Emergency Management Director Tom Hansen reported the numbers as he is the head of the Haz-Mat repository.
Juvenile Crime Prevention Grant (54)
Horne said that funding has increased dramatically for the Juvenile Crime Prevention Program. County funding was maintained at the same level for the Board’s goal of investing crime prevention and jail alternatives with the objective of reducing future demands on shelter costs, juvenile detention costs, the County jail and law enforcement. Because of the County’s investment, grant funds have been leveraged from the State which amount to $182,005 for FY 2006.
Horne said that Juvenile Court Services is a mandatory program. Most of the budget goes for youth detention and shelter costs for Johnson County youths. The budget has been fairly stable over the last two fiscal years. This is the first budget for Juvenile Court Services Director Lloyd Smith and he decreased the budget by $30. Horne said that there have been other requests in the Court Services areas. County Attorney J. Patrick White has asked for an increase. Horne said that is a Supplemental expenditure so that does not count against the cap. The others are Law Enforcement Proceeds, Forfeiture Funds, and Sheriff’s Law Enforcement Funds.
FISCAL YEAR 2006 COUNTY BUDGET
Horne said that most of the discussion would be about the General Fund because they are at the cap. Horne explained that there had been excess funds but that it was decided to not leave them in the carry over. It was moved to some capital projects and to start up the Employee Computer Purchase funds again. Horne said that the tax base is now just over $4 billion, a 3.7% growth. There is about 1/2 billion dollars lost in TIFs. Stutsman said that TIFs are supposed to help economic development and tax relief but instead they cause more problems than good. Horne said about $72 million dollars in taxes are lost due to the TIFs. Lehman said that TIFs are supposed to encourage people to do things in places they otherwise wouldn’t and that Sycamore Mall is the only place where the TIF has actually been used for that purpose. Horne said that the property tax levels are frozen at certain dollar amounts so effectively although the amount doesn’t go down, the proportion does. Horne pointed out that there has been a 13% increase in health insurance costs. Neuzil said that he would like to see the strategic plan again to review it and see if priorities match up with the goals of the budget. Horne said that he will check the numbers again and update the Board at the next budget meeting.
Adjourned at 11:30 a.m.
Attest: Tom Slockett, Auditor
By Casie Kadlec, Recording Secretary