MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:
JANUARY 18, 2006
TABLE OF CONTENTS
Page
Fiscal Year 2007 Budget Discussion: Public Safety Service Area.............................................. 1
Ambulance (01).......................................................................................................... 1
Medical Examiner (10)................................................................................................ 4
Juvenile Crime Prevention Grant (54)........................................................................... 7
Juvenile Justice (27).................................................................................................... 7
Fiscal Year 2007 Budget Discussion: Mental Health/Developmental Disabilities Service Area..... 8
Mental Health/Developmental Disabilities (46).............................................................. 8
Discussion: Fiscal Year 2007 County Budget.......................................................................... 19
Chairperson Lehman 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.
Budget Coordinator Rich Claiborne said he ran a departmental income statement on the Ambulance Department, and they are currently at 48.23% of budget spent on expenditures, and the target is about 54%. The department is therefore holding expenses below the target. Revenues are currently 64% received, and their target is 54% which means they are 10% ahead of schedule on the revenue side. Ambulance Directgor Steve Spenler said they had a very good December as well. M. Sullivan asked whether they were still seeing the call volume go up. Spenler said they were up about 200 transports above last year, which is fairly significant. Stutsman asked whether any of those were voluntary transports. Spenler said that a small percentage of them were, but these are mostly emergencies. He said that they have seen some increase in hospital to hospital transportation, but not a significant increase. Neuzil said he found the numbers interesting, because good to Spenler isn’t necessarily good for the public. Lehman said that he noticed that one of their requests was for fuel increases. Neuzil said he thinks that everyone will be asking for more for fuel, and the latest report he heard was to expect a 75% increase by September, so he is glad they figured that one in. Spenler said that he has always looked at fuel expenditures on a monthly basis, but has never kept close track. In the last six months, he has developed a spread sheet which he looks at very closely on a monthly basis just to see if there is anything that jumps out at him. He said that fuel is not a huge percentage of their budget, but it is certainly a part of it. Neuzil said that they would have to have an increase in $11,000 just to keep up with fuel costs, which is a significant amount.
Lehman asked Claiborne if he wanted to go through the requests or changes in this budget. Claiborne replied that fuel was the only significant increase in the expenditures. He said that there were some expenditures for vehicle maintenance for the supervisor response vehicle. Harney asked why the maintenance was so high on that vehicle. Spenler said that was an addition to that line, and that it was a new vehicle. M. Sullivan said that the line item takes care of the maintenance for two vehicles. M. Sullivan said that item could be broken down per each vehicle as well. Harney asked about the increase in cost for uniform purchases, which went from $7,254 to $13,900. Spenler said he would have to go back and check on that. He said they added two full-time staff people, but he wasn’t aware that he increased the uniform allotment. Stutsman asked whether they added the supervisors vehicle this year. Spenler said that they did. Neuzil asked whether Spenler drove it. He said that he did, but that the on-call ambulance supervisor usually uses it.
Lehman asked Spenler to go over his technology needs. Spenler said that Amazon and Field Data is their patient care charting and data collection and billing software, for which they pay yearly support fees. He said that Infotronics is their time system, for which they also pay a yearly support fee.
Lehman moved them to Capital Expenditures. He clarified that JCAS has a rotational schedule built in where they are putting money aside for new vehicles, but the next purchase won’t be until 2008. Spenler said that he is just trying to let the Board know what the replacement schedule is, and the expected replacement cost for vehicles. He said that they will be replacing Ambulance 24 next fiscal year, that is the current cost. He said they currently have $41,910.44 in that line item. He said they would be setting aside $32,397 this year and next. Lehman asked if JCAS had replaced one out of sequence due to an accident. Spenler replied that they had to replace Ambulance 21 this year instead of next because it was totaled in an accident. He said they haven’t replaced a new ambulance now for three fiscal years. Lehman noted that JCAS calls are up 200 already this year, and asked whether Spenler anticipates that this will mean putting more miles on some of the existing vehicles, or whether they may need another vehicle. Spenler said that he didn’t anticipate it at this time. He said they are currently running three ambulances 24 hours a day with three full crews, and they have two backup vehicles. He said that with the maintenance schedule that they have, they take good care of the trucks, and having a seven to eight year replacement cycle has served them pretty well. Harney asked whether they would have enough ambulances to move one up to north Coralville if a station is built there. Spenler said there wouldn’t be enough need to have two there, so the one that’s currently at the Coralville Fire Department would move up there, and JCAS would just change around their response areas depending on which ambulance responds where. Lehman asked whether the station in Coralville is 24 hours. Spenler said it was, and that it has been for one complete year.
R. Sullivan asked whether the cost that they are setting aside for ambulance replacements allows for some trade-in value for the vehicle that they will be replacing. Spenler said that it does. Stutsman asked who sets up the schedule and monitors it. Spenler said that he does. Lehman asked if there were any trends that the Board needed to be aware of. Spenler said that they were in contract negotiations right now, and things seem to be going fairly well. He said that he can’t think of anything that will be a major expenditure. He said they might give a little bit more for training funds, but that shouldn’t be a significant increase. He said they were going to change a little bit in how they allocate uniform money, which shouldn’t be a significant increase either.
Harney noted that there was not much money in this budget for staff training. Spenler said it was a contractual amount. He said that full-time employees get $300 for education and training. He said JCAS provides all the training that they need to recertify in-house, so the $300 is for education and training above and beyond that. Spenler said that on the second Tuesday of every month they provide continuing education in-house. They have speakers come from the University of Iowa at no cost to the department or the employee. He said they also have a conference in February where they provide continuing education.
R. Sullivan asked whether Spenler saw any budget lines where he thought the department would be way under budget. Spenler replied that overtime is always something that is kind of a mystery, and he predicted that they would be under a little bit with that. He said that with everything else he thinks they will be quite close. Stutsman asked Claiborne whether the salaries were included in this. Claiborne replied that he had a combination income statement in front of him. He said that part-time non-benefit wages was right on target. The only one that is a little high is part-time regular wages. Stutsman said she was talking about next year. Lehman asked whether Spenler thought they would have to put in something for overtime for part-time employees who are in New Orleans assisting with Katrina cleanup. Spenler said that now that JCAS wouldn’t be paying their wage while they are down there, that should be a wash although it may cost them a little bit in overtime. Spenler said that there is a large number of his staff that is involved with that team.
Stutsman said that it is encouraging that JCAS’s revenues are going to be higher than their total expenditures for the proposed budget. Spenler said that the 20% raise that they did a few years back put them in line with their fees, and increasing it to cost-of-living on a yearly basis has helped them keep in line with their fees. He said that they are still, in looking with other services, low as far as what they charge especially in comparison with surrounding counties. R. Sullivan said that JCAS has also benefited from the training that office people have received about collections. Spenler said that when they went to computerized patient care charting and they didn’t have to do duplicate data entry, it shortened their billing cycle which means that they get the bills out much quicker. Because of this, they have seen almost a 20% increase in their first month’s collections. M. Sullivan said that a 50% tax subsidy in this industry is incredible. He said that cities run services across the country and they don’t come close to having 50% revenues to expenditures at all. Lehman said that if it is a private one, the taxpayers aren’t paying for the user fee. Lehman said that the survey said that people are willing to subsidize this because public safety is important to them. Spenler said that if they were private they would definitely be charging a higher fee. He said that they are seeing less reimbursement from Medicare, although the industry is lobbying to have Medicare reimbursed at the cost of providing service or close to it, but now it is significantly less. He said that Medicaid is even worse than that. He said that they can bill approximately $12,000 to Medicare and will get $8,000 back and write off $4,000. That same $12,000 to Medicaid, they will get $4,000 back and write off $8,000. Lehman said that they have closed that gap over the year or two. Spenler said that they are billing to the maximum that they can be reimbursed, so they aren’t losing out anything there, but they weren’t doing that in the past.
Lehman noted that Spenler had not asked for any new personnel. M. Sullivan said that personnel is in the decision package, and they are still negotiating the contract. Neuzil said that over 90% of the County’s budget it personnel. Harney asked when they expected the negotiations to be done. M. Sullivan said that it should be soon. Claiborne said that Human Resources Administrator Lora Shramek gave him an estimate of a 3.25% increase, and he said he was told to work with those estimates. Lehman said that as they get further along in this process, the Board will need to know what the figure is to see what they have to work with, and they may have to reducing some requests because of personnel costs. M. Sullivan said that they were going to have work sessions scheduled after all the department budgets have been presented to the Board where they will take time to figure out what they have to work with. Stutsman noted that they do not have any figures on allowable growth. Claiborne said that he is in the process of working with the Assessors and the Auditor’s office. Claiborne said that the assessments he saw were up about 8.8%, and rollback was around 4.3%. Lehman said that by the time they have gone through all these presentations they will have all the information they need.
Claiborne said that currently the Medical Examiner is at 54.59% of expenditures spent year to date, which is right on schedule. Revenues are currently at 68.85% received, so it is about 14% over the target figure of 54% year to date, which means that revenues are ahead of schedule. M. Sullivan added that to bring the department itself up to its current expenditures in line required a budget amendment this year for autopsies. He said that this is always a thing that is hard to pinpoint, and when looking at the numbers from year to year, they are inconsistent. He said that the Medical Examiner felt like the requests M. Sullivan placed in the budget are all in line with what he would want for this department.
M. Sullivan said that they had a meeting with Linn County and Johnson County representatives and the area representatives in Cedar Rapids a few months ago, and during that discussion, Stutsman had mentioned the issue of out-of-state reimbursements for autopsies. He said that Johnson County is not currently reimbursed for doing autopsies for residents from outside of the state of Iowa, although the law requires that the autopsies be done. He said that the only element to the state law is that they can seek reimbursement if a law enforcement agency from another state requested that the individual was brought in here. He said that he did not find any examples of that at all. However, he said he would prepare some proposed language for the legislators and encourage them to look at that law and amend it to add language which would allow the County to seek reimbursement for out-of-state residents who come to the UIHC, and that the County would then get reimbursed if the individual happened to die and have to be autopsied in Johnson County. He said that he would anticipate that other states would then ask for reciprocity. Stutsman said that maybe at one time they thought it was a wash, but as the University of Iowa Hospital has gotten bigger and bigger, this may not be the case anymore. Harney said that they are running out of time to submit any new bills. M. Sullivan said that it is less difficult to amend something than it is to create a whole new bill.
Neuzil asked about the item regarding cell phones. M. Sullivan said it should be $4,000 not $3,000. Neuzil also said he was confused about why cell phones are $4,000 for the Medical Examiner, and are also $4,000 for the entire Ambulance Department, plus the Medical Examiner also gets pagers which is in additional $3,600, which would equal $7,600 for cell phones and pagers for only a limited number of employees. M. Sullivan clarified that there are six MEIs on call, as well as Mike Hensch and five deputy MEs and Dr. Scheckel, which is about 13 people. M. Sullivan said he talked to Hensch about this, who said that they conduct all of their business on their cell phones. Stutsman noted that there was no other line item for just regular phones. M. Sullivan asked why they also needed a pager. Stutsman said that they need to do some work on cell phones and proposed that the County just give employees a certain allowance to apply towards their own personal cell phones. R. Sullivan said that one issue that he has is that there are at least two big chunks of the County that almost no cell phone providers even cover, which is kind of a scary thought when you think about Medical Examiners and Ambulance staff. M. Sullivan said he asked Hensch if they had appropriate coverage, and he said that he did. Stutsman said an allotment appealed to her because then they wouldn’t have to monitor whether employees were making personal calls. Neuzil asked why they needed cell phones and pagers, since most cell phones today have pager capabilities.
M. Sullivan said that if there were any questions the Board needed answered today, he and Claiborne would answer them at the next session, and will give them an update about what they talked about today.
Stutsman asked why there was such a huge jump in the autopsies, since the revenue has only increased by $8,000. M. Sullivan said he estimated the revenues conservatively from the autopsies based on just less than half of the autopsies that are done that Johnson County pays for are reimbursed back to the county. He said the increase in this isn’t an increase in the price they pay for autopsies, since the UIHC charges $300 less than the state does. He said that it is clearly tied to the number of autopsies that increase. Stutsman asked why they are doing so many more autopsies. M. Sullivan said that the autopsies are done by state law. He said that if the autopsy is ordered by the Medical Examiner’s office, then the county pays for it. He said that they are doing all the autopsies required by law, and are also doing a large number of them that are recommended, which is at the discretion of Dr. Sheckel. Harney said there had been changes in the requirements by state law. Stutsman said she understood that, but she was unclear on the huge increase. She said that she would like to see some numbers regarding how many autopsies are required by law, how many they are doing that are not required. She said that this was always brought to her attention as a concern that once the County got into this, they would end up doing a whole lot more autopsies than were really necessary. M. Sullivan said he would have Hensch prepare a report for the next meeting. R. Sullivan said that he sat in on the interview for this job, and one of the questions the doctors had was the optional cases. He said that they made it sound like it was under 10% where there was that flexibility. He said that Mike Hensch seemed to know the number off the top of his head. Stutsman said that now that the University has gotten out of this, she is not interested in the County being used as a training school for physicians at UIHC for autopsies. M. Sullivan said that was why they separated it out. He said that when the autopsies are done, under Iowa law, Dr. Scheckel nor any of the Medical Examiners are allowed to do autopsies. He said they use two places to get the autopsies done: the pathology department at UIHC, and pathologists through Towncrest.
Harney said that this is the one department about which he gets the most questions. Stutsman said that if you look at how this department has increased in the past year, it is astounding. She said she just wants to know what they are getting from the increase. R. Sullivan asked whether they had half of Hensch’s salary in this year’s budget. M. Sullivan said that the amendment was strictly for the autopsies. He said they had set aside $23,000 for a part-time, non-benefit position but then they decided to hire a full time administrator. R. Sullivan noted then that there would be about a $40,000 increase in personnel costs this year.
Harney asked what the fees to the University of Iowa Medical Examiner were for. M. Sullivan said they were paid for the state autopsies which are not reimbursed. He said that it is for the professional time. He said that the other part of it is the on-call time they pay to the deputy medical examiners and to Dr. Sheckel. He said that they pay them a $125 per diem rate to be on call. M. Sullivan said they used to do it by the hour, but that became cost prohibitive. Lehman asked about the fuel maintenance item. He asked whether they had a location to store the vehicle. M. Sullivan said they don’t have a location for it right now. M. Sullivan said that Hensch’s concern was leaving the vehicle outside in the colder months. M. Sullivan said that for now they are going to put it in a garage across the street from the Administration Building. Harney asked if the cost for transportation alluded to the lease of a vehicle. M. Sullivan said that they leased two vehicles through the University, which is still cheaper for them to do than to buy a vehicle and put it in replacement rotation. The two vehicles are a car for the Medical Examiner, and a van to transport bodies. He said that they get lower rates for fuel because they are on the car state contract, which is cheaper than they could get on the open market.
Lehman said that the training has stayed steady at$5,000, and he was wondering why since they haven’t hired new people. M. Sullivan said this was for continuing education. He said that this allows all the Deputy Medical Examiners to attend the Iowa Association of Medical Examiners Conference once a year in Des Moines.
M. Sullivan said there were no changes with the Juvenile Crime Prevention Grant. He said that Contract Employee Marlene Perrin brings in the money and the bills, and then the Chairperson signs off on the state vouchers once they come in. He said that he talked to Perrin, and there were no changes that she was aware of as of today. He said that when the Chair signs off on that, he keeps a file of the Juvenile Justice Crime Prevention Grant bills, and a file of all the revenues. He said that when the state grant checks come in, he deposits them and the only other source of income they are seeing now is donations. He said that Perrin asked him to leave the donations item off, because she doesn’t know if they will be receiving any donations next year. Stutsman said she would like to leave these donations in, because maybe Social Services Coordinator Amy Correia could do some work towards soliciting more donations. R. Sullivan said that he was not able to see where Perrin was being reimbursed for administering the grant. M. Sullivan asked what PPB was, and maybe that was where her reimbursement came from. R. Sullivan said that if they don’t break it out, they probably should, particularly now that it would be funding part of Correia’s salary. Stutsman said that this isn’t Decat, and that it wasn’t funding Correia’s salary. Neuzil said that the money would just go into a general fund, not specifically Correia’s salary. M. Sullivan said that he would ask Perrin whether her salary comes out of this grant. M. Sullivan said that usually the administrative cost comes out of the first check. M. Sullivan said he would check on this, and also find out what PPB means.
Claiborne said that there were some nominal increases in utilities and rent for Juvenile Justice. Lehman asked what was meant by Shelter Overage. Stutsman said that it was the amount that the County pays for kids that are in shelter, but is not reimbursed for this. M. Sullivan said the reason that it is increasing is because the County used to have access to a fair number of shelters, and now they don’t have access to the same number. The shelters that the kids in Johnson County are going to are the more expensive ones. Stutsman said that because of state cutbacks, many of the shelters have gone out of business. R. Sullivan said that it was not even the lack of shelters that adds to the cost, it’s the lack of the other services that makes shelter the only option. R. Sullivan said that there were kids in shelter that ten years ago would not have needed to be in shelter, but there was no other option for them. Stutsman said that the other thing was that if there is not room in the Detention Hall, they stay in shelter longer.
Neuzil said that if they do move into the new facility, there would be an extra $31,000 in the budget. M. Sullivan said that they would be able to eliminate the cost of janitorial services as well. R. Sullivan said that after talking with some folks at the state, it sounds like Johnson County made a wise move going in with Linn County on those beds because there are other counties who are paying much more. He said that the fear would be that they paid for beds they didn’t use, but it’s worked out perfectly. R. Sullivan said that there are people in Des Moines who transport to Sioux City and Davenport, and they have to pay Deputies to do that. Stutsman said that part of the rationale in going with that contract was that Cedar Rapids offers a much better service than Linn County.
M. Sullivan said the last thing under “other” is just a very small thing in the block grants that is part of the public service area, department 20. He said it is the first four block grants, which are classified as emergency management. It includes the Red Cross, Disaster Services, the Haz-Mat grant, and the Hazardous Mitigation grant. He said that Disaster Services Director Tom Hansen sees an increase in the block grant for the Red Cross and no increase in any of the other block grants. Neuzil asked if this was just a request from his board, or whether it was his own initiative. M. Sullivan said that he wasn’t sure. Neuzil said that they didn’t know what they were going to do with block grants this year. R. Sullivan said that he didn’t know what this did to their budget. Stutsman noted that the Board didn’t approve their budget, just the block grants. M. Sullivan said they would have further discussion on block grants later on. Claiborne said that block grants were the last thing they would meet about, on February 10, 2006. Stutsman said that on that day she would like to review the new requests that they have had, such as the Human Rights Ordinance and how that would fit in with the budget.
Recessed at 10:15 a.m.; reconvened at 10:30 a.m.
Mental Health/Developmental Disabilities Director Elaine Sweet said that she brought several staff members who had helped with preparing the budget with her to the meeting this morning. She started by directing the Board’s attention to a recent article from the Gazette, talking about the huge shortfall in Linn County’s MH/DD fund, which quotes Craig Wood, the CPC in Linn County talking about how they are going to have to cut services and the way they do business. She also cut and pasted some email exchanges among CPCs in the last few weeks, started by Wood talking about the $1 million shortfall and asking other counties if it’s going to be a problem. Sweet said this discussion demonstrates how MH/DD funding across the state is in trouble. She said that these budget cuts have caught up with many counties, and the problem just continues to grow worse across the state. The good news for Johnson County is that they have been able to stay on top of it, even with the budget cuts on the State level, even with the things that are happening across the state, and with the different budget numbers that she is bringing the Board today, there are still ways that they can achieve efficiencies and work together so that Johnson County will still be in a better position than many of the other counties, especially the larger ones. However, she emphasized that the budget she was bringing to the Board today is not business as usual.
Sweet said that when they submitted the annual report to the State on December 1, 2005, they immediately started working on the budget. She said that she was surprised when they got through the initial run of the budget and found that Johnson County was looking at some deficit spending and some real changes in how things are looking. She said that there was an error in the budget sent in to Claiborne and M. Sullivan, and distributed a revised revenue page.
Sweet said that one of the complexities of the MH/DD budget is that bills don’t come in every month for a month’s worth of services. She said that some things are billed by the month, some things are billed quarterly, some come semi-annually. That means that they can’t just take a month times twelve and expect that they are going to know what their expenses are going to be for the year. She said that there are also midyear increases that come through for waiver programs that affect a budget in the middle of the year. She said that the column that is dated FY 06 is the result of a very intensive effort of looking at every single line item in the budget, including past year history, current year history, and giving their best guess as to what that number is going to be at the end of the year. The budget FY 07 baseline was their first passthrough at the budget. She said that when they did their first passthrough, they were looking at deficit spending for the remainder of this year and next year, and a negative fund balance at the end of FY 07 of about $1 million. She said that therefore they went back and redid the budget and the budget that was presented to the Board is the budget FY 07 number. She said they took a look at the difference between that original passthrough and the FY 07 baseline is business as usual.
Sweet said there are no changes in what they have been doing in prior years. The budget continues to fund the same services for the same people, factoring in increases in revenues and the things that they know are coming down from the State and Federal level. She went on to say that they did the exact same thing with the expenses. She said that the FY 07 baseline was the first passthrough. Business as usual anticipated increases in utilization and expenses came down to a negative deficit spending for this year and for next year, and a negative fund balance at the end of 2007. Neuzil asked if the FY 07 baseline number was an estimate at this point, or whether they knew from the Auditor’s Office how much money they get from taxes. Sweet replied that the State decides how much money they get from the State, based on information that the Auditor sends in. She said that every December 1st the Auditor is required to submit information to the Department of Management, and MH/DD has to submit their financial and statistical information. During the month of December the division of MH/DD takes a look at all the counties in Iowa and how much money has been set aside for MH/DD and decides how much money each county gets. She said that is where the fund balances come in. If there is a fund balance less than 10%, the County receives 100% of its money, 10%-25% there’s a 25% withholding. She said that the Auditor’s Office submitted Johnson County’s 643c form which is what is used to determine the State allocations on December 1, 2005. MH/DD submitted their annual report the first week in December. On December 22nd, Jim Overland’s office got the information from the Department of Management and calculated all of the Counties allocations. She said that their fund balance was 17%, which threw them into the 25% withholding. On December 28, 2005, they met with M. Sullivan and Claiborne in the morning and reviewed the budget. That afternoon, Doug forwarded her an email that he had gotten earlier in December which stated that the Auditor’s Office had found another $150,000 to add to MH/DD’s expenses for last fiscal year. She said that she called Overland’s office and told him this, but his response was that the allocations had already gone out and couldn’t be changed. She said it wouldn’t have made a difference anyway this year, although it could have made a difference of three-quarters of a million dollars, but it didn’t. Sweet said that she went to a CPC meeting on Friday, and Overland’s staff was telling people not to count on their money because the legislature was going to be looking at the allocations again. She said that there were two counties who appealed their allocation, so it’s going back to the Legislature which will be acting on it before the end of January. If those appeals are granted it’s going to take another $200,000 off of Johnson County MH/DD’s allocation from this year. They are going to redo the entire State’s allocation, and the money that they are going to give those two counties has to come from all the other counties. She said that while the Board of Supervisors has the MH/DD budget proposal as of December 28, 2005 those are two significant things that have happened since they submitted it.
Neuzil asked whether in regard to the current real estate taxes, the $2.9 million dollars has been calculated from the Auditor’s and Assessor’s Office. Sweet said that $2.9 million doesn’t change. Neuzil asked whether this will change for 2007. Sweet said it would not. Neuzil clarified that this was an official number, and asked why it changed from FY 05 to FY 06 if it can’t change. Sweet said that the number presented is the number that was actually collected. Lehman said that the levy is set but the tax base increases, so that figure should go up. Sweet said that it isn’t the levy that is set, it’s the dollar amount. Stutsman clarified that it was based on the baseline. Sweet said that it was the total dollar amount, regardless of the valuation of property. She said that the levy itself might change, but that dollar amount doesn’t. Sweet said that if they don’t levy the max, then they aren’t eligible for some of the other State allocations. She said that it is not in there this year because the Legislature forgot to put it in.
Sweet said that the $2.9 million figure is the result of Senate File 69 when they capped out the dollar amount on current real estate taxes, then the State starting picking up approximately 50% of mental health funding that was before property taxes, so that current real estate taxes and mental health property tax relief are almost equal. Neuzil said that they were paying half, and the County is paying half. Sweet agreed. She said that if a County doesn’t levy the amount allowed, there are other revenue items that are reduced because of that in typical years. Neuzil said he just wanted to know if the number she had estimated for FY 07 was solid. Sweet said that it was.
Sweet went on to talk about local purchase service title 20, the community services allocation, the allowable growth, and the equalization fund allocation. She said that was the bulk of their revenues. There are some other minor taxes which the Auditor’s Office budget, like the delinquent utility property taxes and those things, but the bulk of MH/DD income comes from the real estate taxes, the property tax relief, state allocations, and the Targeted Case Management (TCM) program.
Sweet then directed the Board to the financial statements. She said that they went back and looked at actual cash basis for 2002 through 2005. They looked at FY 06, re-estimated that in December, and looked at the budget 2006 and 2007 numbers. She said that the very last column shows that they are looking at revenues of $10 million, and services of $8 million. That $8 million does not include the salary, wage, and benefit budget. She said that when they prepare their budget, they just have to estimate this part of it.
Lehman asked if Sweet has made any major changes to her budget. She said that there have been since she was forced to go back and cut the budget. She said on her first passthrough she did a budget based on what it looks like is going to happen, and it came out to be a negative situation so she had to go back and cut in certain areas, assuming that Services Management Plan amendments would follow those cuts. R. Sullivan said that he thought they needed to go back through the budget and see where those are, and highlight them. Neuzil asked what the bottom line was, saying that Sweet was presenting a budget, and after the carry-over amount they have, how much does she anticipate they have left. Sweet replied that based on accrual, the budget that they have right now, and not taking into consideration the extra $150,000 in audit adjustments or the extra $200,000 based on Legislative action the fund balance will be right around $500,000. Neuzil asked if that includes the Jail Diversion Program. Sweet said that it includes all of the decision packages. Stutsman said that therefore the Board of Supervisors’ basic decision is how big they want the fund balance, and as far as the decision packages, where they are most comfortable. She said she assumed that they would continue to levy the max, and that’s what included in the budget.
Sweet said that would be her first recommendation, to not reduce that maximum levy. Lehman observed that there were a lot of hypotheticals in the budget, in terms of amendments to the Services Management Plan. Sweet said she started out by saying the good news is that MH/DD still has the ability to gain efficiencies and they have areas to work, whereas many counties have exhausted all the possibilities. She said that she introduced Mary Dubert last evening, who is the retired CPC from Scott County that is probably as good as they get in working with certain areas like community mental health centers, and she is going to help MH/DD with the Services Management Plan amendments and look at some of these key areas where they still have opportunity to gain some efficiencies. She said that she is not coming in with doom and gloom, because she does think there are places that they can look without doing things that are going to hurt people dramatically. She emphasized that she is not saying that there is going to be money available to fund everybody they have funded in the past, and as they work through the detail she said she would point out some of those places.
Sweet said that the 2007 baseline was her first passthrough, and the 2007 budget is the one that she revised and submitted. The next column is the difference between the two. She said that by looking at the December 28, 2006 budget versus baseline column, they can see exactly where she made cuts, and the amount of those cuts. In the area of enhanced services, the Federal government has decreased the Federal share of what they are paying for case management. The non-Federal share has gone from 33% to 38%, and the State has reduced the portion of that they’re going to pay for. Therefore, more of the cost of case management is going to be forced back to counties. She pointed out that everywhere it says enhanced services case management, that is what she is referring to: the County’s share of the case management.
R. Sullivan asked if the number reflected is providing service to less people. Sweet replied that that would be the end result. She said that it would mean also managing costs and rates. She said that they were not looking at just one outcome, but there would be a combination of a lot of different things. R. Sullivan said that he felt that the best thing financially for the County and the best thing for people in general is to keep them in the system at the most minimal cost possible as opposed to cutting them off from the system all together. He said that he would rather see some type of across-the-board cut rather than taking 10% of the people served out of the system. Lehman said there were a lot of different variables. Lehman clarified that R. Sullivan was saying that rather than raising the eligibility and having some people drop out of the system, they should do some other type of shift where everyone could still stay in the system, but they might not get the same level of service. R. Sullivan said that one of the easiest places to look at when cutting a budget is to say that there is an individual who doesn’t use a lot of services, so they should just cut the services. He said that although that seems to make sense, what they have found is that when the individual leaves services, she ends up coming back later and there is a greater cost to get her back into the system than to just keep her on that minimal level of service. He said that they should look at the people who they know aren’t going to leave services, and just lower the level of service.
Stutsman said that was Sweet’s job: to determine which of those people need the services to maintain, versus who might be able to do okay without them. R. Sullivan agreed, but said in terms of giving general direction, this was how he would approach it. Stutsman said that she didn’t know how they could talk about across-board-cuts. She said it seems like there are so many variables, they would have to take each group and the services and evaluate them. Stutsman said that these decisions are best left to the experts. She said that the Board should approve the budget and see where they want to be, what kind of fund balance they want at the end of the year. She said the department head should manage it. Neuzil said they do have a Planning Council, and then the Board would get a request from Planning Council to determine whether eligibility requirements that Johnson County provides is different from what everybody else is providing.
R. Sullivan said he thought that was true, but they were just talking about uniforms for Ambulance, and he liked the idea of the Board giving general philosophical direction. Stutsman said that their philosophical direction is a question of whether they want to cut services, whether they maintain services, and how that reflects on the final bottom line. Sweet said that she agreed with everything she has heard. She said that she has a lot vested in Johnson County MH/DD services, and that she wants to see the County be successful in what they do. She said she has also worked with the numbers, and she knows that they cannot continue to provide the same level of service to the same number of people. She said that it is illegal to overspend the fund balance, and her first passthrough had them at a negative $1 million. She said that if they decide that they want the fund balance to be $1 million, that means they need to cut the million they are projecting they will be in the hole, and find another million to put them at that $1 million fund balance, and accommodate the $150,000 and the potential $200,000 on top of it. She said that this means they would need to find $2 million to cut. She said that she didn’t know how they could do that and continue to serve the same number of people that they have been in the past. She said there was not much they could do with their targeted case management program, but for those non-Title 19 cases it is different. She said she couldn’t honestly say that they could cut $2 million without changing the way the MH/DD department is managed. She said they have to find some ways to streamline how they are doing case management for non-Title 19 cases.
Sweet said that they left decision packages in after visiting with M. Sullivan and Claiborne, just for Board discussion, but she said she couldn’t legitimately come to the Board asking for increases in staff with the budget situation the way it is. She said that if they are going to find that money to cut, it needs to be a combination of a lot of different things. She said that the budget is no longer funding brain injuries, cutting back on non-waiver mental retardation services, and significant cuts for mentally ill. She directed the Board to look at that section in their packets. She said that the services that they have had the Mental Health Center managing for them as an access point, and this is what they have reclaimed. She said that this budget includes some pretty significant decreases in those areas. She said they are finding as they work with Community Mental Health Center Intake through MH/DD now, rather than the Mental Health Center, that they are finding numbers of cases that they have been paying for that are not legally settled in Johnson County that they have been able to move to other places. She said they also found many clients where the research wasn’t done to make sure they met the financial eligibility criteria. She said they have already made steps in some of these areas that are going to turn more money in.
Sweet said they will have to be aggressive in pursuing other funding options and patient assistance programs in order to find other ways to fund prescription medications. Sweet said she budgeted a significant cut in psychiatry, and they have already taken steps to make that happen. The contract they signed with the Mental Health Center that took effect October 1, 2006 requires them to move a lot of their psychiatric appointments from half-hour and one hour to quarter-hour appointments. If they are seeing four people in an hour instead of one person in an hour instead, even if only three of those four are eligible for Title 19 funding, that means they have the opportunity to bring in more funding that they haven’t accessed in the past. She said that these are the kinds of things that are intertwined throughout the line items in the budget.
Lehman asked whether 15 minute psychiatric appointments could do any good. Sweet said they would be med checks, and that if every other mental health center in the state can do it, then Johnson County can too. She said there will still be some that need longer appointments, but not all of them. Sweet said if the Board focuses on the column that compares the budget to the baseline, they will be able to tell where she has made cuts, and encouraged the Board to contact her if they have any questions.
Stutsman asked to go through the decision packages. She said that she wasn’t comfortable cutting all the brain injury funding, because it doesn’t add up to that much. Sweet replied that she has to administer whatever is in the plan. She said if they have a services management plan that says they are going to service B.I., then they will probably have to implement a waiting list early on. She also pointed out that there are some mandated services where they cannot put people on a waiting list. She said that if they are looking at the mandated services equaling the amount of money available, that would mean that every one who is not getting a mandated service would go on a waiting list. She said that it’s a combination of budget, services management plan, waiting list, and other things. She said they have the plan amendment process started, and will be discussing the things that impact the financial statements in those plan amendments. Sweet said that she was receptive to suggestions about cuts. The budget she submitted reflects the way she would see it working the best, but is willing to listen to other ideas.
Neuzil asked if Sweet will have the budget situation laid out at the next Planning Council meeting. She said she would. Sweet said the other thing they could do is to implement waiting lists right now to help this year’s budget. However, she said that if they do this they run the risk of being over 10% fund balance, and losing money because of it. R. Sullivan said he thought they were better off working under the current plan and fixing it in the future than trying to fix the problem now. Stutsman agreed. Sweet mentioned that mandated services are about half of the budget. R. Sullivan said that they have some flexibility within those mandated services, since they could cut provider rates, lower the amount of service, and limit the number of waiver slots. Sweet agreed, and added that they could cut the number of waiver slots. She said that they are going to review the HCBS site waiver budgets to be sure that those are appropriate rates. She said they have been seeing some astronomical increases coming through, and it is not unusual to see a waiver site rate go up $80 a day. R. Sullivan added that in some of these cases there are two staff people to four client ratio, and they could change the ratio to one-to-four. Stutsman asked if the Board could make those determinations. Sweet said the case manager and the team work together, and some of that is controllable.
Sweet said that they will also be working with case managers to make sure they are being consistent with all of the clients across the board. She said another thing they could do is to transfer folks to ARO funding, and they also have some ability to transfer from County funding to HCBS funding through the Residential Community Services (RCS). She said that persons with mental retardation are now eligible for waiver while they are residing in RCS, and MH/DD hasn’t done anything to work with Chatham Oaks in making that conversion. She said there are still a lot of positive, pro-active things that can be done. Stutsman asked what would happen if the Federal government keeps cutting. She asked whether they would be in a dilemma if they had all these people on mandated waiver services, and whether the Federal government could keep cutting. Sweet said that they could, and if someone is so disabled or so ill that they need a higher level of services, the County will be paying for them anyway. She said that if they continue to cut at the Federal level, the County will have to cut non-mandated services. Stutsman asked whether they had any flexibility within those mandated services. Sweet replied that they have very little. Stutsman asked whether it was better not to do the waivers which would give the County more flexibility. Stutsman said she was a little unclear about who was mandated. She asked whether it was because they offer waivers it meant that they have to provide all these mandated services. Sweet replied that they have to provide waiver services, as mandated by Federal law. R. Sullivan added that State law requires that Counties provide services to people who qualify.
Sweet said she thinks they have a great system in Johnson County, and they have done a good job of serving people. She said they are still in a better position than most counties in Iowa, and that they have the resources to address this potential problem positively and proactively, and continue to provide a very high level of services to the people who need it, and to conscientiously spend the taxpayers dollars. She said that she is confident that they can make these things happen if they don’t keep cutting funding more and more. She said that all the counties are feeling the pinch, and are having to make some choices and cut back. She went on to say that what they do now will determine the future of Johnson County MH/DD services. She said they should carefully consider what they are doing, and do it through the Services Management Plan amendments futuristically rather than just doing things on the spur of the moment. She went on to say that they have some excellent resources, and good people on Planning Council who are willing to help with the plan amendment, they have very good resources within the department to help with the process. She said that she is so grateful that the Board is so active all the time in MH/DD because that means they are used to seeing the numbers.
Lehman urged them to discuss the decision packages. Sweet said that the first package is for jail alternatives and a mobile crisis team member. Currently they have Jail Diversion Coordinator Malinda Lamb and one staff person. Decision packages one and two include a proposal for a mobile crisis team member and an additional case manager to work together and to focus on mental health commitments, mobile crisis intervention, emergency hospitalizations, and preventative measures to individuals in community settings. Stutsman asked whether this would be limited to working in the Jail. Sweet said it would not, and would include working with commitments and the mobile crises response, and would be preventative. She said that the section of the work paper that would be affected by these two positions are lines 399 through 438.
Sweet said that Decision Packet Two, and anything related to case management would result in the cost of case management services going up, the rate going up and additional monies coming into the case management program. She said it would also go back to the enhanced services, that portion that they are billed back from the State for case management, it would be an increase in that also.
Stutsman went back to the first decision package, and asked who was currently providing those services. Sweet said that those are services, like MHI in-patient. These two positions, working together on the mobile crisis side and the preventative side might influence that cost. She said that if they look at the MHI line item, it shows that MH/DD has done some good things in keeping that cost down. Lehman said that evaluating whether there has been a savings in another area of the budget is another thing they could do to justify other cuts. Stutsman said that the main goal of the Jail Diversion Program is to lower the cost of the jail. She said that if she’s not seeing any difference in the cost of the jail, then she cannot support it. Lehman said that the savings are in the Sheriff’s Department.
Sweet said that on line 399 they can see that in the columns for decision packages one and two they factored in $5,000 that they think can be saved in that area the first year by those two positions. She said there are similar items on lines 411, 412 and 413. She said they have factored the savings into those decision packages as well. Sweet said that she can’t report on the Sheriff’s budget, all she can do is report on what Lamb is doing. She said that they agreed when they started the program that six months after the first placement, Lamb would report to the Board. She said the six months is up, and Lamb is pulling those numbers together. Sweet said that Lamb has also managed to get some people who are in the jail on medication programs that are saving the County $1,000 a month, some of the folks that are out-of-state cases and are legally settled in other counties. She said she didn’t know how much that was actually saving the jail, but that is something that Sheriff Lonny Pulkrabek is tracking and will report to the Board. She went on to say that the last time she and Lamb talked, they were working on getting the 13th placement into the community. Sweet said another thing that is important is the recidivism when it comes to the jail. She said that Lamb is able to get folks on their medication when they’re in the jail, and have them stabilized when they come out which means that they aren’t going back into the jail or going into the MHIs and community hospitals on commitments. R. Sullivan said it made total sense to him how Decision Package One is an overall savings because of the things she just talked about. He asked whether the savings with Decision Package Two would come because they were anticipating that person case managing the folks who would otherwise be in the jail. Sweet said that this was correct. She said that more preventative things could be done with the caseload that the case managers are carrying right now. R. Sullivan said that typically a new case management position would not be a savings, but clarified that Sweet was saying that with the way the Jail Diversion Program is going, it’s going to necessitate another case management position. Sweet replied that they have a handful of case managers that are working with Lamb now, and it’s in the infancy stage. Sweet said that the coordination between Lamb’s program and the case managers and getting folks stabilized is really showing that it’s going to be a positive effort. She said that with the way the budget is looking, she would not come and ask for this position right now. She said it would be a case of wait and see. Sweet said she wants to have the opportunity to look at case assignments and what’s going on within the department, and possibly free up time so that they don’t need the position. R. Sullivan said that in this tight budget, if these positions are going to be cost-savers, then they would be foolish not to go ahead with them if they are going to reduce the overall budget.
Harney asked Sweet where the money comes from to fund Lamb’s position and the other staff person. Sweet said that Lamb’s salary and benefits are coming out of the MH/DD services budget. She said it was hard to quantify, but her ability to work with MECCA and keep folks out of jail and commitments is saving the County money. Neuzil said that this program is not just about savings, it is also about citizens who have said they want jail alternatives. Harney agreed, but asked if there was another way to fund Lamb’s position. Sweet said she thinks it belongs in MH/DD. R. Sullivan said that if mental health is the presenting issue, then it ought to be dealt with in MH/DD. Sweet said the biggest problem is the substance abuse piece of it. She said that Lamb is serving people who have mental health issues and substance abuse issues. Lamb cannot go in and actually work with the substance abuse piece of it. Sweet said that there is no doubt in her mind that because of Lamb’s work and MECCA’s work, there are people who are not in mental health institutes that the County would be paying for. However, she conceded that there was no way to identify the savings.
Stutsman said that another way of looking at this is that they are dealing with 13 people with two full-time employees, and now they are asking for two more staff. She said that was a very expensive program. Sweet acknowledged this. Stutsman said that they can talk about savings in other places, but sooner or later they have to evaluate whether it is cost effective. Sweet said that it is a good program that is serving people. She said that Decision Package Three is a car for that program, because they have 20 case managers and two jail alternatives staff who are sharing two automobiles. They are supposed to be serving people in the community and in the jail. She said that people are routinely using their own cars. She said that she would recommend that they keep reimbursing mileage. She said that Decision Package Four is a second jail alternative staff member, which is directly in response to the Criminal Justice Coordinating Board and the AXT training that occurred this summer, and the mobile crisis piece of it. She said that if they want staff who are able to respond to crises as they are happening and be able to work in jail diversion and programming, most of those crises don’t occur during regular business hours. She said that this Decision Package is in response to that mobile crisis piece.
Stutsman said that she had a real issue with this, and asked why the current staff can’t be on call or have different shifts. She said that supervisors at DHS carry pagers, so why would they spend $100,000 for somebody to cover hours that maybe their own staff should be covering. Sweet replied that Lamb is already carrying a pager. She said that right now Lamb and the one other staff person cannot keep up with the 13 people. Lamb is already working far more than a 40 hour week, and said that she didn’t know how two people could possibly cover evenings, weekends, holidays and nights. She asked how anyone would go on vacation if this happened. Stutsman said that if they had more staff they could do so. Sweet said that was what this proposal was addressing, to have the staff cover the routine office hours and to have people on call to cover the off-hours. She said they would pay them to be on-call. Stutsman said it would be cheaper to just hire someone. R. Sullivan said they had provider agencies that are able to respond in terms of emergency 24/7. He asked if they could put out some kind of RFP as opposed to this proposal, and say that for a certain amount of money an agency would cover that additional time. Sweet said they could certainly look at that. Sweet said they looked at what is operational in other counties for mobile crisis. She said they had to have professional people responding who have the appropriate credentials. Neuzil asked what would happen if they didn’t have this. Sweet said that they would then just go on the way they are. He replied that it might be worthwhile to look at contracting something out for this.
Sweet said that part of what the mobile crisis people do is to deescalate situations that are emerging catastrophes. She said that this service does not exist in Johnson County. Neuzil said that he didn’t want Lamb to be overextended. Stutsman said that to approve all these packages means cuts. She said that she doesn’t want to spend everything on the jail. R. Sullivan said that it was possible that the first position could actually save money. Stutsman replied that she wasn’t seeing that which frustrated her. She said it was all speculative. Neuzil said they were all warned that jail alternatives were going to be expensive. Sweet clarified that Lamb wasn’t serving the jail, she is serving people with mental health issues. If Lamb weren’t serving them in the jail and preparing them to come out, then MH/DD would be serving them somewhere else somehow, whether that was in a mental health institution or a residential care facility. She said that she and Lamb are getting the six month report together and will present it soon.
R. Sullivan said that the one person who had legal settlement elsewhere who Lamb was able to place in a different County saved Johnson County $25,000. Neuzil said they were talking about Lamb plus the additional person they already have plus a targeted case manager, which means three individuals, plus the additional staff. Sweet replied that there would be three staff people plus the on-call professionals. R. Sullivan said that Linn and Polk Counties have jail diversion programs, and it would be helpful to know how they are staffed and how much the program costs. Sweet said she would look into this.
Neuzil said they were all unsure about decision package four. The rest of the Board agreed. Harney said he was wondering where the funding for this position would come from. Sweet said it would have to come from MH/DD. Neuzil said that it was a question of how many services can be provided. Sweet said that with decision package four they might be able to have people on call for one night to test it out. She said there has been nothing done to start a mobile crisis program so far. Lamb has gotten two calls from the Iowa City Police Department to go and intervene with clients with mental health issues before it got to be a problem, but this is something they have just done ad hoc during office hours.
Sweet explained that decision package five requests temporary clerical assistance to implement the goals of the Services Management Plan. Sweet said that in the plan amendment process the goals need to be revisited to make sure that they are workable and achievable goals. Lehman said that there was a lot to digest here, and it would be a work in progress as Sweet waits to hear back from the State and the audit, which will hopefully be good news. Sweet said they are starting some intensive work on the Services Management Plan amendments on Friday at 8 a.m.
Lehman clarified that the next budget work session would be Wednesday, January 25, 2006 at 9:00 a.m. M. Sullivan said that he and Claiborne would have a summary report prepared for that meeting. Stutsman brought up the issue of whether department heads should come in or not. She said she feels like either they should all come in, or none of them should come in. She said she didn’t have a problem with department heads coming in and answering questions, but she does have a problem when it becomes a dog and pony show about who can do the best presentation to the Board. She said she wanted a level playing field for all the departments. Stutsman suggested that the department heads come in strictly as a resource, not to present their budget. Harney agreed. He said there was a difference between answering questions and making a sales pitch.
Adjourned at 11:47 a.m.
______________________________________________________________________
Attest: Tom Slockett, Auditor
By:
On the _______ day of _____________________, 2006
By Casie Kadlec, Recording Secretary
Sent to the Board of Supervisors on March 28, 2006 at 4:30 p.m.