MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:
FEBRUARY 2, 2006
TABLE OF CONTENTS
Page
Executive Session: Collective Bargaining Tentative Agreement with American Federation of State, Municipal and County Employees (AFSCME Local 183) Unit of SEATS.............................................................. 1
Mental Health/Developmental Disabilities Director Elaine Sweet: The Following Mental Health/Developmental Disabilities Annual Reports: Administrative: Central Point of Coordination (Chapter 25 Rules); Clinical Case Management (Chapter 24 Rules); and Jail Alternatives: Six-Month Status Report.................................................... 2
Planning and Zoning Administrator Rick Dvorak, Assistant Planning and Zoning Administrator R.J. Moore, and East Central Iowa Council of Governments Representative Chad Sands: Johnson County Comprehensive Land Use Plan Update Proposal; Service Agreement for the Preparation of a Comprehensive Land Use Plan; and Press Release to Advertise the Need for Johnson County Board of Supervisors is Seeking Volunteers for Planning Effort 8
Executive Assistant Mike Sullivan: Reports and Inquiries......................................................... 10
Reports and Inquiries from the Board of Supervisors............................................................... 10
Chairperson Lehman called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 9:05 a.m. Members present were: Pat Harney, Mike Lehman, Terrence Neuzil, Sally Stutsman, and Rod Sullivan.
Motion by Sullivan, second by Stutsman, to enter Executive Session at 9:05 a.m. to discuss collective bargaining strategy for the SEATS Department under section 20.17(3), Code of Iowa: “negotiating sessions, strategy meetings of public employees… shall be exempt from the provisions of chapter 21 (Official Meetings Open to the Public).” Roll call: aye: Harney, Stutsman, Lehman, Neuzil, Sullivan.
Motion by Stutsman, second by Sullivan, to leave Executive Session at 9:12 a.m. Roll call: aye: Harney, Stutsman, Lehman, Neuzil, Sullivan.
Recessed to formal meeting at 9:12 a.m.; reconvened at 9:22 a.m.
Mental Health/Developmental Disabilities Director Elaine Sweet and Financial and Statistical Supervisor Deb Guard were welcomed by the Lehman. Lehman said that the annual administrative, central point of coordination, and clinical case management reports are required to be filed with the State, and asked Sweet to give some background. Sweet replied that MH/DD services is required to file an annual report with the State each year. The report is due on December 1, 2006 for the prior fiscal year which reports financial information for MH/DD clients which must match the financial audit information that the Auditor’s Office files with the Department of Management. They also must report on the number of clients served in the various categories, there are a number of other components to the report also. Sweet distributed the annual report. The first section of the report gives progress on the strategic plan, goals, and action steps. Chapter 25 requires counties to have a strategic plan. She said their committees and Planning Council works with them to do that, which they then incorporate into the Services Management Plan that goes to public hearing and is approved by the Board of Supervisors, submitted to the State, and ultimately approved at the State level by the MH/DD commission and the Director of Human Services. The Strategic Management Plan has been in place for several years, and Sweet said that MH/DD is in the process of amending it. FY 2007 is the year the department is required to submit new strategic goals and action plans.
Sweet expressed her desire to discuss some of the highlights of the report. She said that Goal 1 and Goal 2 are goals of the Continuous Quality Improvement Outcomes Committee. Those two goals address emergency crisis response and corrections collaboration. There are a number of initiatives that have happened over the last few years, and the department has identified case managers working very closely with the clerk of court, the mental health advocate, judicial referees, hospitals, and other involved parties to facilitate the commitment process and to minimize the cost for involuntary admissions and the costs of hospitalizations. They also recently implemented the MH/DD Jail Alternatives Mobile Crisis Coordinator position and one staff member. Sweet said that Mobile Crisis Coordinator Malinda Lamb will give the Board a six month progress report on this initiative.
Sweet said that of the really exciting things that happened in FY 05 was that they were awarded a grant from the National Institute of Mental Health, which allowed them to have intensive cross-training for mental health and substance abuse communities in Johnson County. She said that this training brought all these people together, and they were able to do a lot of brainstorming and planning.
Sweet explained that on the Quality Assurance side MH/DD continues to do several initiatives. They were awarded a three year accreditation by the Iowa State Department of Human Services for their Targeted Case Management program. They do annual satisfaction surveys, and were able to do a county-wide needs-assessment several years ago on which they continue to follow up. They conduct routine quality assurance file reviews, and contract with the Iowa State Association of Counties for their County Rate Information System (CRIS) which provides a level of quality with contractor rate negotiations and the provider community. She said they engage in ongoing HIPAA training with help from the Board of Supervisors Office.
Sweet noted that on the financial side, the MH/DD management information system is fully operational. They are interfacing with the County’s GEMS financial program which has allowed for more accurate and timely processing of MH/DD claims. Sweet said they have been working with Polk County and other counties in developing the case management module, and they continue to watch the MH/DD fund balance very carefully. She said that in regard to fiscal resources, they aggressively search for outside funding. There is a Finance Committee that looks at the MR waiver slots each month and makes recommendations to the Board. The Planning Council and four subcommittees meet regularly, and they also have a Targeted Case Management (TCM) Advisory Board. All six of the boards act in an advisory capacity to the Board of Supervisors. In FY 05 they had 30 public stakeholder meetings. The instances of participation from the 98 individuals who attended meetings was over 333.
Sweet explained that the service coordination and case management side has been coordinated, and they have standardized their recruitment efforts. The management information system is providing for more efficient utilization of MH/DD staff time, and more consistency in applying the Services Management Plan policies. Their contract with County Case management services through ISAC allows the department to have quarterly random file reviews of their open and closed cases.
Sweet said that MH/DD space needs has been identified as an issue, and the Board of Supervisors is working to address that. The department has also developed a MH/DD and Case Management operations manuals. Furthermore, they communicate regularly with area legislators, and host or participate in legislative forums to educate and to make the public aware of how important MH/DD funding and services are.
Finally, Sweet spoke about the needs assessment that was conducted in FY 03 and FY 04. In response to the needs assessment, several things have happened: a new permanent housing project has been approved, an evening/weekend clubhouse has been developed; a Mobile Crisis/Jail Diversion Coordinator has been employed; MH/DD has developed a web page on the County’s website; there is ongoing dialogue with UIHC to expand existing services and develop new ones; and MH/DD services has developed internal staff support to assist clients in accessing Pharmaceutical Assistance Programs.
Sweet directed the Board to packets presented earlier in the meeting, and discussed some of the graphs and charts. She said that the Johnson County Board of Supervisors is central to the MH/DD Services community. She described the graphs, pointing out that on an accrual basis in FY 05 MH/DD services had expenditures of over $10 million and served 1,488 clients, 789 of whom had mental illness, 372 of whom had chronic mental illness, 299 with mental retardation and 98 with developmental disabilities or brain injuries. She said that the TCM Advisory Board acts in an advisory capacity to the Board of Supervisors, and they also contract with the Iowa State Association of Counties TCMS for technical assistance with the case management program. She said the case management clinical social work part of their services expenses totaled about $1.5 million, $1 million of that which was reimbursed as TCM. At the beginning of the year they served 643 clients in the case management service coordination program, and by the end of the year that had increased by 24 clients. She said that the $1 million in revenue on the case management side is funded by Federal and State money, most of it coming from the Federal government. Sweet explained that TCM is a mandated program, and the County chooses how to provide it. There is currently legislation pending at the Federal level to cut TCM funds significantly and to shift that cost to the State and local level. She said that one of the new things that occurred with TCM last year was the State’s development of a new children’s mental health case management program, which is also a mandated service to be effective as of July 2005. Johnson County elected to contract with DHS to provide that case management. Sweet said that in FY 05 they had an addition of a new clinical supervisor, bringing the total number of staff to 21. The case managers averaged 42 cases, 24 of which were TCM.
Sweet explained that the central point of coordination function is also a mandated service. On this side MH/DD contracts with ISAC’s CRIS program for technical assistance with the rate negotiations and contracts. They negotiated 21 local contracts in FY 05 and paid service providers over $8 million in FY 05 for services. The administrative central point of coordination function includes things like payroll, determining eligibility for services, determining the services the persons are eligible for, authorizing the services, authorizing the rates, monitoring the costs of providing the services, processing claims, recording the expenses, working with the budgets, financial statements and annual reports. She said they had six financial and statistical staff persons working in that area. In total they had 21 Johnson County contracts for services and worked with 155 out of county providers. She pointed out a graph which showed the revenues. She said the revenues total $10,338, 385. Real estate taxes were 28.2% of the budget, miscellaneous taxes were 1.8%, state allocations were 30.6%, case management 9.9%, state reimbursements 0.7%, property tax relief 28.4%, client participation 0.1% and miscellaneous income 0.3%.
Sweet said that it is important that the annual report be filed on time because if it is not, they are not eligible for the State allocations or the property tax relief. She went on to say that they report the department’s expenses to Planning Council and the Board of Supervisors on a monthly basis. At the end of the year when they consider the accruals, the expenses for FY 05 were over $10 million. By diagnostic group they are broken down into mental illness, chronic mental illness, mental retardation, and developmental disabilities. The general administration coordination services remain the same. On the diagnostic side, 13.9% of the total expenses were directed toward persons with mental illness, 24.5% for persons with chronic mental illness, 37.8% for persons with mental retardation, and 5.5% for persons with developmental disabilities including brain injury. On the services side, personal and environmental services incurred 7% of the total expenditures, treatment services 17.7%, vocational services 9.7%, licensed and certified living arrangements 39.2%, and 7.8% went to institutional, hospital and commitment services. She said that all translates into fund balance and the last two handouts take a look at the trend in fund balances and the amounts of those fund balances going back to the implementation of Senate File 69 in 1996. In the initial year when counties were required to set MH/DD aside and treat it as a separate fund, Johnson County put just under $800,000 into that fund. Each year the revenues are added on an accrual basis and the expenses come out on an accrual basis giving the department the balance in their bank account. At the end of June 2005 that fund balance was $1,789,173.
Lehman said that the cooperation that Sweet needs between the staff, consumers and providers is significant. He said that the Board appreciates the fact that they have put this together, and that over 80% of the funding goes directly to service providers. He said that it is difficult to keep it all in perspective. Neuzil said that when looking at the MH/DD budget, it’s bigger than many County government budgets all together. Sweet said that the reason it works is because of the excellent staff, and the interest in participation from the Board of Supervisors.
Sweet reported that cuts are pending on the Federal level, as well as on the State level. She said that she and Linn County MH/DD Director Craig Wood got together and put together some numbers on the economic impact of MH/DD services in the North Corridor. Last year they serviced 4,488 individuals. In total the services provided to clients was over $108 million. Linn County and Johnson County employed 2,126 people. She said that MH/DD services is not only good for the people that they serve, but it is also good for the economy of the region. She said that everyone is concerned when there is talk of shifting costs to the County when their budgets are capped since there are very few places where the department can go to look for additional revenue. Lehman said that was a good perspective on it, and that it is important not to lose sight of who is receiving the services.
Guard presented a report with a PowerPoint presentation on the management information system. She said she wanted to talk about how far the department has come in four years. The County accountant used to write up all the claims for the department and check authorization by hand prior to the payment. There were approximately 23,000 lines at that time that had to be checked. After everything had been paid, MH/DD then had to take all those claims and individual lines and reenter them into CRIS. She said that now they do everything electronically. Claims go through the MIS system which checks against units approved and rates so nothing has to be manually looked up and checked unless an issue comes up. Prior to this new system, state bill processing was manual and required the use of multiple spreadsheets to keep track of waiver and ARO services, authorizations and rates. It used to take up to two weeks to process it, and now it takes about two days. It comes in on a magnetic media form and it can be converted into an Excel spreadsheet which can then be uploaded into the system. It checks all the services against the authorizations automatically so they don’t need to be looked up all the time. Authorizations used to be made by the case managers and submitted to the CPC for approval. Case managers then had to prepare and print out separate NODs to be sent to Providers after authorizations were received, and had to manually look up the rates, which also had to be checked by another person to make sure the rates were correct. Now the authorizations requests are made directly into the MIS. Contracted rates are put into the system so that when a case manager goes to ask for a service, they just enter in who the provider is, what the service is, and the number of units. In the past, Network Providers had to wait for paper authorization approvals. Now they can actually go into the system, look at anybody who is their client receiving services and can see what the authorization is on that client. The case managers can also just print the authorization approval off and send it to providers.
Guard then explained that the total number of claims generated were 1,824. The total number of individual billing lines processed was over 47,000. The number of MIS services authorizations approved was 23,472, which are individual services. The total number of ISIS plans and plan changes approved and entered were 574. The number of providers who were paid, including administrative and service providers, was 270. Nine Network Providers, which are those with the most billings, faithfully use the MIS system every month, and the majority of large billings are uploaded by the provider and processed through the MIS, saving significant data entry time.
Finally, Guard discussed the future. She discussed the case management module, giving and overview of the items that are being looked at for this module. Case managers will be able to see an overview of their clients and tasks, and a mechanism will be put in that will make them aware of when a task is due. She said that users can enter case notes quickly, and client information will be gathered at intake right into the system. Assessment needs and social history forms will be in there, as will pre-authorization forms and documents. The case management agency and the provider will be able to create individual service plans within the system. Also included in the system will be authorization forms and documents, critical incidents for clients, discharge summaries and follow-up processes. The user will be able to view and print reports necessary to the process flow or business function. Finally, they are trying to figure out how to do the billing interfaces with Iowa Medicaid Enterprises (IME) and Merit Behavior Care (MBC). This way the bill would just automatically come in, load into the system, and a payment would be generated. Guard explained that the overall goals for the future are to avoid duplication, promote communication, and provide consistency. She mentioned that the challenges include the need for additional resources to expand system capabilities and ensure timely retrieval of data, the process of getting reports and queries from the County IS Department, and the continuos changes in legislation
Lehman asked if this allows counties to communicate with each other electronically. Guard replied that it is not a shared system. Sweet added that where it is helpful with the legal settlement is with the community mental health center. She said that they are internal to the system, so they are able to share a lot of information electronically. She said that the case management module will promote this for case managers. R. Sullivan asked if their goal was to get all the agencies on this system.
Mobile Crisis Coordinator Malinda Lamb presented a report on the Jail Alternatives program. She passed out a handout that was a breakdown of the clients they have worked with. It listed the number of clients served, the number of days they had spent in jail in the previous year, the number of days they were in jail after they had been in the program, and the number and cost of medications they were receiving, which are quite expensive, and the legal settlement of the clients. She said that she looked at if those people would have come in for the same amount of time this year as they did last year what the cost to the County would have been, including the medications and the time in jail. She used the figure of $60 per day, and using the cost of medication purchased from the Waterfront Hy-Vee. At the end of the handout there is a total. Lehman asked for some clarification about the medication column, and asked who paid for it. Lamb said that most of the time the County is paying for the medications while they are incarcerated because while they are in jail they lose their insurance and access to Medicaid. Sweet said that when they are in jail, it is not just the cost of being in jail but also their medications which the County pays for. When they are placed in the community many of them are eligible for Medicaid and other funding to pay for their medications. She said that in many cases they are state cases or are settled in other counties. Lamb said that some services may also be covered by their own insurance. Lehman said he emailed J. Patrick White about the NACo drug card and asked if the Sheriff’s Department could use it as an entity, and he said they could not.
Lamb said that one of the things she has worked with is connecting clients who may not fit the criteria but do take psychotropic drugs with other patient assistance programs. Some companies won’t work with people who are incarcerated, but some will. She said she has worked with the PA and so far they have set up three people in the jail on these programs and have saved approximately $734. She said that they also have managed to get some medication samples from pharmaceutical companies. The savings came up to about $9,000. This past week Lamb worked with a company on getting samples of some other fairly highly priced drugs. She went on to say that there are other clients who the program doesn’t work with in terms of getting them out of the jail, but they may work with them in providing a continuum of care. Finally, she sent out a program evaluation to a lot of the agencies they have worked with so far. Some of them came back with yes/no answers, but some did provide additional comments which she listed below. R. Sullivan asked about the timeframe. Lamb said that it covers up until Monday of last week. She said it started in July 2005, so the report covers six months. Lehman said that this doesn’t absolve someone from a crime, but it does give attorneys and judges information to understand why people are there. Lamb said they work with lawyers, the defense, and the prosecutors who handle the legal end. Harney clarified that there were 18 people who had been diverted. Neuzil said that this report showed that the mental health jail diversion program is working. He said there were three parts of it: the first was helping people, jail space reduction, and cost savings.
Lehman thanked Sweet and Lamb for their work. County Sheriff Lonny Pulkrabek said that last year the County spent $559,000 housing inmates out-of-county, and there has been a reduction in out-of-county housing costs this year. He said that the jail’s population growth is at about 3% a year and this may not eliminate overcrowding but it is slowing the growth. Pulkrabek appreciates Lamb’s program and that the Board supports it. Harney said that it was a real tribute to people working together to make this work. Lehman asked if there were other counties who were trying to do the same type of program that she could liaison with. Lamb said she has mostly talked to people in other states. She said that they are very different in each state and county, so finding one that is similar to Johnson County’s has required her looking out of state, with whom she is in contact.
Lehman asked about Lamb’s upcoming presentation in St Louis. Lamb said that she and Kathy McGuinness from MECCA got accepted to present at the Mental Health and Corrections Consortium which is in Kansas City in May. Harney asked whether the judges have been cooperative. Lamb said that they have. Sweet added that many of the other alternative programs that are out there concentrate on moving people from the jail into community placements, whereas this program is proactive and works with people who are in the jail, getting them the treatment and the meds they need to stabilize them as they leave the jail. She said that there are a lot of things that are happening that don’t ever appear on the reports because they are so hard to quantify. She said that if someone is not eligible for the Jail Alternatives Program, they still have the mental health professional resource that’s in the jail daily which is able to assist the Sheriff’s staff in working with folks with mental health issues who are there and are probably not going to be leaving. Harney asked Lamb to elaborate briefly on the fact that it is not just that these people are released, it is the follow up to keep them on medications in the future. Lamb said they continue to follow people after they are released. Lamb said they need to see people doing well with no problems, including not refusing to take meds. She said the program wants to see people doing very well before they back off. She said they stay in contact with them at minimum of one time a week. Lamb said they hook them up with services and increase the communication across the board. The follow up is definitely there and will continue to be there until the staff feel that the individuals are stable. The Board thanked Sweet, Lamb, Guard, and Pulkrabek for their presentation.
Recessed at 10:16, reconvened at 10:23
Planning and Zoning Administrator Rick Dvorak explained that East Central Iowa Council of Governments (ECICOG) Representative Chad Sands would present the proposal. He said there had been some discussion about support staff to the planning committee. Because of that he invited several different departments to participate. Today Ambulance Director Steve Spenler and Johnson County Council of Governments Executive Director Jeff Davidson agreed to participate. He said that the Health Department, Secondary Roads and RCS will also be represented. He said that because of that it would be a very supportive staff to this. He said they would be inviting Assistant County Attorney Andy Chappell to participate as well if the Board agrees.
Sands said they talked about the process of doing a Land Use Plan a lot at the last meeting. He presented handouts which talk about having town meetings. He said the proposal is intended to be flexible enough to allow for the plan that the County wants to adopt, whether it’s more or less comprehensive in nature. He asked if there were any questions that the Board would like clarified. Lehman said that Chappell had made some recommendations. Sands said he would incorporate the suggestions. Lehman asked where the meetings would be held, and where the public postings would be posted. Sands said that the County would put together the notices as they always do. Lehman said that this was fairly similar to what was done to review the Land Use Plan in 1998. He said that in this case they have branched out more to other departments. Sands said the intent was to be as locally driven as possible, and to get as much public input as possible. Assistant Planning and Zoning Administrator R.J. Moore said that Sands in this proposal has taken steps further than were taken eight years ago to ensure further grassroots involvement. He said that Sands proposed to encourage more public participation in the planning process, which the Planning Department thought was a good idea. He also noted that the Planning Department recommended that the planning committee should be made up of 15-20 citizens outside of the planning commission. Lehman noted that the organization would give monthly review sessions to the Board, and the Board would be encouraged to attend these sessions. He said that the Board could still be active in expressing interests in the points they want to see addressed. Moore agreed, and said they would encourage the commission to participate in any way that they want to with these meetings as well. Harney asked how large they envisioned the planning commission to be. Sands said that at least 15 people would be good. Moore said that they would like to send out a press release asking for volunteers.
Lehman said that the next agenda item is the contract itself, which describes the cost of doing the services that are in the proposal. He mentioned that it’s not to exceed $28,158. Sands said that it is a not-to-exceed fee, so if it takes less time the County will only be billed for that amount. If they run into some unexpected work that no one expected they will have to agree on the scope of that unforeseen work at that time. Dvorak said they usually can keep a pretty good handle on it. He said they would try to monitor it a lot better in the past. Lehman referred to the discussion of the P&Z budget yesterday where it was mentioned that there was some money set aside for this project, but they have also asked for increased help for the coming year. Sands said that there was a minor change that Chappell wanted made in the Service Agreement, which he would do. Moore said that they would put this on the formal agenda for next week.
They moved on to a discussion about recruiting volunteers. Moore said that he drafted a press release asking for volunteers for this commission. He said they would use the form that is on the Board’s website for volunteers for boards and commissions. He asked how the Board felt about the deadline. R. Sullivan said they have already gotten some applications. Lehman asked Executive Assistant Mike Sullivan what the normal window was for applications. M. Sullivan said it was two weeks. They agreed that the February deadline seemed appropriate. Moore said the application would have to be sent to the Board’s office by February 28, 2006. Moore said that after they get the applications they may need to put it on the agenda and discuss them at that point. Lehman clarified that the Board of Supervisors would make the decision of who was chosen to be on the committee.
M. Sullivan reported that the week of April 23, 2006 is County Government week. He said he received the information from the National Association of Counties (NACO) which he distributed to the Board by email. He said that it would be appropriate to put this on the Communications Committee agenda. The packet includes a press release, a sample proclamation, and a lot of activities that go along with it. He said the theme this year is Protecting Our Communities. Lehman said that the Board Chair usually gives a county address. He said that Neuzil had suggested that someone in law enforcement give a presentation about protecting the public. Lehman said that he and R. Sullivan are on the Communications Committee and will see about bringing that along. M. Sullivan offered his assistance in coordination.
Neuzil attended the annual Chamber of Commerce meeting and visited the new hotel in downtown Iowa City across from the Public Library. He invited people to the DVIP Souper Bowl on February 2, 2006 and to his listening post February 3, 2006 at 4:30 at McBride’s Landing in Solon.
R. Sullivan had a meeting with Anderson Bogert to talk about road designs for Prairie du Chien, attended budget work sessions, worked with the Senior Center, sat in on a Drug Free Communities Partnership meeting at MECCA, and attended a retirement party for Sheriff’s Detective Mike Scheetz.
Harney attended the ECICOG Board of Directors meeting, the Chamber of Commerce Ag Committee breakfast, a RAGBRAI planning advisory committee meeting, a liaison meeting with Sweet, an Iowa City Council and Jail Alternative Sub-Committee meeting, and the Chamber of Commerce banquet.
Lehman said the Board is in the middle of Budget work sessions. He also said that he and Stutsman will be attended the Chamber of Commerce trip to Washington D.C.
Adjourned at 10:48 a.m.
______________________________________________________________________
Attest: Tom Slockett, Auditor
By:
On the _______ day of _____________________, 2006
By Jill Moffett, Recording Secretary
Sent to the Board of Supervisors on March 9, 2006 at 10:30 a.m.