MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:
JANUARY 8, 2007
TABLE OF CONTENTS
Page
Discussion: Fiscal Year 2008 Department Budgets................................................................... 1
Secondary Roads (49)................................................................................................. 1
Mental Health/Developmental Disabilities (46).............................................................. 6
Chairperson Harney 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, Larry Meyers, Terrence Neuzil, Sally Stutsman, and Rod Sullivan.
Budget Coordinator Rich Claiborne said that the entire Secondary Roads budget is around $8.7 million for FY 07. Today, they are looking at about $5 million worth of non-personnel expenses. The overall budget is actually down half a million from FY 07. County Engineer Greg Parker said that most of the changes they have are construction related. Stutsman asked about expending some of the money out of the reserve fund. Parker said that Secondary Roads has always had a reserve cash balance. Last year, it was floating around two million. He explained that last year, they approved a budget that was actually greater than what their revenues were, so their expenditures were greater than their revenues. The cash reserve balance is there for emergency services. For example, last week, they had a bridge that was knocked down, and fixing that was not in the original budget. They are looking at $300,000 to $500,000 that is not in the budget. That would mean that they would not do another construction project. Or, they may continue to complete that project on an escalated schedule. Still, the funds have to come from somewhere. The reserve balance is also there in the case of emergencies like tornadoes or terrible winter. Stutsman said she just wanted to make sure that the funds did not come out of the Reservoir Trust Fund. Parker said those funds do not come out of the Reservoir Trust Fund. R. Sullivan asked if there is a recommendation for how much should be in reserve. Parker said that with a County this size, they would not want to go below $1.5 million. R. Sullivan asked if insurance pays for the bridge trouble. Parker said the individual who hit the bridge has insurance, but he thinks that it probably won’t be enough to cover the whole cost.
Stutsman asked if the County ever received any more money for Highway 965 and it coming back to Johnson County. She also asked if Cedar Rapids spent the money they received. Parker said that the money for that transfer of jurisdiction is in an account in Cedar Rapids. He said that former County Attorney J. Patrick White said that he wanted to handle that. Harney said that Cedar Rapids has no desire to give that money up. Parker said the ball is in Cedar Rapids’s court and all Johnson County can do is ask. Parker noted that the money does have to be spent on that particular roadway.
Parker said that this budget will be passed as static, but it can be changed throughout the year so that if the Board wants to see more macadam based rock roads rebuilt, they can do that. Neuzil said that creating a capital savings fund through the rural levy would make sense. Stutsman said that she is hearing people who want more dust control. Harney thought people were more concerned about bridges needing replaced. Neuzil said that a capital savings fund could do all of these things. Parker said that if the rural areas knew that the money was going to be spent on rural projects, they would probably be fine with that. R. Sullivan asked if Linn or Story Counties has a capital line item. Parker said that Linn County does not have a capital improvements program. He said those are more in the cities. This is why he was saying that if they want a CIP project for the rural areas, they should specify that. Neuzil said that they wouldn’t have to be too specific about exact projects, but the implication is that by increasing this fund, the Board wants more projects. Stutsman said they do need to be specific. Parker said that they can put so much into a CIP project each year and build it up to do a project at the end of, for example, three years. Stutsman said that she would want to say that a certain road is going to be a hard surface road in three years, and then plan for that. Parker thought they could include that as part of the 5 Year Road Plan. Neuzil and Stutsman said that they should have some money left over because they have taken off the North Corridor project.
Neuzil asked how they funded the new building. Parker said that the Tiffin shed is coming out of the reserve funds as a one-time expenditure. A portion will come out of this year’s budget and a portion will come out of next year’s budget. He said that is the same plan for the Swisher shed. Meyers asked what the price of the building is. Parker estimated $400,000. He said that may include the property cost, or a portion of that. He said this project includes the building, a salt storage facility, fuel islands, and seal coating the parking lot.
Neuzil said that it seems that there is still some uncertainty about creating a capital savings fund. He thought they should. Stutsman said her only hesitation about not being specific about the projects is that when rural tax payers get their next bill and ask what they are getting, the Board needs to be specific. Neuzil said that they can put that information into the 5 Year Road Plan. R. Sullivan said they could look at the top five or six vehicle counts on gravel roads, and conclude which ones would be good ones to target for chip seal. Harney said that he is cautious in that if they start another levy, he thinks it should be for trails. He noted that not too many roads out there that carry the load R. Sullivan is talking about. He said these are probably conversations the Board should have had a week before coming in for the budget meeting. Neuzil said this is awkward because the 5-Year Road Plan discussion is still to take place. Neuzil said that right now Parker does not know what they will have on the 5 Year Road Plan. Parker has to turn in the budget in the next two weeks, whereas the 5 Year Road Plan is not finalized until the middle of April. So, Parker has to put forward a budget based on what he thinks the Board will approve.
Parker said that he has consulted with his staff, and they would like to incorporate one to five miles of macadam based road a year, if possible. These are all budget dependent items. It also depends on if the weather holds. Neuzil asked if they should put some additional funding in the re-grade in this year’s FY 08 budget. Parker said if that is the direction the Board wants to go as far as re-grading, that is in line with his recommendation. Neuzil asked if the Engineer knows of specific roads that they absolutely need. Parker said the road they did last year was based on projected needs. They were basing their re-grades on safety needs and amount of traffic. The recommendation also takes into consideration the design of the road and site distances. Neuzil asked if Parker could have that information for the 5 Year Road Plan discussion. If so, Neuzil thought they should put some money aside for this year. Parker responded that they can put together a list that would prioritize roads based on the information they discussed. Neuzil said they could just add that to the 5 Year Road Plan as programs that the County Engineer identifies as priorities. Harney said he is fine with Parker coming up with the roads, but he isn’t sure he is ready to increase taxes to make improvements.
Neuzil said they could include trails in a capital improvement program. Parker agreed and said that typically, CIP’s are used to set aside money based on need of the community. R. Sullivan said that he thought if the project were part of the 5 Year Road Plan, it would be in that plan. But this CIP fund, if they set it up, would not be for trails because that would have to come out of a General Fund if it isn’t part of a roads project. Harney said he is under the impression that they cannot use road dollars for trails. Neuzil said that if trails are part of a roads project, they can. He said they would have to have two trails funds, one for trails included in road projects and one for trails not associated with the road. R. Sullivan thought they could do those projects as part of a road project, therefore not needing an extra fund. Neuzil said that not if it isn’t for a trail upgrade. Neuzil said that Rural Funds would go toward projects like North Dubuque Street. Parker said that if they are looking at adding trails as part of a construction project, and if they are expecting to expend those funds for trails as part of a construction project, that means that something else in the 5 Year Road Plan is going to have to go. This is because they just don’t have the money to do it, unless they increase funds.
Executive Assistant Mike Sullivan said that they do know based on the Trails Plan where the connectivity is going to be, so they know which roads need to be upgraded. He said they would not have to set up a separate trails funds in Secondary Roads to use Secondary Roads dollars. Parker said it would need to be listed as part of the 5 Year Road Plan, and it would be listed as special funds. Claiborne said that they already created a line item in capital projects for trail savings, and they will be addressing capital projects as one of the final steps of the budget process, so the Board will still have an opportunity to put General Basic funds aside for trails. Parker said that those funds would be special funds like the Mehaffey Bridge Road funds that are set aside.
Stutsman said that the Board needs to have a work session to talk through these policies with Secondary Roads before the 5 Year Road Plan meeting. R. Sullivan agreed. He added that he would like to get a sense of where they are at in relation to their peer counties regarding the Rural Fund. That could help them explain to the taxpayers an increase if that is in line with what other counties are doing. Stutsman said that ISAC would have that information. She added that rural residents who have to pay more taxes will want to see their road fixed. Parker said they can create the CIP list. The 5 Year Road Plan would include what they want to include in the CIP.
R. Sullivan said that the roads that are problematic are the ones within the growth areas of cities. They have talked about what kind of agreements they need to do. They have to have an agreement with other entities before they can put a particular road in the plan. Harney said that they should have a work session on this later. Neuzil agreed but said that they do need to figure out the funding. Harney said they can set a line item, but they don’t have to set that just yet. There is some time to say how much they might charge. Claiborne confirmed that the Board does want a line item in Capital Improvements. The Board agreed. R. Sullivan said he is for putting some money into it, but the Board might not decide to do that. Parker said it would allow the Board to spend dollars as they feel necessary based on the Capital Improvements Program.
Stutsman asked how that money is different than the 5 Year Road Plan. Harney explained that if they are going to levy the Rural Fund for additional projects, they are going to put that into a fund for those specific projects. It will become part of the 5 Year Road Plan. Stutsman said that they are creating another fund for something that is already in the 5 Year Road Plan. Parker said that it will be. Harney said it is just designating the dollars for a specific area. Parker explained that they would be creating additional funds that would allow the County to do additional projects. Stutsman said that these projects would be funded by the Johnson County taxpayers with no State or Federal dollars. Parker said no, they can match with Federal or State funds. They could also just flat out fund a project. Harney asked which way is easier to track. Claiborne said that if they did a line item in Rural Basic, the cash would accumulate in there. It wouldn't create another fund. He said that he knows the Auditor's Office doesn't like all of those additional funds. Stutsman said that they haven't had any trouble coming up with match dollars. Parker said that their pot only has so much money in it, so they plan accordingly.
Stutsman said that they need to be honest with the taxpayers and say that they have this amount of money that is going to be spent on this project rather than have a side fund. Harney said it might be easier to track with this. Parker said if the Board wants to do additional projects, they can use the CIP money to do so. Stutsman said to put it in the 5 Year Road Plan. Parker said it would be, but their money for construction projects is dwindling. The amount of construction that they can do at this point is what they have in front of them, but if they create a CIP, they will increase the amount of projects. Parker said that the money for construction projects is not growing. Neuzil said that all they are doing is to create a fund for additional projects if they are asking for them. Harney said they could designate 4%, for example, of the tax levy to upgrading roads. M. Sullivan said that the bottom line is that if the Board wants to go above what Parker already has in the 5 Year Road Plan, they will need to levy more for it. The only thing they use their rural basic fund for now is to transfer into Secondary Roads. Neuzil said that all they are deciding here is if they want to fund special projects in the 5 Year Road Plan, they track it in a CIP. Neuzil said that all they are deciding is if they want to increase the amount of special projects. M. Sullivan added that if the Board would rather have the project in the 5 Year Road Plan, then they need to put the money in Parker’s budget to do so.
Parker said that Linn County was able to rebuild their gravel roads because their Board gave the Secondary Roads an additional million dollars a year. Neuzil said part of that was a sales tax. Stutsman said that seems much more straightforward. She thought they could put a million dollars in the maintenance budget for road regrades and such. Parker said in five to six years, Linn County was re-grading 30 to 50 miles a year, and he doesn’t know if they could achieve that. Stutsman asked if that was macadam. Parker said yes, and there was usually no road design done. What they are doing is putting a gravel road back to its original condition. Stutsman wondered if they should make a policy to put all the oil roads back into macadam base because people are still fuming about those roads. Parker thought they might be seal coat.
Harney asked if they are going to have to include anything in the budget regarding the merge of the SEATS mechanics. Parker said that Brase is going to be bringing 20 additional buses, so they are looking at least one more mechanic. They might be looking at adding a fleet manager. Things are manageable now, but that could change when they bring in another entity. He explained that Iowa Code dictates that Secondary Roads funds are only to be used or expended for Secondary Roads purposes, so Secondary Roads cannot assist SEATS. All of the mechanics will have to be paid in part by SEATS. He said they will need a manager because now they will have to be invoicing another department. They are going to have to make sure that fuel is ordered and maintained. R. Sullivan said that they should be in touch with Maximus that does cost recouping for shared groups. M. Sullivan said that is a good point; they will do the work for them. Parker said that would be great. He said that with an outside entity, they are going to have to have clear and concise documentation of how those expenses are being separated out. R. Sullivan said that Maximus will help them do that.
Parker said that they will be looking at fleet maintenance software. They have 2 mechanics now and may need 4. One person oversees the operation, but he anticipates that he will become a full-time mechanic. Harney asked if they have talked to Information Services Director Jean Schultz about the cost of that software. Parker said he has not at this point. M. Sullivan said that because it is in the initial planning stages, they can fund this out of the Technology Fund. Parker said that is something they are going to discuss with the liaisons this week. Parker reminded the Board that the 5 Year Road Plan work session is on January 16, 2007.
Recessed at 10:15 a.m.; reconvened at 10:25 a.m.
Claiborne said that are eight decision packages from the Mental Health/Developmental Disabilities Department. Mental Health/Developmental Disabilities Director Elaine Sweet said that there have been many changes due to new legislation. Last year, there were 13 different pieces of legislation that impacted MH/DD services, and most of those have been implemented since September 2006. Most of the changes were significant. The State Payment Program alone brought an additional 140 cases and an estimated $2 million dollars in annual revenues to MH/DD. They have always been handling the case management portion of the State cases, but on the administrative side, there has been a very significant impact. That means that for those 140 people, MH/DD is now reviewing and approving their funding based on their Services Management Plan, maintaining the contracts for the State Payment Program, authorizing the funding, communicating the funding decision to the providers, processing claims, and generating the payment. Then, they are reporting monthly all of the activity associated with those 140 people. This is just one of many new pieces of legislation.
Sweet explained that another piece of legislation includes negating the Adult Rehab Option (ARO) program. That program will be no more as of June 30, 2007. In place of that, there is a new program called a remedial program that they are still trying to learn. The State has not yet figured that out. They have draft rules and are communicating bits and pieces that change often. One requirement is that a Licensed Practitioner of the Healing Arts (LPHA) work with each individual client in the program. But in Iowa City, they have not been able to find any LPHA’s because the risk of payback to the remedial program is so great. They had 130 clients on the ARO who will not have those services available to them. There is the potential for some of that coming back to 100% County funding if they aren’t able to work with providers to put the LPHA’s in place. One of the problems with ARO is that a lot of providers were using it as a habilitation program rather than a rehabilitation one. When they rewrote the rules for the remedial program, they also said they are going to have to do something about the people who are getting habilitation services. They announced that there would be a new waiver-like service for people with chronic mental illness called habilitation waiver. That goes into effect on January 1, 2007, and they have not yet seen the rules on that. They are assuming it will be retroactive to January 1, 2007.
Sweet noted that Chapter 79 in the new documentation rules changes the rules on the audits that occur. The Office of the Inspector General or the SURS unit of Iowa Medical Enterprise who process the Medicaid claims in Iowa can now come in unannounced at any point and demand all records for audits. Moreover, every piece of paper in a Medicaid file, has to have certain pieces of information including the agency name, the client’s first, middle, and last name, on both sides of the pieces of paper. MH/DD is currently in the process of reviewing their over 400 records with these changes in mind. The average medical record has between 80 and 90 pieces of paper in it. That means two stickers for every sheet for over 400 medical records.
There is legislation also that affects the State psych. Papers, Sweet said. The MH/DD department instead of the County Attorney’s Office, as of October 1, 2006 is now administering these. The Courts are no longer finding psychiatric beds for commitments; the responsibility is now with MH/DD.
Sweet said that because of these changes, the budget looks really different this year. The decision packages are related mostly to the changes she just described. In the eight years she has been at the County, her position has become more complex and more time consuming, but she has never seen anything like what it has been in the last year. It is to the point where she is averaging over 50 hours a week, losing vacation time, and she cannot begin to keep up. She said that she would never complain about working above a 40 hour week, but when she can’t keep up with the workload even doing that, they do need to take a look at that. In the past six months, the time that she has had to work with providers has been really limited, as has the time available to work with staff. While they have been working on these legislative changes, she and a number of administrative staff have been pulled from their normal duties to work with these new requirements. They are, therefore, proposing an Assistant Director for the department to help with the work load and to act as a backup when she has to be absent.
Neuzil asked what the level of that employee would be. Sweet said that in all of the other departments, it appears that the Assistant Director is just a level or two below the Director. She said that certainly Human Resources Administrator Laura Shramek will have to take a look at that and make a recommendation. The position would include benefits, a computer, continuing education, printer, software, travel, office equipment, and furniture. Harney asked how much of this might get picked up by the State budget. Sweet said that their budget is a combination of federal, state, and local dollars, and this position would be funded via this combined budget. She said how much would come out of County dollars depends on how much time the person would spend with the Targeted Case Management Program (TCM) because that program generates revenue. Eighty two percent would be coming back in revenues.
Claiborne said that he and Deputy Auditor Dana Aschenbrenner have been working on creating the new accounts into GEMS. Overall, there is a new revenue item that will be around $2 million. He asked if this new program is State funded. Sweet said that the $2 million dollars is from the State to pay for services that are going to cost $2 million. Claiborne asked if that includes the personnel. Sweet responded that it doesn’t include the administrative time that they spend at the local level. And that time is not reimbursable to the County. There is no additional money for that piece of it. She said the County would probably have to come up with about 90% of the funds for the Assistant Director. Stutsman said that the pay range for the Assistant would be about a pay range 22, which is about $54,600 to $58,500. The benefits run between 30 and 35% of the salary. Stutsman said that the Health Department Assistant Director and the Ambulance Director is in pay range 23. There is no one who is at a pay range 22 right now. Sweet said the Assistant Director would be in 23. Stutsman said that means the salary would be $58,900 to $63,100. Sweet asked what the biweekly salary would be. Stutsman said $2,266 for starting, and level three is $2,311. Sweet said that they should be looking at next year’s scale. M. Sullivan said they can start below the range for six months. Stutsman said those numbers are old though.
Sweet said that the second decision package proposes a half-time Information Technology Support person. In February, they will be testing the TCM module that they have been discussing for the past several years. In combination with the CPC responsibilities and the additional reporting responsibilities, they think it wise to look at a part-time information technology person just for MH/DD. She added that Schultz and her staff have been wonderful in providing support, but one thing that is difficult is understanding the terminology and knowing exactly what MH/DD needs to be pulling out of the system. She said that Information Services staff is also pulled in a lot of directions and this can become difficult for Schultz and her staff. She said that Black Hawk County has a fulltime Information Technology support person for CPC. Linn County just purchased the system and has two Information Technology people to support it.
Stutsman asked if they could fill a half time position with such a specialized position. Sweet said they could have that person be dedicated halftime to MH/DD and halftime to another department or to MH/DD if that is a worry. Or, they could share a person with Linn County. There are some options. Because of their annual report being due when it is, they didn’t have time to investigate these options to the degree they would have liked. Stutsman asked Claiborne if any other department has its own basic tech person. She said she is hesitant to go down this path because other departments could make this case, and then they would end up with a separate Information Services Department. Neuzil said the Auditor’s Office and the Sheriff’s Office each have a technology person. R. Sullivan said that there is a certain amount of Information Services that is already charged to MH/DD so they could increase that level and then Maximus would increase the amount that is reimbursed. R. Sullivan said that if the concern is if the money comes out of MH/DD or the General Fund, as long as the person is dedicated to MH/DD, it would come out of MH/DD whether the person was Schultz’s employee or not.
MH/DD Contract Employee Doug White said it is only a part of the rate that goes into their calculation for recovering. It is not that they get a charge directly to MH/DD from the General Fund. R. Sullivan said that he saw a document that indicated it was. Sweet clarified that they get an allocation from Maximus that says to use 10% of their salaries and wages, and count that as an indirect cost for their cost report. That allocation includes the Board’s time, the Auditor’s time, Human Resources’s time, and Information Services’s time. They use that in calculating their targeted case management rate. Then, that money comes back into MH/DD in the line item of TCM revenues. All of this money is being spent out the General Fund but MH/DD grows by that amount. Several years ago, the State realized this and said that money should be going back into the General Fund, so they said that all counties need to go back and figure out how much money has been involved since Senate File 69, and pay that money back to the General Fund. At that point, MH/DD talked with the County Attorney’s Office as did Linn County, and they agreed that they weren’t going to do that based on various laws in place. That is sitting in the Attorney General’s Office waiting for a determination. She said that the money they had to pay back was about the same as the money the lost due to their fund balance being too high. She said that because the government didn’t tell counties to do that in 1996, there were counties like Johnson County and Linn County that lost money in their State allocation.
Stutsman said that Schultz has put in for another Information Support Technician. She asked who does the reports. Sweet said that for the most part they are done by Program Analyst Shirley Barker. Sweet said that they cannot do their own reports. White said because of this, they end up looking at that system and putting it into an Excel spreadsheet which is inefficient. Sweet said that one of the ways they differ from other departments is that the State sets the MH/DD fund and the State sets the requirements. So, when they say the annual report is due at midnight on December 1st, they don’t care if that is a Saturday or a Sunday. Quite often they don’t get numbers from the Auditor until noon on Friday. If there are any Information Service needs over the weekend, there is no one to support them unless Schultz comes in over the weekend. She said this year, the report ended up getting locked up on email because the file was so big so MH/DD staff ended up staying until eight o’clock that night cutting up the report into pieces and sending it. This is huge because if the report did not go through on time, they would have been denied their $5 million budget from the State. They might have had the right to appeal if that happened though.
Sweet said that the third decision package is a Mobile Crisis/Jail Alternatives request. Right now, they only have Mobile Crisis Coordinator Malinda Lamb and one other person in the department, and they are at maximum. Lamb’s staff person recently resigned. Lamb is in the process of interviewing four excellent candidates. R. Sullivan asked if the Board were to approve this position, would the budget allow Lamb to bring the person on early. If Lamb has two good candidates out of this interview process, she could potentially offer two jobs.
Sweet said that she is going to have to amend her budget for the State Payment Program. When the budget was approved last year, no one knew that the State Payment Program was going to happen, so her budget is not adequate right now. It also depends how much they want to leave in the fund balance. Her best projection for this year if they go business as usual is that they will end this year at about a 12% fund balance. She added that they have no history to base what is going to happen with the new habilitation program, the ARO, and the State Payment Program. But, they did their best in putting the budget together. Based on FY 08, they are looking at a 7% fund balance without the decision packages, and with them, a fund balance of 4%. Or, it could be between these figures if some packages get passed and others not. All of this assumes that the State is going to pay what they said they would. She said that they might have to pay the $400,000 that White is trying to save them.
Stutsman asked about the Mobile Crisis/Jail Alternatives job. Sweet said the new position would allow them to move on with the mobile crisis portion of the job. Stutsman asked if this requires a new job description. Sweet said no. Harney asked if that person would work out of their office. Sweet said the employee would work with Lamb. Sweet said that last year, they asked for this same position. The plan was to use this position to develop the mobile crisis team. They had another $95,000 for the mobile crisis response team, and the plan was to use on-call professionals. The third jail alternatives person would provide the core staff within the department. The position got pulled out of the budget, but the $95,000 did not. Stutsman said that it might be good to approve the position now so they can use the money already there. Sweet said the money there now could easily cover both this position and the on-call staff. The on-call people would be mental health professionals from the University. There would be a basic fee for having them on-call, and then if they actually responded, there would be a contractual fee. R. Sullivan said it makes a lot of sense to do this now. Stutsman said that the liaisons had given Sweet direction to decrease the fund balance, and this would be one way to do that.
Sweet said that Lamb has helped law enforcement to help a situation not escalate. She said that Lamb has done an exceptional job of gaining the confidence and trust of the entire criminal justice community. There have been times when law enforcement has asked her to assist with a developing situation, not involving jail. M. Sullivan said that the Board can give Sweet the go ahead now for the new position. Sweet said that it would have to move from a decision package to her payroll.
Sweet said that when someone gets sick in MH/DD, there is no one there to pick up the work. She said that there is a real need to look at having that kind of back-up. Harney said he doesn’t question that the position is needed. He felt they are giving double talk to other departments who are saying they want to do something, and the Board says they have to wait until budget time. R. Sullivan explained that the difference is that the money they are discussing here can only be used in the MH/DD department, whereas other departments could potentially use other money. Stutsman added that she didn’t appreciate how the Health Department request was handled. R. Sullivan, Stutsman, and Meyers agreed that it would be a good idea to approve this position. Harney said he doesn’t have a problem with the position, but it still has to go through the process. M. Sullivan explained that if Ambulance Director Steve Spenler has a paramedic quit tomorrow, the Board does not take any action for him to hire a new paramedic. He simply takes action. But, if he want to hire a critical care paramedic, that would be a new job that needs approval. M. Sullivan said they can do an informal and then formal if they want to, but that isn’t the usual way for this situation. He said he can put on this Thursday’s agenda. Stutsman asked if anyone else remembers having already approved this position last year. R. Sullivan said he thought they did, as did Harney. Sweet said the dollars didn’t get put into the budget. Sweet said there were two decision packages last year, one for the $95,000 for the on-call staff and one for the additional Jail Alternatives person.
Sweet said that the next two packages are for Account Clerks, which will need a job description developed in conjunction with Human Resources. They currently have a budgeted and approved position for one Account Clerk but they have not finalized the job description and filled it. They have been using temporary assistance. The Targeted Case Management is almost a full time responsibility that they have no backup for. She said that it has taken a lot of her time to handle state payment. She has had to approve funding requests, handle notices of decision, communicating with the State, and communicating with the case managers. The first Account Clerk is for the State Payment Program but would also be asked to back up the Targeted Case Management billing. Sweet said they have another position that was approved two years ago that was not yet filled. Stutsman asked why they are adding another one. Sweet said they have been using that person for clerical support for Targeted Case Management unit for filing and customer satisfaction surveys. That was a different decision package for different things. Harney asked why they wouldn’t just change the job description for that position, and fill it. Then, they can add a part time person for the other work. Sweet said the money that was approved in the budget a couple of years ago is a full time position doing the things already specified. Now, they have the State Payment Program without an employee to help. Stutsman said that they had approved an Account Clerk in 2006, but that position was never filled. That money was used to supplement contract employees. Stutsman said that the Board approved that, so that money has been carried over, and now Sweet is asking for another one. Neuzil said that they could eliminate that previous position and add this position instead. They could keep a line item to better clarify.
Sweet said the position that was approved a couple of years ago is a position that needs to be filled but they never did the job description or filled it for a number of reasons. But the work has been there and the work has been getting done. It was done with temporary staff. Now, instead of hiring a State Payment Clerk, they are asking to use the same terminology and hire an Account Clerk because that position is there and need to be filled. Those two positions could be interchangeable. Neuzil said the Board wants a better description of what is being spent. They could have a line item for temporary employees to fill the position. He said this is just an idea. Stutsman said that it sounds as if Sweet wants to keep the money she has for temporary people and add another Account Clerk. Sweet said that they have used far too many temporary staff people because there has never been time to go through the total hiring process. Sweet said if they were to take away the current decision package, there would be no one to do the State cases. The person they have the money already set aside for is doing consumer satisfaction surveys, filing for the targeted case managers, and putting stickers on the 400 files. Harney said he doesn’t have a problem with that. He thought they have one position to do this and then a position for the other part, instead of adding another position where they could be adding a full time person. R. Sullivan said that the idea that for two full fiscal years they couldn’t get the person hired shows they need to get on top of the personnel. Neuzil said that right now, they have one Account Clerk, who is funded, and Sweet is asking for two more Account Clerks. Neuzil said that what he is hearing from the Board is that if they approve an Account Clerk, they want her to hire an Account Clerk. He said that they want Sweet to fill the one position that was supposed to be filled two years ago. Or, she can take the current Account Clerk off the budget line and call it a temporary clerk.
Sweet said it seems to be a matter of semantics. One person simply cannot keep up with the workload. She said that one of the temporary positions has been doing all of the MH/DD claims. Previously, Human Services Accountant Kathy Lynch was doing those, and then they came over to MH/DD. Neuzil said that they don’t want to take anything away from the department. R. Sullivan said they just want permanent positions. Sweet said they would be hard-pressed to get the work done with just one of these new Account Clerks. It could get done, but the workload would be very high. Neuzil said that some packages are budget neutral. Sweet said that package 5 shows a savings. Neuzil said they aren’t making any promises, but if they do approve an Account Clerk, Sweet should be sure to fill those positions. Sweet said that Stutsman had a good idea of using the conference rooms at North Governor that conceivably could be made into offices if needed until they get into the new building.
Sweet said that number six is a full time case manager, but she would recommend hiring two part time individuals. She said that the Targeted Case Management Advisory Board should be looking at what point they should hire case managers. She said that case managers often say that the levels are too high and they need to hire additional staff. She said they reorganized the department to bring down the case management case load in June and July. Then, all the State level changes came through and the reorganization went on hold. She said they have a pending grievance that began when the Iowa State Association of Counties (ISAC) technical assistance did a case file review and found two of the case managers whose files are significantly non-compliant with Medicaid rules. In one case, the files were 82% deficient. That generated a request for additional case managers. She said that she sent out a survey to County state management agencies across the State. Approximately 50% of the counties used Southeast Iowa Case Management or the Department of Human Services. She said that she is finding that their case management unit has some of the lowest case loads in the State. There are many things to take into consideration though. A case load in one County is not the same as the case load in another. Johnson County tends to have clients who need more services. They have clerical staff and specialized case managers who take a lot of the work load from the case management staff. Those factors combined suggest that she isn’t ready to go out and hire a couple more case managers. But, they do need to think about this for the future, or if the case loads suddenly get really high. She said that case management unit is a Medicaid program that requires them to follow Medicaid rules. If they don’t, there are significant consequences in terms of accreditation and paybacks. There will be paybacks to Medicaid to the work of those two case managers.
R. Sullivan asked if they should pull decision package 6 out of the book. Sweet said not necessarily. Their case load is really hard to predict. For example, if the State gets rid of Adult Rehabilitation Option, then there are 130 people who no longer need case managers. But, when the cases get to 35 or 40 per case manager, they need to look for case management staff. Stutsman said this is difficult because the Board is being asked to tax for a position that MH/DD may or may not need. R. Sullivan said that they can always come back and ask for this later via the fund balance. So, they should pull the package. The Board agreed to pull this package.
Sweet said that Lamb asked to submit the next decision package based on the information that she has from the 6th Judicial Department of Corrections, who are looking at an allocation for a mental health dual diagnosis court. Lamb and County Attorney Janet Lyness thought it would be a good idea to put together a decision package for the position of Jail Alternatives Team Member (for Mental Health/Dual Diagnosis Court) in anticipation of funds coming through. She noted that she felt inadequate to discuss this. This would allow a person to go before this court instead of before the regular court system. It would save money and help people get appropriate mental health care or drug treatment instead of entering into the criminal justice system. Stutsman asked when they will find out about money. Harney and Sweet said they didn’t know when that budget session would be. Neuzil said that he would need more background. Harney said he doesn't have enough detail, and they don't know if it will be approved. On the other hand, if the money comes through and the position comes through, then it would be a shame to not have something in place. R. Sullivan said they could pull from the reserve if they had to.
Sweet said that Senators Bolkcom and Dvorsky were concerned about where the MH/DD fund balance is at. The difference between what they projected and what they ended up having was influenced by four things. After they did a projection in December, the Auditor's Office notified them of a post-audit adjustment that took out $158,000 of one year. They have talked with the Board about the problems at the Community Mental Health Center and the lack of staffing. Later, the Mental Health lost all of their psychiatrists. In FY 05, the Mental Health Center expenses were $1,641,000. They would expect there to be an increase each year. By the end of the year, they would be at a significant budget excess, but this was not the case. In FY 05, they paid the Center $1,641,000, in FY 06, they paid only $1,284,000, or $360,000 less than they had paid before because of lost staff. They then got the letter from Maximus about the cost allocation doubling. She said they never knew that until September, and that doubling added about $150,000 to their revenues. Sweet said that she shares the concern that the Senators and the Board have. She would like to put together a one-page precise summary of these factors and then to meet with the Senators to discuss the information. If they move ahead, Sweet said they are already looking at the fund balance going from 11% to 5% at the end of 2008 without considering the $400,000 that may come off the fund because of White’s letter. Harney asked what will happen next year if they approve all of these employees. She said that all they can do is their best with the information that they have to accommodate and provide the most service to the most people with the best programs they can.
Regarding decision package number 8, Sweet said that case manager's often use their own vehicles on the job. They have had occasions where their cars have been damaged, and they are short on vehicles. The oldest vehicle has about 130,000 miles on it from local visits. So, they would like to purchase a new vehicle. Harney suggested that they looking into getting the vehicle where the CountyAssessor gets theirs because they get good deals.
Adjourned at 11:20 a.m.
______________________________________________________________________
Attest: Tom Slockett, Auditor
By:
On the _______ day of _____________________, 2007
By Casie Kadlec, Recording Secretary
Sent to the Board of Supervisors on March 8, 2007 at 12:00 p.m.