MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:
JANUARY 12, 2009
Block Grants.......................................................................................................................... 1
General Basic Block Grants (20)................................................................................. 1
Mental Health/Disability Services Director Kris Artley: Fiscal Year 2010 Budget....................... 8
Mental Health/Disability Services (46)......................................................................... 8
FY2010 County Budget......................................................................................................... 11
General County Budget for FY2010........................................................................... 11
Chairperson Neuzil called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 9:03 a.m. Members present were: Pat Harney, Larry Meyers, Terrence Neuzil, and Rod Sullivan; absent: Sally Stutsman.
Emergency Management Coordinator Dave Wilson said he cleaned up a lot of Department 20. Line item number four has a $50,000 increase because a second full-time equivalent (FTE) is added. Neuzil asked Wilson to talk about the $50,000. Wilson said it is not truly for the FTE but is to catch up. Presently EMA receives $100,000 from Block Grant 20. This is an increase from $78,815 allocated last year. In prior times they did a good job of keeping the block grant tied into what it costs to operate a salary and benefits for a 1.5 FTE department. When it transferred the transition was not handled well. The salary and benefits never kept up with what it should have been. It has been a 1.5 FTE department long before he came along and under former Emergency Management Coordinator Tom Hansen’s tenure they went into a contract with Cedar County EMA. This lasted for a brief period of time that did not keep on course where it should have been to do the 50% of wages and benefits as the contract stipulated. Last year they severed their contract and they had an increase in the Emergency Management Performance Grant going from $28,000 to $39,000 and this year they anticipate $41,000. They were behind the power curve when they got numbers from Deputy Auditor Chris Edwards and there were several years they were in the 60-70’s for the block grant and drew down the cash balance badly for EMA Department 2009. He consulted with County Attorney Janet Lyness and Assistant County Attorney Andy Chappell because there was never a set in the bylaws about laid out plans of how they were to fund this. Through their recollections the best case was to have the Board help them through the block grant process to fund the salary and benefits to operate the department.
Last year Wilson asked the Board for an increase so he could get the department closer to on track for what it would cost for a 2.0 FTE department but then the floods hit. Currently they operate on a 2.0 FTE department for Johnson County Emergency Management. Story County is identical with a 2.0 FTE staff, Linn County is the largest with 6 FTEs, and Polk County has 5 FTEs so looking at the formula they are on track. At the present time they have the least amount of county dollars of all other counties. The projected costs he calculated with Edwards and Human Resources Administrator Lora Shramek was for wages and benefits for 2.0 FTE based on cost of living range from $18,000 to $20,000. The worst case budget scenario is $149,527. At some point they need to get the department back on track where it has positive money going into it so they can save some money. Most money that EMA receives passes through or is specifically tied to a grant. The proposed request is to bump the budget to $150,000 which is a $50,000 increase to essentially cover the wages and benefits or the variable of the unknown of 2.0 FTE.
Wilson said there is a question about what they are going to do with a 22 year old County Rescue 52 truck. He said he had originally asked to have the money set aside for the project but because of the bad timing he is not making it a large issue. If the Board wants to set aside some money for this project this is the right time to do so but he understands economy is bad. R. Sullivan asked if the $100,000 for the budget was a steady number. Wilson said it is not a steady figure because last year the Board increased the budget from $78,815 where it had sat for the previous seven years to $100,000. R. Sullivan said maybe seven years ago the $78,815 might have covered the 2.0 FTEs. Wilson said he believes when former Emergency Management Coordinator Jim McGinley transferred to Hansen that it probably covered the 1.5 FTE. R. Sullivan said over the eight years with no increase the salary portion started to eat up more of the total transfer so the reserves were down to nothing. Wilson said the best he could tell this is what happened because when he looks at budgets on file there is no record of money being used for programs. There was a lot of Homeland Security money that came in and out but nothing else changed besides the draining of reserves.
Wilson said the only program that caused a problem was the Haz-Mat Program. The Haz-Mat Program was established in 1988 and it levied a $.25 per capita. The number has not gone up except for a brief period of time when they increased it to purchase the new rescue truck and then they brought it back down. It is a very technology driven program requiring replacement of sensors, etc. every year and the program has been over budget for several years. When he began the job he brought this issue to the Haz-Mat people because they continually go over budget by at least $5,000 a year. He said they need to get this in line and talk about increasing the per capita charge. R. Sullivan said the overage was coming out of the reserves. Wilson the money was absolutely coming out of the reserves because it operates as a subset of the department. Haz-Mat only generates $32,508 through the $.25 per capita and it drew down the cash balance. To the best of his knowledge the combination of the block grant not keeping up with the full FTE cost and the Haz-Mat team budget the per capita not keeping up with the cost of living and their equipment prices going through the roof with team budget not being held to the fire have put them in the position they are in today. He said none of the other programs are out of line. Rescue maintenance and boat costs have been increasing every year but they have it under control. The recent floods helped them on the boat program which he will show later. Harney said when McGinley took the department over it was 1.25 FTE and there was enough money in savings when Hansen came along to make the department a 1.5 FTE.
Wilson said the present quotes for the replacement of the box truck or refurbishment of the chassis would be $95,000 in the current years funds. The department total budget is under $260,000 and this is the second year they are planning for a flat budget. He had little increase last year except cost of living. The request is to have the Block Grant 20 to go from $100,000 to $150,000 and essentially it would maintain the 2.0 FTE department and give a couple thousand dollars to save to get the cash balance back up and an amount yet to be determined by the Board to set aside for the replacement of the box on Rescue 52. Meyers asked if the box replacement would come out of the increase. Wilson said he would designate a separate line for five years and the amount will be held back so it cannot be dipped into for anything else. Budget Coordinator Rich Claiborne said on the County budget side instead of 150 Block Grant it would be 160 and Wilson would set up a line in his own budget but he would not do it in capital expenditures on his budget. Meyers asked whether that amount of money set aside would be over and above the $50,000. Wilson said he is correct. The good thing to remember is though the money on paper transfer around but the money never leaves them or loses interest until the voucher is written.
Wilson said the Program was started in the 1970’s and the entire truck was new in 1987. It was a 12 foot aluminum and wood box design for a 15 year life expectancy. It is presently on its second chassis and they took off a three quarter ton Ford Econoline chassis that Facilities Director David Kempf is now using with a dump truck bed. They put on a Freightliner FL-60 Diesel and it has been a good chassis. With some upkeep it would be fine for a number of years to come. It is the second complete truck in the program since its inception in 1974. The original truck was an old 1974 three quarter ton Chevy they sold in April, 2008 for $2,700. The FL-60 chassis still has another five to ten years of serviceable life but it does need to be refurbished because the electrical is worn and there are some other components needing work. They have seen an increase in maintenance over the last 24 months and in this year alone they spent $6,428 as of December 31, 2008. The box is 22 years old and was only designed to last 15 years. The original truck was entirely replaced at the 13 year mark. The request is to refurbish the chassis and purchase a new all aluminum custom non walk in box and do the upgrades to the FL-60 Diesel's chassis. The problems they have seen range from the air brake system to the electrical and things he considers to be easy fixes. The request for information quotes they sent out to a couple of vendors looked like it would be $90,000 to $95,000 depending on the vendor to do the project this year. What they would get is a brand new aluminum box which is lighter and less prone to corrosion and still fits in the sally port which is important because it is a tight and confined space.
Wilson said the light tower is no longer functional so there is no emergency seam lighting in the way of flood lights on the truck presently. The two stem lights that were on the back have been broke off because they were fitted afterwards and they clip the steam pipes if they are not put all the way down. The extendable stem light was bought out and is no longer making parts so there is no seam lighting on the extrication so they must use the fire departments. The paint job on the chassis looks tough. The new electrical components for the chassis go through the entire air brake system. The old bumpers are very corroded. The interior of the cab needs a lot of electrical upgrades and they have seen a significant increase in the maintenance costs of the vehicle. The brakes and generator on board have caused problems over the last year. Storage is very poor, the equipment represents several thousand dollars because they have two full sets of hydraulic gear. The thing was originally an ambulance box so it is not designed to do what it is doing so everything is cobbled making it hard on the equipment it carries. The repairs would include a new light tower, generator, new paint for the chassis and box, and new emergency lighting system.
R. Sullivan asked what it would cost to buy brand new. Wilson asked if he meant a new box or a whole new truck. R. Sullivan said a whole new truck. Wilson said probably $130,000. Neuzil asked what the timeline was. Wilson said he went with refurbishment versus replacement for several reasons. In his mind he could see them getting out of the rescue program within the next ten to fifteen years. He said they cannot get out any sooner because of the growth. They are not seeing much growth in the rural areas where the truck is predominantly used in Oxford, Tiffin, Swisher, Shueyville, and other peripheral areas. It is not a problem with the traps in Coralville or Iowa City but in the regions outside of that. Even in the Coralville or North Liberty area where there are a couple of paid guys who still have an extrication time of over four minutes. They have their truck out the door in under three minutes 90% of the time or better. The push is on to have more departments to have some level of paid guys, it still becomes a problem when people are trapped in their vehicles on the interstate and are waiting to be cut out of a vehicle. Harney said he would like to add in for the Board’s information that the Emergency Management Commission had a lot of discussion on whether to even replace because the fire departments having all the extrication equipment and other things that goes along with it. There are so many other instances that go along where there is not a fire scene where the Sheriff uses it for an emergency situation where a fire truck may not be present.
Wilson said the option to fully replace would cost $130,000 and to refurbish would cost $95,000 to $100,000. If the money is there, they will go ahead with a complete replacement. He does not want to pitch the replacement because he figured he would be turned down immediately because of economic conditions. He is thinking they just need something to last them the ten to 15 years he anticipates the County still participating in this type of business. Neuzil asked what Wilson's timeline was for when the changes need to be made. Wilson said he would like to see the program done in the next two years. Neuzil said it is always easier to put some in now and more in a year later. Harney said he is in favor a full replacement because if they buy new they have some vehicle warranties. Neuzil said if they want this for ten years it solves the ten year problem. Wilson said either option solves their problem. The benefits of replacing a whole new truck he would not speck out a Freightliner FL-60. The simple reason is getting in maintenance and maintaining is more costly because it has to go to one of two specific places and it costs additional downtime. Neuzil asked what he would ask for if they set aside $65,000 for the next two years. Wilson said if the money was set aside he would ask for an entirely new truck and see if he could get a new one for the money. Most likely it would end up being a large Kodiak Chevy or Ford large diesel truck but it probably would not be a Freightliner because he would like to get service in town.
Neuzil said he would like to see it put on the list but they are not making any decisions right now. R. Sullivan said for the difference of $30,000 to have it brand new with warranties is worth it even if they wanted to get out in ten years they would have something worthwhile for a trade. Meyers said when they look at the list of maintenance items that keep popping up it adds up. Wilson said the components that keep breaking down on them are costing an inordinate amount of money partially because it is Freightliner Diesel. R. Sullivan said another thing the Emergency Management agency needs to decide is whichever way the Board goes, if the department is going to be phased out in ten years than maybe they are not going to set anything aside. If Emergency Management plans on not phasing out the program then they need to set up a replacement schedule so they are never asking for $50,000 if they put $10,000 a year. This is probably what they should have done 15 years ago. Neuzil said that transition is happening and the same thing Wilson is dealing with happened with Conservation where they ran bare bones and when they need something they spend an extra $100,000 rather than the other way around. He said it is just a different strategy from a different Board of Supervisors that took a different approach to this. The Board has gotten the message that they spend half now or get ready for a big price tag next year. They continue to be warned that this is the good year for their budget so next year and the following year are going to be really tough. Harney said Claiborne should not have left it. He said he wanted to share how the City of Iowa City used to have a rotation with their fleet of vehicles and before he left they wanted to do a full upgrade of the vehicles in one year because they could bond. He does not know if it fits this profile. Neuzil said they do not bond for vehicles. M. Sullivan said they can bond for vehicles but the County does not. He said when Wilson was in Cedar Rapids he did the same thing with his ambulances. Wilson said they had a dozen trucks and they set aside money every year. He said he would rather have come in and seen there was money set aside.
Neuzil asked of the $260,000 of the budget set aside every year the County contributes $100,000 and he is wondering where the rest of the money comes from. Wilson said from other resources and grants. Meyers asked how often the truck is called out. Wilson said it was a pretty steady incline and there was a large blip from 2006-2007 that was unexplainable. It went from 132 responses in 2003 to 229 responses for 2008. The vehicle does not go out on medical calls; it goes out on traps. When he worked up in Linn County they did not get nearly as many traps or major traumas. The only thing he can think of to attribute to this is there are more lanes of traffic to navigate through. Meyers said he is not familiar with the term traps. Wilson said traps means someone trapped in their vehicle. Harney asked if they use it for a lot of rescues. Wilson said it goes out for ice and water rescues but a substantial portion is traps. They have two sets of tools on the truck for good reason because often time they have two extrications at a single scene. Meyers asked if other departments are slowly acquiring the trap equipment. Wilson said the other departments have the equipment but the problem is the manpower for Monday through Friday during the day and the skill level. Most departments are volunteer within the County and the only career department is Iowa City. To get trained deputies on scene is very important. He said he is an instructor who trains every year in November and December.
Wilson said Emergency Management and the Iowa City Fire Department are the only two programs that guarantee 24 hours, seven days a week. As a reminder, the daily population of 118,000 are only serviced by the one 24/7 career fire department. This is important for the 8:00 a.m. extrication calls in any Johnson County town on weekdays. All volunteer departments depend on available responders with the exception of the career Law Enforcement, Career Ambulance Service, and career Iowa City Fire Department. At most they have three to four paid guys to cover. Their program provides a lot of rural backup and it is used a lot for farm stuff. They assist with backup calls and assisted in two Iowa City Backup calls in the last 24 months for extrications. The Iowa City Fire Department tends to stay in their own fire districts within city limits.
Wilson said they were able to purchase a levy builder that was supported 100% through flood reimbursement. They purchased a new MCI Trailer in Tiffin funded by grant funding. They replaced one of the 12 boats stationed throughout the County and it was completely supported through flood reimbursement on hourly rental rates. They only have two aged boats, one down in Solon and the other at the Sheriff's Department. Harney asked about the trailer in Tiffin. Wilson said the Emergency Medical Services Association purchased a disaster services trailer for Hills, Solon, and Tiffin. He said they replaced an old 1970s snowmobile and refurbishment of a Toboggan. They used the funds they generated through sale of old junk to replace the snowmobile last year. The boats have been on a good replacement schedule that started the last couple of years under Hansen. After the flood they were able to build back and replace many of the boats. During the flood they used a lot of Hesco Barrier and other things that have never been used that were donated resources or items from Safeguard Iowa. There are still some donated water, cleanup kits, and hygiene kits in reserves. The Quick Levy Builder and Sleeve were valuable tools during the flood. EPA Region 7 brought in at no cost and stayed for months that saved the County an estimated half a million dollars on cleanup on household hazardous waste, stray buoys, and stray barrels. The EMA purchased three Probagger's that filled 750 bags per hour per machine. The City of Davenport donated and hauled for no charge 20,000 filled sandbags. There were also 24 Federal pumps brought in at no charge to locals. He wished to thank the Board for participating valuably during ESC meetings.
Wilson said they have been successful in turning the department around and making it into a pretty efficient operation. They have successfully written a $1.9 million PSIC grant that goes directly towards the JECC/EOC and the $21,000 Hazard Mitigation Grant Program to cover FEMA compliant Mitigation Planning. The County and Cities currently were non complaint meaning they would have seen a decreased reimbursement from FEMA. R. Sullivan said they were told that was already completed. Wilson said Hansen had worked with ECICOG and even if it had been accepted it was never accepted by FEMA and it must be redone every five years. They have increased their reimbursement through presidential declared disasters. They have eligible programs such as buyouts, storm shelters, warning system, and ring levees, etc. The EMPG in 2008 was $39,000 that was increased to $41,000 in 2009 which is the cap for the award. HMEP, the Haz-Mat training program, took a major reduction in 2008 from $5,000 to $1,675. The DOT funded it better so the amount will be $2,500 for 2009. The CERT in 2008 was $5,000 and in 2009 will be $3,000. Additionally they did the Iowa City Evacuation Plan so they received $9,500. The total competitive grants awarded and written at EMA is $122,675. Grants are often hard to work with because they are for specific items and cannot be used for day to day operations.
Wilson said they have trained 493 people in 19 months. They brought training from Michigan and Texas to Iowa for the first time ever. They had C-CERT train the trainer programs here twice, one was televised and videotaped for digital distribution in St. Petersburg, Florida. Each instructor receives 24 kits valued at $97. They have done ICS training to the 300, 400, 402, etc. levels which has not been done in the County. They were paper compliant on NIMS but those grants are tied to Homeland Security. If they had been audited there would have been trouble. He has included Senior Leadership Courses and by having trainings locally they save a lot of money. They are truly complaint for the first time in a long time and the State was pleased to see it. The Iowa City Evacuation plan is in place and the Code Red system was purchased last year through flood reimbursement funds. Partnerships have been improved and have provided training for elected and senior officials. They have a better response and recovery and reimbursable costs are at a higher amount. For all eligible projects they did a 100% letter which is better than most counties and recouped costs never before thought to request.
Wilson said the mitigation projects worked closely with Planning and Zoning. During the flood, they had brought in a lot of gear that was replaced in the way of donated goods. There were four million used sandbags that they never had to purchase. Total there are six semi loads of water at $4 a case, one semi load of Clean up kits at $14 a piece, and one semi load of Hygiene kits at $4 each. The Salvation Army was invaluable. The Variable message signed used by DOT, County Roads, and others did not cost them any money. The 24 donated Federal pumps would have cost several thousand dollars. They brought in Coast Guard's DART Team to help assist and they still have some leftover stuff to use for future floods. Harney said he wanted to add Wilson has done a tremendous management job. The Board was under the assumption the hazard mitigation grant and other items had been taken care of which were not. He said Wilson has done a great job of getting things accomplished while saving money in his normal budget. In addition Wilson helped cut the cost of a generator out by the Coralville dam in half. Neuzil said the request right now is to increase up to $147,000 from $100,000 that will cover salary and an additional line of potential for $65,000 which is payment for half a new truck under capital expenditures.
Recessed at 9:44 a.m.; reconvened at 9:47 a.m. with Stutsman present.
Mental Health/Disability Services Director Kris Artley said Department of Revenue and Finance Representative Jim Nervig sent a notification out stating the property tax credits which come under homestead, military, and elderly disabled are not funded through the State General Fund and will not be reduced. The understanding is the Base Mental Health Property Relief dollars will be cut by 1.5%. There is also an additional amount that is coming this current fiscal year that has been factored into the re-estimate trying to make the 1.5% adjustment on the base. She is unsure what Nervig means by the elderly disabled. Stutsman said it’s a tax credit. Artley said she discounted that one entirely. She said when she factored in a guesstimate for next year she was hitting the 5% mark and found on the ISAC website the CPI is 5.3% so she can guarantee this is what the providers will come and hit the department with. Neuzil said it might be something to bring up at a Planning Council meeting. Artley said all of this stuff is going to Planning Council. She said the billable portion of the service for Targeted Case Management and from July 2007 to June 2008 they experienced a 21% growth in number of consumers. They went from 406 billable units up to 492. In the first quarter of this year they have seen a 3.46% growth billing out 509 clients per month.
R. Sullivan said it is interesting because although there is a jump in the MR there is an incredible jump in the CMI. Artley said she meets with case managers every week. The pre TCM are those people who have Medicaid eligibility and go into the case management program. They have 60 days from the day they are assigned. They were derelict in getting those people on board in a timely manner by having seasoned case managers and assigning all the pre TCM cases to her plus the County social work. Once the case manager has the cases ready to go the initial assessment, evaluation, and credentialing are brought to the group who assign it a case manager. She hopes they can start generating revenue better. She said what would happen was a case manager would walk in and there would be 12 people who needed attention, two of them were brand new cases that hadn't been opened, resulting in the previous ten being served and the new cases sitting for long periods of time. In August, they had 11 new cases assigned but it has tapered off progressively. The service coordination column has 16 cases in the first half of the year and those people need social work involvement but do not qualify for Medicaid so they cannot bill. The systems management are cases that come and County money is spent on them but nothing will likely change in these peoples lives so they monitor to make sure the money is properly allocated. They have seen an increase of 106 people total, 60 are case management cases.
Artley said growth has been overwhelming making budgeting a challenge. Since last time she has done a re-estimate for FY09. She operates her budget very conservatively because she would rather underestimate than overestimate. Her re-estimate they will come in at $14,970,924 for revenues. The initial estimate was over $15 million. She is going to have to do some cutting within the department of $926,000 which is why they need input from the Planning Council to figure out where their priorities are and what they want her to do. If they look at the FY09 budget for the case management portion the $2,002,800 is at the current way of billing which is monthly. On January 27, 2009 and 28, 2009 they are going to ICN training to figure out how to convert to an hourly rate. Artley said she would be more comfortable backing off to 95% that will allow still for the continued growth of the program but she does not feel confident they will be able to recapture all the administrative costs as they have in the past. She said this is the way they are tightening down on the Medicaid program which is why she plugged in the $14,323,000 total figure. The bottom line is she started at $15,024,700 and cuts must be made where revenues are projected. There are some adjustments for property tax relief changes where they receive $2,936,246 and there will be an adjustment of a plus figure of $23,556 that brings them to $2,959,802 for this year. For next year they apply the 1.5% reduction which is why she lowered it for FY10.
Neuzil asked Artley if she knew exactly what should be getting from State and local funds. Artley said she cannot get any concrete response from the Auditor's Office and she doesn't think Claiborne did either. Neuzil said they are not quite there yet. He wonders when the Auditors Office will have a timeline. Claiborne said the suggestion they all came up with was let's clean this up because it is not news to anyone that this is a good year to clean it up. He said they should take Artley's projection for revenues and be conservative with better accounting and a more streamlined budget. Artley said they have had so much slush money before and that has all been eaten up. A week makes a huge difference because she now has the happier numbers compliments of GEMS and at 50% of the year they have utilized 48% of the budget. However they have not paid any of the money for the administrative block grant to the Mental Health Center because they are still trying to make them create an accurate bill. They have started to hold a few of the State bills. If she projected appropriately they are probably close to 49% and that does not leave any room for growth. October was a terrible month but that was the month they got all of their quarterly billings so she is expecting to be hit again in January. They are holding bills at the moment until the State dollars come through.
R. Sullivan asked if they were just holding the State bills. Artley said the local people are being paid but they are holding the State bills. In terms of the accountability she did not want to say anything the evening the legislators were here, the reason they saw the MR numbers go up was because no one was tracking the children. She made them go back and figure out who was in the system because there was no tracking accountability in their system as far as children. They do not pay for the children but they do provide County social work time. The few people who come in with an MR diagnosis have been very high needs and have gone to Glenwood State Hospital School. The other thing being observed is a tremendous increase in court commitments. They tapered off in December finally and have done a fantastic job of tracking these. The majority of the people going through the court committal do not belong to Johnson County but they are having to do all of the work. Their psychiatrically mentally ill patients are placed in Residential Care Facility for Psychiatrically Mentally Ill (RCFPMI) which is one of the most expensive levels of care provided. The intent is to keep patients there for a short period of time but because of the residency issue and Abbey Center having that level of care if people are living there they go straight in. Their intent is to get them out as quickly as possible into residential care facility level or out into the community but it takes time.
Artley said that to show how tenuous the situation is for providers, they were just notified this week that the RCFPMI at Charlotte is closing its wing because they cannot afford to keep it open. There will be fewer beds at that level and more competition for those beds making things really tight. The intent once her office is moved is to bring the budget for FY10 to less than the estimate for the revenues. The estimate for the revenues is $14,323,264 which is a 1.59% increase in revenues that is strictly based on any growth they would have through the case management program. Neuzil said they will put Artley back on the agenda for the January 21, 2009 meeting at 1:00 p.m. He is hopeful by then they will have a few more answers from the Auditor's Office. Artley said she really wants input from the Planning Council regarding what they feel is important. Neuzil said they will not only have to get a heads up of future expenses but he is curious about the determinations of poverty level percentages. He asked what Artley has factored in the budget for percentages whether it was 250 or 225. Artley said everything was left the same when she reestimated the $15 million. The Planning Council will receive a sheet detailing the responses for factoring or soliciting information. Of the counties that responded, the majority are at the 150%. There are some that have a sliding fee scale for people at mental health centers.
Neuzil asked when they have the Planning Council meeting if she is expecting a response or just information. Artley said she would like response with discussion. Stutsman asked Artley if the responses are only from some counties. She would like to see responses from counties more similar to Johnson County. Artley said they mass emailed everybody and these are the responses they currently have. There might still be more responses filing in. Artley said they will augment the list. Harney said several show a sliding fee up to 250%. Artley said that is for mental health centers. Harney asked if it matched theirs or if they going with the State 150%. Artley said they have initially discussed going from 250% to 200% across the board. R. Sullivan asked if she is talking about putting limitations on once a month psychiatric visits where they have one a month for the first two to three months and afterwards have one every six months. Artley said there are two issues; one is the scheduling where they put in the management that a person would come into the system and have whatever they need to get them stabilized. Sometimes this takes one month other times it takes three. Thereafter their intent is to have a psychiatric midcheck every three months which is necessary to ensure people are on the right medications. If they want therapy in the interim it is another story. It seems they are being charged one rate no matter what the service is. They are being requested many exceptions to policy which is nice because they are making everyone go individually by grouping as they come due. She and Social Worker Steve Nachazel sit down each week that they come back and look at the individuals. If there is any potential for them to apply for Social Security Disability they put that as a requirement in their NOD, if it is a child or a household that has children they require them to go to the Department of Human Services and apply for Medicaid, and if they determine a patient is able bodied then they require them to go to apply for work. After the new system had been implemented on September 1 there was a large paper stack because many people were asking for exceptions to the department’s policy.
R. Sullivan asked if there is some sort of ability to move people towards the University if they won’t change that. Artley said they are starting to acknowledge the fact that there are some fiscal issues. With the MedFund, they kept excellent information and tracked the first quarter and gave the information back to Dr. Pomerantz about the compliance rate of all the physicians going for generic prescriptions. Some were up there and others were middle of the road. The second quarter was just turned over to him and two of them are over 100% now. The bottom line issue is that if patients go to a psychiatrist rather than a doctor the fee should be less and it is not. R. Sullivan said if they are looking to save $900,000 and doing some quick calculations just by fixing that problem could save $200,000. Artley said their best guess according to Financial and Statistical Supervisor Deb Guard if they go from 250% to 200% poverty level the number of people it would impact would save $200,000. Neuzil said these are the types of things that Planning Council needs to see.
Harney asked about state reimbursement for space changes. Artley said the LAE report is a Department of Human Services item. The only way to get compensation is to have her know what percentage of utilities they are responsible for and they can try to recapture those costs in their rate but not for rent. It would be built into the rate for Medicaid reimbursement and right now she is unsure what the bills will come out to. The rent reimbursement continues to be an issue and they continue to pay rent for one provider in town. It is now under new management so maybe they can collaborate for new policies. She has been approached by one of the smaller providers to have a meeting because of dire fiscal straits. It is unclear of whether they will ask for midyear adjustment in their rates or if they will want an infusion of funds to fix financial problems. The other thing they have no control over is every time providers do a new cost report to adjust their rates for a given waiver Des Moines puts their stamp of approval and it comes to them. She has seen everything from a 5% to 25% increase. They only pair the nonfederal share but if they receive a lot of them it adds up quickly. The developmentally disabled population is discretionary except for people at ICFMR level. There are not many people in that category but they are extremely high needs. Claiborne asked if for the January 21, 2009 meeting he will have the real numbers to put in the State form. Artley said if she can get herself organized in her new space.
Neuzil said they will hold off on discussion of the budget because they do not have enough information at this time for a real discussion. Claiborne said he is having crews check the numbers for capital projects. They are going to have around $6 million. The Finance Committee talked about applying over $5 million to pay off the bank loan for the building and then only bonds will be left. They would put the remaining $1 million in reserves because growth was small this year. Neuzil said the discussion can take place on January 21, 2009 when they start to get better direction the Board can determine basically the infill of reaching the General Fund cap. Artley asked about property taxes and whether they will stay status quo or be reduced. Neuzil said the last they have seen is a minimal growth for this year. He said from the Assessors Office they have determined much of the growth comes from TIF areas but there is still some small growth in other areas. Claiborne said 67% of growth this year is tied up in a TIF so they do not see a lot of revenue. Artley asked if they are expecting to see more nonpayment. R. Sullivan said they saw an increase in payment for the first half. Neuzil said the transition of using credit cards to pay property taxes has helped. R. Sullivan said there could be some people who are looking and paying ahead because they see the hard times in the future. M. Sullivan said valuations won’t go much over the next two years.
Adjourned at 10:18 a.m.
By Nancy Tomkovicz, Recording Secretary