MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:
JUNE 11, 2009
TABLE OF CONTENTS
Page
Community Mental Health Center of Mid-Eastern Iowa
Goodwill Industries of the Heartland
Mayors Youth Empowerment Program
Business from the Board of Supervisors: Appointments to the Johnson County Rural Advisory Committee
Reports and Inquiries from the Board of Supervisors
Reports and Inquiries from Executive Assistant Andy Johnson
Chairperson Neuzil called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 8:29 p.m. Members present were: Pat Harney, Larry Meyers, Terrence Neuzil, Sally Stutsman, and Rod Sullivan.
Mental Health/Disability Services Director Kris Artley said this year has been very exacting because MH/DS is trying to create new internal documentation in addition to just negotiating the rates. On average MH/DS spent two and a half hours with each provider. The services with contracts still to be confirmed will be brought before the Board next week. They included the hospitals, the pharmacies and the District Court. Artley said Contract Analyst Suzanne Kirschner went through past County Rate Information System (CRIS) reports to create a history showing providers of past approved rates versus the actual costs. Artley said she greatly appreciated Kirschner’s efforts in lieu of a regular MH/DS Budget Coordinator.
Artley said MH/DS supports the service rates negotiated with the Arc of Southeast Iowa. The Arc is a CRIS cost report provider who directs 80% – 85% of their service provision to children under the age of 18, but also offers services to the transition age individual. The Arc is Home and Community Based Services (HCBS) waiver certified for mental retardation, brain injury, rehabilitation services, and are certified by the American Camp Association. The Supported Community Living (SCL) rate, which is MH/DS main concern, was $23.31 for the 2008 CRIS cost report. As their approved FY09 rate was $28.75, they have agreed to accept $25.84 for FY10. It is an 11.26% decrease. It is the same amount as the State of Iowa approved rate under the Mental Retardation (MR) waiver.
Artley said the approved FY09 hourly rate of $40.42 for the Supported Employment Service was less than the actual 2008 CRIS cost report information so they’ve requested a 3% increase over the FY09 approved rate. The rest of the services are covered under the State approved waiver rates so the one to one service are $17.83 and group respite is $10.05. MH/DS supports all these proposed rates. Artley said MH/DS is going to provide a summary of the budgetary information to the social workers, so they can easily see the services the providers have to offer and the funding streams they can access.
Artley said that Chatham Oaks, Inc. is also a CRIS cost report participant, so they are a County preferred provider. Chatham Oaks is licensed annually through the Department of Inspections and Appeals (DIA) and are accredited through 2011 under the Chapter 24 rules by the Iowa Department of Human Services (IDHS) and Mental Health & Disability Services Division. They serve adults with Chronic Mental Illness (CMI) and Brain Injury (BI) diagnosis and have several long-time residents with a Mental Retardation (MR) diagnosis. Presently there is no wait list. In March 2008, Chatham Oaks became a Home Based Rehabilitation (HBR) service provider. The approved State rate is $46.70 per hour, with no CRIS history available. In FY10 they will also provide day rehabilitation, likely by August 2009, with a staffing ratio of one to three. The rate has yet to be determined by the State as they have to submit a cost report. Chatham Oaks will not request an increase for the maintenance portion of the Residential Care Facility (RCF) rate the County pays. However, the Social Security Administration (SSA) allotment will increase from $26.95 to $28.14 per day for those eligible. Chatham Oaks has requested a 3% increase in the SCL rate for 2010 from $53.50 to $55.10.
Sullivan said he appreciated having the summaries prior to the meeting and feels it is not necessary to go through each provider in this level of detail. He said that Artley’s recommendation is what is important and felt the report was positive about the good partnerships that are in place. Artley said everyone negotiated their rates cognizant of future issues MH/DS is facing, because in the future only Federal stimulus dollars will support growth. The State is currently anticipating $20,000,000 for FY09, $27,000,000 for FY10 and then $15,000,000 in FY11 statewide. Neuzil asked if the rest of the Board is happy with highlights of the contracts. Harney said he doesn’t need this level of detail, but the public deserves to know what the Board is approving. Artley said the definition sheets for this report have been updated and the attachments combined.
Artley said Community Mental Health Center of Mid-Eastern Iowa will be adding new services for FY10. MH/DS can better serve clients if some nursing services are offered, so they discussed it with the Center. Through Magellan there are two levels of nursing services: 1) emergency assessment, billed per occurrence at the rate of $157.00 for non Medicaid participants, as a stop gap measure before the psychiatrist level, and 2) psychiatric nursing, which focuses on medication review, monitoring and management for evaluation between psychiatric visits. A third service for group psychotherapy is also being added. For all services, MH/DS is accepting the Magellan rate and will look at the cost report when available next year.
Artley said Goodwill Industries of The Heartland has requested a 3% increase in the Sheltered Workshop and the SCL. The Supported Employment Services (SES) and individual and group Work Activity Services are at the State approved rate, but the County can negotiate the rate, so Goodwill has requested a 3% increase. There are five new services that the County need pay only the non-federal share. The best guess today is the County will save approximately $150,000 this year through these services, because they are not 100% County funded.
Artley recommended the Board leave the SCL rate for Hillcrest Family Services at the FY08 actual rate as some efficiencies could be created in utilization. Burch House, the residential care facility, had a CRIS rate of $124.98 and Hillcrest requested a 3% increase. In the past, Hillcrest told residents there was a food fee, which Hillcrest didn’t feel was appropriate to include in the CRIS rate. After some discussion, the food fee was removed on a per diem basis, which reduced the price to $122.72.
Artley said that Life Skills, Inc. is a County preferred provider who participates in the CRIS report. Life Skills biggest challenge is the Evening Club’s rent keeps going up. The facility sits on two bus lines and is accessible from town, so they have requested a rate increase to accommodate their increase in rent. In previous cost reports, the rent was spread over the whole agency, but now they are trying to target actual dollars to this service. Artley said that they are not requesting an increase in their SCL rate and everything else is State approved.
Artley said Mayors Youth Empowerment Program (MYEP) is also a preferred provider. Most of their services are waiver approved and established. The suggested rate was not meeting their needs and MH/DS has agreed to a 2.8% increase over the CRIS actual rate of $24.32, bringing it up to $25 per hour. She recommends a 3% increase from the actual 2008 Respite Program rate. MYEP requested a 3% increase in SCL, but didn’t require a change for Supported Employment. It appeared MYEP was only making one way trips for transportation and in their negotiations they decided it would be more productive to do a roundtrip, which raised the rate to $14.03 per trip.
Artley said Reach for Your Potential (RYP) is a CRIS cost report provider. Their actual rate for Adult Daycare (AD) was reported at $70.25. Again due to reallocation of resources RYP determined they could accept a $67.00 per diem. The CRIS actual rate for SCL was $29.04, with Medicaid approving them at $32.00. It does not look good if the County is paying less than the Medicaid rate, so MH/DS recommends approving the $32.00 per hour rate.
Artley said Successful Living requested a 2.61% increase over the FY09 rate and provide HBR. That is a waiver approved service, so they are paid at the State rate.
Artley said Systems Unlimited has requested to keep most rates the same. They are requesting a 3.9% increase over the FY09 rate for both levels of Adult Daycare. Systems Unlimited also requested a 3% increase for individual Adult Daycare and reduced their request by 1.12% for their RCF rate. Systems Unlimited requested a 3% increase for SCL and a 3% increase for the Services Group with the rest of the rates remaining unchanged.
Artley said First Resources Corporation would like to establish a contract with the County. First Resources entered the area one year ago and provide intensive psychiatric rehabilitation, which is funded by Magellan. They also have a HBR Day program and Community Support Program (CSP) through Magellan. First Resources would like to add a SCL service with a rate of $35 per hour to be reviewed next year following their first cost report. They are an established company with an established, steadily growing client base.
Artley said Rescare is well-established in this part of the state and would like to offer services of the CSP based on the Magellan rate, day habilitation with the State approved rate and HBR. Rescare would also like to offer intensive psych rehabilitation for the Magellan contract, respite, and SCL for the County rate of $39.50 with a State approved rate of $34.98. They would also entertain having a SES at $33.43 per hour.
Sullivan said Rescare has a different home county, so asked how that affects their work in Johnson County. Artley replied that Rescare has set up a separate shop in Johnson County. Sullivan said that it is just a County rate then. Artley agreed. Neuzil asked, if residents would like more details, would they contact Artley or the Board. He then said the Board could have the report available in their office for members of the public. Artley agreed to leave an extra copy for the Board.
Board of Supervisors Executive Assistant Andy Johnson said currently the authorized signatories are Former Board of Supervisors Executive Assistant Mike Sullivan and R. Sullivan who chaired the Board last year. The form that indicates making the change states that the authorized representatives have been recognized by resolution, code or statute.
Johnson said the Rural Advisory Committee is an advisory board to the Housing Trust Fund of Johnson County. Seven members have agreed to continue, but James Leighton, Tracy Glaesemann, and Steve Long have decided not to continue. There are no new applications, so the Board need only reappoint those that have indicated a willingness to continue to serve. Meyers said the Board also needs to make a plea for applications. Johnson said this group oversees a Federal Home Loan Bank grant that assists rural homeowners with repair and rehabilitation.
Stutsman said she attended the Council of Human Services meeting, the Case Management Services Board meeting, and a Finance Committee meeting.
Neuzil said he met with National Association of Counties regional staff.
Johnson noted the Treasurer’s tax sale will be held June 15, 2009 at 8:00 a.m. There is a Department Head meeting on June 16, 2009 at 1:30 p.m., a Strategic Planning meeting on June 17, 2009 at 9:00 a.m., and the Board meeting on June 18, 2009 at 9:00 a.m.
Adjourned at 9:00 p.m.
Attest: Tom Slockett, Auditor
By Nancy Tomkovicz, Recording Secretary
Sent to the Board of Supervisors on July 21, 2009 at 12:00 p.m.