MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:
JULY 16, 2009
TABLE OF CONTENTS
Page
East Central Iowa Council of Governments Community Development Director Chad Sands: Community Development Block Grant (CDBG) Property Acquisition Program................................. 1
Mental Health/Disability Services Director Kris Artley: Appointments to the Mental Health/Disability Services Planning Council............................................................................................................ 2
Mental Health/Disability Services Director Kris Artley: FY10 Proposed Rates for University of Iowa Hospitals and Clinics and Carver College of Medicine University of Iowa Physicians......................... 2
Mental Health/Disability Services Director Kris Artley: FY10 Provider Contract and Service Rates for St. Luke’s Hospital, Cedar Rapids................................................................................................... 2
Mental Health/Disability Services Director Kris Artley: FY09 Results Regarding Mental Health/Disability Services Implementation of the Patient Assistance Prescription Program and New Medication Formulary 3
County Auditor Tom Slockett: Proposals Received for Johnson County Audit.................... 5
Assistant County Engineer Ed Bartels: Road Maintenance Agreement as Part of CUP# 15489 with Cedar Ridge Winery and Distillery...................................................................................................... 6
Assistant County Engineer Ed Bartels: Changing Classification of a Technician II Position to a Technician I Position....................................................................................................................................... 7
Planning and Zoning Administrator Rick Dvorak: Policy Regarding Fees Charged to Other Governmental Entities....................................................................................................................................... 8
Executive Assistant Andy Johnson: Agreement for Use of Public Right-Of-Way of White Oak Avenue NE North of 130th Street NE on Sunday, September 6, 2009 from 10:00 A.M. To 7:00 P.M. for the Purpose of The Sutliff Bridge Authority Street Dance and Fundraiser................................................................ 9
Reports and Inquiries from Executive Assistant Andy Johnson............................................ 9
Reports and Inquiries from the Board of Supervisors........................................................... 9
Chairperson Neuzil called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 9:28 a.m. Members present were: Pat Harney, Larry Meyers, Terrence Neuzil, Sally Stutsman, and Rod Sullivan.
Community Development Director for East Central Iowa Council of Governments Chad Sands said ECICOG Planner Hillary Copeland could not be present for the meeting. If Sands is unable to answer any of the Board’s questions, he will consult Copeland. The CDBG buy out application goes one step further than the original buy out application that was already submitted. The application is essentially completed and is due July 31, 2009. He will go through the application with the Board members at this meeting and answer questions. At the formal meeting next week, a motion to approve the application will be requested. The application is for two owner-occupied houses and five rental properties on Driftwood Lane and Riverfront Estates. The application is complete, with the exception of a few photographs that Copeland will take before sending it in. The application is fairly straightforward and similar to the original buy out application that was submitted in January 2009. Stutsman asked Sands if this is the final step. Sands indicated he is unsure and suggested that Planning and Zoning Administrator Rick Dvorak may be able to answer that question, and the answer may depend on local needs.
Mental Health/Disability Services Director Kris Artley introduced MH/DS Planning Council Chairman Dion Williams. She said there are two reappointment requests for veteran planning council members Williams and Dr. Lowell Lumin. The Executive Committee met and reviewed applications for both provider and general memberships. There were two open general memberships and one open provider membership. Williams referred to general membership applications received from the Community Intervention Director at the Crisis Center Keri Neblett and from Family Resource Director at Mark Twain Stephanie Van Housen. Successful Living Director Steve Noack has expressed interest in filling the provider membership position. Artley said there are no Planning Council Membership terms set to expire in FY10. Staggering the membership terms may need to be addressed again in the future. She said the aforementioned applicants would add good dimension to the Planning Council. Neuzil said it would be added to the Formal agenda.
Artley said there is one hospital that is ready to finalize their renegotiation rates and that is the University of Iowa. Last year, the accepted frozen rate schedule had inadvertently dropped their Impact Program from the service matrix, although it has now been reincluded. This year the University of Iowa has agreed to accept a 3% increase in all of their rates across the board.
Artley said she did some revisions to St. Luke’s Hospital’s contract to make it was germane to Johnson County’s Services Management Plan. She was making sure the County was the funder of last resort and determining how Medicare and Medicaid payments would be handled. However, the person who needs to have the final stamp of approval is on vacation, so it will be put on a future agenda. Their rates per Linn County are frozen from last year. There will be no rate increases, but Johnson County will have a contract with St. Luke’s Hospital, as other counties do. Sullivan clarified that the County will have a contract with St. Luke’s Hospital, but that it will not happen next week. Artley said she would bring it back to the Board after the currently unavailable person approves the change of verbiage.
Artley said that she asked Contract Analyst Suzanne Kirschner to provide a brief overview to the Board of the results of 2009. Kirschner stated that there was a hefty proposal last year to decrease the medication fund for MH/DS. She said they have been working on it for about three years, and have been at about a $750,000/year level for the medications. In 2006, management was assumed in-house within MH/DS. She said she will describe progress that has been made within the past year. The management objective for last fiscal year was to reduce costs while maintaining medications for eligible clients. It went before the Service Management Plan Task Force, and a new medication fund base-line was proposed to go into effect July 1, 2008. With those recommended changes, a cost savings of 72% was anticipated. At the beginning of the fiscal year, the Service Management Plan was revised, although NPS on-line medication claim processing continued to be utilized through all participating pharmacy providers. The formulary was also revised. Two levels were maintained, the first level being the generics in the same therapeutic categories including anti-convulsants, anti-depressants, anti-psychotics, Parkinson’s, sedative-hypnotics, and anti-anxiety medications. Upon the recommendation of the participating providers, the stimulant/amphetamine category was reduced to two medications in that therapeutic class. The two medications are the generic equivalents to Ritalin and Adderral. The therapeutic class was maintained. The biggest change involved tier 2 brand name medications involving the use of an internal Patient Assistance Program (PAP), rather than automatically funding those brand name prescriptions.
PAPs provide free or low-cost prescription medication to low-income people who are uninsured or underinsured and meet the guidelines. The medications involving PAPs generally come directly from the pharmaceutical companies that manufacture them. The proposed PAP initiative was to manage the PAP program internally, rather than automatically funding the brand name medication. Internal personnel were utilized to assist clients to navigate through the PAP process and paperwork. It ensured the Johnson County applicants were seeking assistance from all available funding sources before they accessed County funds. Kirschner said she wants to be clear that funding for brand name medications did not stop; people just had to apply for all other funding sources before it was provided by the County. If a brand name script was prescribed and had a PAP application, it was funded by Johnson County until the person’s eligibility was determined through the program.
At the start of the program in July 2008, there were 348 eligible clients in the program. At the end of FY09, there were 346 eligible clients. The client base has been maintained, with a 1% decrease in the number of eligible clients. The number of scripts from July 2008 to June 2009 decreased from 586 to 459 scripts/month. In previous years, brand name medications constituted only 20% of the total number of prescriptions, but were consuming 80% of available dollars. The number of brand name prescriptions has decreased 23% since the inception of internal management of the PAP program. In 2006, $622,000 was spent per year for brand name medications. In 2007, when state clients were added to their caseload, $640,000 was spent. In 2008, $616,000 was spent. In FY09 the amount spent on brand name medications has dropped down to $64,000/year, consuming 29% of the budget. In previous years, the brand name medications consumed over 80% of the budget. Generally, the time from application to determination of eligibility is between six to eight weeks. In the month of June of 2009, zero dollars were spent on brand name medications compared to $52,000 spent on brand name medications by the County in the month of June of 2008.
Kirschner said it is also important to look at the level of effort that has been put into the program. There is one part-time staff at MH/DS who oversees the administration of the entire medication fund. Raw billing information is received weekly and is used to generate utilization reports from weekly medication claims. Reports are analyzed to determine what can be done to optimize efficiency and increase cost savings. PAP potential is one component that is analyzed. The clerical portion is delegated to three accounting clerks, who spend less than 20 hours per week total to complete the paperwork. It is estimated that the implementation of the PAP costs $48,000 per year in staff costs. Overall captured savings are estimated to be $551,000 per year. Those funds are now able to be used to serve more clients within the MH/DS community and to continue services.
Kirschner reviewed the annual cost by fiscal year spent on brand name medications and stated that the amount spent on generic medications has slightly increased. She said the same number of clients are being served, and they are basically receiving the same medications. There has been an overall 70% decrease since internal management began in 2006. Monthly claims for both brand name and generic medications have decreased from an average of $60,000 to an average of $19,000. During the last two months of the last fiscal year, claims were below $10,000 per month. Kirschner said that proposed goals have been met including reducing costs, maintaining medications, and maintaining client base. An 80% monthly cost savings has been achieved compared to the 72% monthly cost savings that was projected one year ago. Harney said it is a much larger cost savings than he expected when the project began. Stutsman clarified that people are still getting brand name medications. Sullivan clarified that clients do not seem to be leaving the program due to the changes.
County Auditor Tom Slockett said he has been in touch with Executive Assistant Andy Johnson regarding the Request for Proposals for an audit, as the five-year contract with the CPA firm of EideBailly has ended. The Auditor's Office sent about a dozen RFPs, which yielded two responses, one from Eide Bailly and one from Anderson Larkin & Company P.C. (ALC). The State Auditor responded that they are unable to audit Johnson County, because it is one of the larger counties in the state and they would then have to stop service to many other smaller counties. Slockett said he has always felt the State Auditor's Office has great expertise in local government, and it would be of value to have them perform the audit. However, one reason Johnson County originally switched to Eide Bailly more than ten years ago, was to save money. Slockett originally thought the Board could have the option to hear from either of the two companies, and also either give the Board the Auditor's recommendation prior to deciding whether to talk to them, or, to avoid bias, withhold their recommendation until after the Board talked to them. Slockett said that Johnson indicated to him that at least three Board members were interested in hearing the Auditor's recommendation.
Slockett said first and foremost, EideBailly is an excellent, reputable accounting firm, who does a terrific job, and Johnson County has no problems with them whatsoever. EideBailly helps the County throughout the year whenever questions arise, and they have high quality personnel. The County has regularly received the highest recommendation from an outside auditor. As the Auditor's Office makes the recommendation to change to Anderson Larkin & Company P.C. from Ottumwa, it should not reflect negatively in any way on EideBailly, who has served the County very well.
Slockett explained that when their office reviewed the responses to the RFPs, they were pleasantly surprised to find that ALC was significantly lower in cost. Initially, the Auditor's Office was concerned with that and wondered if ALC knew what they were getting into and if their costs were realistic. ALC audits a number of other smaller counties and the City of Ottumwa, which has a budget about half that of Johnson County. However, Slockett said city budgets are more complicated, including enterprise funds such as transportation and swimming pools. Deputy Auditor Dana Aschenbrenner and Deputy Auditor Chris Edwards interviewed a partner with ALC and were very impressed with the qualifications of the partner and their staff. ALC's audit products are online through the State Auditor's website and Aschenbrenner and Edwards reviewed the products and found no significant difference between the quality of ALC's product and the product Johnson County has received in the past.
Slockett said the Auditor's Office is very reassured that ALC can do the audit. He noted the bias is against change, however, when they evaluated the cost, they found that a savings of $40,000 could be realized for the first three years, and a savings of about $76,000 for five years. The savings increases over time due to the familiarity between the new auditors and the County. He said the Auditor's Office intends to complete more preparation work for the actual financial statements, which is best practice. He reported that ALC said they feel that will be possible and was included in their estimate.
Slockett said the Auditor's Office recommends a three year contract and has every expectation that things will progress smoothly. Sullivan asked if the price would be good for five years, if after two years, the Board decided to contract for two more years. Slockett said that while that is not normally the case, he will explore that option with ALC. He said he will ask ALC if they would agree to a three year contract with an option to extend it for two more years at the initial bid price. Sullivan said he is pleased with the recommendation to switch firms, which is not any commentary on EideBailly. Sullivan recalls Arthur Anderson and ENRON, and said at some point, it does make sense to switch the auditing firm, even if it is more costly. Slockett agreed a fresh perspective is a favorable approach, in spite of the fact that it is more work for the Auditor’s Office. Stutsman said she agrees with the recommendation.
Bartels said Secondary Roads recommendation is for conditional use permit #15489. He requested that the Board put it on their formal agenda for July 23, 2009 to authorize and to approve the chairperson to sign that road maintenance agreement as referenced. Harney said the Vineyard had wanted to make a change on the term of that contract, and it was holding the road contract up. Jeff Quint with Cedar Ridge said the Road Agreement was drafted by Greg Parker and the Secondary Roads Department some time ago. It is his understanding it has been reviewed by the County Attorney. He wants the record to reflect that he has already signed the agreement, and it has been notarized. The only signature needed at this time is from the Board. It can be signed as is, and the project can be moved forward. The previous hold up on the contract was Quint’s request for a term limit to the contract. He said the contract is open-ended as it currently states that Cedar Ridge would pay for the improvements to the road, but also for maintenance of that road. Quint said he thinks that Johnson County is currently responsible for maintaining the road at their expense. That expense will move to Cedar Ridge for some period of time, but Quint would like to know when the expense would revert back to the County. He stated that if there are any other large developments in the area, he would ask the Board for some type of cost-share from the other people who may be tearing up the roads. Quint does want to propose language for the Board’s consideration today to add language after item 2D on the contract, stating the following: “All CRW&D responsibilities shall continue through December 31, 2018, unless earlier terminated or modified by mutual consent expressed in writing, signed and acknowledged by CRW&D and JCSRD.” Quint stated the agreement could either be signed today ‘as is’ or with a term limit including the suggested language. Neuzil asked if Bartels would forward it to Parker and have him provide the Board with an executive summary of the pros and cons.
Dvorak said the past policy of Secondary Roads has been not to enter into agreements that have a term limit until such time as something at the site changes or there are road improvements. Dvorak said Parker is not present at the meeting, but that Parker has had a strong opinion about that not being changed in the document. Dvorak said he talked to Quint about how possible additional development in the area could have a great impact on his cost sharing of the road. In that case, it could be renegotiated. Sullivan said the City of Swisher has the potential to get out close to where Quint is developing, and asked if it should be accounted for in some way. Dvorak said there was an agreement when the property was annexed, which specified the developer would have to pay for all improvements up to 140th street. That is about where Quint is planning to go with his road. That was already discussed. Sullivan clarified that the agreement is already in place, but it just has not happened yet. Dvorak said that is his understanding. He said if there were major changes with the land across the road, the contract could possibly be renegotiated at that time. He does not think Parker is interested in putting a closing date on the contract at this time and he concurs. Stutsman agreed and said it seems there are options to renegotiate the agreement in the future. Harney said it is his understanding that the contract could be renegotiated at any time if anything changed pertaining to the road. Stutsman asked County Attorney Janet Lyness if the last statement in the agreement covers it. Lyness said yes. Quint said he has signed the agreement, but just wanted to make the additional request.
Bartels recommended the item to change a Technician II position to a Technician I position be placed on the Formal agenda for July 23, 2009. He said the department has had a difficult time filling the position in the past. The last date of employment for the current Technician II is July 24, 2009. He is hoping the position can be filled quickly to better meet the current staffing needs of the department. Stutsman asked about the fiscal impact of the change. Bartels replied it is budget neutral. Stutsman asked why Bartels thinks it will be easier to fill a Technician I position versus a Technician II position. Bartels said people who would meet the qualifications for Technician II are harder to obtain due to older Department of Transportation (DOT) technicians moving into private practice. The private sector often pays a bit more for their skills, which are quite valuable. In the past, the County has been more likely to retain an employee that began in a Technician I position. There could be an opportunity for advancement to a Technician II position in the future. It seems there is a better chance of obtaining someone for the Technician I position versus the Technician II position at this time. Harney asked if the County has tried to hire a Technician II. Bartels said they have in the past, but they have not tried yet for this current opening. Neuzil said Bartels can work with Executive Assistant Andy Johnson to get it on the agenda.
Dvorak said he is asking permission from the Board for Planning and Zoning to be able to charge other government agencies for costs to do inspections, rezoning, subdivisions, etc. It would apply to all government agencies except Johnson County departments. It would apply to both State and Federal Government agencies. He indicated that there had been concern about charging County departments, and he stated that he removed that from the proposal. He said the policy presented to the Board was reviewed by Assistant County Attorney Andy Chappell to ensure that it is technically correct.
Stutsman said she is supportive of charging for services. She also wants to talk about charging between County departments. Although money would basically be shifted from one department to another, it may also be important to have an accurate reflection of what buildings and other projects are actually costing departments. When P and Z absorbs the cost for another department, it is not reflected in the actual cost of the building. Sullivan said he strongly agrees and thinks it makes sense to know exactly what it costs for departments to do things. He does not think that P and Z should have to absorb that cost.
Dvorak said he thinks the builders included fees in their bid letting for the Conservation Building. He said Assistant Planner Josh Busard has also had to work hard to get his leadership in energy and environmental design (LEED) professional accreditation. Dvorak said Busard has close to 80 hours in on that review, in addition to visiting sites and making sure that subcontractors know what needs to be done. Revenue is not being generated from that staff time and there is no accounting of it. Neuzil said he is happy with the policy changes, but he is cautious about tracking costs between County departments. He said if it starts happening for P and Z, it may have to start happening within every single department.
Meyers said, in principle, he agrees that each department should accurately reflect their income and expenses. However, he thinks it would raise a lot of additional questions, such as whether or not Information Services should bill each time they get a call from a department for some type of service. Sullivan said he thinks there is a difference between the two departments. He said Dvorak has a set fee schedule that is followed if services are provided to the general public. He would like to see the County pay that same internal cost. Harney said he does not have a problem with tracking costs, but is concerned about charging within the County. Stutsman said she is concerned about budgeting issues due to potentially not having an accurate reflection of costs due to lack of tracking between departments. Sullivan said there is potential over the next few years to replace old Secondary Roads buildings. If there are no charges, the General Fund could end up subsidizing the Rural Fund for those costs. Neuzil said the discussion will continue regarding County departments charging other County departments.
Johnson said the Sutliff Bridge Authority has requested permission for the road closure and indicated it has been done in the past. Johnson has been in contact with Parker from Secondary Roads, and Parker indicated that he is usually notified when Board permission has been given. Parker then works with the applicant on anything else that is required. It will be put on the agenda for next week.
Johnson said the Strategic Planning Session this week was cancelled due to scheduling issues. The next Key Issues Meeting will be at 9:00 a.m. on July 22, 2009. The next Board Meeting is July 23, 2009.
Sullivan attended a P and Z staff meeting, a a Chamber of Commerce Agriculture Committee meeting, a Livable Community Policy Board meeting, and a meeting of Diversity Focus.
Meyers attended a liaison meeting with Medical Examiner Mike Hensch and the Facilities Planning Subcommittee of the Criminal Justice Coordinating Committee. Meyers reminded the public that Solon Beef Days is scheduled for July 17-18, 2009.
Stutsman noted that she was in Washington D.C. for most of the week as part of the team for the Easter Seals Project ACTION.
Harney met with Secondary Roads staff and reviewed some road issues with residents. He attended the Iowa City Area Development (ICAD) Planning Preparedness, Shovel Ready Site Program. Emergency Management Director Dave Wilson was awarded $1,927,882.00 from the Public Safety Interoperable Communications Grant to be used towards the Joint Emergency Communications Center (JECC).
Neuzil had a liaison meeting with Hensch. He attended the Johnson County Council of Governments Regional Trails and Bicycling Committee Meeting. Neuzil was in Des Moines as a representative for the County Rate Information System at the Iowa Medicaid Enterprise Offices. He visited the JECC with Wilson. Neuzil was asked to serve as a member of the Rebuild Iowa Office Coordinating Council as a representative of County Government throughout the State. He has been assigned to serve on the Infrastructure and Public Assistance Subcommittee. Neuzil will not be present for the Key Issues Meeting on July 22, 2009 due to serving as a judge for We the People, a state-wide teacher training constitution competition. Neuzil said his next Listening Post is scheduled for July 20, 2009 at the Iowa City/Johnson County Senior Center at 11:00 a.m.
Adjourned at 10:50 a.m.
By Nancy Tomkovicz, Recording Secretary