MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:
NOVEMBER 12, 2009
TABLE OF CONTENTS
Page
Human Resources Administrator Lora Shramek: Synchrony Employee Assistance Program (EAP) Contract Effective November 16, 2009 to November 15, 2010.................................................... 1
Human Resources Administrator Lora Shramek: Wellmark Blue Cross and Blue Shield Off-Renewal Contract Effective January 1, 2010 to June 30, 2010 and Corresponding Self-Funding for Single and Family Coverage....................................................................................................................................... 1
Human Resources Administrator Lora Shramek: Health and Dental Care Coverage for Non-Bargaining Employees....................................................................................................................................... 2
Human Resources Administrator Lora Shramek: Employee Medical Flex Plan Limits.......... 2
Human Resources Administrator Lora Shramek: Dental Rates............................................. 5
Ambulance Director Steve Spenler: Progress Report............................................................. 5
Reports and Inquiries from Executive Assistant Andy Johnson............................................ 9
Board of Supervisors: Letter to U.S. General Services Administration Regarding Property for Proposed Justice Center............................................................................................................................. 9
Board of Supervisors: Appointment of Representative from Secondary Roads to the Trails Advisory Committee....................................................................................................................................... 9
Board of Supervisors: Appointments to the Johnson County Juvenile Justice Youth Development Program 9
Reports and Inquiries from the Board of Supervisors......................................................... 10
County Attorney Janet Lyness: Juvenile Diversion Drug Court Graduation Ceremony...... 10
Chairperson Neuzil called the Johnson County Board of Supervisors to order in the Johnson County Health and Human Services Building at 7:03 p.m. Members present were: Pat Harney, Terrence Neuzil, Janelle Rettig, Sally Stutsman, and Rod Sullivan.
Human Resources Administrator Lora Shramek said Synchrony has been providing Employee Assistance Program (EAP) services to Johnson County for the past 12 years. The County has a 4.5% utilization rate, which represents 18 new cases and is within the appropriate range. Synchrony also provided two customized trainings to 48 people at the Public Health Department. Twelve additional people attended training at Synchrony during the year. Seven hours of management consultation were also provided. Shramek said the rate continues to be $24 per employee and she recommended the Board renew the contract for EAP services from Synchrony. The Board agreed to put the contract on a future Formal agenda for approval.
Shramek said the County will need to sign another agreement with Wellmark since the plan design will be changed to increase deductibles and out-of-pocket maximums effective January 1, 2010. She recommended that the self-funding level for health plans be adjusted down 2.75% to match the recommended fees. That would result in a cost of $392.40 per month for a single plan, and $1,088.90 per month for a family plan. These plans currently cost $403.20 and $1,118.90 per month respectively. Shramek said she is making the recommendation despite recent legislation that will increase costs, but she thinks the County’s funding level is currently strong.
Rettig asked Shramek to clarify what changes will occur effective January 1, 2010. Shramek said deductibles and out-of-pocket maximums will increase. Rettig asked if deductibles will increase from $100 to $200. Shramek said they will increase from $200 to $400. Out-of-pocket maximums are currently $500 and $1,000, and will increase to $750 and $1,500. Neuzil said this contract will be placed on a future Formal agenda.
Shramek said the Board has historically voted to pass along Administrative Unit benefit changes to non-bargaining employees. The Board previously voted to pass along the vision benefit, but dental and health care coverage have yet to be addressed. She stated that she recommends changing the deductibles and out-of-pocket maximums to the amounts listed above. She also recommends increasing dental care coverage maximums from $750 to $1,000 and increasing orthodontic maximums from $750 to $2,000, which would include dependent children. The Board agreed to place the item on a future Formal agenda for approval.
Shramek said according to Section 125 of the Internal Revenue Service Code, the limit for medical flex plans is $5,000 and the maximum for Johnson County’s employees is currently $3,000. Eight out of the total 141 participants are at the maximum. Unlike dependent care, which requires money be put in before drawing it out, funds for medical claims are provided in advance and paid back through payroll deductions throughout the year. If an employee terminates employment prior to the end of the year, the County has no way to ensure reimbursement for the medical claims previously paid out. Therefore, there is a risk that the County will lose money as a result.
Shramek said she does not recommend that the Board consider increasing the limit for medical flex plans. The County has a good health care plan and will be paying $750 per individual and $1,500 per family, despite increased deductibles and out-of-pocket maximums. That is half of the $3,000 limit for medical flex plans. Shramek said an increase in dental care benefits is also being considered. A lot of people like to set aside money for orthodontic coverage, but the maximum is increasing substantially from $750 to $2,000. The annual benefit is also increasing by 25% so out-of-pocket employee costs will go down. In addition, vision care coverage will be implemented effective January 1, 2010 for full-time employees who are either non-bargaining or with Public Professional and Maintenance Employees (PPME) Units. As a result, out-of-pocket vision care expenses will decrease for those individuals. Shramek restated that she does not recommend that the Board consider an increase in the $3,000 medical flex plan limit at this time.
Neuzil asked if Shramek has checked with other communities to determine if there is any available recourse to collect money paid out for medical claims. Shramek said there is no recourse and that is one of the risks of the plan. There is also risk to the employees because they may set aside money for the plan and not use it. Shramek said the numbers usually balance out when the medical flex plans and dependent care plans are considered together. Stutsman asked if there are many employees who terminate employment and have medical claims for which the County has not been reimbursed. Shramek said yes, and it actually happens quite often. Sullivan asked if Shramek has had any requests from employees to raise the maximum amount, particularly from the eight employees who are currently at the maximum amount. Shramek said no.
Rettig asked if there are reasons, other than the risk previously mentioned, that Shramek doesn’t think the County’s current limit should be increased. Shramek said there are also employees who put too much money into the plan and subsequently lose it. When she began employment at Johnson County 12 years ago, the limit was $1,500, and she recommended doubling it to $3,000 about 10 years ago. Her experience is that the County has a good benefit plan, and there are not many people who are either at the current limit or needing to set aside more money.
Rettig asked what risks would be involved in allowing an increase in the maximum. The Federal government allows an increase from the County’s current limit, and she is not clear why the County would have a vested interest in not allowing employees to have what they need. Shramek said if an employee set aside $5,000 for the plan, had surgery in January, and subsequently left employment, the County would lose $5,000. Rettig asked how many people have left the County with medical expenses during the time of Shramek’s employment. Shramek replied quite a few. Rettig asked how much money has been lost as a result. Shramek said she can’t state an exact amount. Rettig said she has had a chronic illness and understands how families can reach the $3,000 maximum fairly quickly, regardless of the medical, dental, and vision benefits provided. She is not sure it is their role to watch over the amounts employees are choosing to contribute to the plan. She thinks employees should be advised of the risk of losing money, and the County should lobby the Federal government to make changes to the plan. Rettig again stated that she does not understand the risk an increase would have for the County and how it would balance out.
Shramek said that none of the eight people at the current maximum have expressed a need for an increase. Stutsman said Clerk II Robert Black did request an increase, and the item is on the agenda for that reason. Stutsman said she didn’t previously know that raising the amount is an option. She thought the County was allowing the maximum amount to be contributed to the plans. Neuzil said it sounds like there may be some additional research that can be completed within Human Resources. He suggested working on some of the financial questions with Budget Coordinator Rich Claiborne.
Black said he approached Shramek about this issue three to four years ago when he was trying to get braces and was told the amount couldn't be increased. He asked what the limit is. Shramek asked if he is referring to the Internal Revenue Service’s limit. Black said yes. Shramek replied $5,000. Black asked where she obtained that information. Shramek said she obtained the information from her file and asked if the maximum amount has been increased. Black said he has publication 969 from the IRS, and there is no limit on the percentage of an employee’s salary that can be deposited into the flexible spending account. He said there is a limit on the amount that can be put into dependent care plans, according to the IRS. Shramek said that amount is $5,000. Black agreed and said there is no limit on the amount that can be put into a medical flex spending account, according to the IRS. Sullivan said the limit may have come from a plan administrator at some point in time.
Black said he checked with a lot of schools, and many of them have a $5,000 limit. The University of Iowa has a $7,500 limit. He said he understands Shramek’s point regarding risk to the County, but the plans save both the County and employees money. Black said he is bringing the issue up again because he is again buying braces, and they will cost $5,300. He said he does not max out his medical flex account, but he does use it. He knows a lot of people are never going to use it, but it should be available to them. He understands the County takes a risk, but he doesn’t think many people will use all of the money in their plan and subsequently disappear. He said he is sure there is legal recourse available to the County in such a situation. Shramek said there is not. Neuzil said he was also wondering about that, but it sounds like the costs and litigation involved would not be worth it. Sullivan said the County definitely loses money in some instances, but the County also obtains money when employees fail to use the full amount of money they have set aside for it. Black agreed and said those individuals should have planned better.
Black said he does tax preparation so he is aware of the IRS regulations. A lot of people come to him and ask him questions about the plans. Black said he is not sure if the handouts provide sufficient explanation. He thinks more individuals would participate in the plans if they understood how they result in savings.
Neuzil said he thinks the issue should be researched for the next week or two. Questions can be forwarded to Shramek, and she can follow up to see if the related rules and regulations have changed. Shramek agreed and said she apologizes if the rules did change, but the limit was previously $5,000. Black said he has done taxes for 17 years, and there has never been a limit on medical flex spending, although there has always been a limit on dependent care flex plans. Neuzil said the issue will be clarified. Harney asked County Attorney Janet Lyness if there is a way to collect on claims paid out. Neuzil asked if the last check can be held or garnished. Shramek and Lyness said no.
Rettig said she would like to know the medical flex plan limits of other governmental entities in the area, including cities, school districts, and the University. Black said he is not sure about the school districts’ limits, but he knows the University’s limit is $7,500. Shramek said she can check with other counties. Neuzil agreed that information should be obtained through research. Stutsman said she is also interested in knowing the amount of money lost by the County as a result of employee termination. Sullivan said they will also need to know how much money the County has gained for the plan. Shramek agreed. Neuzil asked if it is okay to forward any additional comments from Supervisors to Shramek and said the issue will be put on a future meeting agenda. Stutsman said she does not think the limit can be increased for 2010 because the information is due by November 20, 2009. Shramek agreed and said information has already been provided to employees. Black and Neuzil agreed.
Black said the limit previously increased from $1,500 to $3,000, but deductibles were previously $500 and are increasing to $1,500. He said more of the money he sets aside is used to pay his deductible, and they are moving backwards in his opinion. Shramek said the deductible is $750. Black said he has a family plan so it is $1,500. Shramek asked if he is referring to the out-of-pocket maximum. Black said yes. Neuzil said the issue will be put on a future meeting agenda following completion of the research.
Shramek said she did receive information regarding dental rates, but she doesn’t know if she can technically discuss it now. Neuzil said she can report the rates, but the Board cannot have discussion. Shramek said information was received regarding dental rates, which is similar to the information previously received regarding health care coverage for mid-renewal, and she recommends increasing dental rates accordingly. The current rate for single plans is $26.90, and it would increase to $28.98. The current rate for family dental plans is $77.00, and it would increase to $88.81. Shramek said those amounts represent increases related to orthodontics and annual benefit maximums.
Ambulance Director Steve Spenler said he will be presenting a progress report for FY09. He said information previously presented has not changed. Ambulance is still the pre-hospital medical care and transportation service for Johnson County. They provide 911 emergency advanced life support as well as some non-emergency care and transport. In addition, their billing department files claims, bills for their services, assists patients in filing claims, and collects revenue. Ambulance now has a contract with the University of Iowa Children’s Hospital to provide management and staff to their two ground units. Those units primarily pick up premature babies from around the state and transport them to the University for continued care.
Ambulance also provides services to the University’s athletic department for their large venues, including football, basketball, and wrestling. Stutsman asked if Spenler can explain how the Children’s Hospital is managed. Spenler said they provide maintenance on the two ambulances owned by the Children’s Hospital and provide an on call driver 24 hours a day, seven days a week. When there is a call for service, the driver picks up the ambulance, drives to the University, picks up a team of individuals, and responds to the specified location. Care and stabilization are provided before transport to the University. Stutsman asked if they travel all across the state. Spenler said it is primarily to the eastern half of Iowa, from Mason City to Burlington, although it can involve travel to most of the state.
Spenler said the Department also provides standby ambulance coverage for a number of community events, including high school football games. They provide the service free of charge to individuals who are having an event and request it, as long as on-duty crews are available. He said they do that often and also provide public education. Crews respond to daycares and community events to talk about safety and illness prevention. In addition, they hold an emergency medical services (EMS) awareness fair once a year in the fall, in conjunction with Safe Kids Johnson County. It is designated Safe Kids Day, and information is provided about illness prevention, bicycle safety, water safety, etc.
Ambulance staff provide support to the Johnson County EMS Association. They also serve as liaisons to all of the first response agencies in the County to provide continuing education and assistance with State certifications and the development of medical direction and protocol. The Department is also an internship site for paramedic students who are attending Kirkwood or the University.
Spenler said call volume increased to 33% from FY05 to FY09, although there has been a slight decrease in call volume during FY10. The number is still up from two years ago, however. He said the majority of calls are for emergencies and involve patient transports. Their services are sometimes cancelled following dispatch, however. For example, they may arrive at the scene of an accident and find there are no injuries. In addition, some individuals refuse transport after initial care is provided. In those instances, individuals are asked to make an informed decision and fill out paperwork. Ambulance does not bill for those refusals. Spenler said cancellations have actually decreased from FY08.
Sullivan asked if the data regarding type of service provided has changed since the emergency medical dispatch was instituted. Spenler said he would have to check on that. Sullivan said he hopes it has resulted in more transports and less provision of other services. Spenler said most of the department’s growth has been in transports so their percentage has generally increased. There were 4,908 transports in FY08 and 4,708 in FY09. Stutsman asked if those numbers include non-emergency transports. Spenler said yes. That number has increased, and a little over 100 non-emergency transports were done in FY09.
Spenler said Iowa City continues to be the largest response area, followed by North Liberty and Coralville. Spenler said calls to Iowa City increased approximately 4% in FY09, and calls to North Liberty increased by 7%. Surprisingly, calls to Coralville decreased by approximately 13%, and he doesn’t know why.
Spenler said he measures response times on a monthly basis. He thinks services across the country evaluate their performance, at least in part, by their response times. Obviously, people want EMS to respond quickly to their calls. The data collected helps Spenler evaluate whether they the department is adequately staffed, appropriately located, and if changes are necessary. For example, they have previously discussed staffing a fourth ambulance during peak hours. Spenler said looking at response times for particular areas helps him to decide the best times to add an ambulance. As call volumes have increased dramatically over the years, response times have actually decreased. He said that information indicates that the Ambulance Department is currently well staffed and has productive crews. Spenler said the State of Iowa is considering implementing standards. The proposed standards are response times of 20 minutes 80% of the time for rural areas, and eight minutes 80% of the time for urban areas. Ambulance has significantly surpassed those proposed standards. He said 90% to 93% of their response times within Iowa City have been less than eight minutes.
Spenler said Ambulance’s subsidy for FY09 was $680,916, which represents an increase from the previous year, and is due to an increase in revenue. The increase in revenue reflects the increase in costs for services that was implemented two years ago. Rettig said call volume from FY08 to FY09 increased by approximately 1%; however, the change in revenue was dramatic. She asked if that was when the increase in costs was implemented. Spenler said yes. He said call volume increased, but they primarily collect revenue from transports, which increased approximately 3%. Rettig said she finds it interesting that the Department’s subsidy has dramatically decreased from FY05 to FY09, despite an increase in call volume. Spenler agreed and said it involves paying attention to what other services in the area are charging, while being fair to customers and responsible to taxpayers. They do not want to leave any money on the table when insurance companies are billed and have increased revenues through those strategies.
Spenler said collections are somewhat different from their budget and have to do with what is billed out versus what is received. Contractuals involve write offs to Medicare, Medicaid, and Wellmark. Wellmark has been included since only last year, and rate adjustments have resulted in a low number of write offs to that company. Spenler said the remainder of the progress report involves the balance or debt, and it is approximately 18.2% for FY09, which is fairly good within the industry. Some urban areas are at approximately 50%.
Spenler said he also considers unit hours, which involve the number of hours an ambulance is staffed. They have three ambulances that are staffed 24 hours a day, seven days a week, which results in 26,280 hours. Reducing the information to hours per unit helps him to plan and budget. He said the cost per unit hour is increasing as the Department’s budget increases, and he tracks it every pay period. In FY05, each of the three ambulance units responded to a call every five hours, on average. Currently, the units are responding to a call approximately every four hours. Staff are responding to a larger number of calls, have increased their efficiency, and have decreased their response times. Spenler said Ambulance has great staff.
Spenler said although there has been a decrease in calls during calendar year 2009, the number is an average, and calls are not equally distributed. For example, there were 11 requests for service in a two hour period of time on November 8, 2009. Those peak demands create a challenge, and employees are called in to work. That information is then collected and reviewed to make necessary adjustments. Although there was a 5% decrease in overall call volume in FY09, calls on Fridays, Saturdays, and Sundays actually increased. Trying to staff three ambulances 24 hours, seven days a week is something they will no longer consider when they add additional units. Instead, peak demand will be considered, and they will staff accordingly.
Spenler said there has been a lot of discussion concerning the need for a new Ambulance building. When the current facility was built, Ambulance employed 22 people, had less than 3,000 calls, and had three ambulances. Obviously, they have far more calls than that currently. He said there are 52 staff, six ambulances, and crowding in the current facility. Spenler said, in terms of satellite stations, there has been discussion about adding a fourth station at the SEATS/Secondary Roads Building. The ambulance at the current Coralville Fire Station will be moved to the new north Coralville Fire Station during December.
Spenler said in terms of fee schedules, reimbursement from Wellmark, Medicare, and Medicaid is always a challenge. If the Medicare Ambulance Access Preservation Act is passed this year, there is potential for Medicare reimbursements to increase by 6%. However, it is highly likely that it will not pass this year, which could result in a 2% decrease. The Medicare Pay for Performance initiatives will also be addressed in the next few years and would involve the creation of parameters that must be met and reported by Ambulance. If the parameters are met, 100% reimbursement will be obtained. If the parameters are not met, the department will be reimbursed accordingly. Spenler said collecting and reporting the data will be a challenge within the Department. Stutsman said she thinks Spenler’s presentation illustrates how well Ambulance is run. Spenler said he loves his job, loves the service, and has great staff members. The Department would not run as well without them.
Executive Assistant Andy Johnson said the survey regarding Sutliff Bridge will be located on the County website until November 24, 2009. A Budget Work Session for the Board is scheduled for November 16, 2009 to consider the budgets of the Sheriff’s Office and Secondary Roads. The Formal and Informal Board Meetings have been rescheduled from November 19, 2009 to November 17, 2009 at 9:00 a.m. due to the Iowa State Association of Counties Convention in Coralville, which is scheduled for November 18-20, 2009. The Board has a tour of road projects scheduled for November 17, 2009 at 1:00 p.m.
Neuzil said Lyness worked on this letter, and it has moved through the Criminal Justice Coordinating Committee and received Board approval for the signature of the Chairperson. Johnson said he thinks Lyness made a couple of minor changes, and the completed letter has been made available to the Board. He put the item on the agenda to ensure the current format of the letter is approved. Neuzil asked the other Board members to review the letter again and forward any additional necessary changes to Lyness or Johnson. He said he will probably sign the letter on November 16, 2009 if additional changes are not required.
Johnson said Roadside Vegetation Manager Christopher Henze currently serves as Representative on the Trails Advisory Committee. It has been suggested that Assistant County Engineer Robert Winstead be appointed to serve in that position for the purpose of rotating duties. If the Board is comfortable with the change, the item will be placed on a future Formal Meeting agenda. Sullivan said he thinks it makes sense to have an engineer on the Committee, and it has been a missing link in the past. Neuzil asked Johnson to add the item to a future Formal Meeting agenda.
Johnson said the Johnson County Juvenile Justice Youth Development Program is a fairly large board with representatives from various sectors with 50 potential members. The bylaws include having three representatives from a social services agency, and MECCA Vice President of Clinical Operations Ron Berg resigned. There are two new applications from United Way Director of Community Impact Patti Fields and MECCA Prevention Manager Kelly Vander Werff. If both appointments are approved, there would be a total of four representatives from social services agencies, including two males and two females. The recommendation is to put the names of Fields and Vander Werff on a future Formal Meeting agenda for approval. Neuzil asked the other Board members if they are comfortable with that. Stutsman agreed.
Rettig attended a Tiffin City Council Work Session and the Coralville Roundtable. She said she attended the Veterans’ Day Banquet and would like to thank all of the veterans who have served. Rettig said National Hunger and Homelessness Awareness Week begins November 15, 2009, and she encouraged County residents to get involved and donate items to food pantries and to people in need, if they are able to do so.
Stutsman attended a Communications Committee Meeting, an Economic Development Committee Meeting, a Department of Human Services Council Meeting, the Veterans Day Banquet, a Local Government Affairs Meeting, a Space Needs Committee Meeting, a Finance Committee Meeting, and a liaison meeting with Facilities Manager David Kempf. She also participated in a Decat Meeting by telephone.
Stutsman said the County will be having a project to raise funds for the United Way during the week of December 4, 2009. Everyone is welcome to attend and share ideas for the silent auction. The first day will be Taco Day, which will cost $5.00 per person, and donations will be collected. A potluck will be held the next day and a soup and chili cook-off on the final day. Kempf is working on a trophy for the winner of the chili cook-off.
Harney attended A Toast to our Communities, a Community Foundation of Johnson County Meeting, a Communications Committee Meeting, an Economic Development Committee Meeting, an Iowa City Area Development Group strategic planning session, a Criminal Justice Coordinating Committee Facilities Subcomittee Meeting, and the Veterans' Day Banquet. He also had a liaison meeting with Kempf.
Neuzil attended a public information officer team building workshop through Iowa Homeland Security. Neuzil reported that his next Listening Post is scheduled for November 16, 2009 at 4:00 p.m. at Jonesy’s in Solon.
Lyness said the Johnson County Juvenile Diversion Drug Court’s first graduation is scheduled for November 18, 2009 from 1:30 p.m. to 3:30 p.m. in Courtroom 3A of the Johnson County Courthouse. There will be four graduates from the program, and they are very proud of them. There will be a special ceremony to honor the graduates.
Neuzil encouraged residents to learn more about County government at www.johnson-county.com.
Adjourned at 7:55 p.m.
By Nancy Tomkovicz, Recording Secretary