• Discussion: Fiscal Year 2001 Budget
• Mental Health/Developmental Disabilities Director Elaine Sweet: Fiscal Year 2001 Budget

Chairperson Stutsman called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 1:05 p.m. Members present were: Charles Duffy, Jonathan Jordahl, Mike Lehman, Sally Stutsman, and Carol Thompson.

Deputy Auditor Dan Stolze said there were changes made in the revised copy of the spreadsheet that apply to Nutrition and a re-estimate of taxes. He said that Department 18 in General Basic, Department 21 in General Supplemental and Department 23 in Rural Basic were where the tax revenues had been put in. He said that they re-estimated the tax revenues which show up in another part of the spreadsheet and it helps them re-estimate the other revenues that go in the line items. He said that some of the things that go in are related to taxes, but aren’t part of the levy such as penalties and interest on taxes and delinquent taxes that are in Department 18. He said that the re-estimated 2000 revenues for Department 18 have gone to more than 1.5 million. He said it was due to re-estimating the penalties and interest on delinquent taxes, and that the preliminary figure was $3,000, but they think it’ll be over $60,000. He said that he looked at what they’d been getting in interests and penalties and it was more than what had been budgeted.

Stolze said that the increase in general interest in Department 18 had made the number go up from the previous spreadsheet. He said it was only budgeted at $520,000, but they’re re-estimating that it will be $40,000 higher. He said that there will be an additional $100,000 in revenues beyond what was listed in the original spreadsheet. Jordahl asked if there is a separate listing of the things, and Stolze said that there isn’t. Lehman asked if it reflected a better job of investing. Stolze said that County Treasurer Tom Kriz had given them the numbers for the interest that he re-estimated, but it hadn’t been reflected in their re-estimated number, because they didn’t have anything else in the department that was worth anything at that point. Stutsman asked for clarification about the budget amount they had to begin with. Stolze said it meant what was budgeted for this year for those items. Stutsman said that she wanted to make sure that they were working from accurate information. Thompson asked if the re-estimated column includes revenue increases the department heads put in their budgets plus what they had calculated themselves. Stolze said it did. He said Department 18 was something that they did in the Auditor’s Office and most of what was in there was related to tax revenues. He said that some things like interest weren’t taxed. He said that they hadn’t put a re-estimated number in because they didn’t have tax information at this time.

Thompson asked if 639 and 537 were not comparable because they already amended the budget and reallocated money. Stolze said that she was probably referring to the expenditure side of Central Services. Stutsman asked if there is anything else in Central Services that would account for the increase. Stolze said that it accounted for a little over $100,000 re-estimated revenues for this year, giving them more than what they thought. He said they predicted that the Fiscal 2001 budget was going to be higher. He said that the increase was related to the penalties and interest on delinquent taxes and the figure that Kriz put in the next year’s budget. He said that it added another $120,000. He said the net effect for this was an increase of $233,000 in General Funds more than what was listed on the earlier spreadsheet.

Jordahl asked if there was another difference. Stolze said the FY 2001 budget figure works into the calculation of how much they’ll have to tax because it was used to determine what their fund balance would be. Jordahl asked what the FY 01 increase was. Stolze said that the 10.6% increase was based on the original budget number, making it look higher. Jordahl said that $1,392,000 was not $200,000 away from $1,514,000, that it was closer to $100,000. Stolze said that the re-estimated and FY 2001 budget numbers were both over $100,000 more than on the first spreadsheet, and they both had the same impact. He said that the re-estimated column projects a higher fund balance at the end of this current fiscal year. He said that they are also projecting another $100,000 more revenues next year. Stolze said that he had added FY 2000 6 month percentage columns in the new spreadsheet. He said that it gives them a chance to see the percentage of expenditures and revenues that have been collected and paid up through a 6 month point in the current fiscal year. He said that he’d go into more detail on Tuesday, when he presented the financial reports.

Thompson asked if there were some that they paid at the beginning of the year. Stolze said that they paid 75% of the budget all at one time in October for insurance accounts. Stutsman asked Dan if there was anything else. Dan said that he’d already described the primary changes that had ripple effects throughout the rest of the spreadsheet. He said that the primary number that it changed was the transfer number from General Supplemental into General Basic, because as they increased revenues the transfer number didn’t have to be so high, so the number was decreased by about $230,000. Stolze said that Deputy Auditor Chris Edwards had estimated what the maximum amount could be that they could tax for in General Supplemental that could be transferred in and paid out of General Basic. He said that they are limited to that by what the Code says General Supplemental could tax for, and used the employer FICA, IPERS and health insurance contributions to make the estimation. He said it would be based on all the salaries and departments in General Basic. He said that substance abuse and EMS could also have expenditures paid out of General Supplemental. He said that Edwards estimated all the things that could be taxed out of Supplemental but paid for and expended in General Basic. He said that they could make that transfer in there because of the $3.50 levy limit. Stutsman said that there wasn’t that limit in General Supplemental.

Jordahl asked about transferring from General Supplemental to General Basic. He said that their interest is not in transferring from General Supplemental to General Basic, but in levying up to the maximum for things that can’t be levied in General Supplemental, and taking things that they are currently paying for out of General Basic and paying for them out of General Supplemental instead. Thompson said that Jordahl had it backwards, and they can put as much in General Basic as they want and anything from General Supplemental, and they could levy the rest in Supplemental. Stolze said that they are having a problem with the $3.50 limit on the levy in General Basic. He pointed out that the spreadsheet listed how much they had to tax for, because they aren’t getting enough revenues to cover the expenditures. He said that it figures in the transfers from General Basic to Capital Projects, Capital Expenditures, and Technology, that are budgeted. He said it also took into account what they project the fund balance to be as of July 1, and what the minimum balance would be what would need to be established. He said that they were using the 2.2 million as a starting point. He said that if the amount put them over $3.50, the spreadsheet transferred an amount automatically in from Supplemental to get the levy down to $3.50. He said that the transfer number from Supplemental into Basic was needed to keep the levy limit at $3.50.

Thompson asked how they arrived at $2,149,000. Stolze said it was a plug number that the spreadsheet calculates automatically. He said that if they took $2,149,000 transfer off the spreadsheet, the levy would be over $3.50. Stutsman asked if they levy at the maximum amount every year. Stolze said that they did in General Basic. Thompson said that if they increased their budget in General Basic, they could transfer more money from Supplemental to cover that. Stolze said that he and Chris had supposed that there was probably a limit to the amount that could be taxed in General Supplemental, and when they looked at the Code, they found things that they allowed to be taxed out of Supplemental. Stolze said that Edwards had estimated what the items could be taxed in Supplemental and paid for out of Basic, for departments that are in General Basic, keeping the levy at $3.50. Jordahl asked why they couldn’t pay for it directly out of Supplemental. He said that since they had been levying at $3.50, and their concern was the amount of the levy, they could just continue to levy at $3.50. Stutsman asked if it was related to keeping the levy up, based on the tax freeze, and if they would be penalized if they didn’t keep the full amount up, because that was what the freeze was based on. Jordahl said that some things couldn’t be taxed from General Supplemental. Stutsman said that she thought it was all the same thing. Jordahl said that some of the things they wanted to pay for couldn’t be levied for in General Supplemental. He said that in order to put more money into those areas they had to levy in General Basic, and they had to categorize the more flexible things into General Basic. Thompson said that the maximum amount they could put in is $3,120,000. Stolze said that it is an estimated amount, but that’s what they figure is the maximum amount that the transfer number could be.

Thompson asked if they increased health insurance from 5% to 8.5%, the 3 million would increase by $40,000. Stolze said it would probably go up a little bit, because the number was based on a 5% increase, but not make a big difference. Stolze said that Department 20 was already in General Basic. Thompson asked if other substance abuse treatment beside what was required in the Code allowed as one of the expenses. Stolze said he didn’t know.

Stolze said there was a listing of things that they could tax for in Supplemental. Thompson said that Fund 41 has the substance abuse treatment that they paid for in Mount Pleasant. Stolze said that 41 was institutional. Thompson said that if someone from the County has to go to one of the institutions for substance abuse treatment, they have to pay for it. Jordahl said they supported MECCA through the United Way Joint Funding Process. Thompson said that they’d made sure that the counties have to support some substance abuse treatment inside their County, and MECCA is what they support. Stolze said that included the cost of impatient and outpatient substance abuse admission, transportation, care, and treatment in the Alcoholic Treatment Center in Oakdale, the State Mental Health Institute or community based facility, care of children admitted or committed to the Juvenile Home in Toledo. He said Chris took the entire budget amount from institutional and included it. Thompson said that MECCA was almost $300,000 more. Pillard said that that what was requested, not what was paid.

Stutsman asked if there was anything else that needed to be clarified. Stolze said that if they had a maximum amount they could levy for in Supplemental and transfer to basic at 3.12 million, right now the transfer amount is a little over 2.1 million. He said that $971,000 was what they could levy for in Supplemental and transfer into Basic. Jordahl asked why they should pay for in General Basic. Thompson said that they could transfer money in from General Supplemental. Jordahl said that they could only tax in General Supplemental for things that they could pay for there, so why shouldn’t they pay for it there and tax for the things that they can’t pay for out of General Supplemental in General Basic. Stutsman said that it was for increased flexibility. Jordahl said that anything that could be taxed for in General Supplemental that is currently being transferred into General Basic is being done to get the amount they were taxing for in General Basic up to $3.50 so that they could tax for anything in General Supplemental. Thompson said that money had been transferring in for a long time. Jordahl said that it had been because there was no need to tax for $3.50 in General Basic. He said the only way you could tax for anything in General Supplemental is if you’re taxing the maximum in General Basic. Thompson said that if you have more than the 3.5 levy in General Basic and they had some things in General Basic that could be paid for in General Supplemental, they are allowed to transfer the money from Supplemental into Basic. Jordahl said that it wasn’t possible to put more money into General Basic than the 3.50 levy. Lehman said that they could do it by transferring but not taxing.

Stutsman said that they were trying to maximize taxing within the law. Stolze said that it would be easier to do without the 3.50 limit. He said that in order to do what they wanted and keep the levy at 3.50 they have to transfer money in. Jordahl said that they can’t pay for the General Basic items with General Supplemental taxation. Stolze said that the Code allowed for things to be taxed from Supplemental, and that they had determined which items they could tax. Stolze said that it didn’t need to be at the maximum in General Basic to levy anything in Supplemental, because things like Elections were in Supplemental no matter what.

Stutsman said that it would help if they knew what Legislature intended when the wrote the Code, because they limited the County governments but allowed for loopholes. She said that they were trying to find out how much they could raise taxes and be within the limit. Jordahl asked for the highest that they can legally tax in Johnson County this year. He said that they could only tax 3.50 for things that had to be paid from the General Fund, and in order to establish the largest amount they could tax in General Supplemental, they had to look at the total of everything they could justify taxing for out of the General Supplemental Fund that was being paid out of General Basic and take it out of General Supplemental so they could tax for the whole amount. Stolze said that the only thing that would limit them would be the transfer items. He said there was no limit on what was paid out of Supplemental.

Thompson asked if Stolze had calculated how much they could get from allowable growth. Stolze said $11,743,000 was based on the FY 2000 tax times 2.68 percent inflation factor, which was what the State had given them. He said that it includes new construction that the Assessor gave them multiplied by the current year tax levy. It was also based on allowable growth and unusual needs dollars as an increase from last year. He said that $1,062,000 was what they could increase the 2001 budget by, allowing for new growth. He said 2.89 million included the transfer into General Basic. He said $3,180,198 was what the tax askings are from General Supplemental. He said $3,666,004 was the total which included the current year taxes plus unusual needs plus the allowable growth dollars in Supplemental. He said that was another $700,000 that they could go up in Supplemental to get up to the dollar amount that would have been considered under the property tax freeze. Pillard said that transferring from General Basic into General Supplemental adds $205,797. Stolze said that as the amount of transfer from Supplemental to Basic goes up, then the tax askings go up until they get to $3,666,004.

Thompson asked how the expected additional revenue relates to the expected budget request. Stolze said that they’d been given more money in General Basic, so the transfer number from Supplemental to Basic went down over $200,000. Stutsman asked about the total amount of requests that they had. Stolze said that in the 2nd spreadsheet, the transfer figure was over 4.3 million. Thompson asked if they should cut 1.1 million from the budget requests. Stolze said they should start with the highest numbers. He said that they were estimating that there was approximately $900,000 additional. Thompson asked if it would cover it if they took an additional $971,000. She said that it was probably too good to be true. Stolze said if they went up to the maximum transfer, it would put them a couple hundred thousand dollars over the amount based on the property tax freeze.

Jordahl said they had priorities, like Capital Projects, that were pushing the budget. He asked whether the term growth referred to revenue from expansion or an allowed inflation factor. He said that allowable growth and new growth were different numbers. Stolze said that the unusual needs money was based on the inflation factor and allowable growth was based on the new evaluation of the County.

Recessed at 2:02 p.m.; Reconvened at 2:07 p.m.

Shramek said that she would speak on health care coverage. She said that the first information sheet covered the current premiums that they were charging, broken down by department. She said that Blue Cross/Blue Shield has recommended an 8.5% increase. She recommended a 5% medical increase into the health insurance pool. Shramek said that enrollment had increased 6% since the last period, from 440 to 446. She said that the trend was most likely going to continue because of the increased number of employees and retired employees. She said that Blue Cross/Blue Shield wasn’t increasing individual or aggregate stop loss. She said that they were going to be decreasing the monthly administrative fee from $16.54 per contract to $16.02 per contract.

Shramek said that Blue Cross/Blue Shield was changing the network access fee from $4.95 per contract per month to 11% of provider savings. She said the result was an administration increase of $1,365 per month, or $16,380 a year. Shramek said that over a 2 year period, the savings they got from the network access fees was $910,000, of which Blue Cross/Blue Shield would collect 11%. She said that all of the Blue Cross/Blue Shield contracts were adopting the method of fee scheduling. Thompson said that they always have the option of switching companies. Shramek said that the range of fees were between 10% and 21%, and that she was trying to negotiated an additional 1% discount.

Shramek said the County’s hospital and facility charges decreased by 21% last year. She said that the increase in doctors fees shows an emphasis on doctors and a de-emphasis on hospitals. She said that the Wellmark underwriters increased it by 8.5%. Shramek discussed the monthly administrative fee comparison. She said that the individual and aggregate stop loss was static, and the administration fee was decreasing slightly. She said that they were increasing the number of single plans by 9.29%, and family was increasing by 5.91%. She said that Unity Choice is a managed care plan that the County doesn’t participate in, and that the charges are part of the claims experience, and not separated out into a pharmaceutical plan. She said that attachment points decreased 5% to 10% lower than the claims experience.

Shramek explained that the County has a $35,000 individual stop loss and 5 cases that went in excess of the $35,000 stop loss. She said that 2 had been cancelled and the other 3 are active. She said that all the claims between $10,000 and $35,000 were paid 100% by the County, which showed some of the higher dollar claims and the diagnosis information. She said that the Wellness Director uses this information to target programs for the following year. Stutsman commented that they had a young work force. Shramek said that in the Code of Iowa, their plan was required to have aggregate stop loss. She said that individual access loss is $35,000 and that the aggregate is 120%. Shramek said that she and Blue Cross/Blue Shield were recommending Option A for renewal. Option A is the administrative fee of $1,602 per contract per month and 11% of provider savings. She said that there was a high utilization of facilities, making a flat amount per month more beneficial. She said that if the facility charge continues to decrease, then they should consider other options.

Shramek said that there are 2 plans for the retiree group. She said that there are 18 retirees on the plan, and the current fee charge is $115.86. Lehman asked if there was an option to get dependant and spouse insurance. Shramek said that they were single plans but the spouse was qualified to also take a single plan. Stutsman asked if they are included in administrative fees, and Shramek said that they are. She said that retiree claims were more supplemental because Medicare was picking up the majority of the claims. She said that they were covered through age 65 in 509a. Stutsman asked if it would be a problem for retirees to be on the plan for a long time. Shramek said that it was something that the Board should monitor. She said that the plan was implemented in 1994, but there aren’t any minimum service requirements, like a certain amount of time working for the County. Stutsman remarked that there were many variables to consider. Shramek said that the claims experience was a cost to the County. Stutsman said that in the future they may have to cut aspects of the program.

Administrative Assistant Carol Peters said that since they increased the premiums for FY 2000, the pool has leveled off at $620,000 to $65,000. Shramek reminded the Board that premium rates were increased by 25%. Duffy said that administrative fees were expensive. Stutsman asked if the pool was at one time over 1 million. Jordahl said that it was and Blue Cross and the Auditor’s Office wanted to hold down the premium increase to be able to fund other things. Shramek asked Peters what claims had amounted to in an average month. Peters said about $170 per month. Peters said that one of the things that the Board chose to do was fund some of the medical expenses out of the pool as opposed to individual budgets. Shramek asked what the amounts are on an annual basis. Peters said it was about $6,000 to $7,000.

Shramek said Blue Cross/Blue Shield recommended an 8.5% medical increase. She said there was also the option of a 5% increase. She said that some kind of an increase was necessary because of the 25% last year. Stutsman said that they hadn’t had any big claims this year. Jordahl said that stop loss took a lot. Thompson asked if both last year and this year were atypical. Shramek said that this year was better than average and last year was worse than average. Stutsman asked if the 5% is needed. Shramek said that she wouldn’t go less than 5% because the increase was inevitable and it is better to increase it gradually. Stutsman asked the Board for feedback. Thompson agreed with 5%. Jordahl expressed a desire to see a graph of the fund balance and predictions. Shramek said that Wellmark and Blue Cross/Blue Shield had taken those factors into consideration when projecting the 8.5% recommendation. She said that their department didn’t have access to the process. Stutsman said that they should go with the 5% increase with the option to decrease it in the future. Thompson asked Shramek about the 3 year period of no premium increase. Peters said that one of the reasons that the Board hadn’t increased it was the tax limitation on the counties. She said that last year they had decided to increase it by 25% and continue raising it on a regular basis. Shramek said that last year Blue Cross/Blue Shield had recommended 30%. Thompson said that health care goes up at a greater rate than inflation. Shramek recommended that the 5% increase come into effect on July 1, because premiums were subtracted from employees’ paychecks for the following month. She said that last year the Auditor’s Office had to amend all the departmental budgets by one month.

Shramek said that the recommendation from Delta Dental is to hold the premiums at the same rate. She said that they had been given an adjustment figure based on the single family ratios and their past claims experience. She said that dental plans, in addition to self-funded health care pools, have to have aggregate stop loss. She said that the Code requires 125% and that they currently carry 120%, which was costing them $0.54 per contract, or $2,689 per year. She said that the recommendation was to increase the 120% to 125%, lowering the fee from $0.54 to $0.35 to a total savings of $946 per year. She said that their dental care plan has a maximum exposure of $750 per covered person. She said that there wasn’t a need for stop loss coverage, so she didn’t see a need for the County to carry more than what the law requires.

Shramek said that she contacted an actuary from the Des Moines State Insurance Department, about requesting a waiver from the State Department of Insurance. She said that there had been legislation eliminating dental aggregate stop loss that had been a part of other proposals which failed to pass. The actuary recommended that Johnson County write a letter requesting a change in legislation. Stutsman asked the Board if Shramek should write the letter. Shramek said she wanted to and that she thought that aggregate stop loss for a dental plan was added because of the existence of aggregate stop loss in health insurance.

Shramek said that it would be $3.17 per contract, with an annual expense of $170,384. She said that if they were convertible moving from $120 to $125, rates would go to $2.98. She said that if they leave the plan as it is, the rates will go up, and if they change to the higher level of aggregate stop loss, the rates will decrease by $0.19, for a $946 savings per month. Stutsman asked the Board if they were in favor. They said yes.

Shramek reminded that Board that the County funds 100% of the single coverage for full time employees, and they pay the same dollar amount for a family. She said that the County pays 1/3 and the employee pays 2/3 for family dental coverage. She said that the annual benefit maximum is $750. Shramek said that 794 employees fall into the cost bracket of 0 to $499. She said that 49 fall into the bracket of spending between $500 and $749 per year, and 23 spent $750 to $1,000. She said that the majority of people are adequately covered. She said that they’d be picking up 23 cases based on last year’s experience if the plan was funded at a higher level of benefit. She said that Delta Dental had provided rates on what that would cost. She said that if they increased the annual benefit maximum from $750 to $1,000 it would increase their rates by 6.07%. Shramek explained that their current orthodontic lifetime maximum is $750. She said that they paid 50% for orthodontic coverage. She said that if it is increased from $750 to $1,000, it would result in a 1.76% increase. Thompson said that besides orthodontics, not much would cost more than $1,000. Shramek said a bridge or a root canal would be expensive. Thompson thanked Shramek for the report.

Stutsman asked Shramek if eye care coverage was being lobbied. Shramek said it had been taken off the table. She said it’s not a good idea to offer division insurance as a stand-alone benefit, because only people who need the coverage enroll in it, and the claim usage forced the rates up. She said that AFSCME offers a Vision Insurance Plan. Stutsman asked what was the likelihood of increasing the health pool by 5%. Jordahl said that it depends on whether or not they can understand the other numbers.

Shramek discussed merit pay. She said that there was an 8 step pay plan in place for non-bargaining employees, and there wasn’t a need to increase the figure beyond the $40,000 set aside last year for the plan. She said that 3 factors went into the $40,000 recommendation, the automatic steps based on years of service, merit consideration, and new employees. She said that it counterbalanced with the salary budget, where a vacant position provides savings. She said that she was only responsible for recommending something for the merit increase portion. Shramek said she had to project figures because she didn’t have 100% of the merit increased turned in, since they hadn’t completed the fiscal year. She said that they might have to budget for a cost of living adjustment, and a merit increase beyond that. She said that the more the year progressed, the clearer the number became. She said that she thought the $40,000 included full years. Lehman said that the Facility Manager position hadn’t been filled for several months, and asked if the filling of the position was allowed for in the budget. Shramek said that they also had to take vacation pay out.

Recessed at 3:00 p.m.; reconvened at 3:10 p.m.

MH/MR/DD/BI Director Elaine Sweet said that MH/MR/DD was projecting deficit spending for the fiscal year. She said they were projecting $83,650, not including any new clients entering the system for the remaining 7 months, potential provider rate increases, or the October and November 1999 billings for the State hospitals and schools. She said that if everything was factored in, they anticipate that the deficit spending will approximate $250,000 if action isn’t taking. She said that the Planning Council asked for a subcommittee of the Continuous Quality Improvement and the Finance Committee to review the situation and make recommendations. She said if that was possible, the fund balance would remain at $747,817, 9% of the budget.

Sweet said that the beginning fund balance for the last fiscal year was $851,517, and based on the activity in FY 1999, the fund balance was reduced to $747,817. She said that they prepared the FY 2001 budget assuming that they would bring the fiscal year expenditures to the budgeted $8,228,051 and that the fund balance would remain constant. She asked that Board to levy the maximum amount for Fund 10 for FY 2001.

Sweet said that the FY 2000 tax levy, at $3,138,395, is based on 1996 expenditures. She said the property tax relief is at $2,936,000, giving them a tax base with the property tax relief of over 6 million. She said additional taxes and tax replacements are $30,975. She said State Allocations are $462,634 for the local purchase service grant. She said that the Community Services Allocation is $737,089 and the provider rate increase allowance is $63,993, for an additional 1.2 million in State and federal funds. She said the Growth Allocation was broken down into Growth Allocation, Incentive Fund and the Equalization Fund. She said that the Planning Council totaled $769,645. She said that other revenues included the Case Management Program, generating, $400,000, and miscellaneous revenues comprised of client participation’s. Sweet said the total available amount is $8,549,453. She said that the numbers she was quoting had been verified by the State and will by used for FY 2001. Sweet said that the beginning fund balance will be $747,817, as it was at the end of the last fiscal year. She said that Sandy Hills had spoken about cash flow needs and a reasonable level of fund balance being anywhere from 15% to 25%. She said a reasonable level of cash balances will be $1,230,000, requiring an addition of $482,183 into the fund, reducing spending to $8,067,270. She said that she prepared the FY 2001 budget based on those assumptions, but that her computer program could adjust figures according to the Board’s wishes.

Sweet said that she’d been doing research on how things were being funded, and that there was potential for shifting the funding and finding alternative revenue sources. She said that at $8,067,270, they would have to change procedures, reevaluate eligibility and coordinate with other human services agencies. She said that proposal included the reorganization of the MH/DD Services Department. She said that personnel-related expenses would be decreased by $10,655 for the next fiscal year, assuming that the Case Management Supervisor and the Social Worker Supervisor positions would be combined, and the Management Analyst Position reclassified to a managerial position. She said that the Social Worker Supervisor position was currently open. She said that before Christmas a part time case manager resigned. Sweet said that Kelly Weston, the current Case Management Supervisor, has requested to transfer into the part time staff position. She said that the changes wouldn’t affect the filled positions. She would like the changes implemented as soon as possible. Stutsman said that she didn’t see a problem with reallocating positions without adding them.

Thompson asked if one supervisor for each 7 or 8 staff members is realistic. Sweet said that it is based on the current status of the department. She said that there would be fewer cases as a result of the case file review. She said that they may hire a part time file clerk, but she thought that the existing staff would be able to do that. Stutsman asked if that was part of the job description of the existing staff. Sweet said she had 2 clerical employees who could do filing. Sweet said that her department could improve in productivity.

Lehman asked if $10,655 projected for the remainder of this year. Sweet said that it was for the next fiscal year. Lehman asked if there would be savings in the next 6 months. Sweet said that it was hard to tell because of the abnormality of the current year. She said the Management Analyst position had been left vacant since last January, and the Social Worker Supervisor position was empty since the middle of December. She said the Case Management Supervisor was on maternity leave for 3 months. Lehman asked if the vacant positions would save money for the department. Sweet said that she adjusted the Auditor’s Office’s projection for her proposals. She said that with all the variables, there was a difference of $10,600.

Stutsman commented that Sweet had headed the department for almost a year and is capable of determining the needs for the department. Sweet said that she feels comfortable with her proposals. Jordahl asked to what extent the positions have been redefined. Sweet said the job descriptions are in the process of being updated. She said that the Union was aware that they were considering reclassifying the Management Analyst Position to a management position, but they haven’t received a formal notification. Stutsman expressed a concern that the Union would protest. Sweet said that they may work through a process for it. She said that the Administrative Assistant position will be outside the bargaining unit. Stutsman remarked upon the size of her workload. She said it was a good opportunity for people requesting changes and resignations, and it would be least disruptive to reorganize now than in the future. Sweet said that they had and additional 1 and 1/2 positions open and a full time employee on an extended sick leave, and the department needs stability.

Jordahl said that they can’t vote to approve a position until they have the position description. Sweet recommended putting the item on the agenda for Tuesday, when she’d be able to provide job descriptions. The Board agreed. Thompson asked if Kelly Weston would stay long enough to train for the new position, and not be replaced when she left. Sweet said that Weston was an expert manager and has been picking up the cases for the vacancies, but was eager to have less responsibility.

Jordahl said that he thought that provider increases were unlimited. Sweet said that she thought that they would be lucky if they come in at 7%. She said that one large provider in Blackhawk County announced a 25% rate increase which would begin in FY 2001. She said that it was going to be a trend with providers. She said that they would talk about the rates when they begin negotiating contracts. She said that their providers are not being reimbursed, and were maintaining waiting lists because they can’t retain staff and quality is suffering.

Thompson asked what percentage of treatment costs is applied to the costs that they contract versus the cost that the State sets. Sweet said she’d have to look at the waiver. She said that waiver rates were climbing significantly. Thompson asked if waiver rates were set by the State, and Sweet said that they were set by State and Federal governments. She said that they had budgeted $214,438 for waiver SCL for FY 2000. She said that they are projecting $514,000. She said that she just found out that Johnson County has never supported employment through the waiver, which was a way of cost-shifting from County funds to Federal and State funds. She said they hadn’t attempted to access Federal and State Day Care Funds because it’d been simpler to pay everything from Johnson County. She said that they’d identified inconsistency in client eligibility based on income and participation.

Thompson asked about the day care funds. Stutsman said that in the past the County had put money in the fund. She said that they can’t pay for MH/MR/DD child care, but they could pay for other child care. She said that there were no eligibility guidelines, and they would be limiting eligibility by using DHS guidelines. Sweet said that there were families 300% above the poverty income guidelines whose day care Johnson County was funding. Thompson asked if the family would supply the regular rate and the County would supply the remainder needed for care for the special needs child. Sweet said that sometimes the County paid for all of it. Stutsman said that guidelines would free some funds.

Jordahl recommended that they utilize any additional State and Federal funding available to them to preserve money for the MH/MR/DD fund. Stutsman said that was a policy that hadn’t been enforced because the incentive wasn’t there. Sweet said that she didn’t want to see different eligibility and client participation criteria for every service that they will fund because of large administrative costs. She said she hoped to find some quick fixes to reduce the spending level as well as give them ample time to establish a quality system. Thompson said that many counties don’t pay for preventative children’s services. Sweet said that the amount of money put into preventative services has benefited Johnson County in many areas. She said that they had the resources to manage an excellent system, but needed to bring it into balance.

Thompson asked Sweet if they can make enough cuts to manage a 3% decrease in the operating budget with a 7% provider increase. Sweet said she thinks they can if everyone works together on it. She said that they were paying a lot in rent for people who could find help elsewhere. She said they need to make more effort to put people in services that are progressive and to monitor those services. Stutsman said that they should get the Medicaid Rehab option in place. Sweet said that they might have to reevaluate it 3 or 4 months into the fiscal year, but they have the mechanisms in place to monitor things throughout the year. Stutsman said they could resort to the priority list if they need to.

Lehman said that the system would require a lot of staff retraining. Sweet said that she’d like to see Case Managers and Social Workers take a leadership role in planning and coordinating services. She said that in some cases the Case Manager isn’t aware of a client’s participation in services for several months. She said she had an appeal hearing last week because she refused to pay one retroactively. She said that they resolved it by agreeing to pay as a final warning, and she also started denying requests for rent payment for a year in advance. She said she looked at them every 3 months, giving the Case Manager and the client 3 months opportunity to find alternate funding sources. She said that she also approved medications after adequate review.

Jordahl asked about provider rate increases. Sweet said that the number is an allocation that the State allows the department to pass on to providers. She said that providers can implement any increase they want. Jordahl said that they have to set a rate for everyone. Sweet said that Johnson County negotiates contracts independently of the other counties, so rates differ between counties. She said that CPC Administrators had formed the 10 Counties CPC Group. Jordahl asked if it was a new organization. Sweet said that it had been started with 5 counties in May, and had grown to 10.

Thompson asked if $63,993 is what the State allowed or is the cost of the 5% increase. Sweet said that it was what the State had allocated to each County. Jordahl asked for an approximate rate set by providers. Sweet estimated $400,000 in rate increases. Thompson said the State would restrict them to a 2% increase. Sweet said that after they drop out of the POS System there won’t be restrictions. Jordahl asked when that would happen. Sweet said starting in FY 2001. Jordahl asked if $400,000 is part of the proposed budget for next year. Sweet said they would have to control the number of units they pay for to accommodate the increases in the rates.

Sweet discussed a document from the State showing the ending fund balances of June 30, 1998 for MH/DD. She said that $851,517 was the beginning fund balance, and $747,817 was the ending balance. She compared that to other counties and said that Johnson County was on the lower end. Thompson asked Sweet to see if there is a way to cover the fund balance. Sweet asked how July, August and September expenses are paid when they have a $700,000 fund balance. Stolze said that the balance was an accrual balance, which takes into account all expenditures as of June 30 that they are obligated to pay. He said that they had accrued $870,000 of expense that wasn’t paid as of June 30 in FY 1999, lowering the balance on an accrual basis. He said that the cash balance was $1,558,000. Thompson said that when they add $870,000 in accrued expenses, they subtract the first month’s payment out of the previous year. Stolze said that when they pay bills in July and August, their accounting system doesn’t care what time frame it’s from and it appeared on the report from this fiscal year even though it related to last year. Thompson asked if they take out the payment from the first month of the year. Stolze said it can be if it’s approximately the same every year. Thompson asked Stolze to project how much cash would be available at the end of this year. Stolze said that they can if they get reestimated revenues and expenses. Sweet asked if the 1.5 million was in a separate bank account. Stolze said it should be separate because MH/DD is a separate fund. Sweet said that her average expenses are $700,000 per month. She said that in 3 months that is more than 1.5 million in the bank account. She asked where the money came from. Thompson said that there were revenues coming in. Sweet said that she had been told that there was approximately 1 million dollars in the General Fund that assisted the cash flow but never showed up in the budget. Stolze said that he didn’t know anything about that. Sweet said that they would have to spend more time talking about that. Pillard said it also depended on the department’s expenditures.

Thompson said that they should levy the maximum, saying if there’s cash to cover ongoing needs, they shouldn’t give up the 2nd Supervisor because of the training and checking needs. Jordahl said that Sweet is the 2nd Supervisor. Sweet said that she wanted one clinical supervisor for consistency in rules. Thompson said that if necessary they should keep it vacant, but not completely give up on it. Stutsman advised Sweet to test the plan that she made. Jordahl said it wasn’t consistent with the shortfall in the budget to add a position. Sweet said that when they were done with the case file review, they would have reconsider the positions.

Sweet asked the Board if she should provide the detail to support her plans, or if they want to adjust the projection for cash flow or fund balances. Jordahl said he wants to talk to County Auditor Tom Slockett about the cash flows. Stutsman said that she didn’t need any more detail and asked about State money from the property tax relief. Sweet said that she didn’t know. Sweet said if they want the fund balance changed, it will affect the detail prepared for the Auditor’s Office. Stutsman asked if the Board was comfortable with the fund balance the way it is or increase it to 25%. Sweet said the State recommends 15% to 25%, and Hills recommends 15%, or 1.2 million. Jordahl asked if it was necessary to cut services to raise the fund balance. Thompson said that if a client was negatively impacted, Sweet would consult the Board to make a change in the program.

Stutsman asked the Board if they are directing Sweet to 15%. Sweet said that there was an opportunity to amend the budget if it wasn’t working. Thompson asked if there were written day care guidelines. Sweet said that they were using Title 20 guidelines, but there were many inconsistencies. Jordahl said he didn’t agree with 15% until he’d spoken with Slockett. Stutsman said that they would do 15% and the maximum levy.

Adjourned at 4:10 p.m.

Attest: Tom Slockett, Auditor

By Casie Parkins, Recording Secretary