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

• Mental Health/Developmental Disabilities (46)

Ambulance Director Mike Sullivan: Fiscal Year 2002 Budget

• Ambulance (01)
• Emergency Medical Services (31)
• Ambulance Special Revenue Fund (56)

Physical Plant Director Mike Scheer: Fiscal Year 2002 Budget

• Physical Plant (17)

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: Mike Lehman and Sally Stutsman; absent Charles Duffy, Jonathan Jordahl and Carol Thompson.

Jonathan Jordahl arrived at 1:06 p.m., Carol Thompson arrived at 1:07 p.m.

Mental Health/Developmental Disabilities Director Elaine Sweet stated that Senate File 69 mandates that they work within a limited property tax base. Sweet said that at the end of Fiscal Year 2000, they added over $400,000 to MH/DD services and that happened as a result of the following: there was a late bill that came in from the State in the amount of $330,000; and the administrative expenses including the staff salaries were about $100,000 under budget because of all the turnover in MH/DD services. She said when you take those 2 things into consideration; Fiscal Year 2000 would just about break even with regard to revenues and expenses. Sweet said the proposed FY 02 budget asks that they spend part of the carryover balance and incorporate that into services. Sweet said that the Fiscal Year 2002 budget asks that about 40% of the carry over from Fiscal Year 2000 or $176,941 be expended to services for purposes in the diagnostic categories.

Sweet continued to say the budget includes revenues, which total $8,961,558 that was net of the 2 decision packages that are included in the budget. Real estate taxes are budgeted at $2,855,377 and property tax relief at 2,936,246, which are numbers that are limited by Senate File 69. She said that the allowable growth and Senate fund and Equalization funds totaled just over $1,000,000. She said they budgeted case management at $512,000, which assumes 3,200 units of service at $160 per unit. Those numbers are based on recent quality assurance activities that have occurred since the accreditation survey. Sweet stated that client participation fees are also included in the budget that are budgeted at about $20,000 in new revenues for the department. Overall the expenses are $9,129,000 represent an 11.1% increase from the Fiscal Year 2001 budget. Sweet stated they did not include any provider rate increases in the Fiscal Year 2001 budget. However, they have been giving provider rate increases and with the recommendation of the Finance Committee, they have incorporated another 3% provider rate increase in the Fiscal Year 2002 budget. Sweet said they have seen increased utilization in the services of supported community living, respite and vocational services. They considered those increased utilization numbers in the budget as presented. She said daycare for MR children increased while the daycare for DD children decreased.

Sweet said they get statements from the State saying how much to budget in certain areas and all of those have been incorporated in the budget. She said there is one line item in the revenue section of the budget and that was the Equalization Fund allocation which was budgeted at $501,768. Sweet said that in order to qualify for that, you have to levy the maximum amount of property taxes. She said if you do that, this fund attempts to equalize the expenditures per capita in all the Iowa counties. Lehman said there is a means if you’re at a cap where the State realize you’re taxed at a maximum, there is a fund that can help. Sweet stated that if they don’t levy the full amount of property taxes for MH/DD then they don’t qualify for those funds. Sweet said that this was a new line item and in the past this money was incorporated into other line items. Sweet stated they took a lot of time when preparing this budget to put things in account numbers where they made sense and they even added account numbers when necessary so that they can better track in the future where they are spending their money and where they are getting their revenues in. She stated it would be a couple year transition period in working with these new account numbers and getting things so that they can monitor the trends, but they’ve made a good start.

Sweet said the State recommends keeping a 15 to 25% fund balance and the recommendation that came out of Finance Committee was a minimum balance of $750,000. Budget Coordinator Jeffrey Horne and Stutsman asked if they were still OK with that. Sweet said yes. Sweet stated that for MH/DD services, the Auditor’s Office often quotes cash fund balances rather than accrual fund balances. They are required, however, to report accrual fund balances to the State. She said the numbers they send in their annual reports match up with the Office of Management and Budget numbers that the County sends them in. She said that MH/DD services looks to be sure that the numbers that she reports are the same as the Auditor has reported for the County. She continued to say that in their case, it’s the accrual fund balance they look at, but she believes they are the only county department that is based on accruals.

Jordahl asked if they were surprised by the size of the large bill that came in from the State. She said yes. Jordahl asked if a more thorough knowledge of accrual accounting for MH/DD on the part of the Auditors Office could have lessened that surprise. Sweet said if they had the resources in place within MH/DD, they would have been better able to predict that. She said that would go back to the Encumbrance Program that she’s been talking about since she came to Johnson County. She said they need to be able to encumber those funds when people are admitted to services, and if they had that in place they would have been better able to predict that themselves. Jordahl said he assumed Sweet would be actively involved with Horne and Information Services Director Jean Schultz as they look at financial software for the County, to address the needs in her department. Sweet stated they have already started that process and it is possible that the upgraded COMAS system will be able to do that for them. Sweet said there will be a year where they see rather than 5 quarterly billings from the State instead of 4, and it will likely be this year. Jordahl asked what the carryover balance necessity is for that. Sweet stated that the FY 02 budget projects using $176,941 of the carryover and they may very well use that carryover this year.

Sweet stated that the revenues are the numbers they get from the State and from the Auditors Office with the exception of the Case Management Reimbursable Services, which are $539,565 and that includes the 2 decision packages. Sweet stated that the other addition this year is the client participation fees and that is a result of the changes in the Services Management Plan, which they are budgeting at $20,000. Stutsman asked if that correct. Sweet said they have no so it’s a projection. Sweet said the Case Management is at $539,000 and that is the reimbursement they get from the Federal and State government for the targeted case management. Stutsman asked if they had a process in place for accepting those fees for clients. Sweet said yes. Sweet continued that she didn’t think they should bill retroactively and she was even hesitant to do the first billing right before Christmas with the population groups they serve. She said there would be a lot of negative public reaction if they do that. Sweet stated that anytime a case manager brings to her attention that the change of policy is a hardship for the family, they are making an administrative exception for transitioning them in. She said they are not just saying that as of such and such a date there is a new policy and they’re not going to help anymore. She said no one is being cut off or told the services are discontinued. The Board and Sweet discussed the Equalization fund. They also discussed how the MH/DD department keeps track of client participation statistics.

Sweet stated that the decision packages are based on the department goals and benchmarks. She said the 2 decision packages she submitted relate to the Service Management Plan’s goals and objectives and to the Targeted Case Management Site Survey. The first decision package proposes that they add a 3/4 time Quality Assurance Specialist to the department. Sweet said that as a result of the Case Management Accreditation Site Survey it is clear that they have to do a better job at quality assurance, particularly with regard to case management. She said the nice thing about case management is that it only costs the County about 18 3/4% of the total cost. She said that whatever targeted case management is identified as costing the County, there is a Federal component that reimburses that, a State component, and a County component. She said the Federal and State components are about 81% and the County component is only about 18%. She said the Quality Assurance Specialist would be working with the targeted case management and would add to the cost of the Targeted Case Management Program. She said that total cost is calculated in the cost of the Case Management Program reduced to a unit cost and they are reimbursed so that the total increase in expenditures for that position would be $24,834 and $15,397 of that would be reimbursed in the Targeted Case Management Rate. She said that individual can work in the actual case files and can also conduct billing audits to be sure that the billing piece for targeted case management is in place as well. Stutsman asked if the Board didn’t approve the position, would Sweet still have the person who is doing the work now keep doing it. Sweet said that would be a decision for the Board, but she feels the position is needed, because there is temporary person already doing the work. Sweet said if the Board decides to approve the decision packages she would like to move ahead with them prior to July 1, 2001 if it is a possibility.

Sweet stated that the second decision package is to increase what is now a 3/4 time data technician to a full time data technician. She said this position does all the statistical analysis, captures all of the data, and records all of the data for the annual reports. She said the amount of work this position does has increased but there has been no increase in the position since 1997. She said there is some duplication in the department because they have what is required by Senate file 69, which created the data technician position in 1996, and the targeted case management billing clerk has been duplicating some of what the data technician is doing also. She said they are looking at combining those 2 things which would free up that other position to provide the clerical support that the service coordinators have been asking for for years. She said that by increasing the data technician to full time they could have that person concentrating on all of the statistical and COMAS part of the position. She stated that developing the Encumbrance Program would be a very big part of the increase in this position. Jordahl asked if the Auditor’s Office could do part of this work. Thompson and Sweet said it’s not the same work.

Lehman asked if the COMAS system would help this position. Sweet said they were telling them that the COMAS system will. Sweet said that in visiting with Black Hawk County they were working with a new computer system that was doing their automated billing and they had everything linked with all of the providers, MH/DD services, and the Auditors Office, and everything is automated. Sweet said that Linn County has invited in a computer firm to do a presentation in January and she’s going to see if Schultz and Horne and maybe someone from the Auditor’s Office can accompany her to look at the system. Horne said the Auditor’s Office probably wouldn’t go. Stutsman asked if she was talking about buying a system outside of COMAS. Sweet said she thought they would be duplicative. She said the majority of this function isn’t going to be service coordination or case management. She said the majority of the function will still be statistical and reporting. Stutsman stated that what she was getting at was she didn’t want Sweet to come in a year from now and say she wanted to buy the other system after the personnel is in place. She didn’t want her to come in and say if they held off and put the money into purchasing a system, maybe they wouldn’t have to have the personnel increases. Sweet stated the machine is not going to do all of those things and they aren’t going to look at buying a system if COMAS will do it. Stutsman asked how long they wait on COMAS. Sweet stated that COMAS was supposed to be operational on July 1st of 2000 and they still don’t have a date as to when it’s going to be in. She stated it becomes harder all the time to try and deal with the numbers when they don’t have any kind of an Encumbrance Program.

Jordahl stated that the trepidation that any Supervisor ought to feel looking at any of this is that we are going to hire more staff to do more administration and it’s going to cost money that comes directly out of services, except to the extent that in the case of the targeted case management there is Federal reimbursement. She said when you talk about administrative costs, in 1996 when Senate File 69 was established, it’s unfortunate that Johnson County just didn’t say they were going to do it this way because so many of the things that happened were just Band-Aids to meet regulations. She said if you take a look at the other counties she didn’t think they’d find another county in the State of Iowa that actually has fewer resources directed towards the CPC function. She said that COMAS, and the Encumbrance is a CPC function, it’s not a Service Coordination piece of that. She stated that by having everything within this umbrella it’s kind of nice because you can share costs, but it also really clouds up the financial piece of it. She said it was unfortunate that since 1996 all of the salaries and wages from her department have been charged to administration and that’s not how it should be. She said that all of the service coordination in the case management is a service and should have been charged to a service coordination function. She said they were turning in annual reports now that are consistent and when you look at the annual reports that just went out you see that the statistics say that 12% of the budget is spent on administration. She said that was not true, it’s probably one or 2% that is spent on administration because of the account numbers that have been used in the past. She said they are not heavy on the administration side in Johnson County by any stretch of the word. She said the monies have been going to services more so than anywhere else in the State. She said they could certainly be pulling some of that information also. She said that Johnson County has the 4th or the 5th highest in the State MH/DD services budget and probably the smallest CPC staff of those. She said if you look at Scott County, Linn County, and all of the other large counties, you’ve got CPC offices that have multiple staff positions. She said that Johnson County doesn’t have any. Sweet stated that they don’t even have a full time CPC in Johnson County because she’s also the Targeted Case Management Administrator and she’s the administrator for the social work function. She said they won’t find another county this size that doesn’t have a full time CPC. Thompson stated that the $9,000 comes out to about 1/10th of a percent of the budget which isn’t really a huge increase.

Thompson stated it was a good budget and Stutsman agreed saying it was great and they have so much more confidence in it. Sweet said she’d never forget last years budget process because she had been there such a short time that nothing made any sense and it was quite a variance since last year. Jordahl stated it didn’t make any sense before she got here either. Stutsman stated it’s been a tedious process, but she is grateful that she stuck with it. She congratulated Sweet and her staff. Sweet stated they are having fun because they are seeing where they are making good, positive changes and it’s good for the staff to see that. She said staff is participating in almost everything they are doing. Stutsman said she didn’t think they were prepared for Senate File 69 and they just didn’t deal with it. Sweet thought they did the best they could. Stutsman stated that was generous of her. Sweet said they need to do some fixing. Jordahl said the budget was looking a lot better and the accuracy Sweet was going to add was going to make it possible to actually project a budget into the future which is desperately needed.

Recessed at 2:25 p.m.; reconvened at 2:59 p.m. with Jordahl absent.

First, Ambulance Department Director Mike Sullivan stated that he forgot to include the Coralville Satellite Office rent in the amount of $3,176 when he first submitted his budget to the Board but it has been taken care of now. He listed the following goals for the Ambulance Department: continue to provide efficient and effective emergency medical services; to promote or provide resources for staff development; to provide community awareness/education programs that promote trauma prevention and strengthening the chain of survival; and to continue to meet other EMS business obligations and generate revenue. Sullivan said his benchmarks tied to each of these goals. He said they want to achieve an EMS response time of 6 minutes in urban areas and 15 minutes in rural areas with 90% of the calls. In order to keep achieving this, there are some staffing issues that he addressed in the budget for personnel. Sullivan said he wants to continue to conduct 10 on-site continuing education programs and 10 case review sessions in Fiscal Year 2002. He stated they are paid to attend these sessions and it provides continuing education that is required by State law for them to maintain their certification. He said he wants to conduct one drinking and driving awareness program, Journey Unknown, for the area high schools. Sullivan said they want to continue to provide administrative and technical support for the University of Iowa Hospitals and Clinics Mobile Care Program, which is a revenue generating program for. They would also like to continue to provide Emergency Medical Services coverage for athletic events at the University of Iowa, which is also a revenue generating service.

Sullivan said the first decision package has total increases and expenditures of $197,305, which provides for his short term and long range capital expenditures and technology projects. He stated the total increases in revenues is estimated at $15,690 and that does take into consideration the changes in the Medicare reimbursement and the service level fee increases that the Board recently approved. Sullivan said that revenues change a lot in the Ambulance Service because it’s a volume driven business and currently there is a lot going on at the Federal level. Recently, Congress passed an appropriations bill that’s going to give relief from the Balanced Budget Act of 1997, which imposed a fee schedule on the ambulance industry. Sullivan said it looks like there’s going to be more relief in the fee schedule in reimbursement and mileage. He said there’s a high likelihood that the impact the fee schedule is going to have on the revenues is going to be reduced significantly, but he’ll have a better idea in a week or 2.

Sullivan requested $1,750 to continue with their Sweet Soft, Infotronic, billing and data collection, and the time systems software maintenance programs, which is an annual expense. Sullivan recently submitted a project to the Document Management Subcommittee requesting $33,000, for them to review and submit to the Board of Supervisors for approval. Sullivan requested upgrading their current Sweet Soft software, which is old and the new State mandate is coming in January. He stated they are able to gather the data now but it is recommended by Information Services that he put an Amazon billing and data collection software program for $6,925 in Fiscal Year 2000’s budget to upgrade the current billing and data management software. He stated it is Windows based like everything else and when they implement the document management plan to merge documents with paper clip, all of it will be able to come together.

Sullivan said for capital expenditures they have an 8 year rotation for 5 ambulances for replacement. Sullivan moved ambulance 20 and 21 back a year for replacement. He stated they were originally scheduled to be replaced a year sooner, so knowing that 22 is due for replacement this next fiscal year, 20 would have been due in 2004, with 21 due in 2005. He stated they really need to keep on track with the replacement schedule or they are going to have a significant increase in the maintenance packages to maintain them. Sullivan said in FY 02 they will be replacing ambulance 22 in the amount of $44,520 and if they stay in line with the replacement schedule, they will put in capital projects $15,000 for ambulance 20 and another $21,200 for ambulance 21.

Sullivan said for capital projects they are still with the northwest ambulance satellite location. He said that in looking at how the funding schedule would go, in 2005 he is asking that the Board consider setting aside $13,750 for that project as they go. Sullivan said they are still looking at $65,000 as a minimum for a building that they would construct. He said the issue right now is to find a place to put it. He stated that the corridor where they’ve talked about before is basically full. He said he needs to look at a place out there where they can have a small parcel of land to put a building on or do something cooperatively with the City. Thompson asked if they were not planning on staying in the SEATS location more than 5 years. Sullivan stated they are out there for 5 years at a minimum or 6 years and if they can get a location put together at the end of that five year period, that would be ideal. Thompson asked if the $13,000 a year for 5 years would give them the $65,000. Sullivan stated it would. He said there was a request for $3,000 for storage construction at the Iowa City location and that would help with the document management.

Sullivan requested 2.60 FTE positions for Fiscal Year 2002. He stated there were 2 options for the positions, the first to provide EMS response coverage during the identified peak response periods, using a 4th ambulance. He stated that would allow them to meet their benchmark success measurement for achieving their response times throughout the County. He stated they are also getting more responses in the City of Iowa City. He said that in order to address their needs with that as well as the entire County, he doesn’t need two full FTE’s. He said the other option with the .6 FTE’s, using existing personnel coupled with this he could make that other ambulance a 24 hour operation. He stated that right now, the numbers don’t show him that he needs 3 trucks on after midnight. He stated where he really needs the ambulances is during the mid morning and late evening hours to respond to the calls. He said they are running the 3 trucks right now that way, 3 ambulances all day until 11 and then 2 full staffed ambulances after 11:00 p.m. to 7:00 a.m. in the morning. He said this was the most efficient way to use personnel to staff the department without making another 24 hour truck. He stated they would still have the peak demand needs. Sullivan said last time he had a personnel increase was Fiscal Year 2000. He stated the personnel increase comes to $37,137 for FY2002 if it’s approved. He said the non-personnel increases which includes the omission of the Coralville rent is $20,085. He said the department total increase for the department alone is $57,222. He stated that is a department total increase of about 3.6% over last year. He explained that the revenues, since the rates were already adjusted, were inline with the national fee schedule.

Sullivan said Department 56, Ambulance Special Revenue Fund, was not active last year. He said they do have some anticipated deposits coming to that and it is budgeted for $1,000 in expenses and $1,000 in revenues. He said they would not expend anything that is not available in revenues. He stated this year they have had 3 separate people provide donations, which was the concept for having Department 56, to have a place to put donations when people call and say they want to donate money to the Service.

Sullivan went through the essential performance measurements for the ambulance industry. First Sullivan went over EMS response history and his response report for FY 98 through his projections of FY 01. He stated they are now seeing a leveling off of EMS response requests. In Fiscal Year 1999 they had 5,061 calls and the following year they had 5,200 calls. He said they are going to be just at the 5,200 this year. He said that is good news because with the leveling off of services, for the expense aspect for the future, it looks like they will have control there. The second performance measurement was the key performance measurement. He said there are actually 11 performance measurements that the industry uses, and three key measurements tied directly to the budget are the cost per response, the per capital cost and the unit hour costs. He stated that measures how efficient you are using your money. He said it reflects, since Fiscal Year 1997, that there is stability in the performance of the service. He stated the per capita cost in 1997 was $5.62. He said it is now $6.41. He said the cost per response in 1997 was $268.90, and now it is $279.02. He explained that there are increases, but he does not consider them exponential, and are not what the industry looks at right now. He said they were at the national average, which is $280.56 for ambulance response, and they are at $279.02. He stated the unit hour utilization is only $63.70, and it was $72.89 in 1998.

Horne noted that under the revenues, the University of Iowa call fees, he saw there is a wild fluctuation with zero this year and next year will they get that back again. Sullivan said in the Fiscal Year 2001 budget, that money was actually put in the University of Iowa standby fees. He stated he had reduced that amount and split out the University of Iowa call fees, which will now be the mobile care program. He stated that is the mobile care operation and the athletic items. Last, the Board and Sullivan discussed the changes that Congress made again and how it might affect revenues at the Ambulance Service.

Physical Plant Director Mike Scheer stated most of their budget increases are for maintenance for the Jail and equipment for the Jail. Scheer explained that the Jail is old and is costing them a lot in repairs. Scheer said they have had heating pumps go out, have had to replace doors, and have had to replace some of the handicap electronic locks. Scheer stated there were some items they were able to decrease in their budget such as custodial supplies, and stationery forms. Thompson stated that this year’s budget increase is 3.5% over what they budgeted last year but that they didn’t really have a budget for that department, they just carried over some from the prior years. Scheer agreed and said this would have been former Physical Plant Director Pat Langenberg's budget for this year and nothing was allotted for things growing older, and it should have that money added to it for the possibility of items needing repair. Thompson said this includes $18,000 or more for repairs at the Jail this year and there will have to be an amendment to the budget. Thompson stated there was an additional 1.8% or $9,000 to add to the FY 02 budget. Thompson asked if Scheer was actually projecting to spend slightly less next year than this year. Scheer agreed, and said that a lot of the items that have already been replaced shouldn’t have to be again. Scheer said it is estimated by R.M. Boggs that it will only be $3,500 to patch the cooling tower at the Jail. Stutsman stated that Boggs has been there a lot this year, and asked if there was enough money in the budget to cover his service costs. Scheer said yes. Stutsman asked if there were any other changes in expense. Scheer stated there weren’t. He said they have 280 hours on the lawn mowers and they just replaced the hand mowers. He said he was told to replace them every 5 years and they replaced one last year and one this year so they are on the schedule for changing. He said he would then start budgeting X amount of dollars per year after this year, in the FY 03 budget.

Stutsman asked if Scheer had any personnel increases. Scheer said he didn’t. Thompson stated they should probably note that the budget in the past was running over budget so there is more than a 3.5% increase projected. Horne said electricity is a problem in the budget. Stutsman asked about natural gas. Scheer said they are locked into a certain price, but the colder it gets, the more electricity and fuel they use and this month with it being so cold, they could expect an increase. Horne said they are already over in the budget for electricity and they’ve only received November’s bill. Thompson stated they were obviously using more someplace and it probably has to do with whatever is wrong with the heat in the Administration Building. The Board and Scheer discussed the heating problems with the Administration Building. Thompson said there is only one month’s performance on this years budget, so it will be a tight budget. Scheer said it would be tighter yet if stays cold, which they are predicting it to.

Stutsman noted there would be no change in revenues in the FY02 budget. Scheer said they are putting away money each year in capital projects to replace Truck 52. Scheer said that Dwight Dobberstein told him that the Courthouse restrooms have already been bid. Thompson asked if the bids came in on target. Scheer said there was just a few thousand dollars difference. Lehman stated that one thing they might want to discuss when this comes to the Board is whether or not projects like this would go in budget 17 or 85. Horne said that the Courthouse wall, the steps inside, and the lobby ceiling on second floor are all in the Department 17 budget, as estimated by Dwight Dobberstein. Thompson stated that basically what is here is upkeep on an historic building and Stutsman agreed. Stutsman reminded the Board that ever since she’s been on the Board these things have been on the capital projects worksheet. Thompson stated that they are hearing from Insurance Agent Bob Saunders that the retaining wall is not safe. Thompson stated they had two choices: they can repair it with modern materials that look rustic, or they could replace it like it was. She said it’s not part of the historic structure, so they are not required to do it historically. Thompson said Saunders said the steps are also semi dangerous because they are hollowed out.

Thompson said the cooling tower in the Jail is putting out a lot of moist air into the room which causes damage to everything in the room and the designed part of the building that would take the moisture out of the room isn’t doing it. She said that the cooling tower should have apparently lasted for a long time and it’s only lasting 20 years because of the rusting problem. Thompson asked if they should fix the cooling tower where it is and let it continue to rust or move it to the roof or the outside which is where a cooling tower would ordinarily be placed on a building, which is $100,000. Scheer said that is again a long term decision. He said they could patch it and then hopefully there will be plans for a new jail within 5 years. Lehman asked if there was any means to install special exhaust fans to pull the moisture out of the room. Scheer said the Dobberstein thinks it might be possible to put a fan in and get some of it out. Thompson said if they put a new roof on the building they could probably but a fan in at the same time. Lehman asked about the black cast pipe. Scheer stated those were all in the amendment. Lehman asked if that was closer to the estimate. Scheer stated it was. Lehman stated $25,000. Stutsman summarized some of the items on the budget, citing the overhaul of Jail, lock door, black cast pipe at the Jail, $25,000; replacing the Jail roof, $150,000. The Board discussed capital projects and capital expenditures budgeting and the need to come up with a county building plan.

Adjourned at 4:13 p.m.

Attest: Tom Slockett, Auditor

By Casie Parkins, Recording Secretary