Interim Ambulance Director Steve Spenler said that the Ambulance Department goals are to provide efficient, effective emergency medical services, adjusting to any changing demands when indicated. He commented that their benchmark for this is to achieve a response time of 6 minutes in urban and 15 minutes in rural areas 90% of the time, which is a standard in the ambulance industry. He said it is a benchmark for the number of trucks measured by response times. Stutsman asked if they have achieved those times. Spenler said when they started the 3rd ambulance in Coralville in FY 99, the year before they were responding in Coralville with an average time of 7.9 minutes for all calls. This last fiscal year was at 5.4 minutes on the average in Coralville. He said that’s taking into account that they’re running about 17% more calls. In Iowa City they are at 4.4 minutes average for all calls. He said the Lone Tree response was about 17.8 minutes but its tough to get a good average there because the call volume is so low that one call can really skew things. He said Oxford was about 15.5 minutes, which was down from 17.1 in 1998. North Liberty is about 11 minutes, down a couple minutes from 1998. Overall in the rural areas in FY01 they averaged 13.3 minutes per call. He said they respond in 14 minutes to 90% of their calls. Stutsman asked if in the rural areas if this was for first responders or just for the Ambulance Department? Spenler replied that it was a good point because Johnson County has an ambulance service and also EMS system and it all works together. Spenler said that in almost all of the cities there is a dedicated group of individuals who are almost always on the scene before the Ambulance Department gets there. Spenler went on to say that calls went up about 17% since 98, then stabilized last year, and they’ve already have seen a 4% increase from last year at this time.

Spenler said that the second goal of the Ambulance Service is to provide resources to keep the staff trained and educated to the standard of care for the industry. The Ambulance Service provides onsite training monthly and also offers certification courses. Spenler said they also do quarterly skills reviews as mandated by Medical Director Dr. Huss, which is done in house when people are on duty. Spenler said they provide programs to educate and make the public aware of our Emergency Medical Services such as a yearly EMS Fair and a drunk driving education program at the area high schools.

Spenler said another goal is to support County first responders and area EMS training centers to provide quality EMS care. In the Johnson County EMS system, they support one support liaison to each of the County first response teams to help with their quarterly training, and to update them on changes in periodicals and equipment procedures. He said they to continue to meet the other EMS business obligations to generate revenue for the Ambulance department. Spenler said that aside from the 911 ambulance responses, they work with the University to provide staff for their mobile care units and provide staff to cover all University of Iowa football, basketball, and wrestling events as well as the larger concerts at Carver Hawkeye arena.

Spenler said their total increase in expenditures is 291,165 and total increase in revenues of $50,400. Currently, revenues are about 42% of expenses. Increases in revenues for this fiscal year are primarily due to an increase in Medicare fee structures, Spenler said. He said that they continue to see an increase in those revenues due to the increase in fee structure. He said they’re at the Medicare structure for all rates, except for the Advanced Life Support II and mileage. Spenler noted that during the upcoming fiscal year, there will probably be raises in the Medicare fee structure, which might mean that the Ambulance Department might need to readjust their rates as well. He said the County’s transfer rate is currently $158, and the implementation of the new Medicare fee structure might allow $229. Later, he surmised that emergency rates might not raise in this same proportion. Stutsman asked when this rate change was going to occur, and Spenler answered it was supposed to be April 1st, but he didn’t know if it was still on schedule. Stutsman asked if the County would then change its rates, when the Medicare changes happened? Spenler said yes; since Medicare sets the maximum allowable rates, the County needs to be at that rate. Stutsman asked if this would bring in additional revenues, and Spenler said yes. Stutsman asked if, when the County changes its fee structure, it affects everyone, even those with private insurance? Spenler answered yes, because the County can only charge one fee.

Thompson said she noticed that Spenler’s re-estimated budget is a little over what was budgeted, and asked if he was going to need a budget amendment for the current year? He answered that he possibly would need an amendment. Spenler said that right now, the Ambulance Department is in line on their budget, because certain items, such as fuel costs and cellular phone service, were almost half of what was budgeted. Lehman asked about the drops in revenues in Standby Fees and CPR Classes. Spenler explained that the department used to work at concerts at the Iowa Memorial Union, but they no longer use County services for those events. Spenler said they had created something of an education program at the Ambulance Department, but they were losing money teaching the CPR classes, so they dropped the program. He said the classes are available elsewhere in the community. Neuzil said he is concerned that the budget goes up pretty significantly in a year when the Board may not be able to give any increases. Neuzil noted that Spenler is asking for close to $300,000 in non-personnel and an additional $118,000 in personnel, which is a high rate of increase. Spenler said he understood this, and said he would explain some of the items as he went. Spenler thought the department is doing fine, and providing an excellent service to Johnson County, and would continue to do so if the Board did not fund any budget increases. Spenler said that some of the budget requests, such as the truck lines, would save the County money in the long run.

Neuzil asked if the County could save money if Iowa City took over the Ambulance program as a City service? Neuzil noted that this has been discussed. Spenler did not think this would save money, and said he didn’t think Iowa City could provide it any cheaper than the County. Because of economies of scale, Spenler said, a great injustice would be done to people living in rural areas. Stutsman said that the majority of the calls are Iowa City calls, and Spenler confirmed this, saying that Iowa City calls account for 50% of the department’s calls. This would take away 50% of the department’s revenues. Thompson noted that the County department would still need to staff all the shifts that they do; Spenler confirmed this. Spenler said even with 50% fewer calls, the department would still need to have 2 trucks on, or at least one on and another on-call, which is fairly inefficient. Neuzil said he wasn’t suggesting this should happen, but said it has been discussed. Thompson noted that rural residents want someone available to them, just as people in Iowa City do. Stutsman said that staff training and skills are kept current by the number of calls taken; with 50% fewer calls, this could also be an issue. Neuzil thought there is interest in this issue; Stutsman disagreed, saying the City Manager is not interested. Harney didn’t think the City could be nearly as cost-effective as is the County, overall. Field Supervisor Cory Bonnett noted that there is a large startup cost to an Ambulance program, buying the trucks, equipment, software, etc. Spenler said that Johnson County is an EMS system, with first responders working as a team; this system would be disrupted. Stutsman said that since the Johnson County Ambulance Department provides such a good service, she is not in favor of exploring the possibility of Iowa City providing its own ambulance service. Spenler said there would be a lot of paramedics doing the same number of calls and being less proficient on their skill level. Spenler said that Johnson County should provide the best ambulance service it can, so that Iowa City doesn’t want to provide its own service. Thompson said this is a good way to look at the issue.

Neuzil said he didn’t know where the Board would come up with $400,000 for the Ambulance Department. Thompson asked Spenler about his request for 4 extra shift people and a part time Clerk, and wondered if this was to add a shift? Spenler said that 4 full-time Paramedics would allow the Ambulance Department to provide 3 ambulances 24 hours a day. Currently they have 2 ambulances 24 hours a day, and 1 ambulance 16 hours a day; thus, there are 3 ambulances from 7 a.m. to 11 p.m., and 2 between 11 p.m. and 7 a.m. Thompson asked why 4 shifts are needed to fund the period from 11 p.m. to 7 a.m.? Spenler explained that they created an extra shift in July of 2000, hiring 4 people, but they have 96 hours a week that are not staffed by anyone. For these hours, he said, which they call open hours, they go through a call list, assign part-time personnel to those hours, or fill them on overtime. Spenler said the 4 positions being requested are really only 2.8 full-time equivalent; 1.2 would be used to fill the open hours referred to above, and they would no longer need part-time staff to do that. Thompson asked about a disparity in the numbers regarding reduction of part-time wages, and Spenler explained that the difference was due to the additional clerk he requested. Neuzil asked if it would just be cheaper to have part-time staff fill the hours in question, and Spenler said the problem is that the on-call crew has 30 minutes to respond, and isn’t nearly as efficient as a full-time crew. Spenler said that part-time employees are already busy, and so the Ambulance Department ends up paying overtime; he said the department paid $67,000 in overtime, last year, and this will be reduced with the addition of 4 full-time personnel. Neuzil asked if the overtime and part-time reductions would offset the additional costs, and Spenler said no; it does cost more to create the 4 full-time positions. Thompson asked what would happen if the Board could not give all 4 positions, but only 1, or even 3? Would this mess up the plan? Spenler said no. It would be difficult to go with 1 or 3, because the department works in pairs, but said 2 would certainly work. Spenler emphasized that even if nothing is done, the Ambulance Department will still provide a very good service.

Spenler said the department has 10% higher call volume than in 1998, and the busiest hours are early Saturday and Sunday morning, between 1:00 and 2:00 a.m. He said they run 56 calls during those hours, busier than any other time. Spenler said that 90% of the page-ins come after 11:00 at night, resulting in high expenses for these on-call employees. Spenler said that employees are paid for a minimum of 2.5 hours when they are called in, and the Board thought this was fair. Stutsman noted that these expenses would be lowered if the Board approved the 4 additional positions, and said there are expenses either way. Spenler agreed. Thompson asked how often 2 ambulances are both out, and a 3rd call comes in. Spenler said this occurs rarely. Thompson asked if there is some industry standard, to know when it is time to staff another shift? Spender replied that he has asked many people this question, and said it is based on response times. Harney asked if part-time employees got benefits, and Spenler said they did not, but if they work an average of 20 hours a week over a 6-month period of time, then they get paid what the benefits would have cost, had they been half-time. If they average 40 hours, they receive an amount of money equal to the cost of full-time benefits for that period. Spenler said they traditionally pay 2-3 people half-time benefits every 6 months, and occasionally pay someone full-time benefits. Lehman asked if these amounts are budgeted, and Spenler said yes.

Spenler further detailed the numbers involved in his decision package, and emphasized that on Friday and Saturday night, they are up and running calls all night long, without much of a lapse. After 4 a.m., he said, the call volume traditionally drops way down. Neuzil said he thought it was going to be extremely difficult to meet the needs the Ambulance Department was proposing, and Spenler said he understood it was a tight budget year. He thought that the results would be excellent for the community, with top-notch response and a much better service. Harney asked if the additional ambulance would be kept here, and Spenler said no, one would be kept at the 2000 James Street Coralville location. Currently, there is a group at this site for 16 hours, but not during the overnight shift.

Thompson asked if the clerk is related to the extra shift, or was it just to help out in the office? Spenler said it would just be in the office, to help out with the billing of the department. He said that as an alternate to the proposed increase of 16 hours a week, 8 hours a week would also be helpful, on a temporary basis. He said this would also give the department someone who was trained and available to come in on days off or sick time, when they needed a clerk. Neuzil asked if they had a space for a clerk, and Spenler said they would have space in the new building. Spenler said the clerk would work on paperwork, and then enter it into the computer system, so the current clerical staff would have more time to work on insurance, billing, and Medicare questions and issues. Spenler said there is currently very little wasted time in the office and said the 2 people currently working there are very busy. Thompson told Spenler that the Board won’t know how much money there is to spend until the middle of January, so they currently have no idea if they will be able to fund what the Ambulance Department is proposing. Thompson said that the Board is nervous because almost every department is telling them that some sort of State funding related to their department is now dwindling. Spenler said that though he couldn’t guarantee it, he expected to be able to justify a rate increase sometime during the fiscal year, which would increase the Ambulance Department’s revenues.

Spenler moved on to the Technology section of the budget, and said that for the most part this consists of items that have already been approved. He said the department is using its new billing and data collection software; $1,500 more is needed, and has been approved through Information Services, to convert the data. The document management project of scanning documents began last fiscal year for the Ambulance Department, and Spenler said Information Services gave him the figure of $20,000 to complete that project. He said this request was already made from Information Services. Stutsman confirmed this, saying the recommendation has been made, and included in their budget. Lehman asked if some of these items were ongoing? Spenler confirmed Lehman’s estimate that some of the items in this section of the budget are ongoing, annual expenses, not new expenses.

In Capital Expenditures, Spenler explained that he has given the Board a replacement schedule for all 5 of the vehicles currently owned by the department. He said the vehicles average about 15,500 miles per year, which is 94,500 miles, per truck, every 7 years. He noted that as trucks age, they cost more to maintain and keep running. He said their oldest truck, Adam 20, has 108,000 miles on it currently. In FY 99, this vehicle cost the department $.25 a mile to run, and in FY 01 this figure jumped to $.80 a mile. Neuzil asked about the price of a new truck, and Spenler said Adam 20 could be replaced for $84,000, with the trade-in. Harney asked if this was only for the chassis; couldn’t the rest of the vehicle be remounted? Spenler said that $84,000 was for a whole new vehicle. Bonnett said the basic cost for a remount is about $63,000, resulting in only a $3,000 or $4,000 saving for the County. Bonnett said that in a remount, the only new parts were the engine, transmission, and chassis; the box, wiring, strobe lights, and electronics were all exactly the same. He noted that the box also significantly corrodes. Spenler said that even if they chose to remount, they could sell the old ambulance for around $17,000, or trade it in. Lehman said if they did trade it in, it would be better to trade the whole thing, so they could sell it right away, without having to match it up to someone else’s unit. Bonnett agreed. Thompson clarified that she thought Spenler was asking the Board to save up for all 5 ambulances, a little bit each year. Spenler confirmed this assessment.

Thompson asked what the Board gave the Ambulance Department last year for vehicles. Spenler said they replaced a vehicle last year, and the plan was to wait a year, replace 3 vehicles, wait another year, and then replace one more. Thompson asked if they would need $128,000 every year, or just the first year, to get it started? Spenler said it would be somewhat of a similar cost to what they would need every year to do a 7-year replacement schedule for all 5 units. Spenler said the Ambulance Department got $90,655 last year, which was later amended to allow a truck purchase a year ahead of schedule. Spenler said they should have about $117,000 for vehicle replacement by the beginning of Fiscal Year 03. Lehman asked Spenler to prepare a historical graph showing what Spenler has been given in these various line items in past budget years. Spenler said last year they set aside $21,200 and $51,000. Thompson asked if Spenler anticipated the cost of the vehicles was going up? Spenler said he was told to figure in a 4% increase in cost every year, which may or may not be accurate. Spenler and Bonnett gave more information on the high costs of maintaining the older ambulances. Neuzil asked if the department needed 5 ambulances; is the 5th ambulance used a lot? Spenler replied that they use it when they have a truck being repaired, and said it is very important to have 4 ambulances ready to go at all times. Spenler and Bonnett said that occasionally they do have all 5 ambulances on the road at once.

The group discussed the department’s transfer procedures; Harney asked if transfers are a good use of County dollars. Neuzil thought, and Spenler confirmed, that the County can make a lot of money on transfers. Spenler said the County does have to turn down some transfer requests, due to staffing availability, but they are lucrative; the Ambulance Department charges $5 per loaded mile. Lehman asked about the availability of other ambulances, in addition to County trucks, for transfers. Spenler replied that, in an emergency, a nursing home calls Johnson County first, but for transfers, they may call a private provider first, because their rates are lower than the County’s.

Harney said he liked the idea of planning for vehicle replacement by putting money away every year, rather than having to come up with the cost all in one year. Neuzil said it is a good policy, but said it is a tough year to start it. Spenler thought the department has the money in the budget to replace the oldest vehicle, and said they could put this vehicle in the garage and only use it when absolutely necessary. Harney and Bonnett discussed the mechanical aspects of the vehicles and chassis, including warranties on various parts of the trucks. Bonnett said that an extended warranty program, which had been very cost-effective for the County, was discontinued in 1996. Lehman noted that if they didn’t replace one ambulance this year, they would have to replace 2 of them next year. Thompson noted that if the Board gave the Ambulance Department the same amount this year as they got last year, the department could still get an ambulance replaced this year, but would be a little short on saving for future years. Spenler confirmed this.

In Capital Projects, Spenler said the only item is a continuation of saving for an ambulance substation in northwest Johnson County, at a cost of $13,750. Spenler said he knew they didn’t have any land for this project. Spenler suggested that this could be an item the Board could choose not to fund this year. Thompson asked if Spenler is satisfied with the space the department currently uses in Coralville? He answered that they were always looking to improve that site, which with its tight quarters is not optimum. Spenler said it is, for the most part, satisfactory. He noted that if they did expand the hours at that site to include a night crew, it would be difficult. Spenler said that if his department had a site north of Coralville, perhaps on Highway 965, Swisher might consider using the Johnson County Ambulance Department, instead of the Cedar Rapids service they currently employ. Spenler said it would not be fair to Swisher to be served by Johnson County now, because Cedar Rapids could get to Swisher faster. Harney asked about the possibility of moving the Coralville truck in with the North Liberty Fire Department. Spenler said that North Liberty would be very interested in having an ambulance at their site, which would provide for Swisher, but the majority of calls using the Coralville truck were from Coralville, so housing it in North Liberty would not make sense. Harney and Spenler agreed that the Oakdale area would be a better location. Spenler said he has talked to the Coralville Fire Chief about this issue, and he is interested in talking to the County about this issue, though he wouldn’t commit one way or the other.

Horne said this is a pass-through grant.

Spenler said this department has been set up to receive donations, and it is spent on training, equipment, and supplies. He noted that this year they bought some CPR equipment from this department.

Recessed at 2:15 p.m.; reconvened at 2:25 p.m.

Lehman and Mental Health/Developmental Disabilities Director Elaine Sweet introduced Deborah Guard, the new Financial and Statistical Supervisor. Sweet noted that the budget is only a "best guess," since the budgetary news from Des Moines changes frequently. She said the only thing that they are really sure of is the fact that State revenues will be decreased by 4.3%, a number that is incorporated in the budget projection. Sweet said she did find an error in the budget sent to the Board; she pointed out a revenue line item for Family Farm Credit Replacement which should be $2,700, not the $27,000 that appears in the budget. She apologized for the error. This adjusts the departmental total to $9,371,377 in revenues.

Sweet said that the $9,371,377 is a fairly accurate projection for MH/DD departmental revenues. She said the 4.3% reduction is apparent in the Local Purchase of Service, the Case Management Reimbursable Services, Community Services Allocation, the Allowable Growth, and the Equalization Fund. The Incentive Fund and the Rate Increase Allocations, which were revenue sources in prior years, no longer exist. She said they are rejoicing in the elimination of the Incentive Fund, as it was hard to administer and work with. She said the 4.3% reduction does not affect the Property Tax Relief line item. Sweet explained that Targeted Case Management is reimbursed on cost. However, the revenues are subject to the 4.3% reduction, which means that Targeted Case Management agencies, including Johnson County, will receive 4.3% less than what it costs them to provide the services. She said they are anticipating an average of 325 Targeted Case Management consumers per month; this has gone up due to the Adult Rehab option, and also the fact that Supported Employment is covered under the MR waiver. She said there has been a gradual increase in the last 6 months in the number of Targeted Case Management cases, and said she expected it to level out to an average of about 325 cases at any point and time.

Sweet said her department, in conjunction with the Auditor’s Office, has redesigned the entire chart of expense accounts. With the implementation of Senate File 69, in 1996, the accounting system became confusing and inconsistent. She said the system is still in transition, and it is complicated because they have to allocate all expenses between the 3 businesses within MH/DD Services: Social Work, Targeted Case Management, or the CPC Function. Sweet pointed out that a lot of things that had large expenses in the past do not now, or will not next year. She said there are also new account numbers that now do have expenses, but have not had them in the past. For the most part, she said, this is just reorganization, not raising or reducing expenses. Sweet noted that the Auditor’s Office cannot drop account numbers until they have been idle for 3 years, so they will be carried, but not used, in the MH/DD books until they eventually drop off.

Sweet said that the Salary/Wages/Benefits line item reflects current staffing levels, and noted that the department is not asking for any new positions. In fact, she said, Guard has just accepted the position of Financial and Statistical Supervisor, and said she does not intend to fill the Administrative Assistant position until they see how this position gels in relation to Guard’s job. She reminded the Board of the changes to the meeting structure of MH/DD’s 6 committees, which used to all meet monthly. Currently, she said, Planning Council meets 8 times per year, and the other 5 committees now meet only 3 times per year. This has reduced the workload of the Administrative Assistant; Sweet thought it might be possible to blend the Financial and Statistical Supervisor with the Administrative Assistant position, and shift some responsibilities between these 2 positions and other administrative positions in the department. Sweet said the salary, wage, and benefit costs of the Mental Health Advocate was also included in the MH/DD budget, and other business-related expenses for the position. She said this position is handled outside of MH/DD, though it is in the department’s budget.

Sweet detailed a couple of new Administrative Expenses in the budget. One is background checks for non-traditional providers. She said this system is now established and in use, and is working quite well. Another new administrative expense is the ISAC County Rate Information System; she said they just paid the $8,000 invoice for this year. Sweet said they have budgeted for it next year, and the budgeted amount will probably be more than they need. Overall, Sweet said, the Administrative Expenses in this budget are a little less than 1.4% of the total budget.

Sweet said as she worked through the expenses, she took into consideration the amendments in the Services Management Plan, and how they would impact expenses. She said Children’s Daycare is budgeted significantly less than what it has been historically, because of the change in eligibility criteria in the Services Management Plan amendments. She said that the Adult Rehab Option and Supported Employment covered under the waiver program, as well as the Brain Injury Waiver, will have significant impact on expenses in those categories. She said all of those things have been incorporated into the current budget.

Sweet said one very positive thing in their budget is that that the Community Mental Health Center decided not to continue the Senior Peer Counseling Program, on which MH/DD was spending $40,000 a year. This will result in a $40,000 savings to this budget. She said the Community Mental Health Center would be providing the service under different programs. By contrast, Sweet said, the Judicial Referee funding that the Board recently approved will add about $20,000 to next year’s budget.

Sweet said she has not incorporated any additional State-level budget cuts into this budget proposal. She said she has not considered Children’s Daycare, Brain Injury Services, and Basic Needs (such as rent and utilities) being funded from the General Fund; they are included in the budget. Sweet noted that it is possible to pay for these items out of the General Fund, but they are currently included in the budget, at a reduced level. Thompson said they did appear in the Fund 45 budget, but the Board was supposed to ask Sweet if she needed them. Thompson asked if $80,000 for Child Daycare would cover the children in the program now? Sweet said it will. Stutsman thought Whitney had included some of the items in her budget; the Board thought she had included around $150,000 for some of these items. Sweet called the Board’s attention to a section of the expenses, Personal and Environmental Services, Children’s Daycare MR/DD is $80,000. Another item, Personal and Environmental Services, Other Summer MR/DD is an additional $30,000 that in the past would have been charged to Children’s Daycare. Sweet said they are pulling this item out separately in order to monitor the summer program. Thompson asked if that $110,000 would cover the children they have on now? Sweet said no, but it would cover the children that they anticipate will be on after the plan amendments take effect, because the amendments change the eligibility criteria. She said a number of families will not be eligible under the new criteria. Neuzil asked when this takes place? Sweet said that State/County Management Team very recently approved the amendments, and when a confirmation letter arrives, the changes will occur. Neuzil asked if the parents have been informed, and Sweet said they have been informally advised by their case workers, though the department hasn’t been able to give official notice of the decision.

Stutsman returned to the earlier issue of Whitney’s budget, noting that she had included $135,000 for Child Care, and she also included $76,000 for Brain Injury. Stutsman read that Whitney wrote "The Board may wish to consider adding funding to Department 45." Thompson said they could decrease Department 45 by that amount. Sweet said if the Board could incorporate that in the General Fund, she would certainly support that, but said they need to plan for it carefully. Thompson said the County spent about $177,000 on Daycare last year, and asked Sweet if she thought $110,000 would be enough for next year. Sweet said yes, and continued by saying there is a new work committee in Children’s Daycare, a branch of the Finance Committee and Research and Development. This committee is looking at alternative funding for the Children’s Daycare Program. She said Linn County has a program that is run through ARC, supported by the businesses of Linn County, through corporate donations. Thompson asked if they are getting the maximum amount from the Grant Wood AEA and the school district; Sweet said she doubted this. She said they have attempted many times to bring the Area Education Agency into the MH/DD Committee structure, but said they are very difficult to access. She said there are a number of children who she believed should be on summer programs through the school system. Neuzil asked if the decision was made to actually fund MH/DD Daycare out of the General Fund, who would administer it? Thompson thought they might have to set aside the administrative costs in a separate line item. Thompson said the mandatory services have to be covered by the MH/DD budget, and Neuzil said that Johnson County does much more than what is mandatory, so other items could also be shifted. Thompson said that eventually the mandatory services should grow to fill up the MH/DD budget. Stutsman asked for clarification from Sweet that they would leave Child Care in her budget; Sweet replied that it is in there for 2002 and 2003. Sweet responded to Neuzil’s earlier question by clarifying that CPCs are able to administer other monies, other than what is in Fund 10 or the MH/DD Services Fund. The Scott County CPC, for example, is responsible for the CPC function, Veteran’s Affairs, Community Services, and a number of different areas. She said this is possible but would require allocating administrative costs, as Thompson had said. Stutsman said it makes sense for MH/DD to manage this, since they know the clients and their needs; she supports having it administered from this budget. Thompson said they want to tax at the cap for MH/DD, without shifting costs before they have to. Neuzil asked why the program is still in the MH/DD budget if the Planning Council chose not to have this program? Sweet replied that Planning Council is only in an advisory capacity to the Board of Supervisors. Sweet said she wasn’t aware that she was to have removed it from her budget; she said she can certainly do this. Neuzil thought Planning Council removed the program; Thompson said they didn’t remove the program, only reduced it. Sweet said they did not remove it; the Services Management Plan that was just amended has a whole section that discusses Children’s Daycare. Sweet said it is budgeted for a total of $110,000 for Fiscal Year 2003, down from $300,000 in Fiscal Year 2000. Neuzil thought other Planning Council members also thought this program has been eliminated, so Sweet said she would make a point of clarifying the situation. Sweet said she wasn’t aware of any families that are having real problems because of the changes.

Sweet said she is sold on music therapy, and said West Music applied to be a provider under the waiver program, to count this as therapy under an SCL program. She said she expected them to be approved, said the budget problems are an impetus for people to look at different ways of doing things, and different ways of being funded. Sweet said she recently talked to legislators about drawing down more federal funds for waiver programs; currently, there is no waiver for persons with developmental disabilities, and there are a lot more services that could be covered under the Brain Injury waiver and the MR waiver. She said CPCs statewide are going to try to bring in more federal funds; currently, counties pay 100% of those services. If they could be waiver-based services, then counties would only be responsible for the non-federal share, approximately 37.5%.

Neuzil asked how Sweet figures out how much money she has to spend, when she works on her budget? Sweet said the levies are maxed out at 1996 levels, which is found on the very first line item on the revenue page, Real Estate Taxes. She said some numbers come from the County Auditor’s Office, such as Current Mobile Home Taxes, and others from the State, such as Local Purchase of Service--Title XX, Community Services Allocation, Mental Health Property Tax Relief, Allowable Growth, and Equalization Fund Allocations. Sweet said they also project some numbers, such as the Case Management Reimbursable Services, which is generated by projecting the number of cases they anticipate and the cost of those services. Sweet said the State numbers are tricky, because they give the numbers once a year, and sometimes change them after this time, necessitating careful monitoring of legislation and activities. Thompson asked about the Equalization Fund; Sweet explained that this fund was a part of the Mental Health Fund that was set aside 3-4 years ago. It became apparent that some counties were spending a lot more per capita for mental health services; the decision was made that everyone should be funding mental health services at least the 75th percentile. Thus, Sweet said, the counties at the higher end are taking lesser amounts of State funding, and the counties at the lower end are picking up more monies, to bring the situation into equilibrium. This makes the per capita cost of mental health services more even throughout the State. She thought Johnson County was at about the 40th or 50th percentile, and is working its way up to the 75th percentile. She said that the University Hospital and the inpatient hospitalizations contribute to the County’s lower per capita cost, because they don’t have to pay for the inpatient hospitalizations, as most counties do.

Neuzil asked how much County tax money goes towards the MH/DD budget; Sweet answered $2,862,000. Neuzil asked if the rest came from State and Federal, and Sweet confirmed this. Neuzil said he didn’t think people understood this. Sweet said the County contribution used to be much higher than this; a portion of the Mental Health Property Tax Relief, of $2,936,000, used to come from counties as well. Sweet said they also generate some revenues through the Targeted Case Management program, but the biggest sources of non-County funding are State and Federal sources. Neuzil asked how the budget cap works for MH/DD? Sweet said they are capped at the $2,862,000 level; this is a dollar amount cap, so it will not raise with increased real estate valuations. Neuzil thought it has changed a little bit each year; Thompson thought this must be related to other smaller taxes, such as utility property taxes and delinquent taxes. She said the Auditor’s Office allocates this number out. Sweet said there is a CPC Restructuring Proposal, or CPC Redesign Proposal, which will soon be going to the State Legislature. One of the pieces of this legislation is that more State funding comes in. This would change the ratio of County to State funding; currently they fund MH/DD Services about equally, 50/50. The Redesign Proposal would alter this so the State contributed 75% of funding, and the counties only 25%. Neuzil asked if they would then lower the cap even more; Sweet said she didn’t know, but they could just kick in more State dollars over a period of years, leaving County funding where it is. Sweet and Neuzil agreed that they didn’t think this would happen. Neuzil thought they should do a better job of educating the public about how MH/DD is funded; Stutsman suggested including this in their budget presentation, and Neuzil concurred. Neuzil said his standard answer, that 38% of the County’s budget goes for Human Services, is not correct. Sweet summarized that about $3 million of her $9 million budget comes from Johnson County property taxpayers. Stutsman said everyone wants simple answers, but the funding sources and issues are very complicated. Thompson said it can be confusing, and noted that the MH/DD budget shows County taxes as a revenue, whereas Planning and Zoning’s budget does not. Neuzil agreed that this is confusing, and repeated his belief that many in the community do not understand this. Sweet said the entire MH/DD system is very complicated, not just in Johnson County, but statewide. Thompson asked if Sweet is again recommending that they stay at the maximum taxable amount? Sweet said yes.

Thompson asked Sweet to talk about fund balances. Sweet pointed out that $2,326,087 is the total of the Allowed Gross, the 25% per capita criteria, and the Community Services; this is what MH/DD was told they would be getting from those 3 sources. Last spring, she said, the decision was made to adjust the State allocations in conjunction with County’s fund balances: the lower the fund balances, the higher the amount of State dollars received. Sweet said Johnson County’s fund balances were high enough to negatively affect MH/DD revenues. Sweet said Johnson County was in the 15%-24% fund balance category. Sweet said she wanted to talk about where they fall in the 15%-24% category, and how it relates to the Targeted Case Management on anticipated revenues last year. She explained that they had tried to carry over $194,000 in Case Management revenues so it wouldn’t go into their fund balance, but they couldn’t find a way to do it. She said those revenues had been unplanned, and they couldn’t get it spent by June 30th, and it couldn’t be set aside in another fund, so it went into MH/DD’s fund balance. Because of this, the fund balance was 17% of expenses, which threw them into the 15%-24% category. If it hadn’t been there, she said, the fund balance would have been 14.8%, and they would have received the full allocation, resulting in more State money. She said this cost the County $297,740. Neuzil asked if they were better off than they were when they were in the 25%-34% fund balance range; Sweet said yes, but it was too bad that they had missed the 0-14% range. Sweet said that, in effect, the $194,000 in retroactive Case Management reimbursement cost the County $297,000. She said this shows how fragile the system is, and how one little item can throw things off to such a high degree. Thompson said Sweet will probably be coming in for a budget amendment if the same situation occurs, to get the money spent in the right year. Sweet said the invoices that they held impacted the cash, but not the accrual basis, so that would not have helped the situation.

Sweet said she will be coming to the Board regularly in the next 6 months to give updates on the management information system; every effort must be made to expend the money in the management information system by the end of the current fiscal year. Sweet said the management information system will also better allow her to monitor and manipulate some of the numbers and accounting at the end of the fiscal year. Neuzil thought this problem was a one-time deal; Sweet said they hoped it was, but said it was legislated and passed on guesswork. She wondered, then, if they would be tinkering with the levels as counties worked to reduce fund balances. Sweet said the thing that will not change is the target reduction of $15,554,000. Thompson thought they will shift the numbers. Sweet said it is also important to remember that there is a statutory requirement that they cannot budget over 99% of their revenues. Thompson asked about a projected fund balance for this year, and Sweet answered she couldn’t even fathom a guess at this early date. She said they just got financial records from the Auditor’s Office that showed their budget 39% spent at the end of November, but a number of additional factors needed to be figured in.

Sweet said that MH/DD badly needs a new management information system to help manage and allocate its large and complicated budget. Sweet said Schultz has been working very closely with MH/DD, and has assigned Program Analyst II Shirley Barker to the project. Stutsman asked if MH/DD was planning on buying a separate system than the financial software the County was proposing, and Sweet answered not necessarily. Sweet said if the County’s system will accommodate MH/DD’s needs, that would be fine. Neuzil didn’t think they would have a County system before July 1, and encouraged Sweet to pursue other options. Horne said one possibility was if MH/DD could separately purchase a software module, which could connect to a future County system. Sweet surmised it will be difficult to find software to accommodate all of MH/DD’s needs with case management and encumbrance. Sweet said she was going to leave these issues in the hands of the County Information Services Department, because she is not an expert in this area. Stutsman asked what is going to happen if/when the State changes their criteria? Sweet said it is so important to have current data, in order to know how to react. Sweet said that currently they have hardly been able to put together the data for the current fiscal year, and they are 5 months into it. She said it is not a comfortable place to be. Neuzil asked if Sweet anticipated the implementation of a waiting list this year? She said it looked like they probably would be using a waiting list, at least by March, but said she didn’t have the data to support it or not. She said she tried to act on the best data available, but with MH/DD’s current information system, that best data wasn’t very good. In closing, Sweet asked the Board not to reduce the property tax.

(Continued in Part 4)