Chairperson Harney called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 3:03 a.m. Members present were: Pat Harney, Mike Lehman, Terrence Neuzil, Sally Stutsman, and Carol Thompson.

Mental Health/Developmental Disabilities Director Elaine Sweet introduced Administrative Assistant Beth Wick, Financial and Statistical Supervisor Debbie Guard, and Clinical Supervisor Bruce Juetten. Sweet said she felt the need to relate the status and some of the difficulties of the department and has prepared a to-do list. She said that they have tried to identify the situation and reasonable actions that are needed. She said that they have also prioritized what they have to do and want to discuss with the Board some possible solutions of what they are facing. Sweet said the to-do list is items that are not normal daily, weekly or monthly routines. They divided the to-do list into 3 categories: Targeted Case Management, Administrative, which is primarily the CPC function and the 3rd identifies routine items.

Sweet said there are 2 Targeted Case Management Cost reports that are due every year. One is the actual Fiscal Year Cost Report that takes the expenses for the Fiscal Year and tells the payer how much it costs MH/DD to provide that service on a unit basis. The payer then looks at the actual cost versus the interim rate and makes up the difference. Sweet said that they aren’t able to do an actual cost report until they have final numbers for the year. She said the Projected Cost Report is due in June each year, but in order to projections they have to have a feel on how they are ending the year. She said they didn’t have any information until December on how they were past early spring in Fiscal Year 02. Sweet said that both the Projected Cost Report and the Actual Targeted Case Management (TCM) are seriously delinquent. She said that Human Services Accountant Kathy Lynch is not an MH/DD staff member, but is responsible for preparing the cost reports. Sweet said that she does not direct Lynch’s work and isn’t able to establish Lynch’s priorities. She said that has been part of the problem and also the workload in MH/DD. Sweet said she considers this to be the biggest priority on their plate right now. She recommends considering this to be the one thing that needs to get done as quickly as possible. She said the action they feel is needed is that MH/DD needs to have draft copies of the cost reports to review. She said she isn’t going to be comfortable just signing them. She said the supporting documentation needs to be there for them to review, also and they need to have further dialogue with the Board of Supervisors as to how the cost reports are signed and the responsibility associated with them under the circumstances. She said both Lynch and MH/DD need to be freed up to complete those cost reports.

Thompson asked if the numbers for the cost reports are ready now. Sweet said they are still working on numbers. Thompson asked which numbers are not available yet. Sweet said Lynch asked her this morning for percentage numbers, but did not specify which ones. Guard said that it has been really difficult trying to come up with percentages because of going back and doing work analysis and using the tracking sheets to assign percentages. She said that they didn’t start doing that on the administrative side until late in the year. Stutsman asked how other counties handle this. Sweet said that usually the TCM program itself is responsible for doing the cost reports. Stutsman said she doesn’t understand why there are so many layers. Thompson said part of it is that it meshes with the local administrative. She said that someone has to figure out where they have shared costs, like the building. She said that those costs have to be allocated to the various programs so that some of those costs could go into the TCM. She said that a lot of counties don’t have this situation because they don’t have any shared costs. Neuzil said it seems like there is a management structure problem. Thompson said that if Lynch doesn’t have the numbers for calculation then there is no way for her to do what she needs to do. Sweet said it is shared responsibility and is not suggesting it is all one person’s fault or all one person’s responsibility. Sweet said directing the work is only one of the problems. She said administrative expense is another problem because MH/DD usually does not pay for any of the indirect expenses. She said that those are paid for by DHS, Department 45, which is another 2 layers of allocation which need to be allocated to MH/DD and then reallocated to TCM, Social Work and the CPC function. She said there are multiple layers of allocations and she doesn’t ever see the administrative expenses or the local administrative reimbursement. Sweet said she is going to be really uncomfortable putting her name on a document and certifying to the Federal government that it is accurate when she isn’t familiar with a large part of the cost report. Neuzil asked Sweet what she did last year. She said she trusted that it would be OK and signed it. She said she has learned a lot in the last year. Thompson said the local administrative reimbursement has been audited many times.

Neuzil asked what Sweet needs the Board to do so that she is able to accomplish this. He asked if she would like the Board to inform Lynch that as a County paid employee, this is a top priority. Sweet said that would be very helpful. Lehman asked what the hold up is in Lynch getting her percentages from Guard. Guard said she doesn’t know because she has given all that she can already. Thompson said if Lynch feels like she has the numbers, she will do the work. Sweet said she is only looking for the Board’s support in letting Lynch know that this is the number one priority that needs to be done as quickly as possible. She said that Lynch didn’t have these numbers to work with until December, even though the cost report was due in June. Sweet said that if this isn’t done soon she thinks it is going to come back to haunt them. Thompson asked if Lynch has not been showing them the spreadsheet. Sweet said that she has not seen any of it. Thompson said that if she asks to see it then she probably could. Stutsman asked if someone from the Board going to work with Lynch. She said that much of this is due to the lack of communication between DHS Area Administrator Cheryl Whitney and Sweet. She said that maybe Sweet needs to establish those lines of communication again. Stutsman said that this will solve the problem for today, but she thinks that they need to sit down and get a handle on this. She said that when she went to Quilogy last week she was embarrassed by the system that Johnson County has for paying the bills versus what other counties were reporting. She said she has never heard of anything so convoluted when they are supposed to be talking about efficiency in government. Stutsman said it makes her wonder if the local administrative reimbursement is worth their time.

Thompson asked if it would be better for Sweet to calculate the TCM and get the numbers from Lynch. Sweet said she would like for the cost reports in the future to be prepared by Guard. She said in the past she has not had a Financial and Statistical Supervisor and thinks this function needs to be moved from Lynch to MH/DD. Thompson said that this is done quarterly, so at the end of any quarter they could have 4 quarters worth to calculate on. She said it would make the transfer of information better if they thought they had the capability to do it. Sweet said that both Guard and Lynch went to cost report training with the intent of Guard becoming more involved. Sweet said she thinks the long-term solution is to have this done in MH/DD, but it doesn’t solve the immediate problem. Harney asked who would make this decision. Sweet said she isn’t sure and would probably visit with Human Resources Director Lora Shramek to see about moving job responsibilities from one job to another and from one department to another. Thompson said she doesn’t think the TCM is in Lynch’s job description.

Stutsman asked if the Board is in agreement to do this. Lehman said the sooner the better. Thompson said that once the new software is working, the billing won't be as complex as it is now. Sweet agreed. Thompson asked if Lynch will still be doing the billing. Sweet said it would be a minor role if any at all. Stutsman asked the other Board Members what they have decided. Harney said he doesn’t mind talking with Lynch. Sweet suggested a casual phone call saying the Board thinks this is a priority and would she work with MH/DD, just so she knows it is the Board’s priority. Guard said that everybody has so much on their plate that it becomes difficult trying to attach 2 different department priorities to get one thing done. Stutsman said she thinks the appropriate process is going through Whitney, since she supervises Lynch. She thinks it is unfair to tell Lynch what they would like her to do without talking to Whitney. Thompson asked if they should also mention transferring the TCM report to Guard. Stutsman and Lehman said yes. Neuzil asked Harney if he would do this because he is Chair. Harney said that is fine.

Sweet said TCM billing is another priority. Thompson asked Sweet if she has been calculating the numbers of clients. Sweet said they have been collecting all of the information. She said that some of it is done manually and some of it is done on a basic spreadsheet. She said it would be duplicating efforts if they entered part of it now and then had to go back. She said that they have as much done as possible to have it ready to go, but there is going to be a fairly significant amount of time involved in doing the billing once they get the projected rate. She said that nothing has been billed this year so right now they are looking at 8 months. She said they are being optimistic to say that they will have an approved rate before the end of February. She said she hopes that sometime in March they would have that approved rate. Harney asked why this is so far behind. Sweet said they haven’t had the data to work with and they aren’t able to do the billing until they have the projected rate, which is based on the projected cost report. Sweet said they don’t know how long it will take for the cash to start coming back so she can see some potential problems with cash flow at the end of the year. Sweet said that there is about $500,000 in their budget, but unless they get this done and get the billings out so that the money is able to start coming back in, the cash fund is going to be short that money at the end of the year. Stutsman asked what they are going to do about this. Thompson said that there isn’t anything they can do about it. She said they have to get the rate.

Harney asked if all of the open employee slots are full now. Sweet said they have the Quality Assurance position, which is currently a .75 that is vacant. She said they also have a .5 Case Manager position that is vacant. She said these go along with her Fiscal Year 2004 budget request to combine these 2 positions into one FTE. She said she would like to take the financial eligibility screening away from the Case Managers and give it to that position, and thus be able to offer the position a little bit more for recruitment. She said this position has been vacant for 3 years and they have tried to recruit for it but they don’t get the applicants they need because the starting salary is so low. Sweet said in the past they have filled the position with independent contractors but are hoping to be able to get a regular employee. Thompson said the Board approved that and Sweet could go ahead with that. Sweet said it is approved for next year’s budget and the job description has not been rewritten at this point in time. She said they need to rewrite the job description, get it approved and then recruit and train that position. Thompson asked if she is going to wait until after July 1st. Sweet said not if the Board gives her approval to move ahead with it now. Thompson said that would be the thing to do. Harney said that if it has been approved then the preparations could be made to have the hiring right after July 1st. Thompson said she has the money and could hire now. Stutsman said it will take the Board telling Shramek that this is a priority. She said the Public Health Department also has job descriptions that they want redone. Sweet said that as they move along, the Board is probably going to have to tell her where they want her to direct her time. Sweet said with all of the things that need done in her department there is no way they can stretch themselves to accomplish them.

Sweet said that Chapter 90 is a brand new section of administrative rules that goes into effect March 11th. She said it means that all of their TCM cases is going to have to be reviewed for preauthorized payment. Sweet said if if someone goes into the hospital for surgery the insurance company says how many days that person is able to stay in the hospital, and any changes have to be approved by the insurance company. She said this is similar to what they will be doing with TCM. She said that right now the implementation date for TCM is March 11, meaning that every TCM case has to be reviewed for appropriateness. She said that once a year every case has to be reviewed for continued need. Sweet said that documentation in those case files is going to be most important. She said that they have to know the things that they have to be watching for and the things that have to be documented in those case files or their TCM cases aren’t going to be authorized for payment. She said that the end result of that would be more of their costs being directed towards social work cases, less towards TCM cases and their revenues would go down accordingly. Sweet said they have to be on top of this. Thompson asked if it is correct that they are having the training on March 16th and the implementation begins on the 11th. Sweet said that is correct. Thompson asked who has to do the preauthorization. Sweet said that Consultec is going to do some of it and Merit is going to do the rest of it. Juetten said they have a hard time obtaining what they need for the files in Johnson County. He said he has tried to address this in emails to service providers as to how they write their diagnosis but it hasn’t worked so far. He said there are going to be problems with this. Stutsman asked who will be going to the training. Sweet said all Case Managers are being encouraged to attend so that they get the hands on training to know what the expectation is going to be for gathering data and those files.

Harney asked who Juetten is sending emails to. Juetten said a number of different parties. Harney asked if this is at the University. Juetten said he isn’t able to approach the University and he really can’t approach Dr. Michaelson although one of the Case Managers complained to him. He said that Dr. Michaelson said he would get in touch with Merit and nail down with them what they expect. Juetten said he has made attempts in the past to contact Merit and CCMS. Thompson asked if it would be up to him to meet with the Psychiatric Hospital and the Mental Health Center to let them know what they need to be documenting. Juetten said that once he has adequate information as to what is expected, he doesn’t think it is going to be an issue, at least with the Mental Health Center. He said that the University is a bit more difficult to deal with. Thompson said that if Jay Cayner is still the Director of Social Services for UIHC, he can be hlepful a sa mediator. Juetten said that things are going to become clearer as the rules for preauthorization are established. He said the pre-authorization has been in the works for at least a year as far as he knows. Thompson asked when all of the pre-authorizations have to be done once everyone is trained. Sweet said she isn’t sure. She said it sounds like they are going to want everyone currently on case management to be approved immediately, but they aren’t going to know for sure though until they actually get the training.

Sweet said the 4th item on their to-do list is the Accreditation Survey. She said that Bonnie Severson is the Quality Assurance Specialist that is responsible for all of the accreditation reviews. Sweet said this is taken very seriously and every line item has to be in compliance with the standards. She said last time it was their policy and procedural manual that saved them with their accreditation. She said that they probably would have been given a one year or probationary status if they hadn’t spent a lot of time in developing their policy and procedure manual. She said they received a 100% score on that and it raised their average high enough so that they were awarded a 3-year accreditation. She said that this time it is probably going to be their services that have the higher score and the administrative component is probably going to be lower. She said the Accreditation Committee is scheduled to come in next fall and are going to be looking at MH/DD records back to the fall of 2000 and score them. Thompson said Accreditation is what relies heavily on the case files. Sweet said both case files and administration. Thompson asked if the case files are reviewed monthly. Juetten said he reviews cases with Case Managers on a regular basis. He said he doesn’t know where he would find the time to review case files. He said that would be a Quality Assurance responsibility. Sweet said that Juetten supervises about 18 Case Managers and concentrates on the clinical. Sweet said they had been doing quarterly case file reviews up until last summer. Sweet said case file review is a responsibility of the Quality Assurance Specialist/Financial Eligibility Specialist that they’ve been talking about. Sweet said that up until this fiscal year they were in good shape. Juetten said their Quality Assurance looks at content in case files and not quality of documentation. Sweet said that County Case Management Services (CCMS) comes in and looks at that portion. Sweet said that CCMS is a service that they contract with ISAC. She said they pay ISAC $4 per month for every case management case to provide them with that sort of technical assistance. Sweet said ISAC will also help them update the Policy and Procedures manual. Sweet pointed out that page 19 talks about the accreditation decisions. She said that providers are awarded a 3-year, 1-year or 180-day accreditation. She said she feels they have done a good job with their TCM and that their problems really only lie in the administrative component and then only in this fiscal year. Juetten said their staff does high quality work. Sweet said that when standards are changed it takes awhile to get them in place. She said the issue also seems to be with catching up and maintaining. She said the action they feel is needed is that if they are going to be accredited in the fall then they are going to have to begin immediately reviewing those standards.

Sweet said another item on their to-do list is standard annual staff evaluations, which Chapter 24 requires. She said that this is an area that they are behind on. She said she doesn’t know that there are any performance evaluations at this point in time that are current. She said one of the problems with the evaluations is identifying which tool they are supposed to use. She said that they haven’t been able to get any confirmation on that. She said that their 28E Agreement with the Department of Human Services says that if they hire people through that 28E Agreement, then they have to use the Iowa Department of Personnel (IDOP) evaluation form. She said they are receiving mixed messages on this from different people and there are different forms for different positions. Stutsman asked what they did last time. Sweet said that there was an IDOP form and now they have changed the IDOP handbook and they haven’t been able to identify any evaluation form through IDOP that they are supposed to be using for the Case Managers. Stutsman asked what other counties are doing. Sweet said she doesn’t think that any of the other counties have 28E Agreements or hire their Case Managers through IDOP. She said they have DHS Case Managers through DHS Case Management. She said that this wouldn’t apply since their Case Managers are hired as Social Worker II’s. Stutsman they have to practical. She said to pick out an evaluation tool and use it. Guard said she only has 2 staff members and was told to use the forms they previously used. She said that when she went back to the files, a different form was used for each person. She said that those employees are on comparable levels so she doesn’t know why there would be different evaluation tools. Thompson suggested that they pick the one they like best. Guard said she was told she couldn’t. Stutsman said that they could bring an evaluation tool to the Board and they would put it on the agenda and make it the official evaluation tool. Guard said that in her conversations with Shramek what was applicable under the Union contract was brought up and whether the Bargaining Unit has a right to say what evaluation tool was used. Thompson said that it is only when you haven’t been doing evaluations and you want to start that you have to get permission from the union. Guard asked how they could change the tool. Thompson said to send them the tool and inform them that this is what they are planning to use.

Juetten said that there are certain protocols that go with certain forms. He said that he has never found a copy of those protocols to fill out the form. He said that with the new IDOP form there are instructions and it is more user friendly. He said it is different from the previous one and he doesn’t know if that is going to be a problem with the Union. Thompson said the important thing is that they use the same standards to retain their workers that DHS does, which means having an annual review. Stutsman asked what happens if they don’t do it. Thompson said they would get Union grievances. Juetten said they have to make sure to keep County and State workers separate. He said he was also told that since they were State workers they could use any evaluation form that the County chose to use because the County is the employer. He said that it was suggested to him to have Whitney do the evaluations. He said there is a slim to none chance of that happening though because Whitney doesn’t have time to do that, she doesn’t supervise those employees, nor does she know anything about what they are doing. He said he wouldn’t even approach her with this suggestion. Stutsman said that too much time is being spent over this and for them to just bring an evaluation form to the Board and they would approve it. Thompson said they do need to talk with Shramek about the procedures and the Union. She said she thinks it is more of a matter of notifying them rather than getting their permission. Juetten asked where the employee gets to make the decision as to how they are going to evaluate the people that work for them. Stutsman said she thinks that is the management decision and is what he is to do. Thompson said that if they would like to have a different one for administrative staff it makes sense to her. Guard agreed.

Sweet said the policy and procedure manual is important and is going to be a part of their accreditation, but it doesn’t need to be done right now. She said it would be on their plate though in the next few months. Sweet said they are thankful that they are part of the CCMS through ISAC. She said that they have completed a sample policy and procedure manual to use as a guide and adapt it to their TCM processes.

Sweet next went over their Quality Assurance priority. She said the Quality Assurance position is responsible for the quarterly QA reviews. She said they are only 2 quarters behind now, but they do need to move on it because by March 31st they are going to be 3 quarters behind. She said she doesn’t think it is going to be a problem once they get a person in that position. Sweet said they could also bring in temporary people to get extra help for some of the priorities. Stutsman asked which things they could do that with. Sweet said that if they could find people with experience in TCM they could come in and do a quarter in about 5 days. Stutsman said that they don’t need the Board’s approval to hire temporaries because they have hired temporaries before.

Sweet said the next priority, the consumer satisfaction survey, is an annual requirement for the TCM Program. She said the last 2 years they have contracted that out and she thinks they should consider doing that again this year on a smaller scale. Stutsman asked if there is a reason to change the evaluation tool. Sweet said there were some Planning Council Members last year that thought they should have changed the tool before they did the satisfaction survey. She said that to be consistent she thinks they should use the same instrument for a few years. Thompson asked if she is comparing the years. Sweet said yes. Stutsman said it seems like some of these things are a management decision. She said it also sounds reasonable to her to use the same tool. Sweet said she would check with Shramek as to the process for hiring people to do the consumer satisfaction survey.

Sweet said the Administrative and Management Information Systems is one of their top priorities. She said that they need to have this up and running by June 30th or they are going to go another year without having the data collection and the historical data to work with. Sweet said they are still waiting for Polk County changes to be finalized. She said that is the first action step that is needed and that adaptation to Johnson County should be fairly simple. She said that there is one table that needs to be completed and then they would migrate their client data to the new system and train staff. She said the system would have to be tested and monitored, to be sure that it is working the way that it is supposed to and that it is giving them accurate information. Stutsman asked who would do that. Sweet said it would be done internally. She said that they would have to be comparing the manual results with the electronic results for a test period to be sure that they are getting the same results both places. Thompson asked if the information in Comas is up to date. Guard said that it is. Stutsman asked if extra staff is needed for the data entry. Sweet said they discussed that and the only data that they are going to migrate to the new system is the client specific data, so there isn’t going to be any history there. She said that if they want history they would have to hire outside help to come in and do the data entry. She said that when she talks about history she is talking about what services they received for the last 3 years, who the provider was, how much did they pay, etc. She said that if they want to have this comparative data then they would have to have someone come in and do it. Guard said she doesn’t think the history is that important because the Comas still works and what is needed could be picked from there and compared if needed. Juetten added that if it was important it could be something that they could do in the future. Guard said something that she has noticed that might want to be in there are things pertinent to legal settlement, such as old addresses and things of that nature. She said that could be done on a per client basis. She said that they could enter the ones that aren’t current clients at a later date.

Sweet said the 28E Agreement with Polk County needs to be renegotiated before June 30th. She said she emailed Assistant County Attorney Andy Chappell and County Attorney J. Patrick White last week to make them aware that they would need to be looking at that. Stutsman asked if she needs any additional help from the Board to get this process moving. Sweet said not at this time but if she does she would let the Board know. Thompson asked if Sweet has done the background work with Polk County. Sweet said that they have had preliminary discussions on it because they have been so busy in trying to get the bugs worked out of the system and get it working. Lehman said the County Attorney doesn’t really have anything to work with yet. Sweet agreed. Thompson said she spoke with Chappell last week and he thinks his role is reviewing a contract to make sure it is legal. She said he doesn’t see that he has a role in negotiating the contract or writing it. Sweet said that is good to know.

Sweet said that other actions needed with regards to the Management Information System include working with Polk County, Quilogy and marketing the MIS to other counties. She said she understands that Polk County is even getting inquiries now from some agencies working on the State level with other providers. She said they are one of the few systems that is HIPAA compliant. She said that the potential for marketing the system is tremendous and now is the time to be doing it. Stutsman asked who would do that. Sweet said that Polk County is working on that, too. She said the association with Polk County has been good for Johnson County. Thompson asked if she feels like they would be honest. Sweet said they have gone out of their way to work with them and they don’t charge. She said they have even offered to have their technical people come and work with the Johnson County Information Service staff. Harney said it’s important to have the 28E Agreement in place. Sweet said there needs to be a partnership if it is going to be 50/50. Thompson asked if she needs backing from IS on that. Sweet said that all of the IS staff are wonderful and are doing everything that they can. Harney asked what they need to keep this going. Sweet said probably spending a little more time in developing the future system with them and working out the kinks in the contracts and agreements and things. Stutsman said the marketing, too. Sweet said that they need to consider the direction that they want to go in for the future. Thompson said this is a big deal and there is a lot of case law on it because of all of the licensing that other computer companies do. She said that maybe they need someone who specializes in that area of the law to help them. Stutsman said maybe they need to think about resources in not only the legalities of it but also in the marketing. She said it isn’t going to work to tell Polk County that the Johnson County Attorney’s Office is too busy to review this. She said that if they are going to be a partner then they have to be a well cooperating partner and that means no delays. Guard said they need to carry their own load. Sweet said they did put in equal amounts of cash. She said that Johnson County purchased the right to use their product, which was $130,000 last spring and they were able to demonstrate they had put in much more than that into their cost, time and effort. She said that Johnson County came out the winner there because it didn’t even account for half of what Polk County had invested in the system to begin with. She said that they each put $50,000 in to continue to develop the product and that is what Polk County is working with right now to make the fixes and get Johnson County on board. Harney asked if it is Polk County or Quilogy that is doing it. Sweet said that Quilogy is working with Polk County. She said that is what the $50,000 is for. She said that one of the things that Johnson County does that Polk County doesn’t is Case Management. She said the Case Management model needs to be developed and Polk County isn’t going to be able to use that. She said that Polk County really is accommodating them and working with them. Thompson said it is a very complex area of the law and it is primarily private business that does it, so all of those rules are going to be grafted onto government.

Lehman said the MIS system is going to be a source of revenue and asked if Johnson County is allowed to have an entity within MH/DD that generates revenue other than tax money. Stutsman said yes. Thompson said that if it works it will be a substantial source of revenue. Stutsman said this is one way for Johnson County to get additional dollars into this budget. Lehman asked if the State Auditors have said this is legitimate. Stutsman asked if they need to have a discussion with White about what they need to make this work and if he is going to be willing to provide the resources or if he has some ideas. Harney said how much they are expected to continue to put into this to keep it updated and operational goes along with that. Sweet said that if they don’t partner with Polk County it would probably cost Johnson County more because they are now sharing the cost of the things that they both need.

Sweet said that she is surprised by Chappell’s comment that he only wants to review a contract because last spring when they were looking at working with Polk County, Chappell and the Polk County Assistant County Attorney were the ones who negotiated the agreement. She said that Polk County, MH/DD and her sat down and reviewed the products that the 2 attorneys came up with. Harney said this might be a place to define what Polk County’s expectations of Johnson County are. Sweet said that last year all that they agreed to was to work on an agreement this year. Stutsman said they are talking about 2 things, the 28E Agreement and the licensing. Sweet said she thinks the licensing is a part of the 28E Agreement. Lehman added maybe the marketing. Sweet said also the format and business structure they want to use is something to consider. She said that maybe the first thing they need to do is sit down with Polk County and come up with a list of everything that needs to be decided and what the questions are. Stutsman said she would like for Johnson County to be timely in their responses to what Polk County needs. Thompson said they also need to get it done in time to get it filed in the State office.

Sweet said the County Rate Information System (CRIS) has requested the Fiscal Year 04 negotiated rates by February 28th and that isn’t going to happen. She said that service information forms are due right now, also. She said that they need to be negotiating the ’04 contracts. She said the contract document itself needs to be revised to accommodate more flexibility. She said they contract with 16 agencies. Thompson asked if Sweet has a current CRIS report from every agency. Sweet said she thinks she doesn’t but isn’t sure.

Sweet said that when they met on the contracting they discussed asking Bremer County CPC Russell Wood assist with some of the contracting by analyzing the rates from the cost report and putting them into a format that could be comparative. She said that she visited with him last week and his hours had been increased and he is also covering temporarily for someone that is out on a leave of absence, making him unavailable currently. She said it does take longer to train someone who isn’t familiar with the system at all then it does to do it oneself. Stutsman asked if Sweet could do it. Sweet said that if she has the time to do it all she could. Thompson asked if Guard or Wick could collect the information from the CRIS reports and put it on the spreadsheet. Guard said she isn’t going to commit because if she has to work on the MIS and the other things she does then she doesn’t have spare time to work on contracts, too. Thompson said it is important to her to have Sweet negotiate the contracts herself, but putting the information in order could be done by someone else. Sweet said that time is the issue here. Stutsman asked if it would take more time to find someone than it would to just do it. Sweet said that if there are people out there who know the system and who would be willing to come in and help them on a temporary basis then it could be done quickly. Thompson asked about an auditing firm. Sweet said that they could probably help also but they would have to pay $125 an hour. Thompson said that it does have to be done and the deadline is coming. Sweet said there is some flexibility with CRIS and she has begged time with them. Wick said she isn’t saying that she couldn’t do it, but she has only been here 9 days and she would have to be trained. Sweet said they also have a lot of Committee meetings they attend. Harney suggested postponing those meetings to get the work done. Sweet said that might be a good idea since some of the things coming out of the Committee meetings are for down the road. Stutsman said that every once in awhile the Board of Supervisors needs to say they are in charge. Sweet said that unless the Board of Supervisors tells them differently, they aren’t going to be spending their time on the B and C priorities until the A’s are done. Sweet said the summer program for children is a big concern for her, too.

Thompson said that for the contracts Sweet needs to get the new contract form. Thompson said they don’t have that nailed down because they were hoping to put in something about incentive payments into that. She said that they also need to get the CRIS information organized and then meetings set up with all of the agencies. Sweet said that part of the contracting process is to be sure that they have all of the supporting documentation from the providers to be sure that they have met their accreditation standards and that they are licensed and doing their background checks on their staff members. She said contracting is a very time consuming process. Stutsman asked about the Board of Supervisors requesting that provider rates for Fiscal Year 2004 being negotiated based on cost. Sweet said she thought the cost identified in the CRIS cost reports is the ongoing discussion that they have had. Stutsman said she thought they had said that cost would be sent in and Sweet would negotiate. She asked if this is meaning that Sweet would base what providers are paid strictly based on the cost. Sweet said that under action needed she said that they need to look at the cost reports and then discuss with the agencies to identify extenuating circumstances and costs not reflected in those cost reports. She said that it is her understanding that the rates the Board wants Sweet to bring to them either need to start with cost or need to document anything different from that cost. Stutsman said that is what she understood too, but she wasn’t reading it in this.

Neuzil left at 4:36 p.m. and returned at 4:40 p.m.

Thompson said Sweet has done well in identifying priorities. She said the problem is how are they going to get done. Thompson asked Sweet if she would be able to get someone else if Russell Wood is not available. Sweet said that there are 2 people she knows of that are very familiar with the MH/DD Services system that are not currently working. She said one is Linda Hinton, who was formerly with the division of MH/DD and was one of Jesse Rasmussen’s associates. Sweet said that Hinton is doing contract work, but not full-time and asked if the County has any work for her. She said the other one is Sandy Holst, who retired with the last round of budget cuts this spring. She said that she has not visited with Holst for quite awhile. Stutsman said that either one of them would be outstanding. Sweet agreed. She said that they would be able to help them get caught up on a lot of things. She said they’ve both held some very responsible positions in state government. Sweet said that another option is if there are any departments in the County having staff that would have some familiarity with contracting maybe they would be available to come in. Stutsman said maybe someone from the Health Department. She said it makes sense to hire someone like Hinton or Holst because they understand the system, but they then still have to put contracts in place. Sweet said that in her conversation with Shramek, she got the impression that contracting probably wasn’t the best way to go because you can’t direct their work. Sweet said they would either hire someone through a temporary agency or as a part-time temporary County employee. She said that if they are going to be hired as a temporary County employee, then they would need a job description. Stutsman asked if Hinton and Holst would sign up through the temporary agency. Sweet said yes. Thompson asked if the temp agency takes 10% or 25%. Sweet said she isn’t sure but she thinks it depends on the salary and wage rate. Stutsman said she thinks it makes more sense for the County to do it rather than to give a cut to a temporary agency. Sweet said she would talk with Shramek again and find out about what benefits they would have to give. Thompson said that the cleanest way is to go through the temporary agency and use their contract. Harney asked if these people have the expertise that Sweet needs. Sweet said yes.

Neuzil asked if Sweet has seen the latest ISAC contracts. Sweet said she forwarded those drafts to the County Attorney’s Office a couple of weeks ago. Stutsman said that all of this would just be temporary because she thinks that once Sweet gets a handle on all of this it would be her job. Sweet said it is her job, whether that means actually doing it or working with her staff to do it. She said the department of MH/DD couldn’t be any better than it is. She said they have a great management team and great staff. Sweet said they do have the ability to do this if they are able to fill the QA position. She said these are the things she likes to do and was hired to do but right now they are so far behind that she doesn’t have time to do it or time to catch up on it. She said that once they get caught up, if they are staffed then they would be able to maintain it. Stutsman asked if Sweet is going to check with Shramek about hiring temporary employees. Sweet asked if that would be OK and then get back to the Board and identify what items in the priority list she feels those employees would be able to help with. Neuzil asked her to send the correspondence with Shramek to them, too.

Thompson asked Sweet if she plans to contract with someone to do just the agency contracts or some of the other work, too. Sweet asked if the Board saw the email that Assistant County Attorney Janet Lyness forwarded this morning. Sweet said that it basically said they shouldn’t be working with anyone they don’t have a contract with or paying anyone they don’t have a contract with. She said she sent Lyness the Polk County contracts, and the non-traditional provider ones. Sweet said she sat down yesterday and changed the Polk County contracts to Johnson County procedures. She said she has it ready to send to Lyness again, asking her what needs to be changed before moving forward. She said that she hopes to get an answer soon on that and can move ahead with that. She said that she has everything in place except for the contracts. Thompson said to let the Board know when she sends it to the County Attorney. Stutsman asked how many non-traditional contracts there are. Sweet said she thinks that there are 8 providing services right now and there are several requests for new ones. She asked if they are providing a valuable service. Sweet said yes. Thompson said that a number of these things are items that the Quality Assurance person would be doing once hired and trained. Sweet said that MH/DD, under normal conditions works very well. She said they have their processes in place and have excellent staff that know what they’re doing.

Sweet said they spent some significant money last year on the provider quality assurance, which is something that needs to be followed up on and continued and done on a regular basis. She said the Quality Assurance position will be able to do this.

Sweet said there is some data entry catch-up. Guard said that involves getting the claims into the Comas system. Guard said that her employees are good, when they’re there. She said they currently have about a 72% attendance rate. Thompson said that if someone’s absence affects their job performance then discipline could be taken. Guard said that isn’t what Human Resources is telling her. She said that one person is on FMLA. Thompson said that Guard can suggest that her employees use the Employee Assistance Program.

Sweet said that waiver consolidation is scheduled for July 1st and is going to have some implications for them on programming and funding. Sweet said that HIPAA is a priority, but she thinks that Executive Assistant Mike Sullivan has a good handle on it. Sweet said the needs assessment is required in Chapter 25, making it a priority since it has to be done, but not right now. Thompson asked when it is due. Sweet said December.

Stutsman said she thinks some time needs to be spent thinking about restructuring Planning Council and the Committees. She said Planning Council is an advisory group. She said that every once in awhile they have to step back and be reasonable about what is accomplished in Planning Council and the Committees. Sweet said other County CPC’s think it is incredible the way they do things in Johnson County. She said other County’s Planning Councils only meet twice a year, which she has also considered. She said that the 1st page of Chapter 24 talks about the Advisory Board that is required for Case Management. She said that Johnson County has used Planning Council and Committees as their Case Management Advisory Board and she doesn’t know that that is the best way to handle that TCM Advisory Board. Thompson said they could just have an Advisory Board that does those things. Sweet said for the TCM, maybe have one CPC Advisory board that met a few times a year and then a TCM Advisory Board that met 3 or 4 times a year. Thompson asked if this would be twice as much work. Sweet said not if they didn’t have all of the Committees. She said that this would only be about 8 meetings a year and right now they have more than that every month. She said they could still call together work groups or task forces for specific things like the waiver spots. She said that once they get caught up with the workload and get into a new routine then it could be restructured.

Sweet said the Family Satisfaction Survey priority was something that Guard and her actually argued with the committees telling them that they don’t have the time to do this. She said the Committee decided it needed to be done by June 30th anyway. Thompson said she thinks that the Committees should be structured so that if they think up things to do then they do it. Sweet said that isn’t happening because in their new strategic goals going to public hearing there is very little identified as being done by someone other than MH/DD Services. She said that it is up to MH/DD Services to implement and monitor virtually everything. Sweet said that they also have 2 reports to do that came out of a Planning Council Meeting that are going to be time intensive because everything is done manually. Thompson said they should tell them that they are not able to do it until an MIS system can do it for them. Stutsman said the Board has to be supportive of saying that Sweet has presented the Board with her work schedule and they have agreed with it.

Sweet said that they have been discussing the 28E Agreement with DHS for years. She said that every month there is less of a need for it, but right now it is not a priority either. Juetten asked if part of that 28E Agreement is providing case management support to State cases. Sweet said she doesn’t think that is part of the 28E Agreement. She said that they do the State cases for DHS but she doesn’t think it is written into the 28E Agreement. Thompson asked if they are reimbursed for it. Sweet said not that she is aware of. Thompson said she gets TCM reimbursement for it. Sweet said for the TCM they do but not for the State cases. Stutsman asked if the Board is willing to go ahead and make that change and drop out of the DHS 28E Agreement. Thompson said she doesn’t see any purpose for it anymore. Lehman said they need to see a list of pros and cons. Thompson asked if they would like her to look at it and write up a report. Stutsman said yes, to write an executive summary of the pros and cons and then put it on the Board’s agenda to take care. Guard said the only things she would be concerned with are the shared equipment and what kind of effect that is going to have. Thompson said that wouldn’t make any difference because they would still break it out in the cost allocation. Stutsman said it is also their building and equipment.

Stutsman asked Sweet if she has enough direction from the Board. Sweet said she has enough to keep her busy for awhile. She said she would email the Board and follow up as she works with these things.

Adjourned at 5:10 p.m.

Attest: Tom Slockett, Auditor

By Casie Parkins, Recording Secretary