Budget and Finance Committee Meeting

November 19, 2004 – 7:30 a.m.

DRAFT Minutes

Members present: Kurt Behrenfeld, Chairman; Marilyn Brown; Kay Breed; Carol Tytler; Dr. Paul DiGiovanni; Danny Ross; Newell Willcox; Scott Steve, Chairman of the Legislature

Others present: Ann Homer, Scott Schrader, Jackie Gailor, Harriet Webb, MJ Uttech, Sandy Attleston, Mary Beach, Elaine Lambert, Audrey Lewis, Cathy Feuerherm, John Carroll, Merwin Armstrong, Brian Liberatore, Dennis Whitt, Larry Cornell, Dr. Charles Capanzano, Linda Medeiros, Jamee Sobko, Karen Mastronardi, Greg Moss

Chairman Behrenfeld called the meeting to order 7:38 a.m.

 

• Health Department – Administration – Dr. DiGiovanni remarked on the increase in the revenue and asked why the increase. Ms. Webb explained that it is because of the State Aid projections and we normally don’t spend all of our projected expenses. She explained that the 2003 revenue was the actual revenue, the 2004 is what was adopted, and we don’t yet have our full year of expenditures. The 2004 revenue could be less that is showing as the adopted number. Mrs. Gailor explained that State Aid is a "last resort" revenue. Mr. Schrader indicated that the number in the budget for 2003 is actually a 2002 actual; last year we received over $900,000; to date this year, we have received $800,000. Mrs. Tytler asked if we can realistically received over $1,000,000 in State Aid in 2005 as budgeted? Mr. Schrader is comfortable with the number. Mrs. Breed asked about the five Public Health Education positions. She indicated that other agencies, such as Cooperative Extension, provide health education. She asked which positions were funded by grants. Mrs. Gailor indicated that all the public health education positions are funded by grants. Mrs. Breed then asked about the other positions in Health Administration and whether or not they were funded by grants. Mrs. Gailor indicated that they are not; a portion of the fiscal person is funded by grants. Mrs. Breed asked about the two overtime lines. Mr. Schrader indicated that one line needs to be deleted; however, it will have no effect on the bottom line. Mr. Schrader indicated that deleting the line will not impact the tax levy as the system that calculates the levy has only taken the amount into account once. Mrs. Brown asked why there was such an increase in the overtime figure. Mrs. Gailor indicated because the tobacco grant this year was requiring a full-time position and they don’t have a person. Rather than going for another position before the grant gets underway, they will be utilizing overtime. Mrs. Tytler asked if the excess money had to be used for salary. Mrs. Gailor indicated that the grant requires a full-time FTE. Mrs. Tytler asked about the position at the hospital doing FHP. Mrs. Gailor indicated that this is not our position. Mrs. Breed asked for the reason for so many lines of office supplies. Mr. Schrader indicated that it is due to project accounting. Mr. Schrader commented that Public Health had not been allocating grant funds until they were able to solidify receipt. The money was being placed in professional services and when the expenditures came up, budget modifications were done to spread the money from professional services to the lines needed. The department is now spreading the money for various lines, which is why there is such a difference being show in several lines. Mrs. Breed asked about the $80,000 in special supplies and maintenance. Mrs. Gailor indicated that this is tied to the grant for school incentives; we haven’t received the grant at this point, so we cannot confirm the amount we will be receiving. This program is to create a school health index, which is an assessment. The question is then why is it allocated to the Special Supplies and Maintenance. Ms. Webb indicated that this money is a pending grant and if we don’t receive the grant, the money will be taken out of the budget. Dr. DiGiovanni indicated that in the future, we should have a line for pending grants as opposed to dumping the number into Special Supplies and Maintenance. Mr. Schrader indicated that we don’t utilize a "pending grants" budget line. The question is still what are $80,000 of special supplies. Ms. Feuerherm indicated that it may be special awards for the students who participates. Mrs. Tytler indicated that it might be for money provided to the schools who will then decide what incentives will be provided to the students. Ms. Webb indicated that the total grant is $113,006. Mrs. Breed asked about $70,000 of advertising. Mrs. Gailor indicated that in Health Education there is a lot of advertising; it is tied to the tobacco grant, which requires a lot of advertising. Mrs. Breed asked if that means that the only things in the budget not covered by grants is administrative positions. Mr. Schrader indicated that it is positions and some office supplies. Dr. DiGiovanni indicated that there is also Article 6 money that pays for certain administrative costs as well. Mr. Schrader indicated that he can ask Public Health to break out revenues by project. He can’t guarantee this will be done by December 9^th, but he will request that it be done. Mr. Behrenfeld indicated that the increase in retirement is due to the increased amount we must pay.

 

• Health Department – Nursing – Mrs. Gailor indicated that with nursing, we take into consideration the accountant’s recommendations based on the fees that should be charged for home health services. This has been increased a little based on the figures provided for the first six months of this year. Perhaps it could be increased a bit, but the County Administrator is not comfortable increasing it at this point. Mrs. Breed asked about the increased number of positions. Mr. Schrader indicated that there is the glitch in the MUNIS system; if a position was vacant at the time this report was generated, it shows up as a zero; it does not mean the position didn’t exist. There are no new positions in the budget for this division. Mrs. Breed asked why the Medical Typist went from $2,000 to $11,049? Mr. Schrader indicated that the budget amount last year was not $2,000. Mrs. Gailor indicated that for many nursing positions last year, due to the recruitment issue, they did not budget the full salary. Mrs. Breed asked about the five keyboard specialist/medical typist positions that show as a $0 or minimal amount and this year show a full salary. Mr. Schrader explained that it is an error in the report. Mrs. Breed asked why were are adding these five positions. The response is that we are not adding positions, there is an error in the report. There are no new positions. Mrs. Breed asked about other compensation and raises. What is it? Mrs. Gailor indicated that this is on call, which is from the time we close until the time we open. The question was asked about the increase in the software – it is nursing and accounting software. Mrs. Breed asked if the amount for maintenance, etc. would go down considerably next year. The response was that it would not as the licensing, user fees, etc. are on going. Ms. Feuerherm indicated that we need to purchase 7 laptops and 4 desktops. The laptops are essential to the operation of the division. Mr. Behrenfeld asked about the decrease in medical fees and services. What is the decrease of about $100,000? Ms. Webb indicated it is because something has been moved out of that line. Mr. Schrader indicated that to date, we are on schedule to spend $372,000. Mr. Behrenfeld asked why the 25% increase in retirement if there isn’t an increase in staff. Mr. Schrader indicated that the departments have historically not been using the formula on the entire payroll, but just on the regular payroll.

 

• Health Department – Environmental Health – Mrs. Breed asked if all positions listed are currently filled? Mr. Schrader responded that they are not; and there is a half of position reduction in this division. Mr. Behrenfeld asked about the decreases in the 54055 accounts. Ms. Webb explained this is because the grant money is now spread out as opposed to being lumped into professional services. Mrs. Tytler asked about the rate of Radon in Cortland County and why the Radon is budgeted at $0. Ms. Webb explained that this is the Radon grant; the money will be placed in the budget via re-appropriation at the end of the year. There will still be dollars available to help residents. Mr. Willcox asked about Medical Supplies and Materials. The response is that it is for rabies. Mr. Willcox asked if this is all free money. Ms. Lewis indicated that some of it is donations, some of it is third party reimbursement; so some of the expenses are coming back. Ms. Lewis pointed out on the larvaciding. The money budgeted is for larvaciding twice; however, the County Administrator has cut it down to an amount that will not allow for larvaciding twice. Mrs. Brown asked about page 203; it appears that this page is misplaced. Mr. Schrader indicated that this is due to revenues being allocated to the wrong divisions. Mrs. Brown asked why, if there are all these errors in the budget, we are even looking at these budgets. Mr. Schrader indicated that line items still need to be looked at even with the revenues misallocated. The numbers are all in the budget; however, they are not in a format that make it easy to look at. Mrs. Breed asked about the cancer screening; is this a grant? What does it allow us to do? Mrs. Gailor indicated that it is colorectal, prostrate, and breast health. Mr. Behrenfeld asked why the tobacco money is down. Mr. Schrader indicated it is due to the State and there is no potential recourse to get more.

 

• Health Department - Jacobus Center for Reproductive Health – Dr. DiGiovanni asked about the changes in Medical Services Clerk. This is due to cutting the part-time position and sharing a position with Environmental Health. Mrs. Tytler asked about the proximity of the JCRH with Environmental Health and how the person in the split position would work out. Mrs. Gailor indicated that specific hours would have to be worked out to spend in each unit. Ms. Lambert indicated that cutting the hours of this position might decrease patient fees. Mrs. Gailor indicated that they are going to work on some initiatives and this might not affect patient fees. Mr. Schrader indicated that with proper management and scheduling there will be no effect on patient fee collection. Dr. DiGiovanni asked about malpractice insurance. Mr. Schrader indicated that the $0 in 2004 was an error on his part, as he did not realize there was a contractual obligation to pay the insurance. This amount is budgeted in 2005.

 

• Health Department – Hospice – Mr. Behrenfeld asked about the increased revenue. Ms. Beach responded that it is due to higher patient census. Mr. Behrenfeld asked about the increase in salaries. The response was that it is due to raises for the nurses. Mr. Schrader indicated that there has been a request to reallocate professional services to a per diem nurse. This will be done but it does not have an impact on the bottom line. Mrs. Brown asked if the revenue stays with Hospice. Mr. Schrader indicated that no, they are used to supplement other health department services. Mrs. Gailor indicated that there is a Hospice Foundation that does fundraising and pays other expenses for the division.

 

• Health Department – Children with Special Needs – The facilitated enrollment grant is being decreased about $40,000. Expenses will be decreased accordingly. Mr. Schrader will get the information to the committee. Mr. Schrader indicated that we can no longer bill the State an administrative add-on. We have to pay the provider what we are paid by the State. Mrs. Gailor indicated that this is mandated for the County to provide and by placing it in the Health Department, we can recoup some administrative costs from the State. Mr. Willcox asked about the financial investigator. Ms. Feuerherm indicated that this the person who is doing eligibility. Mrs. Breed asked about changed in positions. Mrs. Schrader indicated that there is no change in the positions reflected. Dr. DiGiovanni asked if the psychologist has been unfilled and the likelihood of filling it is not good. Ms. Feuerherm indicated that it has been vacant for four years, and she fills it is the time to give it up. Mrs. Gailor indicated that the Director’s salary is now being split with the Nursing Division. Dr. DiGiovanni moved to strike the RI Psychologist; seconded by Mrs. Breed. All members voting in favor; none opposed; motion adopted. The reduction is $22,339 in personnel services; $1,787 reduced in retirement and $1,709 reduced in Social Security for a total reduction of $25,835.

 

• Health Department – Education – Handicapped Children – The revenue is increased because it is a product of expenses and expenses are up considerably. Mrs. Tytler indicated that the transportation issue is what makes this budget so bad. The transportation is due to the lack of services in the community. Mrs. Tytler would like to see some money removed from transportation and placed in a seed fund to help a new provider start a program for the needs of this community. Racker Center is the only provide for certain services in the community and if the family doesn’t like that provider, we have to comply with providing services out of the county as directed by the school district. Dr. DiGiovanni believes that the Board of Health and the Health Committee can work together to do something about this situation and develop local alternatives. The members of the committee expressed concern for the children who are being transported out of the county and how this affects the child. Dr. DiGiovanni believes we need to partner with other providers; make them aware of the situation; and work with them to develop programs.

 

• Mental Health – Family Support Services – Mrs. Breed asked if there are any changes in positions. Mr. Schrader indicated that there are no changes in positions. The question is why there is a decrease in FSS Coordinator. Mr. Schrader believes that it is due to a MUNIS issues. There was a question about why the Client Enhancements MHC decreased from almost $11,000 to $500. Mrs. Medeiros indicated that this is because 2002, 2003 leftover grant money was allowed to be expended in 2004.

 

• Mental Health – Preventive Services for Youth – Mrs. Brown asked about professional services. Mr. Schrader responded that this line is for consultants. Mrs. Medeiros indicated that this was down last year, because it was the only way to balance the 2004 budget. Ms. Mastronardi is actually providing some hands-on services this year as Director, which do not show up in the professional services line. Ms. Mastronardi will provide some of these services next year, but at a lower level. Mr. Schrader indicated that the directive for this division is to be cost neutral to the County. This happened in 2004 and will happen again in 2005. The same directive was given to ICM, FSS, and Horizon House. There are no County dollars invested in these four programs (bottom line). Mrs. Tytler asked what the consultants are. Dr. Capanzano indicated that it is MSWs.

 

• Mental Health – Horizon House – Mrs. Tytler asked where the new psychiatrist position is in this budget. Dr. DiGiovanni moved to increase expenses by $35,776 and fringes $2,218 (FICA) Medicare $519; WC - $473; decrease professional services $38,996; seconded by Mrs. Brown. This is a wash item. All members voting in favor; none opposed; motion adopted.

 

• Mental Health – Intensive Case Management – Mr. Behrenfeld asked why the revenue was down substantially. Mr. Schrader indicated that PSY is now falling under PSY where it belongs and not in the ICM budget. Mrs. Breed asked if all positions are currently staffed. The response was yes. Mrs. Tytler asked about client enhancements. Dr. Capanzano indicated that this is to assist clients in special ways, keeping them out of hospitals, and enhancing their mental health. This could include a therapeutic, special need device that could not be obtained elsewhere. Mr. Schrader indicated that this program enhances the provision of services that other agencies may have been providing.

 

• Mental Health Center (Clinic) – The revenue has increased party due to reallocation from other divisions – particularly the allocation of COPS to the clinic instead of to Horizon House. Mr. Schrader indicated that a revenue adjustment (wash) will be made in OASAS. Mrs. Breed asked if there is any chance in personnel. Mr. Schrader indicated that there is a part-time Medical Health Program Aide being added to provide better support to enhance revenue. Mrs. Tytler asked about the change that is being proposed for the psychiatrist and the NP. Mr. Schrader indicated that this is not reflected in the budget since the details have not been clarified by the State for us in the staffing requirements. Therefore, the money is still in the professional services line. Mr. Schrader indicated that there are several issues with a NP that have to be ironed out. Mrs. Breed asked about the Forensic Counselor. Dr. Capanzano indicated that this an individual who works in the jail. Mr. Willcox asked if this is a mandated position. Mr. Schrader indicated that it is not, however, not having it puts us at significant risk due to Kendra’s Law and various other laws that require care for our mental health patients. Mr. Schrader indicated that it is a liability issue. Mr. Willcox asked if the County Attorney was of the same opinion about this position. Mr. Schrader indicated that he has not had a conversation with Mr. Bardsley about that issue. Mrs. Breed asked about the $43,000 increase in professional services. Mr. Schrader indicated that the increase is due to an increase in the rates of the psychiatrist. This goes away if we hire someone. This is also an addition for 8 hours per week for an additional psychiatrist position. Mr. Behrenfeld asked if we had a choice in this. Mr. Schrader has stressed on Mental Health that they need to see more patients, as that it the way that we generate revenue. Mrs. Medeiros indicated that the 8 additional hours will cost $36,000 and we conservatively anticipate $21,000 of additional revenue, so the additional cost would be $15,000 in the worst case scenario. Mrs. Breed asked about the increase in some of the agency contractual amounts. Mr. Schrader indicated that historically we have provided some County share support for these programs. NYSARC contract has actually asked for an increase in County share; he believes we should not increase County share. Mr. Schrader indicated that the request is based on the statement that there are unmet needs. ARC has a $2.7 million fund balance and Mr. Schrader indicated that he doesn’t believe we should provide additional funding when there is that type of fund balance. Mrs. Breed asked if NYSARC is means based? Mrs. Breed moved to reduce ARC to $44,369; seconded by Mrs. Brown; all members voting in favor; none opposed; motion adopted. Dr. DiGiovanni moved to reduce FC OASAS Contract to $752,598; seconded by Mrs. Brown; all members voting in favor; none opposed; motion adopted. Mr. Schrader indicated that the JMMC Direct Contract is merely passthrough money from the State. The question was asked about MH Contracts. This is passthrough money for the residence.

The meeting adjourned at 10:51 a.m.

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