HEALTH AND HUMAN SERVICES COMMITTEE DECEMBER 16, 2003 - 4:00 P.M. SCOTT HEYMAN CONFERENCE ROOM
Present: M. Robertson, Chair; N. Schuler, F. Proto, M. Koplinka-Loehr (arrived at 4:10 a.m.)
Excused: P. Penniman
Staff: S. Whicher, County Administrator;
N. Zahler, Youth Services Director; B. DeLuca, Mental Health Director; I.
Stein, Office for the Aging Director; L. Homes, Office for the Aging; P.
Carey, Social Services Commissioner, B. Crosby-Grinnell, Social Services
Department; K. Fuller, Recorder
Called to Order
The meeting was called to order at 4:01 p.m.
Changes to Agenda
There were no changes to the agenda.
Chair's Report
Ms. Robertson said she did not have a report.
Office for the Aging
New State Database Requirements
Ms. Stein reported due to a Federal requirement, New York
State is passing down the requirement of a new database system for the Office
for the Aging. Ms. Holmes had sat on the Committee reviewing the various
software programs reviewed by the State and she said the one chosen was SAMS.
The cost of this software, exclusive of a server, would be approximately
$16,000 if all options including web-use capability were chosen, or $6,300
if there were no web-use capability. In addition, the annual cost to
maintain the program and include all updates would be approximately $8,000
per year if the web-use option were chosen, or $2,880 per year without web-use.
Ms. Holmes indicated that the figures given for the software reflect the
ten percent savings by bulk purchasing at the State level. One option
may be to have the County ITS personnel develop a program rather than purchase
the software. At this time it is not known if the present server would
be capable of handling this program. Mr. Whicher stated a decision
regarding the server should be made as quickly as possible as the County
is in the process of purchasing a new server and would need to have as much
information as possible to determine how to proceed. He also indicated
a need to carefully review the implications of developing our own database
as it would also require ITS to provide changes to accommodate the updates
as needed, as well as questions regarding security issues.
2004 Budget Summary
Ms. Stein stated the cut in 2003 was $51,621. In
the 2004 budget the local share was reduced by $15,000 by requesting that
host municipalities take over the local cost for congregate FOODNET meals.
She expressed concern regarding operating expense reductions, saying in 2003
the $7,189 reduction was too much and that the 2004 reduction was another
$692. She then reported that an OTR for the purchase of a computer
that was covered by rollover funds was approved. Ms. Stein said the
reduction in hours of the EISEP in-home care program is an area of concern
as it is now a one-time request; she will definitely ask for these funds
to be renewed next year. Ms. Stein then reported she was notified by
Senator Kuhl of approval of a member item in the amount of $9,750 to be utilized
for the PERS program; she anticipates this to fully fund the program this
year. Also, she is awaiting confirmation of a second member item from
the Assembly in the amount of $8,000 that will be used to conduct the post-2000
census needs assessment that will provide an update of data from the previous
census. The focus for 2004 will include three grant proposals presently
being submitted; however, Ms. Stein indicated that Tompkins County is not
normally considered an underserved population due to the low unemployment
rate which is a criterion for state and federal grants. With regard to programming,
the Making the Link program is designed to make the connection among doctors,
the hospital, and senior citizens stronger. In addition, more intense
and focused outreach will occur concerning benefit entitlements for low-income
individuals at both the State and Federal level. Ms. Stein also reported
that Senator Schumer's regional office has been contacted to seek additional
funding for home delivered meals. In response to an inquiry of the
total funding lost for 2004, Ms. Stein indicated it was equivalent to the
fringe increase, 16% of salaries.
Mr. Whicher reported that the Planning Department is presently
having the census data adjusted for the student population and it is expected
to show a more accurate picture of the County. Members of the Committee
requested copies of the information when complete.
January Meetings
Ms. Robertson said the Committee will continue forward
with the current membership through January and that it is anticipated the
meetings shall remain as they have this past year, the first Wednesday and
third Thursday of the month.
Youth Services
Ms. Zahler provided a written summary of the Tompkins
County Youth Services Department budget updates. This report indicated
the various changes to the programs served by Youth Services, noting that
some areas did not specifically reflect the cuts made by the Legislature
but provided the best means to meet the reductions in the budget. In
trying to meet the Legislature’s direction to cut a staff position, Ms. Zahler
met frequently in the past month with Cooperative Extension and Human Services
Coalition staff to restructure. Given recent staff turnover at Cooperative
Extension and constraints at the HSC, there was not enough time to restructure
before the 2004 budget would be in effect. Ms. Zahler will continue to work
on the structure of her department to meet the goals of the Legislature.
Ms. Zahler reported that for 2004 the department absorbed the
payroll and fringe increases, using rollover, office supply funds, and Drug
Task Force monies to do so. Nevertheless, the net decrease was approximately
$60,000 in local share, so that the department will spend overall 5% less
in local share in 2004 than in 2003. The denied over target requests will
mean a reduction in needs assessment, program development, and grant writing
services to municipal youth commissions. Of their total budget, 22%
goes for staff and office operations; the rest goes directly to pay for services
to youth. Office operating expenses will be cut by 50% for 2004.
When an inquiry was made regarding the recent hiring of a municipal
youth services coordinator at the Town of Ithaca, Ms. Zahler replied that
the program may vary significantly from what the County youth services workers
do and that there have been numerous calls by the municipality to inquire
of procedures. In fact, county staff has been quite active in helping
to orient and train new town recreation personnel. Ms. Zahler spoke
to the Committee of her intent to seek guidance over the course of the next
year to clarify her work plan, in particular with respect to issues such
as a merger with the City Youth Bureau relations with the municipalities,
and contracting with Cooperative Extension for the municipal system.
She indicated that she would like sequencing assistance to enable her to
understand the goals and meet the requests while maintaining present services.
Ms. Robertson suggested that Ms. Zahler meet with her and Mr. Whicher to
determine how to best complete the tasks requested. Mr. Whicher reported
that he will be meeting with municipal leaders next week, about a number
of areas of possible collaboration, and youth services will be discussed.
Ms. Zahler then reported that some funds have been transferred from the Bridges
Runaway Program to the County Youth Services Department, and Nancy Zook will
recruit and certify volunteer host homes to take in teens on an emergency
and short-term basis while awaiting longer-range services.
Human Services Coalition
This portion of the agenda was postponed to allow Ms.
Dill, Human Services Coalition Executive Director, time to obtain appropriate
budgetary information from the agencies.
Mental Health
Mr. DeLuca, Mental Health Executive Director provided
a written report covering five areas of his budget. He reported there
would have been a $700,000 increase in salary and fringes for the department
if no reductions or changes were to take place. He reported the County
was not significantly affected by the budget increases as necessary funding
was produced by state revenues in the amount of $500,000. Mr. DeLuca
cautioned the Committee of the State fiscal policy changes having a drastic
affect on future budgets. He said that the State policy of conversion
of state aid to Medicaid is resulting in 100% state aid loss to the Mental
Health Clinic ($125,000) and Continuing Day Treatment - Skylight Club ($50,000),
a loss of approximately $140,000 to Challenge Industries in 2005, and decrease
in state aid to the Alcohol and Drug Council of Tompkins County. In
the latter, the state has specified that the state portion of Medicaid may
not be increased, which has the potential to eliminate small agencies with
uninsured or underinsured clientele. Mr. DeLuca also expressed
concern that the modifications that will convert many programs to Medicaid
will reduce state aid for programs overall, and will require extensive review
to determine how to best modify programs to give the best treatment without
the loss of funding. The overall result is that we will become much
more reliant on serving Medicaid eligible clients, in great enough numbers
to offset losses from serving uninsured or underinsured people who don’t
qualify for Medicaid. Ms. Robertson indicated that more time should
be spent reviewing this new information and will schedule a portion of a
future meeting to determine some choices and changes to be made.
Mr. DeLuca requested that a letter be sent to a Mental Health Board member who has not attended meetings on a regular basis.
Health Department
RESOLUTION NO. - AUTHORIZING CHANGES IN CHARGE STRUCTURE
- TOMPKINS COUNTY HOME HEALTH CARE - HEALTH DEPARTMENT
It was MOVED by Mr. Koplinka-Loehr, seconded by Mr. Proto,
and unanimously approved by voice vote of members present, to submit the
following resolution to the full Legislature for approval:
WHEREAS, Tompkins County’s accounting consultant, John
Kropski, CPA, of Freed Maxick & Battaglia, PC has recommended changes
in the Certified Home Health Agency fee structure to maximize Medicaid and
Medicare revenues, and
WHEREAS, New York State currently promulgates rates on
the day the County legislature approves them and it is therefore, desirable
for Tompkins County to adopt the 2004 rates in December 2003, and
WHEREAS, all changes proposed were made to align charges
with actual costs per unit of service as determined during Mr. Kropski’s
most recent review of our financial and statistical data, now therefore be
it
RESOLVED, on recommendation of the Health, Human Services
and Education and Budget and Personnel Committee, That the Tompkins County
Health Department implements the charge structure below, as recommended by
John Kropski, CPA, in order to maximize Medicaid and Medicare revenues.
2004 Tompkins County Home Health Care Fee Schedule
2002
2003 2004
Skilled Nursing
$110.00 $126.00
$140.00
High Tech Nursing $115.00
$135.00 $165.00
Physical Therapy $105.00
$105.00 $105.00
Speech Therapy
$105.00 $105.00
$105.00
Occupational Therapy $105.00
$105.00 $105.00
Medical Social Work $105.00
$105.00 $105.00
Home Health Aide $ 36.00/hour
$ 41.00/hour $ 45.00/hour
$ 70.00/visit $ 75.00/visit $
90.00/visit
RESOLVED, further, That the Department sets the per hour
Nursing Administrative Charge at sixty dollars ($60.00) per hour, for services
as appropriate (i.e. rabies post exposure, hypertension screening clinics,
etc).
SEQR ACTION: TYPE II - 20
* * * * * * * * *
Note: The fees are established to maximize dollars from Medicare
and Medicaid. The department maintains the use of a sliding fee scale
for those patients paying for services out of pocket. In addition we
have negotiated agreements with a number of insurance providers and accept
payment in full from them. The department continues to maintain the
ability to waive a fee in special circumstances.
The following are allowable costs used to determine our average cost per visit:
Administration Costs: Salary and Fringe Benefits for administrators, directors,
supervisors and others, Contractual services including Care at Home, Software
Support/Maintenance, Cost Reporting Services, etc.), Supplies, telephone,
etc., Depreciation, POM, Transportation.
Direct Services Costs: Salary and Fringe Benefits, Contractual Arrangements, Drugs, Depreciation, POM and Transportation.
Withdrawal of Resolution
Ms. Schuler withdrew the following resolution from the agenda:
Expressing County Government Support for the Passage of New York State Legislation Directed
at the Elimination of Open Waste Burning