Health and Human Services Committee Minutes

HEALTH AND HUMAN SERVICES COMMITTEE
JULY 28, 2004 11:30 A.M.
SCOTT HEYMAN CONFERENCE ROOM

Present: M. Robertson, Chair; T. Todd; M. Koplinka-Loehr
Excused: B. Blanchard; N. Schuler
Staff: A. Cole, Public Health Director; P. Carey, Social Services Commissioner; B. Chin, Health Planning
Council; R. DeLuca, Interim Mental Health Commissioner; M. Dill, Human Services Coalition; S. Whicher, County Administrator; Allinger, Health Department; J. Andersson, Health Department; S. Connors, Health Department; B. Crosby, Health Department

Called to Order

The meeting was called to order at 10:45 a.m.

Changes to Agenda

There were no changes to agenda.

Appointment - Board of Health

It was MOVED by Mr. Koplinka-Loehr, seconded by Mr. Todd, and unanimously approved by voice vote of members present, to recommend the following appointment:

Board of Health
William S. Tyler, M.D., Physician Representative, term expires December 31, 2006.

Health Department

RESOLUTION NO. - AUTHORIZATION TO ABSOLVE 2003 HEALTH DEPARTMENT DEFICIT

It was MOVED by Mr. Koplinka-Loehr, seconded by Mr. Todd. Ms. Cole reviewed with the Committee the written material outlining the cause of the $573,000 revenue shortfall. It was explained that it is not anticipated the circumstances creating the deficit should occur again. In addition, Ms. Cole and Ms. Crosby noted that staffing duties have been revised to assist in billing issues that were a result of extensive funding cuts. Mr. Whicher was asked to explain the policy related to the resolution. Mr. Whicher said that it requires looking at the reason for the deficit, whether it was mismanagement or circumstances beyond control. He said it is clear that this is a result of circumstances that were unusual and beyond the Department’s control. He also said that if reimbursements for 2004 provide rollover funds may be available to reimburse the general fund. He suggested an additional Resolved that states if funds are available through rollover in this particular account it be paid back to the general fund over the next two to three years. Ms. Cole noted that her department has repeatedly given rollover funds back to the general fund. The Committee was informed that if there were no resolution the finance officer would take rollover generated from the department to pay back the fund.

It was MOVED by Mr. Koplinka-Loehr, seconded by Mr. Todd to amend the resolution by inserting the following:

"RESOLVED, further, that in the event there is surplus rollover in this program in the next three years, that balance will be returned to the general fund."

Mr. Todd inquired whether it is anticipated this situation would be repeated in the future. He was informed that the funding formula for Medicare had changed and that this, combined with staffing changes, created the problem. Ms. Robertson said if the rollover is from delayed payments from third parties it should consistently create a rollover. Ms. Cole said the lag in billing will balance out and should not affect the program balance in the future. Ms. Robertson stated she did not feel she could support the amendment as she does not feel it is appropriate to take the rollover funds automatically. Mr. Koplinka-Loehr said that the additional resolved sends a message that in some form, compensation for the shortfall is required.

A voice vote on the amendment resulted as follows: Ayes - 2 (Legislators Koplinka-Loehr and Todd); Noes - 1 (Legislator Robertson); Excused - 2 (Legislators Blanchard and Schuler). MOTION FAILED.

It was MOVED by Mr. Koplinka-Loehr, seconded by Mr. Todd, and unanimously approved by voice vote of members present, to table the resolution until the next meeting of the Committee. RESOLUTION TABLED.

In addition, it was requested that a copy of the administrative policy related to this matter be provided.

WHEREAS, the Tompkins County Health Department closed out 2003 with a deficit of $248,852 according to the Finance Director’s books, and
WHEREAS, the majority of the deficit was due to complex home care billing issues, lower referrals and a reduction in services rendered, and
WHEREAS, the program is currently on target and difficult billing issues are being resolved, and
WHEREAS, the Department has addressed the issue with its accountant, the Board of Health, County Administration and the Health and Human Services Committee and they have found this one year to be an anomaly, now therefore be it
RESOLVED, on recommendation of the Health and Human Services Committee and Budget and Capital Committee, That the Health Department is hereby absolved of the $248,852 deficit from 2003, and the amount will not need to be taken from the Departmental budget.
SEQR ACTION: TYPE II-20

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RESOLUTION NO. - AUTHORIZATION TO ACCEPT INNOVATIVE DENTAL HEALTH SERVICES GRANT FUNDS AND ASSOCIATED BUDGET ADJUSTMENT – HEALTH DEPARTMENT AND DEPARTMENT OF SOCIAL SERVICES

It was MOVED by Mr. Koplinka-Loehr, seconded by Mr. Todd to recommend approval of the following resolution to the full Legislature. Ms. Robertson inquired how much the total program costs and was informed by Ms. Cole that she did not have the information with her at this time. In addition, it was noted the adjustment includes only the 2004 amount.

Ms. Robertson asked that a report on the dental program be provided to the Committee.

A voice vote resulted as follows: Ayes - 3 (Legislators Koplinka-Loehr, Robertson, and Todd); Noes - 0; Excused - 2 (Legislators Blanchard and Schuler). MOTION APPROVED

WHEREAS, the Tompkins County Health Department has been awarded a second $32,109 grant by New York State to support the Tompkins County Department of Social Services program to increase accessibility of dental care by private Tompkins County providers for Medicaid clients, and
WHEREAS, these grant funds are available as partial reimbursement of expenditures made on that program between July 1, 2004 and June 30, 2005, now therefore be it
RESOLVED, on the recommendation of the Health and Human Service Committee, That the Health Department is authorized to accept and transfer said funds to the Department of Social Services,
RESOLVED, further, That the Director of Finance is authorized to make the following budget adjustment on his books:

REVENUE: A4010.43489 Other State Grants $21,168

APPROPRIATION: A4010.54442 Professional Service Fees $21,168
SEQR ACTION: TYPE II-20

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Explanation: Only two months after officially announcing the awards for last year’s grant period (July 2003 – June 2004), New York State has now awarded a second year’s funding to Public Health to support the Department of Social Services’ Dental Care Access and Case Management program.

Social Services present 2004 budget already authorizes the expenditures eligible for reimbursement from this grant. No new spending authority is required for DSS; the net result of the grant’s acceptance will be greater-than-budgeted reimbursement rate for those costs.

The grant can only be accessed through Public Health. Neither the grant nor the transfer payment to Department of Social Services was anticipated in Public Health’s 2004 budget, necessitating this resolution.

RESOLUTION NO. – APPROPRIATION FROM CONTINGENT FUND – TERMINAL PAY – HEALTH DEPARTMENT

It was MOVED by Mr. Todd, seconded by Mr. Koplinka-Loehr, and unanimously approved by voice vote of members present to recommend the following resolution to the full Legislature for approval:

WHEREAS, the Health Department had two Community Health Nurse resignations effective April 1, 2004 and May 7, 2004, and
WHEREAS, the Fiscal Policy of Tompkins County allows for terminal pay from the Contingent Fund, now therefore be it
RESOLVED, on recommendation of the Health and Human Services and Budget and Capital Committees, That the Director of Finance is hereby authorized and directed to make the following budget appropriation:
FROM: A1990.54440 Contingent Fund $7,151
TO: A4016.51000580 Community Health Nurse $5,145
A4016.58800 Fringes $2,006
SEQR ACTION: TYPE II-20

* * * * * * * * * * Explanation: Resignation reasons given were related to high workload/stress due to insufficient numbers of staff and the budget process (has been on the “block” twice in the last two budget cycles) and the need for job security.

Department of Social Services

Preliminary Budget Discussion

Ms. Carey stated that as the departmental budget is constantly changing due to the undetermined State budget as well as reimbursements, she did not have a document to submit. Ms. Carey and Mr. Herden provided an overview of the proposed budget including the department's restructuring as a result of the loss of twelve positions in 2003 and an additional 9.2 positions in 2004. This restructuring has been designed to provide more outcome-based services to meet the needs of the clients. In addition, the streamlining of Medicaid applications and utilization of outside sources are providing best practices within the department to provide maximum resources available.

Mr. Herden stated that while all efforts are made to come within the budget certain factors require over target requests. The increase in fringe rate in 2004 has the largest impact on the budget; last year the increase was partially covered by rollover funds; at the end of this year there will be $475,000 in fringe costs for current staff as a maintenance of effort, with no rollover available to cover it. He also stated a variety of other factors that will increase the departmental budget this next year: increased Medicaid costs; increase in Family Health Plus enrollment; children in residential facilities; and increased homeless bednights. Mr. Herden then spoke of changes in Title XX Federal funding that have reduced grants and will affect programs such as Child Protective Services, Adult Protective Services, Preventive Services, and Domestic Violence. These federal reductions will flow down to reduce administration reimbursements to State Programs such as Medicaid, food stamps, Temporary Assistance to Needy Families, and employment. Ms. Carey stated she expects to ask for a maintenance of effort over target request of $650,00 to cover the increased fringes and reduced grants.

A discussion occurred during which it was noted that reducing services could cause reduced revenue for the department as they receive an overall 78% reimbursement. In addition, because many services are mandated a reduction in services could result in sanctions from the State/Federal governments. At this time many other departments that are faced with reductions are looking to the Department of Social Services to partner with them in order to continue programs and maintain the state/federal funding to bring the most dollars to the County.

Ms. Robertson spoke of the August 11, 2004 meeting including a discussion of Multi-Systemic Therapy services.

Mr. Whicher said that his preliminary budget included a $1 million anticipated increase for mandated services; based on new information he had increased it to $1.4 million. With this new information an additional $250,000 may now be required.

RESOLUTION NO. - ACCEPTANCE OF JUVENILE ACCOUNTABILITY BLOCK GRANT (JABG) FROM NEW YORK STATE DIVISION OF CRIMINAL JUSTICE SERVICES – BUDGET ADJUSTMENT – DEPARTMENT OF SOCIAL SERVICES

It was MOVED by Mr. Koplinka-Loehr, seconded by Mr. Todd, and unanimously approved by voice vote of members present to submit the following resolution to the full Legislature for approval. MOTION APPROVED.

WHEREAS, the Department of Social Services applied to the New York State Division of Criminal Justice Services (NYS DCJS) for a grant to address an unmet need regarding early and consistent assessment of high-risk youth identified by schools, Probation, Mental Health and the Department of Social Services, and
WHEREAS, the DCJS has approved $11,683 in funding through the Youth Risk and Needs Assessment Project through the Juvenile Accountability Block Grant (JABG), and
WHEREAS, the grant will allow the Department to interface with other departments and local agencies to procure a tailored risk and needs assessment tool for use with high risk youth and juvenile offenders, facilitating delivery of comprehensive and effective early intervention services, and
WHEREAS, use of the standardized risk and needs assessment tool early in the juvenile justice process will increase early intervention in school settings, stabilizing the targeted youths’ education programs and preventing out-of-home residential placements, now therefore be it
RESOLVED, on recommendation of the Health and Human Services Committee, That the Department of Social Services is authorized to accept the Juvenile Accountability Block Grant from the New York State Division of Criminal Justice Services for the purposes of identifying and implementing the most appropriate risk assessment services for the identified youth of Tompkins County,
RESOLVED, further, That the Director of Finance shall make the following budget adjustment representing the total project cost:

REVENUE: A6010.43389 State: Other Public Safety $11,683

APPROPRIATION: A6010.54400 DSS Admin: Program Expense $11,683
SEQR ACTION: TYPE II-20

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Explanation: In the school year 2000-2001 there were approximately 502 school suspensions. When examining these suspensions and the PINS (Person In Need of Supervision) petitions filed by schools, a large number of the students are identified as having mental health issues that are not being addressed and the experience in Tompkins County is that students with mental disorders are less likely to succeed in school if they are subjected to school suspensions.

The involved agencies in Tompkins County (DSS, Probation, TC Family Court Judges, TC Mental Health, Law Guardian’s Office, & County Attorney’s Office) have made a commitment to engaging in the development of a common risk and needs assessment program and the Trumansburg, Ithaca City, Lansing, and Dryden School Districts have made commitments to attend meetings and assist in the use of the common assessment tool and the development of a network to refer youth to appropriate services.

The Department of Social Services will fund the staff needed to research available risk and needs assessment tools and will facilitate the establishment and system to maintain the programs to conduct such project. DSS sponsored a VERA Institute, two-day Conference in July 2004 at which time over 45 individuals from agencies, Courts, schools and the general public attended. The one goal of the VERA Institute Conference is the creation of a self-supporting system that can use a common risk and needs assessment in high-risk cases and develop a system to create strength-based treatment plans for youth, share information regarding the service needs of the entire family and immediately address issues and concerns that arise on a case by case basis.

The awarding of the JABG (Grant) allows the Department to coordinate the information-gathering meetings and to compile such information so as to ultimately provide for the purchase of the Risk & Assessment tool that will benefit the youth and intervention agencies of Tompkins County.

The Department of Social Services has researched the Adolescent Well-Being Assessment Tool (Well-BAT) which was developed by the Partnership for Results Program in Auburn, New York and basic costs for a program such as this were obtained to determine feasibility and grant application dollar figures. The final decision of which Assessment Tool will be implemented will be decided after the planning and consultation meetings have occurred.

Request to Fill Vacancy - Caseworker

It was MOVED by Mr. Koplinka-Loehr, seconded by Mr. Todd, and unanimously approved by voice vote of members present to approve the request to fill a caseworker position within the Department of Social Services.

Members discussed the form used to fill vacancies and suggested that it be made more clear whether the job requesting to be filled is a position that performs mandated duties.

Mental Health Department

Mr. DeLuca introduced Mr. Scott from the New York State Office of Mental Health. Ms. Robertson thanked Mr. Scott for attending the meeting and asked him to provide the Committee with information regarding the present status of the single room occupancy (SRO) facility in Tompkins County. Mr. Scott informed the Committee that originally the 2003-04 Governor's budget included 2,000 beds for distribution throughout the state with 150 of them for the western New York region, which includes Erie and Tompkins County. However, the Department of Budget has released funding for only half of the approved beds statewide. They initially approved 71 beds for conversion of an adult home in Rochester but then only released 50 of the 150 approved for the western region. In order to complete the Rochester project they had to borrow some beds that were approved for New York City. Next year the beds will have to be given back to New York City.

In the next fiscal year the remaining approved beds should be released, including the nine planned for Tompkins County. In the interim, there is approval of funds to perform feasibility studies and complete the necessary planning that will eliminate a longer delay once the beds are approved. It was noted that it was planned to have 25 beds provided, making use of 16 apartment beds that had been underutilized. Now discussions are for 9 beds as many of the apartment beds are actually filled. Mr. DeLuca explained that for a five-year period there were many unused resident apartments that would have been able to be converted; in the last four to five months the usage has increased which has eliminated some of the possible beds. Mr. Scott stated that every attempt will be made to find the additional beds so as not to impact the apartment bed allocation. He anticipates that there may be a total of 20-22 beds that will become available for the County.

Mr. Whicher inquired what the timeline would be if the preliminary work were completed in advance of the release of the beds. Mr. Scott indicated he believed that upon approval of the capital project, expected for 2005, completion could occur within 12-18 months with the possible opening in 2006. The facility would have efficiency apartments with a communal meal room and a small program area.

The Committee inquired about the location of this facility and was informed that at the present time a downtown location is being considered. In response to an inquiry the Committee was informed that the Office of Mental Health would maintain a purchase option for property until the release of beds has taken place. Members asked if there is any way to speed up the process and were informed that the efforts of Erie County to gain approval to do preliminary work was worthwhile as it allows Tompkins County to do the same. Until the Office of Budget takes the next step to release the beds Mr. Scott did not feel there is anything further that could be done. Mr. Scott added that he will keep in touch with the County about the preliminary work. He just received the appraisal on the property, and will next work with the architect. As of this fall he will be “at a brick wall” with no other work he can do to move the project forward, until the beds are released.

Human Services Coalition

Ms. Dill provided a summary of the Coalition’s budget and the agency requests for the 2005 budget year. She spoke of and the agencies cutting services and positions over the past two to three years in an effort to keep program costs low. Ms. Dill expressed concern regarding a $5,000 cut in funding from the City of Ithaca and is hoping that this loss can be restored. She indicated that if the funding were not maintained the results would be: increased difficulty in carrying out the HSC mission; less assistance to agencies; less Federal and State funding coming to Tompkins County; less coordination in human services; and less use of available programs by Tompkins County residents.

Ms. Dill reminded the Committee that the HSC Board has not yet formally voted on their Review Committee’s recommendations. The meeting to take that vote is tomorrow. However, she wanted to inform the Committee of the requests from the sixteen programs (including Offender Aid and Restoration), and to outline the Review Committee’s recommendations. The County target dollars for 2004 are: $386,974, of which $41,039 is the recommendation for target increase; and $39,600 is the recommendation for one-time allocations. She spoke of a new agency, Mutual Housing Association of Tompkins County, requesting County support; as housing is a high priority they are recommending a $15,000 target and $5,000 one time award be provided. Also, the Women's Opportunity Center is in need of additional funds due to program funding changes this past year. She noted that Ms. Herath of the Center will address the Committee later in this meeting, to explain further.

Ms. Dill next spoke to the Committee about the new initiatives being put in place to spread the word throughout the County of programs that are available. She stressed the need to maximize the use of existing programs in order to maintain the flow of funds from State and Federal grants and programs.

Ithaca Breast Cancer Alliance

Ms. Sanchirico and Ms. Lourey highlighted the brochures provided to the Committee and spoke of the outcomes of programs that the agency offers. Ms. Lourey was enthusiastic regarding the Breast Cancer 101 program that is a professionally facilitated program in two parts - The Basics of Breast Cancer, and Taking Care of Yourself; and the upcoming workshop for Mental Health Professionals that will be presented by Hester Hill Schnipper, LICSW, BCD, Chief of Oncology Social Work at Beth Israel Deaconess Medical Center. In addition, more workshop programs are being planned. Members inquired how IBCA is staffed and were informed there are 2 people who job-share and four other full time positions. In addition, it was noted that the majority of residents utilizing services are female, although many spouses/mates also seek support from the Alliance. A brief discussion took place regarding services for other forms of cancer and it was explained that IBCA determined not to do so as other agencies provide those services.

Women's Opportunity Center

Ms. Herath, Executive Director, passed out invitations to the 25th anniversary celebration for the Women's Opportunity Center, which will be held tomorrow. At the event there will be 25 women acknowledged for their perseverance and strength. She then spoke to the Committee regarding significant changes in funding for the agency. She explained that her past funding had been divided between the State and the federal governments, and that the past year funding was to be $212,000 from the State Department of Labor with federal funds in the amount of $310,000. She was informed in January 2004 via an e-mail that the program funding had been shifted and that her program was now completely funded through the Workforce Investment Act (WIA) of the Federal government. Upon learning this she stated she was shocked and dismayed to learn that the new regulations would severely restrict her ability to serve many women in the community.

Ms. Herath explained that under the new, federal guidelines a family is described as a man and women legally married and therefore a displaced homemaker is a woman who was legally married and had been taking care of home and family. As a result of this definition, each individual to be served must be able to produce a marriage certificate and paperwork regarding divorce, separation or death of a spouse. This has caused her to be concerned for many of the women in the community who may have had long-term relationships without the legality of marriage, those who may not be legally divorced at this time for various reasons, and those with same-sex partners. She stated that, for example, of the 59 individuals who were seeking assistance in one month only 16 would be eligible to receive services. Single mothers, same-sex partners, and couples living under the same roof without being legally married, are no longer able to receive assistance. She further reported that Federal government is requiring the State Department of Labor auditors check her records monthly to determine that the guidelines are followed and that copies of legal documents are in their files. Ms. Herath said because there is funding provided from the United Way and the County a percentage of those ineligible for the federal aid are able to receive assistance; however many are having to be turned away. Ms. Herath said a great deal of time is spent with calculations to determine how many individuals may be assisted each month.

Ms. Robertson was appalled that a government that claims that they desire to stay out of individuals’ lives would make such a requirement, that in order to be helped an individual must have undertaken a legal ceremony. Ms. Dill noted that the government is changing policies through budgeting procedures.

Ms. Herath said that as this change came during the middle of the fiscal year all funding was maintained; however there is a concern regarding the amount of funding that will be received in 2005.

Ms. Herath spoke of the scholarships that have been granted to clients and how they have changed their lives. One such person was awarded $900 to complete a course and is now self-sufficient and earning $40,000. In another circumstance a woman needed $2.50 per week for gas to go to school; this was provided and she is now a case manager making $30,000. Some have been provided computers to take on-line courses. She spoke of the requirements made to women utilizing services: if in school a C average must be maintained. If assistance with an employer is needed it must be communicated to WOC staff; they may not leave a place of employment without having first spoken to WOC staff. She spoke of three things recipients must do: give their best to their employer; help another woman; and keep in touch with the staff.

Ms. Robertson suggested that clients from the Women's Opportunity Center should speak under privilege of the public at a Legislative meeting.

Ms. Herath also spoke of problems with the computerized systems provided for the State; many times processing of information is delayed due to system malfunctions.