GUESTS: J. Johnson, Family and Children's Service; J. Murphy, Family and Children's Service; S. True, Family and Children's Service; B. Slocum, Office for the Aging; A. Cole, Public Health Director; B. Crosby, Public Health Administrator; S. Kerr, Public Health Department; M. Dill, Human Service Coalition; N. Zahler, Youth Bureau Director; J. Andersson, Environmental Health

Chairman Proto called the meeting to order at 11:30 a.m.

Mr. Proto added a Chair’s report to the agenda.

It was MOVED by Mr. Evans, seconded by Ms. Kiefer, and unanimously adopted by voice vote by members present, to approve the minutes of the July 23 meeting as corrected by Ms. Kiefer.

Ms. Schuler arrived at this time.

Mr. Proto said that Kathy West, Interim County Administrator, is working with the Human Rights Department on the transfer the committee raised questions about at the last meeting.

Mr. Proto said he would be inviting Lauren Austin, Human Rights Director, to a Committee meeting as well as a Public Safety Committee meeting to discuss double bunking at the Jail.

Mr. Proto said committee members should have received a memo from Jim Mason concerning the Ulysses request for $250,000 as a capital request. He asked that committee members bring that memo to the budget review meeting when discussing rural libraries.

The committee reviewed and accepted the budget review timetable.

Caregivers' Resource Center Evaluation

The committee was asked to read the report attached to the agenda.

Budget Adjustments

The following budget adjustment was withdrawn from the agenda:

Revenue: 6774.42770 Miscellaneous Revenue $4,000

Appropriation: 6772.54618 Informational Charges $4,000

Revenue: 6774.42770 Miscellaneous Revenue $2,149.54

Appropriation: 6772.52206 Computer Equipment $2,149.54

Explanation: Adjust information system for year 2000 project.

It was MOVED by Mr. Evans, seconded by Ms. Davis, and unanimously adopted by voice vote, to submit the following budget adjustment to the full Board for approval:

Revenue: 6775.44772 Federal Revenue $4,672

Appropriation: 6775.5100 Salary $4,672

Revenue: 6775.44772 Federal Revenue $ 100

Appropriation: 6775.54330 Printing $ 100

Explanation: Revenue increase in Title V Program.

1999 Budget Update

Ms. Cole briefly explained the impact of the proposed 1999 budget. She said there three reasons that have resulted in large over-target requests: (1) 3.3 percent negotiated salary increases; (2) 1997 was the first time the Department did not have rollover and in fact has to pay the County back; and (3) drastic change in Medicare reimbursement. It appears the department will be losing approximately $400,000 in Medicare reimbursement for 1998 alone. To accommodate the target and all the requirements, the department is asking for almost $271,000 of over-target requests. She presented the committee and reviewed proposed changes in staff as a result of the proposed budget.

Ms. Crosby explained the changes made in June in Medicare that are effective January 1998. She said the department is estimating between a $350,000 to $420,000 loss in revenue this year. The 1998 department's budget is projected to be under. The department was able to seek money from cleaning out some back billing and problem areas in billing which is money that the department will be able to keep. In the past Medicare has paid the department based on every eligible visit made. Starting January 1^st, payments will based on per unduplicated patient. A reserve account has been set up to set aside money to pay the State back when they ask next year and hopes it covers all the costs. The proposed 1999 budget does account for the reduction in revenue. She feels the revenue situation is under control.

Ms. Kerr spoke about the home care program and the new reimbursement system, the Interim Payment System (IPS). The IPS was designed to transition the home care profession from fee-for-service to a prospective payment system (PPS). PPS is designed to slow spending in home health expenditures by setting a per-episode cap for services based on an agency's historical Medicare utilization. Instead, the IPS applied drastic costs to the reimbursement system for home health care providers and reduces reimbursement rates to fiscal year 1994 levels, which represents calendar year 1993. The average cost for a patient in the program is $2,650; the average cost in a nursing home is $50,000 to $80,000 a year. She said they are looking at providing the most efficient and effective service, trying to provide education to the family with caregivers to try to take over what care they can.

Resolution

It was MOVED by Ms. Davis, seconded by Mrs. Schuler, and unanimously adopted by voice vote, to submit the resolution entitled Authorization to Set Billing Rate - Care at Home - Health Department to the Budget and Personnel Committee action for approval.

Ms. Kerr explained the resolution sets fees to bill a private provider initially for care at home services and children with developmental disabilities. Mr. Proto asked what a High Tech Registered Nurse was. Ms. Kerr said in home care patients are going home quicker and sicker that requires more intravenous medications and therapy. Nurses are being trained to provide those particular skills and to run the equipment.

Environmental Health Fees – 1999

The proposed 1999 Environmental Health Fees were presented. The committee will be discussing and approving the fees as part of the budget process. Mr. Andersson is recommending eleven fees increase. A brief discussion followed.

 Youth Bureau

  1999 Budget Update

Ms. Zahler gave the committee a brief update on the 1999 budget. The Learning Web which has proposed a program that was originally recommended by the Youth Board, however as agencies were prioritized, it withdrew its request for $20,000.

  Appeal Process

Ms. Zahler spoke about the funding cut to the One-to One Program. The Program and agency would like to appeal the Youth Board's recommendation. Mr. Proto said two hours have been allocated to review the Youth Bureau's budget. He said during that time the appeal can be heard and a brief presentation made. Originally the Youth Bureau had been allocated an hour and a half, but because of the appeal, an additional 30 minutes is being allowed. Mr. Proto requested the Program send copies of their justification, appeal and any other written material that may be helpful prior to the budget meeting.

  Safe Places Grant Proposal

Ms. Zahler said about three weeks ago the Department received from the Office of Children and Family a grant proposal to distribute to a combination of youth serving agencies and community type facilities that would enable a partnership of places like libraries, historical museums, community centers, or churches to be able to open their doors to provide safe places to young people during under utilized time. It was distributed to a few places who have been talking about projects like this. If selected the project could get $50,000 for the first year and if funds continue $50,000 for year two and $50,000 for year three.

 Family and Children's Service

  Mr. Johnson described the program and relationship with the County and gave a brief overview of the organization. The service has been in the community for 118 years. It is a non-profit agency and governed by a board. Locations are on Cayuga Street and State Street. The four basic program areas are: (1) clinical programs that primarily focuses on work with children and families; (2) home care program which provides home health aid services, respite services, caregiver services; (3) youth service which has the dispositional alternatives program; and (4) employee assistance programs.

The operating budget is about $2.8 million; 47 percent from contractual services (government and private organizations); 45 percent fee for services, approximately 7 percent from Untied Way and one percent from donations and fundraising. The organization serves about 10,000 people a year.

Over the years, the organization has had relationships with virtually every department that has something to do with human services.

Representatives from Mayers Smoke Shop made a presentation regarding their concerns of Local Law No. 3 of 1998 entitled Regulating the Self-Service Sale of Tobacco Products. Mr. Proto said he appreciated both Mr. Rubin and Ms. McNally for coming. He feels the County has offered to work together and that said representatives of Mayers will be involved in discussions after the committee and staff have had an opportunity to review the suggestions made by Mr. Rubin in an effort to tighten up the wording in the Local Law.

The meeting adjourned at 2:02 p.m.