HomeMy WebLinkAbout2014-05-28 Budget Meeting Minutes Health Services
Minutes of Budget Meeting Wednesday, May 28, 2014 Page 1 of 8
Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
MINUTES OF BUDGET MEETING
DESCHUTES COUNTY BOARD OF COMMISSIONERS
WEDNESDAY, MAY 28, 2014 – Morning Session
___________________________
Allen Room, Deschutes Services Building
___________________________
Present were Commissioners Tammy Baney, Anthony DeBone and Alan Unger.
Also present were Tom Anderson, County Administrator; Erik Kropp, Deputy
County Administrator; Mike Maier, Clay Higuchi and Bruce Barrett, Budget
Committee; and, for a portion of the meeting, Wayne Lowery, County Finance
Director/Treasurer; David Givans, County Internal Auditor; Teri Maerki, County
Financial/Budget Analyst; and Deschutes County Health Services staff Jane
Smilie, Director; Scott Johnson, outgoing Director; David Inbody, Operations
Manager; Melissa Rizzo, Developmental Disabilities Program Manager; DeAnn
Carr, Behavioral Health Deputy Director; Sherri Pinner, Business Manager; Tom
Kuhn, Community Health Program Manager; Hillary Saraceno, Regional Early
Learning Hub Manager; and Jodie Barram, Bend City Council Member.
Meeting minutes were taken by Kathe Hirschman, Deschutes County Health
Services.
Mr. Barrett (chair of budget committee) opened the meeting at 2:45 p.m.
___________________________
Jane Smilie introduced Health Services staff present and began the presentation.
Fiscal Year 2013-2014 was a year of extraordinary change for the department.
Oregon Health Plan (OHP) membership continues to grow; Deschutes County
gained over 13,000 new members from 2013 to 2014. The department will keep
tracking the numbers to make sure service capacity matches the demand. County
general funds are critical to meet safety net services for the uninsured—those in
crisis and those released from jail.
Minutes of Budget Meeting Wednesday, May 28, 2014 Page 2 of 8
Sherri Pinner distributed FY 2015 budget by programs for Funds 259 and 270, and
explained the department’s three-year forecast for Medicaid funding to sustain
essential services. The department’s ending fund balance is projected to be $2
million at the end of the three-year forecast. Mr. Maier noted that the forecast
shows a trend that the contingency funds will be gone in FY 2017, and the
department should not look to County general funds to cover. Ms. Pinner noted
that the forecast is specific to OHP revenues and OHP expenditures and is a worst -
case scenario based on information currently available.
Typically, more up-to-date information about funding adjusts the forecast to be
better as we get closer to the dates that are projected here. Mr. Higuchi noted that
actual funds from the State of $7.4 million, which goes up to $10 million, is the
increased per-member-per-month capitated rate for expanded OHP. Mr. Higuchi’s
concern is that the amount coming to us is not keeping up to expenses as we look
farther out. This is a rolling target and the forecast is continually updated based on
current information as it becomes available.
The region is required to update the current Health Assessment and Health
Improvement Plan in 2015. This is an opportunity and should guide the
department’s and the region’s work in setting priorities and moving together to
have an impact.
Between 2006 and 2015, the average annual increase in personnel related costs has
been 9.2% and the County general fund increase has been 2.1%. This is mostly
related to public health programs; OHP covers most of the cost in behavioral health
programs.
OHP expansion has been huge driver over the past year. The department has
received 15 new State grants in public health and behavioral health. There was a
reduction in State general funds which has mainly impacted our safety net
services—those services we are mandated to provide as the Community Mental
Health Provider. The department passed the Triennial Review by the State Public
Health Division with flying colors, and 93 of the 98 Public Health Accreditation
standards were either substantially or fully met. The department has added 23.1
FTE; expanded services in Redmond and La Pine; and got medical sponsors for all
five School Based Health Centers.
The department’s core responsibility is to assure the health of our residents. We
are becoming more diligent about translating broad County Goals and Objectives
into measurable objectives.
Minutes of Budget Meeting Wednesday, May 28, 2014 Page 3 of 8
We post quarterly progress reports on how we are performing with our measurable
objectives to move the County goals forward. The Program Budget narrative
speaks to County general funds received and what services are provided with those
funds.
Common themes for use of County general funds across all the department’s
programs are to fill gaps in funding to assure all citizens receive services they are
eligible for, to provide matching funds to maximize federal funding; to provide
essential administrative and operational support; to advance the Triple Aim with
prevention services; to fulfill our responsibility to protect the health and safety of
residents.
According to the State Public Health Division, county general fund is the second
highest funding stream for public health services across Oregon. Deschutes
County’s general fund contribution is 26%, which is comparable to the State
average.
The departments request for County general funds in 2014-2015 is $156,100
(approximately 3.7% increase over FY 2014 level. The bulk of this is to provide
funding for staff positions—$110,200 for psychiatry, a jail diversion case manager,
therapy for young children; health assessment update; and an internship within
County government for an individual with developmental disabilities. Mr. Maier
asked whether this request was included in the proposed budget.
Tom Anderson explained that it is currently funded out of contingency funds and
the department is requesting it be provided by an increase in County general fund.
The total amount in the budget coming from County general fund is $2,766,000 in
public health and $1,377,000 in behavioral health—the same level of funding as
the prior year. This request is for additional County general fund. Scott Johnson
noted that the gaps can be covered this year out of contingency funds, but they
cannot be covered long-term out of contingency.
Mr. Johnson explained that OHP members lose their coverage when incarcerated.
This benefit is lost even if the individual is not adjudicated yet—while the
individual is incarcerated pre-trail. The department has the responsibility to serve
these individuals when they are released, and before OHP coverage is obtained,
and coordinates with the jail to do so.
Minutes of Budget Meeting Wednesday, May 28, 2014 Page 4 of 8
Ms. Smilie explained that for each piece of the staffing request the department
plans to blend the County general funds with OHP funding so that staff can serve
those with OHP and the under- and un-insured. In addition to the staffing outlined
above, the department is requesting $13,500 to implement an e-learning system
that will help with risk management and compliance, and $32,400 to help the
department replace computer equipment as required by the Information
Technology department. Funds are needed for the e-learning system and computer
replacement for public health staff only as the behavioral health budget has
sufficient funds.
Mr. Higuchi asked whether the $13,500 and $32,400 are one-time expenses or an
ongoing commitment. Ms. Smilie clarified that a portion of the employee
development would be ongoing and the technological improvement would be one-
time. Mr. Maier asked why there had been a big increase in behavioral training
expense. Most of the increase was due to sending staff to a national behavioral
health conference and training conferences for behavioral health electronic health
records staff.
Commissioner Unger asked whether the e-learning system would help reduce
disallowed expenses because staff will train online rather than travelling. Mr.
Johnson replied that it would reduce travel expenses and would also provide the
department a more efficient and effective method of tracking which staff have
taken which trainings. The expense of the e-learning system has been included in
the proposed budget but there is not an offsetting revenue item.
Mr. Anderson asked whether there will be legislative initiative next year to change
the OHP rules to maintain coverage of incarcerated individuals. Mr. Johnson
explained that this would require change in federal law. Commissioner Baney
noted that the Governor does have discretion as to whether or not to suspend
coverage and that he did decide to suspend rather than terminate. Now the
infrastructure has to catch up and we need a fast-track method of getting their
coverage back. This is a big topic at the State level.
The County transferred 2.5 FTE prevention staff from the Children & Families
Commission to Health Services in FY 2014 to continue prevention services.
County general funds in the amount of $26,451 included in FY 2014 for operating
and indirect costs related to those 2.5 FTE were not included in Health Services
budget in FY 2015. The department is requesting these funds be reinstated into
Fund 259 to maintain the current level of service. Children & Families
Commission general fund was reduced by that amount but Health Services budget
was not increased by that amount.
Minutes of Budget Meeting Wednesday, May 28, 2014 Page 5 of 8
Increasing community access remains a priority for the department—bringing
services to individuals throughout the County. A sampling of data from just three
program areas—behavioral health, family planning and WIC—shows that more
than 12,000 individuals have benefitted from these services in Sisters, Redmond,
La Pine, Bend and north Klamath County over the past year. The number served
in outlying areas is expected to increase as new facilities open.
DeAnn Carr gave an overview of behavioral health services and priorities. The
department aims to provide timely and effective access at accessible locations and
to support whole-person health via integration and by expanding the continuum of
care and services that support health. Prevention education and outreach will be
increased. Safety net functions will be a critical piece. As more individuals enroll
in OHP, we will also have an increasing population that is underinsured and will
still have a significant gap that the County will be responsible for as a safety net
provider.
Hillary Saraceno distributed an Early Learning System handout. The Early
Learning Hub is a tri-county effort with Crook and Jefferson Counties targeting
children 0-6 years old who are at-risk. The comprehensive budget for children’s
services in the region is $18.8 million; the Hub is responsible to make sure these
funds are used effectively. Total Early Learning Hub budget is $1.3 million, which
includes State, Maternal Child Health, High Desert Education Service District,
Medicaid, and County funding. When our regional Hub is certified, there will be
additional resources that will offset funding currently provided by the Counties.
Commissioner Baney noted that Ms. Saraceno and the team have done incredible
work in trying to engage the State in rolling this out and asked what is committed
from the State to come into our region when we have been certified as the regional
Hub. Approximately $660,000 for programs is expected to come to the region,
14% of which will be designated to cover the administrative costs of all the
participating providers. WEBCO will need to decide how that will be allocated.
Commissioner Baney reminded the Budget Committee that these funds will go not
only to the Counties but also to other providers. We need to decide what is
Deschutes County’s contribution to the Hub in future. Because we have wanted to
be at the forefront, we have been doing this work, and Commissioner Baney is
concerned that there may be an understanding in the other Counties that because
we’ve been funding the work, we’ll continue to do so. Ms. Saraceno feels there is
an understanding at the State level that it cannot be just the Counties and that
discussion about this in the legislature is coming.
Minutes of Budget Meeting Wednesday, May 28, 2014 Page 6 of 8
Mr. Johnson described the work done over the past year to g et more help from
other communities agencies for the School Based Health Centers (SBHC) in order
to reduce reliance on County general funds. Each SBHC will provide primary care
provided by the medical sponsors, behavioral health services provided by the
department, and public health education for the entire student body provided by
department public health nurses. Medical sponsors are either already providing
services or coming on line at all seven SBHCs. Our partners are Mosaic Medical,
La Pine Community Health Clinic, and St. Charles Medical Group. Advantage
Dental is a critical partner as well and will be providing dental services, primarily
at the Sisters SBHC.
Last year we were using $550, 000 for the SBHCs; with the new medical sponsors,
we have that number down to $363,000. The $190,000 in savings went to offset
costs in Community Health, Reproductive Health, Maternal Child Health and WIC
programs.
Mr. Higuchi noted that the $190,000 saved did not reduce the general fund
contribution but was used to cover costs in other program area s. The program
budget document includes paragraphs describing what the general fund
contribution does in each program area. The department has used the funds to
offset the increase in cost to provide services. Commissioner Baney asked whether
it would be safe to say that the $363,000 is our “fixed cost” now associated with
the SBHCs. Mr. Johnson explained that we can’t promise that this will be the case
but the worst case scenario would be the $363,000 plus normal increases in
indirect and administrative costs.
Commissioner Baney cannot get over the hurdle of applying for a grant to stand up
the SBHCs and not anticipating that the County general fund was going to be
needed to go forward. She understands getting out there, because we can and feel
we should do the project, but at the same time recognizes that the day is coming
when things we have taken on really should not have been ours. The department is
very confident that the SBHCs have incredible value as centers.
Commissioner Unger noted that the SBHCs were a successful platform to help
provide more County services than anticipated and wondered if the cost did not go
down because we expanded services being offered at the SBHCs. Mr. Johnson
explained that if the County had not gone forward with the Sisters SBHC we
would have no place to provide our services in Sisters. We call it a SBHC but we
can do a number of other things out of that location. If we were not constructing
the SBHC we would still be looking at a lease commitment for another site in order
to provide services in Sisters.
Minutes of Budget Meeting Wednesday, May 28, 2014 Page 7 of 8
Commissioner Baney stated that the Board does want to be providing services in
Sisters and this is a way to do that effectively. Mr. Higuchi expressed concern
about the growth of spending, so some action has to be taken. We just don’t have
enough money in the County to cover this growth if, say in three years, it will be
$2 million. We don’t know if $363,000 is the number. We will have to wait and
see, and then figure if $363,000 is worth it.
Ms. Smilie summarized: the department’s request is for $156,100 plus transfer of
$26,451 from Children & Families Commission fund. The department is covering
personnel related increases of $291,444. OHP behavioral health funds are up
while public health funding is down. There has been a 23.1 FTE increase since FY
2014 budget was adopted. Accomplishments: increased access; integration efforts
underway; regional EL Hub application submitted; demonstrated increased
accountability; staff have navigated multiple and majo r changes successfully.
Challenges: sustaining public health programs, services and protections; assuring
timely OHP access; continuing attention to program compliance and performance;
more changes on the way.
Mr. Maier noted that contract payments in public health revenue went down more
than 50%. Ms. Pinner explained that some of the change was due to the
department using the proper revenue line and some were local grants that ended.
Mr. Maier referred to the $1 million reduction in state grants on the behavioral
health side and a $3 mi llion increase in administrative fees and asked what type of
administrative fees. Ms. Pinner explained that OHP capitation has increased .
What used to be indigent clients with no coverage previously paid for with by State
general funds are now OHP capitation clients who have covered benefits. Mr.
Lowery explained that administrative fees are a percentage of the capitation
amount provided by the State to cover the costs of providing the services.
Mr. Anderson explained that he would like to see us get to the point where ideally
we look at each service area and the Commissioners make policy decisions on the
level of commitment to make in that service area. It is awkward without that kind
of policy/financial process going on. If we could do that, it would make this
process more meaningful with the ability to match up the policy decisions with
dollars. Mr. Johnson noted that it would be very helpful to have a clear policy
framework in which to operate and it would help with the department’s strategic
planning.
Being no further discussion, the session ended at 4:23 p.m.
DATED this rlf> Day of 2014 for the W
Deschutes County Board of Commissioners
Tammy Baney, Cha
Anthony DeBone, Vice ~r
ATTEST: ~~~L~fl :
Alan Unger, Commissioner ~~
Recording Secretary
Minutes of Budget Meeting Wednesday, May 28,2014 Page 8 of8
BUDGET COMMITTEE AGENDA
Tuesday, May 27 th , 2014
9:00 AM
9:00 -9:05 AM
9:05 -9:20 AM
9:20 -9:35 AM
• Elect Chair
• Approve minutes from the December 2013 meeting
Sunriver Library County Service District (Fund 751)
(Budget Committee-Commissioners)
• Open public meeting and introductions
• Budget discussion
• Public comment
• Motion to approve budget of $102,975 and set amount of
levy at $99,974
• Motion to be seconded
• Budget Committee votes
• Close budget meeting
Sunriver Service District (Funds 715 & 716)
(Budget Committee-Commissioners, Bob
Wrightson, Jim Wilson & Mike Gocke)
• Open public meeting and introductions
• Budget discussion
• Public comment
• Motions to:
1) Approve Sunriver Service District operating budget of
$6,351,263 and set tax rate at $3.3100 per $1 ,000 of
assessed valuation (Fund 715)
2) Approve Sunriver Service District Reserve budget of
$1,149,122 (Fund 716)
• Motions to be seconded
• Budget Committee votes
• Close budget meeting
Black Butte Ranch Service District (Fund 761)
(Budget Committee-Commissioners, Dave Sullivan,
Tom Mayberry & Carl Burnham)
• Open public meeting and introductions
• Budget discussion
• Public comment
Motions to:
• 1) Approve budget of $1,739,110 and set tax rate at
$1.0499 per $1,000 of assessed valuation
2) Set local option operating tax rate at $.5500 per $1,000
of assessed valuation
Program
Budget
Tab/Page
13/379
71273
7/265
Page 1
BUDGET COMMITTEE AGENDA
Tuesday, May 27 th , 2014
Black Butte Ranch
Svc District (Cont'd)
9:35 -9:50 AM
9:50 -10:00 AM
10:00 AM -Noon
Noon -1:00 PM
1:00 -2:30 PM
2:30 -2:45 PM
2:45 -4:45 PM
• Motion to be seconded
• Budget Committee votes
• Close budget meeting
Deschutes County Extension and 4-H Service
District (Funds 720 & 721)
(Budget Committee-Commissioners, Joe Cross,
Mike Scholeman & Katrina Van Dis)
• Open public meeting and introductions
• Budget discussion
• Public comment
• Motions to:
1) Approve Deschutes County Extension & 4-H Service
District operating budget of $699,835 and set tax rate at
$.0224 per $1,000 of assessed valuation (Fund 720)
2) Approve Deschutes County Extension & 4-H Service
District Reserve budget of $432,300 (Fund 721)
• Motions to be seconded
• Budget Committee votes
• Close budget meeting
Break
Deschutes County
• Open public meeting
• Deschutes County Budget Proposal
Capital Improvement Program (Lunch Discussion)
Other Funds
Health Benefits Trust (Fund 675)
PERS Reserve (Fund 135)
Economic Development Fund (Fund 105)
Video Lottery (Fund 165)
Bethlehem Inn (Fund 128)
General Fund (Fund 001-00 and 001-45)
Break
Health Services
• Introductions
• Budget discussion
Continue the Deschutes County budget m e eting to
Wednesday, May 28t h , at 9:00 AM
Program
Budget
Tab/Page
7/268
8/277
6/228
6/237
6/229
6/223
6/230
6/214
5/168
Page 2
EL System: Our Shared Purpose & Common Agenda
CHILDREN READY
FOR SCHOOL
Direct & Indirect Effects
Adapted from OSU
Family Policy Program
Early Prenatal Care
Parental Access to Alcohol
& Drug Abuse Treatment
Access to Developmental
Screens/Early Evalu'ation
Access to Health, Dental,
Vision, & Other Needed
Care
Reduced Teen Pregnancy
Parenting Education
Family Access to Basic
Resources
Resources & Activities for Children & Families Wise Use of Electronic Media DIAGRAM KEY
Parent Involvement in Care & Education Setting Family Support & Education Services BOXES: Major domain
High Quality Early Childhood Care & Education Services Family Access to Basic Resources with direct affects
BRACKETS: Key factors"-----------v-- ~
with indirect affects
Child Health :
• Health Status
at Birth
• Balanced
Nutrition
• Healthful
Development
• Help with
Special Health
Needs
Educational Environments :
(Home and Early Care/Education)
• Parents as Child's Primary Teacher
• Age-Appropriate Stimulation of Physical, Cogni
tive, Language & Social Skills
• Experiences with Peers
• Quality Care and Education Experiences
• Early Childhood Special Education
Family Functioning :
• Nurturing/Responsive Parenting Strategies
• Parent as Child's Primary Teacher
• Family Marital & Economic Stability
• No Child Maltreatment
• No Family Violence
Communities:
• Low Exposure to
Violence & Fear
• Adequate & Afford
able Housing
• Local Resources:
Child Care & Educ,
Libraries, Parks,
Family Resource
Centers
• Ready Schools &
Kindergartens
• Social Climate:
Neighborhoods,
Shared Supervi
sion, Civility
• Positive Role Mod
els for Children
Ch ild ren Re ady
for Kinde rgarten
~
~----------------------------------~
Parental Access to Alcohol & Drug Abuse Treatment Family Support & Education Family Access to Basic Resources
Access to Health & Mental Health Care Reduced Teen Parenting Reduced Parental Work Demands
Social Supports for Parents & Extended Families
Community Building &
Community Support
Reduced Crime/
Delinquency
Youth Engagement in
School & Community
Coordinated Access to
Needed Family Ser
vices
Primary Prevention
Programs for Children
& Families
Community-School
Integration
Family Friendly Emm» r -f
ployers ::I:-f
c: »c"o
o ::I:-31: om . z
9-f
1:--'
~r
CJ)"
;;tJ II)-n;:::a.»W:a:: C" ..... CUI ~ ..:..:,!" ...... :--' co ..... w~
Early Learning Hub of Central Oregon -rev. 3/24/2014 (Original Document Source : OSU Family Policy Program for the EARLY CHILDHOOD FINANCE COMMIITEE)
• •
ATIACHIVIENT 7.3 -Part 3a (S.2.7.1b)
EL Hub of C.O. -DAS RFA# 201-2183
n •n
Kindergarten readiness means young children have the skills,
knowledge, behaviors and attitudes necessary for success in school
and in life. It includes aspec ts of six domains :
• Physical Health and De velopment
• Social and Emotio nal Development
• Approaches to Lea r ning
• Language and Lit e racy
•
• Cultural Aware ness
Cognition and Ge n eral Kn o~!IlIIIl
that enable children to engage In an b e nefit from le arning
experiences. In order fo r children to be ready, fa mil ies need the
resources to support l ear ning, growth and deve lop ment. Schools and
communities need to w ork together to prov i de culturaUy relevant
environments and experiences that advanc e child develo p ment from
birth to kindergarten entry. Each component plays an essential role in
readiness and no one component can stand alone.
hil ~ n
+R ad Fa mil;
+R I rv;
+ mmun I
= hil ~ n u --~ ho I
Original document source from All Hands Raised-Multnomah Kindergarten Readiness
Collaborative * revised by the Early Learning Hub of Central Oregon community partners to
reflect The Head Start Child Development and Early Learning Framework Domains and to
emphasize the importance of cultural awareness
Requested Changes to Proposed Budget
FY 2015
f
I ~
A)
B)
OHP-Mental Health Services (Fund 270) I FV 2015
I Proposed I Adjustment] Approved
Transfer Out to Fund 142 200,000 200,000
Contingency 4,729,510 (200,000) 4,529,510
Total Requirement Changes
Jail Project (Fund 456) I FV2015
I Proposed I Adjustment I Approved
Transfer In from Fund 142 140,000 140,000
i•I
Ii
I
I1
C)
Total Resource Changes 140,000
New Construction 2,857,956 140,000 2,997,956
Total Requirement Changes 140,000
ISisters Health Clinic (Fund 464) FV 201S
I Proposed I Adjustment I Approved
Beginning Net Working Capital 140,000 210,000
Federal Grants 220,000
Interest Revenue 1,000
Total Resource Changes 431,000
350,000
220,000
1,000
Architecture/Design 15,000
Interfund charges 359
Fees, Permits & SDCs 5,000
15,000
359
5,000
Transfer Out to Fund 142 100 100
New Construction 139,641 410,900 550,541
Total Requirement Changes 431,000
j
i
Ci
D) General County Projects (Fund 142) I FY 2015
I Proposed I Adjustment I Approved
Beginning Net Working Capital 1,780,000 (150,000)
Transfer In from Fund 270 200,000
Transfer In from Fund 464 100
1,630,000
200,000
100
Total Resource Changes 50,100
Transfer Out to Fund 456 140,000 140,000I Building Remodel 250,000
Contingency 2,964,255 (339,900)
250,000
2,624,355
Total Requirement Changes 50,100
I E)
!
t
2 ~
j
:!
1 1 i ~ ,~ C;!
,j
i
,
I
i ~
North County Services Building (Fund 462)
Beginning Net Working Capital
Interest Revenue
Sale of Capital Assets 2,500,000
Total Resource Changes 2,031,000
Architect/Design 40,000 560,000
Interfund charges 1,378
Water & Sewer 1,200
Fees & Permits 5,000 21,500
Electricity 10,000
Debt Service-Prinicipal 150,000
Debt Service-Interest 4,500
Capital Outlay-Unger Building 1,000,000
Capital Outlay-Design Center 5,000 (5,000)
Capital Outlay-Antler 300,000
Transfer Out (to Fund 140) 480,422
Total Requirement Changes 2,031,000
1,000
2,500,000
600,000
1,378
1,200
26,500
10,000
150,000
4,500
1,000,000
300,000
480,422
Requested Changes to Proposed Budget
FY 2015
F) Fair and Expo Center (Fund 618) I FY2015
I Proposed I Adjustment I Approved
Concession Food
Concession Alcohol
Catering Alcohol
Catering outside @ 15%
Catering
Gratuitv 18%
Flatware Rental
Kitchen Rental
Total Resource Changes
Personnel Costs-Food/Bey Manager
Materials & Serices-Food Costs
Materials & Serices-Food/Bev Temp Help
Contingency
Total Requirement Changes
218,368 218,368
213,315 213,315
14,419 14,419
10,000 10,000
146,914 146,914
26,445 26,445
8,000 8,000
2,000 2,000
639,461
102,880 102,880
176,767 176,767
161,059 161,059
218,814 198,755 417,569
639,461
J
n e fit
Fund 259
Public Health Division FY 15 Budget by Programs
Womens
Reproductive Community Maternal Infants & Business
Health Health Child Health Children Services--
FY 15 Budget
Total
Program FTE 8.97 FTE 19.13 FTE 21.17 FTE 9.93 FTE 17.65 FTE 76.85 FTE
RESOURCES:
Beginning Net Working Capital 7,707 160,570 3,836 4,730 1,393,978 1,570,821
Revenues
Federal Government Payments 82,085 2,500 17,000 101,585
State Government Payments 1,004,831 756,096 1,802,299 684,528 4,247,754
Local Government Payments 240,000 240,000
Charges for Services 107,500 945,866 74,791 141,000 1,269,157
Non-Operational Revenue 1,500 6,000 7,500
Interfund Charges 97,600 6,018 103,618
Interfund Grants 294,439 294,439
Transfers In -County General Fund 679,153 897,501 756,494 433,429 2,766,577
Total RESOURCES 1,882,776 3,056,972 2,975,020 1,122,687 1,563,996 10,601,449
REQUIREMENTS:
Expenditures
Salaries
Benefits
879,036
485,484
1,556,006
835,431
1,436,169
829,335
577,274
340,284
157,013
70,495
4,605,498
2,561,029
Personnel Services
Interfund Charges
Internal Service Fund Charges
Grants. Loans, & Reimbursements
Other Materials & Services
Materials & Services
Capital Outlay
Transfers Out
Contingency
TOTAL REQUIREMENTS
1,364,520
119,190
358,822
478,012
40,226
18
2,391,437
187.586
20,089
403,300
610,975
54,558
2,265,504
180,339
232.300
237.712
650,351
32,951
26,215
917,558
89,794
84,391
174,186
30,942
227,508
7,635
13,484
6,700
86,946
114,764
100
5,962
1,215,661
$ 1,882,776 13,056,t~72 $ ~,9751020 $ 1,122,687 $ 1,563,996
7,166,526
7,635
590,393
259,089
1,171,171
2,028,288
100
164,640
1,241,895 _..,_._
$ 10,601,449
_____.______ __",t)+Ah"t&\". k4 !II4SJI$i.'/!<i1kli L, X ,H 0'jiQ.¥iIf t~,,~h""'4J;t ',~1!1J.,,",i!!lIr""'j
Fund 275
Behavioral Health Department FY 15 Budget by Programs
Child and Family
Program
Access & Crisis
Services
Adult
Treatment
Program
Developmental
Disability
Program
Business
Services
•
FY 15 Budget
Total
Program FTE 45.77 FTE 16.57 FTE 66.60 FTE 14.61 FTE 18.70 FTE 162.25 FTE
RESOURCES;
Beginning Net Working Capital $ -$ -$ 3,000 $ 1,252 $ 3,308,996 3,313,248
Licensing and Fees 147,200 147,200
Federal Government Payments 204,849 34,000 238,849
State Govemment Payments 754,892 725,842 3,333.432 3,406.720 8,220,886
Local Government Payments 65,000 65,000
Charges for Services 123,600 8,010 70,000 201,610
ForefeittJres o
Non-Operational Revenue 7.800 11,000 19,500 38,300
Interfund Charges 4.516,773 1,295.657 5.398,337 5,218 11,215.985
Interfund Grants 127.000 127.000
Transfers In -County General Fund 384,826 53.553 637.613 301,311 1.377.303
Transfers In -Acute Care 187.594 187,594
TOTAL RESOURCES $ 6,000,091 $ 2,270,656 $ 9,785,~31 $ 3,709,283 $ 3,367,714 $ 25,132,974
REQUIREMENTS:
Salaries $ 3,035,325 $ 1,153,056 $ 4,384,252 $ 832,129 $ 77,196
Benefits 1,695.176 632,167 2,435.678 477.501 40,120
Personnel Services 4,730,501 1,785,223 6,819,930 1,309,630 117,311 14,762,595
Interfund Charges 9.760 0 0 1,813 11,573
Internal Service Fund Charges 407,034 151,389 586,843 117,014 1,558 1,263,837
Grants, Loans & Reimbursements 5,600 2,000 330,139 1.692,592 2,030,331
Other Materials & Services 737,721 303,130 1,836.546 524,523 281.741 3,683.662
Materials & Services 1,160,115 456,519 2,753,528 2,334,129 285,112 6,989,403
Capital Outlay 100 100
Transfers Out 55,893 21,764 106,276 20,752 215 204,900
Contingency 53,580 7 1151 105,499 44,772 2,964,971 __3_,175.973
TOTAL REQUIREMENTS $ 6,000,091 $ 2,270,656 $ 9,785,231 $ 3,709,283 $ 3,367,714 $ 25,132,974
(.,~ '-'
Budget Committee May 27, 2014
Our Mission:
To promote and protect
the health and safety of our
community.
Better
Health
Less
Cost
Better
Care
Public Health, Behavioral Health and
support of the Early Learning Hub
Health Reform, Medicaid Expansion and Other
Trends Impacting Health Services
2013-2014 A Year of Extraordinary Change
County General Fund: Essential Need &
Request
Community Access, Collaboration &
Programming
Summary
5/
1
5
/
2
0
1
3
Oregon Health Authority
and other funding sources
Deschutes County
Health Services
Regional, County and community-based operations in a
Coordinated Care Organization environment
WEBCO
Wellness & Education Board
Three Counties
Education
CO Health Council
Pacific Source CCO
2008 2009 2010 2011 2012 2013 2014 2015
Deschutes Co 10,362 11,616 13,99 20,009 23,168 23,182 36,446 37,175
Jefferson Co 2,107 2,831 3,518 4,149 4,418 3,806 5,321 5,427
Crook Co. 1,844 2,090 2,508 3,217 3,482 3,513 5,227 5,331
Total 14,313 16,537 20,021 27,375 31,068 30,501 46,994 47,993
OHP Membership Continues to Grow
2008 – 2015
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2008 2009 2010 2011 2012 2013 2014 2015
Crook Co.
Jefferson Co.
Deschutes Co.
10,362 11,616
13,995
20,009
23,168
23,182
2,107
2,831 3,518 4,149 4,418
3,806
1,844 2,090
2,508
3,217 3,482 3,513
36,446
5,321
5,227
37,175
5,427
5,331
We are increasing access more locations, more services, more
providers, more contracted dollars, more staff.
We contract “at risk.” We must assure service to any resident
on OHP with a medical need for BH services.
Federal government: it is “fraud and abuse” to use BH OHP
funds for any other purpose.
We are also the safety net for residents without insurance or
at high risk including those in crisis or leaving the jail.
County GF is critical here.
FY 13
Actual
FY 14
Estimated
Actual
FY 15
Budget
FY 16
Budget
FY 17
Budget
Resources
Beg Net Working Cap $ 6,283,630 $ 7,174,100 $ 8,433,927 $ 6,623,543 $ 4,648,054
OHP Capitation 7,414,146 10,040,529 10,502,582 10,712,634 10,926,886
Other Revenues 46,284 44,598 45,100 45,100 45,100
Total Resources $13,744,060 $17,259,227 $18,981,609 $17,381,277 $15,620,040
Requirements
Materials & Services $ 336,551 $ 506,657 $ 1,147,299 $ 1,047,972 $ 1,105,038
Trans to Operations 6,233,411 8,318,643 11,210,767 11,685,251 12,455,751
Contingency 0 0 6,623,543 4,648,054 2,059,251
Total Requirements $ 6,569,962 $ 8,825,300 $18,981,609 $17,381,277 $15,620,040
*Our projections are revised, at a minimum, on a quarterly basis.
Our target for an ending fund balance at the end of the 3-year forecast is $2 M.
FY 06 thru FY 15 (proposed) Average Annual
Increase
Personnel-related costs 9.2%
County GF support 2.1%
Balance of increased costs covered from other revenue
Example: FY 15 includes $291,444 increased personnel-
related costs not requested in County GF support
Central Oregon
Health Assessment
and Health
Improvement Plan
•Updates required in 2015
•Deschutes, Jefferson,
Crook County
•Documents health needs
•Plan to address them with
evidence-based programs
•Identify partner
responsibilities
•Ensure accountability
“ The implementation of Health Care Reform … presents
promise and challenges to the County’s efforts … Many
more County residents are now covered by … OHP,
significantly increasing state revenues based on covered
lives in the region … It is not clear how many and when
these clients will appear in our facilities for services …
Staff positions have been added … more may be needed
over the next several years …”
Cover Oregon & OHP expansion
15 new State grants - improving services
$1.9 M cut in State GF - safety net impacted
PH Triennial Review- met all 1,179 standards
PH Accreditation Site Visit - 93 of 98 met
23.1 FTE net staff increase since FY 14 adopted
budget - grants, Medicaid expansion
Expanded Redmond and La Pine service
Medical sponsors at all SBHCs
Assess, preserve, promote and protect the basic
health and wellness of residents.
Timely access to quality and affordable health
care for the most vulnerable populations.
Provide physical and behavioral health treatment
and support services to meet community needs.
Promote preventive health through partnerships,
community education, outreach, advocacy.
Promote targeted prevention, diversion and
intervention programs to reduce recidivism and
future demands on county services …
Measures related to
Client access
Program utilization
Satisfaction
Health outcomes
System performance
Fill gaps in funding to ensure all residents that are
eligible and in need of services receive them
Provide matching funds to maximize Federal
funding
Provide essential administrative and operational
support
Advance the triple aim with prevention services
Fulfill our governmental responsibility to protect
the health and safety of residents
LHD Projected Revenues By Source
FY 2014
County General
Funds State IGA Other State &
Federal Funds Fees & Donations Medicaid Other Funds
Series1 $72,114,993 $42,021,293 $25,555,539 $35,991,714 $84,506,573 $14,891,174
$0
$10,000,000
$20,000,000
$30,000,000
$40,000,000
$50,000,000
$60,000,000
$70,000,000
$80,000,000
$90,000,000
Staffing $110,200
Psychiatry, jail diversion case manager, therapy for
young children - safety net services
Health assessment update
Internship within County govt. for person with
developmental disabilities
Employee development $13,500
E-Learning module for public health staff
Technological improvements $32,400
Replacement of WBTs – required by IT
The County transferred 2.5 CFC staff to
Health Services to continue prevention
services
$26,451 in County GF included in FY 14 for
operating and indirect costs was not
included in Health Services budget in FY 15
We request the remaining funds be
reinstated into Fund 259 to maintain our
current level of service
“You are leveraging resources and processes
and using resources to maximize impact in the
community, and for public health, you cannot
ask an organization to do much more than
that.”
March 2014
Sisters Clinic
Under Construction
183 served
Redmond
HS SBHC
Lynch
SBHC
Becky
Johnson
Center
New BH Clinic
Courtney
Annex
Wall St.
Services KIDS
Center Ensworth SBHC
La Pine
SBHC
La Pine
Clinic
South County
Services Center
Community Access Remains a Priority
7,212
served
3,775
served
Bend HS
SBHC 2015
941
served
BH: N. Klamath
Sample data
residents served in:
- Behavioral health
- WIC or
- Family Planning
2013-14 Contracts
Contract Type Estimated Number Estimated Amount
Service Contracts 147 $ 6.8 M
Business Contracts 6 $ 20 K
Total 153 $ 6.8 M+
In addition:
•Contracts for OHP services held at Pacific Source: $1.58 M in FY 14 are
increasing to $1.93 M in FY 15; an increase of $350 K
•$2.5M WIC funds spent in Deschutes County grocery stores and farmers
markets.
2014-15 Priorities
Provide Access to
timely & effective
services at accessible
locations
Support Whole Person
Health through
integration and
expansion of our
continuum of care.
Support System Health
BH Future & County’s role
Transformation of
business approach:
Doing good isn’t enough
Health complexity driven
service models:
Complexity drives
location and services
Whole person health care
Increased prevention,
education, & outreach
Safety net functions
Collaboration with Mosaic to
create a complex care clinic
Co-location with La Pine
Community Health Center
More use of South County
Building for clinical services
Opening a new clinic in
Redmond this month
Adding more full time staff in
Redmond & La Pine
More local services in Sisters
through creation of a new
integrated clinic
Target population: 10,243 at risk 0-6 year olds in the
region
Region’s early childhood resources: $ 18.8M
Total ELH budget: $ 1.3M
Includes state, MCH, HDESD, Medicaid, Counties
Deschutes County investment:
$ 252,288 General Operations
($26,451 not transferred)
$ 89,350 Alternatives to Incarceration
Early Learning Hub
Early Learning Hub
Outcomes & Goals
Programs – Improving Outcomes
10,243 – At Risk Children & Three Tiered Approach
ROI – Every $1 invested in EC foundation yields $7
County Specific
Programs, Projects & Initiatives
1.6 Staff FTE
FY 14 Goals
Partner with the medical community
Reduce County GF revenue needs
FY 15 Benefits
Integrated primary care and behavioral health
services at all clinics
Ease of access, care coordination, decreased
absenteeism, quick return to class
Health education provided to entire student body
Medical sponsors will be in
place at all centers in FY 15
La Pine Community Clinic
La Pine, Gilchrist (Klamath)
Mosaic Medical
Bend High, Ensworth, Lynch
St. Charles Medical Group
Redmond High, Sisters
As requested:
34.4% reduction
in need for County GF
support
FY 14 CGF $554,151
FY 15 CGF $363,499
Reinvested $190,652
-Community Health
-Reproductive Health
-Maternal Child Health
-Women, Infants & Children
FY 15 Budget Highlights:
Request $156,100 County GF
Restore $26,451 from CFC
transfer
Health Services covering
personnel-related increase
of $291,444
OHP funds up, PH down,
new grants secured
23.1 FTE net increase since
adopted FY 14, 241.7 total FTE
Accomplishments:
Increased access
Lives covered
Service locations
Integration efforts underway
Regional Early Learning Hub
application submitted
Demonstrated increased
accountability
Navigated multiple and major
changes successfully
Challenges:
Sustaining public health
programs, services, protections
Assuring timely OHP access
Continuing attention to
program compliance and
performance
More changes on the way