Budget/Finance Committee minutes (5 minutes) ACTION Budget-Finance Committee meeting minutes from 5/14/18 (Attachment #1)

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Douglas Goodman
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Mission: To promote hope, recovery, resilience, quality of life and wellness in Washtenaw County by providing high quality, integrated services to eligible individuals.

Conference Room June 11, 2018 2:00PM-3:30PM I. Introductions (5 minutes) II. III. IV.

1 Mission: To promote hope, recovery, resilience, quality of life and wellness in Washtenaw County by providing high quality, integrated services to eligible individuals. WASHTENAW COUNTY COMMUNITY MENTAL HEALTH (WCCMH) BUDGET-FINANCE AND PROGRAM-QUALITY COMBINED QUARTERLY COMMITTEE MEETING AGENDA 4135 Washtenaw Ave, Ann Arbor, MI Learning Resource Center, Michigan Conference Room June 11, :00PM-3:30PM I. Introductions (5 minutes) II. III. IV. Audience Participation (see guidelines below) (5 minutes) Budget/Finance Committee minutes (5 minutes) ACTION Budget-Finance Committee meeting minutes from 5/14/18 (Attachment #1) Program-Quality Committee minutes (5 minutes) ACTION Program-Quality Committee meeting minutes from 5/14/18 (Attachment #1A) V. Finance Status Reports (10 minutes) Financial Report (Attachment #2) ACTION VI. VII. VIII. IX. Contracts and Leases (5 minutes) ACTION Contracts and Leases Regional Finance Update (5 minutes) Old Business (10 minutes) Youth Crisis Stabilization Team Update Blue Care Network (BCN) update New Business (35 minutes) Bureau of Justice Assistance (BJA) grant proposal Utilization Management Overview-K. Bellus General Fund Overview and Fund Balance Update-K. Bellus/N. Phelps X. Items for Future Discussions (5 minutes) XI. Adjournment Audience Participation Guidelines: Three (3) minutes are allowed per speaker Speakers are asked to bring a copy of their concerns/comments in writing Resolutions on issues will be brought to the appropriate committee as necessary

2 ATTACHMENT #1 WASHTENAW COUNTY COMMUNITY MENTAL HEALTH AGENCY (WCCMH) WCCMH BUDGET-FINANCE COMMITTEE MEETING MINUTES DRAFT 4135 Washtenaw Ave, Ann Arbor, MI Learning Resource Center, Huron Conference Room May 14, :00 pm MEMBERS PRESENT: MEMBERS ABSENT: STAFF PRESENT: OTHERS PRESENT: A. Dusbiber (phone), C. Collins (phone), M. Creekmore, D. Strong M. Bloom R. Clark, R. Dornbos, L. Cooper, M. Harding, T. Cortes, K. Bellus, S. Ray, N. Phelps, T. Florence J. Martin, G. Nelson, L. Lutomski, K. Homan C. Collins called the meeting to order at 1:59 pm. I. Introductions II. Audience Participation III. Budget-Finance Committee Minutes and Actions Budget-Finance Minutes and Actions from the 4/9/18 meeting were reviewed. MOTION BY D.STRONG SUPPORTED BY A.DUSBIBER TO APPROVE THE MINUTES AND ACTIONS FROM THE APRIL 9, 2018 BUDGET-FINANCE COMMITTEE MEETING. MOTION CARRIED Finance Status Reports o N. Phelps reviewed the financial status report for the month ending March 31, o Medicaid Enrollees were 34,418 in March This is 404 less than the same period last year. o Healthy Michigan Enrollees at April 30, 2018 was 18,097. o Medicaid consumers served through March 2018 are unconfirmed due to the medical record conversion. o General Fund consumers served through March 2018 are unconfirmed due to medical record conversion. o Healthy Michigan consumers served through March 2018 are unconfirmed due to medical record conversion. o CLS costs to date are $12.0 Million. This is $833,000 over budget. o Community Inpatient costs to date total $2.7 Million. This is $651,000 over budget. o Licensed Residential costs to date are $5.1 Million. This is $634,000 over budget. o Applied Behavior Analysis/Autism service costs to date are $1.2 Million. This is $39,000 over budget. Page 1 of 3

3 o o Medicaid, Healthy Michigan, and Autism revenue are on budget. Financial performance by funding source: Medicaid is showing a deficit of $817,000 Healthy Michigan is showing a deficit of $1.5 Million Autism is showing a surplus of $132,000. State General Funds is showing a deficit of $352,000 Local Funds is showing a deficit of $78,000 through March ATTACHMENT #1 o The Fund Balance at the beginning of FY2017 is $3.37 Million. The projected use of Fund Balance to close the FY2017 General Fund deficit is $715,000. This will leave roughly $2.65 Million. MOTION BY A.DUSBIBER SUPPORTED BY D.STRONG TO APPROVE THE FINANCIAL STATUS REPORT THROUGH MARCH MOTION CARRIED Contracts and Leases o Med-Equip This contract is for WCCMH to provide Enhanced Pharmacy services for the period of May 1, 2018 September 30, o Cedar Creek Hospital This contract is for inpatient hospitalization services for the period of May 1, 2018 September 30, o Kim Bindus This contract is for court-ordered guardianship assessments for the period of June 1, 2018 September 30, MOTION BY M.CREEKMORE SUPPORTED BY A.DUSBIBER TO APPROVE THE CONTRACTS AND LEASES AS PRESENTED. MOTION CARRIED Regional Finance Update o N. Phelps discussed the regional finance update. She discussed the results from the PIHP that shows the status of all the affiliates in the region. As of right now, there will be a shortfall of over $7.5 Million. o T. Cortes stated that they heard from Gary Owen and that he is recommending from the governor s office a $60 Million supplementary to be distributed in the 4 th quarter as a response to the DAB issue. The mid-year reports are being requested and this is thought to be due to reviewing which PIHPs will be going into the risk corridor. Old Business o N. Phelps discussed the budget amendment continued discussion. The CMH Financial audit will be discussed at the full board meeting. Mark Kettner from Rehmann Robson will be presenting the WCCMH results. Page 2 of 3

4 ATTACHMENT #1 o T. Cortes also mentioned having discussions with the County to make sure we strengthen partnerships to be more proactive than reactive regarding policy changes from the State that could affect WCCMH. New Business o None Items for Future Discussions o Budget Amendment Tracking Meeting adjourned at 2:33 pm. Page 3 of 3

5 ATTACHMENT #1A WASHTENAW COUNTY COMMUNITY MENTAL HEALTH AGENCY (WCCMH) PROGRAM-QUALITY COMMITTEE MEETING MINUTES DRAFT 4135 Washtenaw Ave, Ann Arbor, MI Learning Resource Center, Michigan Conference Room May 14, :00pm MEMBERS PRESENT: MEMBERS ABSENT: STAFF PRESENT: OTHERS PRESENT: K. Walker, S. Antonow, N. Graebner, M. Creekmore, A. Dusbiber (phone), P. Spriggel None T. Cortes, M. Harding, R. Dornbos, T. Florence, S. Ray, K. Bellus J. Martin, L. Lutomski K. Walker called the meeting to order at 3:00. I. Introductions None II. III. Audience Participation None Program/Quality Committee Minutes and Actions Program-Quality Committee Minutes and Actions of 4/9/18 were reviewed. MOTION BY M. CREEKMORE SUPPORTED BY N. GRAEBNER TO APPROVE THE MINUTES AND ACTIONS FROM THE APRIL 9, 2018 PROGRAM-QUALITY COMMITTEE MEETING. MOTION CARRIED IV. Discussion Items Diversion Council update o T. Cortes gave an update on the Diversion Council. o There is a meeting on 5/14/18. o The group will get a first view of the data at this time. o They will take their work from the last council meeting and the outcome recommendations which should bring 5 goals for the group to work on. o The group is looking at having two meetings on both sides of the County to encourage citizen attendance. Community Mental Health Advisory Committee (CMHAC) update o T. Cortes gave an update on the CMHAC. o There is a meeting scheduled this week at Northfield Township. o This meeting will have some learning sessions around crisis and youth suicide prevention. o There will be another meeting towards the end of the month at a different location. Page 1 of 2

6 ATTACHMENT #1A o Suggestion to bring recommendations to the Executive Committee in June. 298 Pilot and Comparative Studies o The State is requesting this will now take place in end of summer/early fall. o T. Cortes stated that there was an from MDHHS indicating that they were postponing the Section 298 until 10/1/19. o T. Cortes requested to be a comparative site for the pilots with the State Youth Crisis Stabilization Team Update o K. Bellus gave an update on the Youth Crisis Stabilization Team o A second meeting was held for a separate Youth Threat Assessment Team. o There was a proposal on what the team would consist of, what representation and with a timeline that will go forward to the superintendents meeting that is happening within the next few weeks. o The goal is to get the word out that there is a crisis response team that can be used proactively to different schools instead of after an event. o Suggestion to involve youth peers to help with the issue V. Old Business Self Determination significant change update o K. Bellus gave an update and distributed the notification that was sent out to the consumers recently VI. New Business Statewide workgroup parity update o K. Bellus gave an update on the statewide workgroup parity update. o This is a Federal Law requirement that came out of the (Mental Health Parity and Addiction Act of 2008) o A group was formed in the State of Michigan to determine parity on individuals with behavior health and medical care issues. o Must be in compliance by October 1, o Will use the SIS, LOCUS and CAFAS tools. o An RFP is being prepared to look for a software provider o This will gain statewide consistency CRCT update o The reports are being updated in the CRCT program and should be available in approximately three weeks. VII. VIII. Items for Future Discussions Diversion Council CMHAC update Youth Crisis Stabilization Update How are the budget adjustments related to parity of service Regional PI Report-July BJA grant is being applied for in conjunction with the Sheriff s office-proposal to the Program meeting in June BCN update Meeting adjourned at 3:52 pm. Page 2 of 2

7 ATTACHMENT #2 1. Washtenaw County Enrollees WASHTENAW COUNTY COMMUNITY MENTAL HEALTH YEAR-TO-DATE FINANCIAL STATUS FISCAL YEAR 2018: For the period ending April 30, 2018 Prepared: June 1, 2018 A summary of FY 2018 Washtenaw County Medicaid and Healthy Michigan Enrollees is shown below: 36,000 35,000 34,000 33,000 32,000 31,000 30,000 29,000 28,000 Washtenaw County Medicaid Enrollees OCT DEC FEB APR JUN AUG 20,000 18,000 16,000 14,000 12,000 10,000 Washtenaw County HMP Enrollees OCT DEC FEB APR JUN AUG FY 2017 FY 2018 FY 2017 FY 2018 Washtenaw County Medicaid Enrollees were 34,568 in April This is a 0.7% decrease from the same time last year (244 less enrollees than in April 2017). Healthy Michigan enrollment at May 29, 2018 was 17, WCCMH Consumers Served to Date Medicaid Consumers Served 3,750 3,500 3,250 3,000 2,750 2,500 2,250 2,000 1,750 OCT DEC FEB APR JUN AUG 1, General Fund Consumers Served OCT DEC FEB APR JUN AUG FY 2017 Medicaid FY 2018 Medicaid FY 2017 Gen. Fund FY 2018 Gen. Fund Medicaid consumers served through April 2018 are unconfirmed due to medical record conversion. General fund consumers served through April 2018 are unconfirmed due to medical record conversion. Page 1 of 7

8 ATTACHMENT #2 1,200 Healthy Michigan Consumers Served 1, OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP FY 2017 HMP FY 2018 HMP Healthy Michigan consumers served through April 2018 are unconfirmed due to medical record conversion. 3. Financial Statement Highlights a. CLS service costs to date are $14.2 Million. This is $1.2 Million over budget. b. Community Impatient costs to date are $3.1 Million. This is $669,000 over budget. c. License Residential costs to date are $6.1 Million. This is $853,000 over budget. d. Applied Behavior Analysis/Autism service costs to date are $1.4 Million. This is $35,000 over budget. e. A significant amount of General Fund is used to supplement Medicaid deductibles for our consumers on a spend-down. Due to medical record conversion the amount spent through April is no available. The amount spent through February 2018 is $311, PIHP Revenue Key Points a. Medicaid, Healthy Michigan Plan and Autism funds are coming in at budget. b. By funding source, Medicaid is showing a deficit of $1.0 Million. c. By funding source, HMP is showing a deficit of $1.7 Million. 5. State General Fund Key Points a. General Fund programs and funding redirected to other Risk-Based programs is showing a deficit of $482,000. b. General Fund overages are primarily resulting in the CLS and Licensed Residential business units. c. General Fund funding has been redirected by the WCCMH as detailed below: i. $22,000 to SED Waiver ii. $222,000 to Child Waiver Page 2 of 7

9 ATTACHMENT #2 6. Local Key Points a. The majority of Local Funding comes from Washtenaw County. b. Local Funds are showing a deficit of $72,000 through April c. Uses of Local Funding include: i. The 10% GF Match of non-residential services ii. Local contribution required by MDHHS iii. Local share for State Facilities iv. Shelter expenses and other Local needs 7. Fund Balance WCCMH s Fund Balance at the beginning of FY 2018 is $2.7 Million. Through April, the use of Fund Balance to close the State General Funds and Local deficit is $544,000. Supplementary Information Regarding WCCMH Financing *** Under a managed care shared-risk financing model the Community Mental Health Partnership of Southeast Michigan (PIHP) contracts with County of Washtenaw (CMHSP). The PIHP makes monthly payments to the CMHSP to reflect 1/12 of the annual budget amount. Upon final close out and confirmation of expenses, the PIHP cost settles with the CMHSP for services provided to Medicaid beneficiaries. Any underspending of budgeted amounts will be returned to the PIHP and any overspending of the budgeted amounts will be paid to the CMHSP. Per Medicaid Subcontracting Agreement, Attachment B: PIHP to CMHSP Funding - *** Michigan Department of Health and Human Services (MDHHS) requires that the PIHP have an approved Financial Risk Management Strategy. The PIHP has established a Medicaid Internal Services Fund (ISF) for purposes of risk protection. This fund was examined by an actuary to establish the appropriate level of funding for this risk pool. In accordance with the MDHHS/PIHP contract, the ISF may be funded up to 7.5% of Medicaid revenues. In cases where Medicaid liability is 100% to 105% of Medicaid revenue and the amount available in the ISF is sufficient, the ISF will be used to cover that deficit. If the ISF is not sufficient, each CMHSP will provide local funding in proportion to their share of the deficit. For cases where the deficit is over 105%, each CMHSP will cover their share of the deficit with their local funds up to the capped risk corridor of 110%. (Total risk obligation for the region is 7.5%). Page 3 of 7

10 Washtenaw County Community Mental Health FINANCIAL PERFORMANCE BY FUND SOURCE APRIL 2018 FYTD ATTACHMENT #2 Total Medicaid ** Revenue B, B3 & HSW $ 37,423, Prior Year Adjustments - Care for Caid 156, Total Medicaid Revenue $ 37,580, Expense Service Costs $ 33,993, Admin. Cost Allocation 4,583, Redirect To Cover COFR Exp. - Redirect To Cover MiChild Exp 70, Total Medicaid Expense $ 38,648, Medicaid Surplus/(Deficit) $ (1,067,926.39) Autism Benefit ** Revenue Medicaid Benefit $ 1,504, MIChild Benefit (80.47) Total Autism Benefit Revenue $ 1,504, Expense Medicaid Service Costs $ 1,172, Admin. Cost Allocation 155, MIChild Service Costs 38, Admin. Cost Allocation 5, Total Autism Benefit Exp. $ 1,372, Total Autism Surplus/(Deficit) $ 132, Healthy Michigan ** Revenue $ 2,336, Expense 4,103, Healthy MI Surplus/(Deficit) $ (1,767,030.21) General Fund Revenue CMH Operations $ 1,625, CMH Operations Contra - Categorical 5, Redirect To SED Waiver (22,540.73) Redirect To Children's Waiver (222,558.15) Redirect To Injectable Meds. (1,185.01) Funding Fr. Other Local Sources 4, Total General Fund Revenue $ 1,388, Total General Fund Expense $ 1,870, General Fund Surplus/(Deficit) $ (482,679.48) SED Waiver Revenue $ 51, Page 4 of 7

11 Washtenaw County Community Mental Health FINANCIAL PERFORMANCE BY FUND SOURCE APRIL 2018 FYTD ATTACHMENT #2 Total Expense 51, SED Waiver Surplus/(Deficit) $ - Children's Waiver Revenue $ 449, Expense 449, CW Surplus/(Deficit) $ - Injectable Meds Revenue $ Expense Inj. Meds. Surplus/(Deficit) $ - Grants And Contracts Revenue $ 735, Expense 752, Grants & Cont. Surplus/(Deficit) $ (16,960.06) CMHSP To CMHSP Revenue $ 443, Redirect to GF $ (4,302.47) Expense 439, CMHSP to CMHSP Surplus/(Deficit) $ - Local Revenue $ 933, Expense 1,006, Local Surplus/(Deficit) $ (72,357.91) Private Grant & All NOR Revenue $ 141, Expense 131, Priv. Grant & NOR Surplus/(Deficit) $ 10, Grand Total Revenue $ 45,121, Expense 48,386, Grand Total Surplus/(Deficit) $ (3,264,539.79) ** Denotes PIHP Medicaid Subcontracting Agreement Funds PIHP Medicaid Surplus/(Deficit) WCCMH Surplus/(Deficit) $ $ $ (2,702,768.09) (561,771.70) (3,264,539.79) Page 5 of 7

12 ATTACHMENT #2 Washtenaw County Community Mental Health For the Seven Months Ending April 30, 2018 Amended Annual Budget YTD Amended Budget YTD Actuals YTD Over/(Under) Budget Operating Revenue PIHP Revenue Medicaid Capitation $ 64,026,769 $ 37,348,949 $ 37,348,949 - Healthy Michigan Capitation 4,006,099 2,336,891 2,336,891 - Autism Capitation 2,706,058 1,578,534 1,578,534 - MDHHS Revenue State General Funds 2,784,574 1,624,335 1,630,171 5,836 Medicaid Fee for Service 1,182, , ,018 (433,482) Grants & Earned Contracts 1,871,648 1,091, ,445 (269,350) All Other Revenue County Appropriation 1,693, , ,969 (438,773) Project Revenue 660, , ,711 32,387 All Other 1,172, ,237 1,336, ,573 TOTAL Operating Revenue $ 80,103,952 $ 46,727,305 $ 46,276,498 $ (450,808) Operating Expenses Administrative Expenses General Administration $ 5,906,253 $ 3,445,314 $ 3,887,326 $ 442,012 Program Administration 3,460,360 2,018,543 2,028,763 10,220 Residential Services Community Living Supports 22,412,073 13,073,709 14,280,634 1,206,924 Licensed Residential 9,095,104 5,305,477 6,158, ,283 Outpatient Services Autism Services 2,406,058 1,403,534 1,439,298 35,764 Case Management 4,555,525 2,657,390 2,632,449 (24,941) Supports Coordination 2,174,125 1,268,240 1,239,173 (29,067) Skill Building 5,651,337 3,296,613 3,630, ,232 Supported Employment 2,285,360 1,333,127 1,140,278 (192,849) Psychiatry 2,720,496 1,586,956 1,492,078 (94,878) Nursing Services 1,930,313 1,126,016 1,115,525 (10,491) Therapy Services 1,631, , ,356 29,651 All Other 8,550,967 4,988,064 4,696,463 (291,601) Other Expenses Community Inpatient 4,170,000 2,432,500 3,102, ,617 Local Matches & Shelter 1,282, , , ,246 Grants & Earned Contracts 1,871,648 1,091, ,405 (252,390) TOTAL Operating Expenses $ 80,103,952 $ 46,727,305 $ 49,541,038 $ 2,813,732 Revenue Over/(Under) Expenses - (3,264,540) (3,264,540) Page 6 of 7

13 ATTACHMENT #2 WASHTENAW COMM MENTAL HEALTH For the Seven Months Ending April 30, 2018 Washtenaw County Community Mental Health Assets Cash Position $3,812,212 Due From MDHHS 153,449 Due From Regional Entity 242,579 Due From Other Agencies 800,173 Accounts Receivable, Net 782,738 Prepaid Expenses 179,036 Provider Advances 1,051,241 Total Assets $7,021,429 Liabilities Accounts Payable $4,126,294 Accrued Claims 698,690 Accrued Liabilities 1,246,099 Community inpatient Liability 984,767 State Facilities Payable 342,411 Due To MDHHS 10,000 Due To Other Agencies 25,029 Deferred Revenue 121,126 Total Liabilities $7,554,415 Net Position (530,930) Total Liabilities and Net Position $7,023,485 Page 7 of 7

14 ATTACHMENT #3 ACTION REQUESTED: To approve the following contracts and leases: BACKGROUND: 1. Expert Care- will provide Community Living Support (CLS) services. Service Contracts Contractor Funding 1. Expert Care Medicaid Estimated Budget Contract Term Service Description July 1, Per consumer September 30, 2018 authorizations CLS Services RECOMMENDATIONS: To approve the contracts and leases listed above. Page 1 of 1

BOARD OF DIRECTORS SPECIAL MEETING

BOARD OF DIRECTORS SPECIAL MEETING Tuesday, September 25, 2018 at 5:00 pm Behavioral Health Center, Room 225, 201 Mulholland Bay City, MI 48708 AGENDA Page 1. CALL TO ORDER & ROLL CALL 2. PUBLIC INPUT