Williamson County and Cities Health District

Transcription

1 Fiscal Year 2018 Budget Table of Contents 1 Executive Summary Background Proposed Budget Summary Summary of Significant Changes for FY Operating Budget Summary Line Item Budget by Division Appendices ACRONYMS ORGANIZATION CHART CURRENT GRANTS, Texas Department of State Health Services (DSHS) CLASSIFICATION SALARY SCHEDULE CLINICAL SERVICES FEES RETAIL FOOD PROGRAM FEES West 3rd Street Georgetown, TX

2 1 EXECUTIVE SUMMARY Williamson County and Cities Health District MEMORANDUM Date: To: Ehab Kawar, Chairman Ed Strout, Director Mary Faith Sterk, Director Dr. Luis Egelsee, Director Selicia Sanchez-Adame, Director Pamela Sanford, Director Joanne Land, Director Marlene McMichael, Director John Teel, Executive Director From: Subject: Transmittal Letter Fiscal Year 2018 Line Item Budget This communication is provided in support of the proposed comprehensive line item budget for the Williamson County and Cities Health District for the 2018 fiscal year. This communication is provided in support of the proposed comprehensive line item budget for the Williamson County and Cities Health District for the 2018 fiscal year and is responsive to the Themes and Goals delineated in the Strategic Plan. During August, September, and October, the District Leadership Team (DLT) created a draft line item budget. Specifically, each Division Director wrote a detailed, comprehensive line item budget for his/her Division, and submitted the draft division budget to Administration for review and revision. Administration compiled all Division budgets into a single Health District budget document, and referred to it as the Continuation budget. As a point of information, a continuation budget is a calculation of all costs required to maintain all current employees, and continue all programs of service at existing service levels. In addition, each Division Director was authorized to request and justify personnel and/or operational expenses above and beyond said Director s FY 2017 adopted budget. Administration made final revenue and expense decisions, and created the attached draft WCCHD budget proposed for FY The total line item expense budget to continue current levels of service at current staffing levels, and to allow for additional personnel and expense costs requested by Division Directors totals $8,809,624, which is a 1.2 percent decrease from the current, adopted 2017 expense budget of $8,913,682 (as last amended September 2017). As a function of balancing expenses to revenues, Administration carefully analyzed all current funding sources for The line item revenue budget for FY 2018 totals $8,809,624. To reconcile FY 2018 expenses with revenues, Administration will continue a modified hiring freeze on the positions listed below: Page 2 of 39

3 (1) Administrative Assistant Administration and Finance Division (1) Assistant Director of Nursing Clinical Services Division One additional position is proposed for freezing for FY 2018: a Sanitarian III position in Environmental Health. This position, funded in 2017 with OSSF revenue, will be vacated through a retirement. The loss of OSSF funds prevents continued funding of this position in FY The position will be held for a potential new program and associated revenue to support it. There is one net new position requested in the FY 2018 budget, as follows: (1) Customer Service Representative II Program Eligibility and Social Services (to start in second quarter) The proposed FY 2018 expense budget includes a modest merit increase of up to two (2) percent. The maximum budget impact (if all eligible Health District employees received this merit increase) is $116,816. It should be noted that the requested line item budget is balanced. Unlike the FY 2017 proposed budget, which contained a line item to transfer a minimum of $6,000 to the TexPool or savings account, this proposed FY 2018 budget contains no specific line item intended to be transferred to the TexPool account at the end of December, The fiscal concept behind Administration s recommendation to refrain from formally planning to increase the unobligated reserve fund is based upon: The Health District will likely realize some amount of salary savings during FY 2018 due to brief job vacancies. These savings will be transferred to the TexPool account Bond rating agencies and most third-party government accounting consultants recommend that local government agencies (like WCCHD) maintain a 90-day fund balance. WCCHD spends about $25,000 each day of the year, meaning we need approximately $2,250,000 in our TexPool account. As of the date of this transmittal letter, WCCHD has a TexPool (unobligated reserve) of over $3 million (a 120(+)-day fund balance). Items of note in this proposed FY 2018 budget include: 1. A $3,000 line item is proposed to begin an employee recognition and awards program. 2. Funds are budgeted to pay all license fees associated with the new Environmental Health software system, called Accela. Accela includes a robust receipting and financial tracking module, an online citizen s portal, and will allow all field inspection staff to begin using portable devices for all inspection activities. 3. Administration anticipates bringing a policy item related to creating and implementing a new program of service during FY 2018, but not included in this proposed budget. Environmental Health will soon seek policy approval from the Board of Health to adopt a Board Order on Swimming Pools/Spas, and implement a fully fee-funded swimming pool/spa permitting and inspection program. If the Board authorizes Administration to create this new level of service, Administration will bring forth a proposed budget amendment during FY Administration is including a line item to pay for the costs of hiring a professional mover to relocate Administration, Disease Control and Prevention, Environmental Health, Tuberculosis Control, Round Rock Clinical Services, and Round Rock Program Eligibility and Social Services to the 355 Texas Avenue location. Page 3 of 39

4 We believe this move will occur in May This line item of approximately $200,000 covers all moving expenses, plus expenses related to specified new furniture and fixtures, and limited interior finish/decorative items. If authorized by the Board of Health, the source of this $200,000 will be the unobligated (TexPool) account. 5. Administration budgeted for DSRIP revenues for all of WCCHD will receive DSRIP incentive payments (incentive portion is approximately $1.3 million) in early February, for work we performed in It is of key importance to note that the federal government has not, as of today s date, approved an extension of the 1115 Medicaid Waiver for Texas; therefore, it is conceivable that no DSRIP funds could be available for FY Member government contributions (all seven cities collectively) will increase over FY 2017 by approximately $128,585 (due to population increases); however, it is of particular note that WCCHD s Administration expects a thorough discussion by the Wilco Commissioners Court during the county s FY 2017/2018 budget year involving the concept of converting WCCHD to a county department. 7. An $8,000 line item is proposed to provide training to key Administration employees for medical billing and coding (strategic plan task to increase Clinical Services revenues). Administration and each member of the DLT will track Health District expenses and revenues on, at a minimum, a monthly basis during FY Should adjustments be required related to revenues, expenses, or both, Administration will seek Board of Health approval for any proposed budget adjustments. Page 4 of 39

5 2 BACKGROUND HISTORY Williamson County and Cities Health District has been providing public health services to the Williamson County community since Beginning as a county health department, it was established as a public health district in 1989 through a Cooperative Agreement between Williamson County and the cities of Cedar Park, Georgetown, Round Rock and Taylor. The cities of Liberty Hill and Hutto joined in 2007, and Leander joined in The District is a separate governmental entity governed by a Board of Health. The Board is comprised of eight directors, six appointed from the member cities and two appointed by the County Commissioners Court. Leander and Liberty Hill currently appoint one shared director. The District Executive Director is a non-voting member of the Board. The Board meets every other month, and the meetings are open to the public and posted on the District s website, and on the Williamson County public meetings website, As a direct consequence of the District s commitment to responsive services to the community and excellence in public health practice, the District achieved national accreditation from the Public Health Accreditation Board (PHAB) in August 2016 and national recognition through Project Public Health Ready in April As of October 1, 2017, the District relinquished its authority to Williamson County as Authorized Agent of the Texas Commission on Environmental Quality (TCEQ) for the regulation of On-Site Sewage Facilities (OSSF). Six employees transferred from District employment to County employment on the same date. District assets and liabilities related to the OSSF program including vehicles, computers, survey equipment, and employee leave balances transferred to the County with the employees. BUDGET PLANNING The Executive Leadership Team of the District consists of the Executive Director, Local Health Authority, Deputy Director, and the Quality and Strategic Management Director. In addition, the District has a District Leadership Team of program directors. With Board approval, the District s Leadership Teams actively participate in determining operating policies, procedures, staffing, and service planning from which the annual budget is derived. The proposed revenue and expenditure estimates comprising the District budget are submitted annually to the Board for consideration and adoption. The District s Cooperative Agreement sets the fiscal year to January-December. During the course of the year, the Board reviews financial reports to assist them in governing the District. When the budget requires revision to reflect the business of the District accurately, an amended budget is submitted to the Board for consideration and adoption. The District s finances are dependent on the health of the local, state and national economy, as approximately ninety percent of the gross revenues financing District operations are derived from federal, state and local funding. In addition, the District s finances are dependent upon the ability to Page 5 of 39

6 strategically and efficiently shift resources in a timely fashion to address the needs of contracting agencies and the needs of the communities served. In the past three fiscal years, the District has worked diligently to reduce non-essential expenses, increase staff productivity and service efficiency, and reduce unit costs of services in order to strengthen business viability. A performance management system, AchieveIt, was implemented in the third quarter of 2017 to enhance the ability of the District to assure accountability for meeting goals. FY2018 will bring the added challenge of office relocation of Administration, Environmental Health, Disease Control and Prevention, and Tuberculosis Control from Georgetown, and Clinical Services and Program Eligibility and Social Services from the Round Rock Public Health Center to a new facility in Round Rock. In addition to performance management and the improved synergy from co-location of programs, workforce support and development will be an added focus for quality improvement in the coming year. Together these strategic initiatives will assist WCCHD in its mission of strengthened business viability. $9,000, to 2017 Budget to Actual Expenditures $8,000, $7,000, $6,000, $5,000, $4,000, $3,000, $2,000, $1,000, $ Estimate Total Budget Actual Expenses The District is on target with this proposed FY2018 budget to continue on its fiscally responsible path while maintaining its commitment to excellence in public health practice and vision of Healthy people thriving in healthy communities in Williamson County. Page 6 of 39

7 3 PROPOSED BUDGET SUMMARY Williamson County and Cities Health District FY2016 Actual FY2017 Current FY2018 Proposed Revenue Sources $8,990,694 $8,913,682 $8,809,624 County Contribution $2,515,900 $2,378,146 $2,469,791 City Contribution $690,018 $696,308 $733,248 State Contracts $2,508,541 $2,272,484 $2,605,840 Medicaid/Medicare $1,394,198 $1,436,794 $1,431,745 Other Contracts & Fees $1,882,037 $1,517,950 $1,369,000 Non-Designated Funds $ 0 $160,000 $200,000 Expenditures $7,657,903 $8,913,682 $8,809,624 Salaries & Fringe $6,374,665 $7,440,686 $7,377,229 Travel $107,490 $196,978 $144,059 Equipment $66,910 $194,523 $33,795 Supplies $334,913 $321,758 $397,019 Other Expenses $773,925 $759,737 $857,522 Page 7 of 39

8 4 SUMMARY OF SIGNIFICANT CHANGES FOR FY2018 Member Government contributions will increase over FY2017 by $128,585 Transfer of EH OSSF program to Williamson County in October 2017 will reduce overall EH fees an estimated $500,000 in FY2018 as compared to FY2017, and reduce budgeted expenditures by $500,000. Due to the growth of the county and increasing numbers of retail food establishments, EH fees for the Retail Food program are estimated to increase by $100,000. Additional fee income will support the implementation of a state-of-the-art, Cloud-based permitting and inspection platform. Continued success in Medicaid reimbursement will bring in an estimated additional $40,000 New contracts to support the East Williamson County Collaborative and the WilCo Wellness Alliance will bring in an additional $70,000. Total 1115 Waiver incentive payments are expected to decrease from FY2017 by $34,947 The requirement to move from County facilities at 312 and 303 Main Street in Georgetown and 211 Commerce Boulevard in Round Rock will incur one-time costs for new equipment, furniture, and moving expenses estimated at $200,000 to be paid for out of Non-Designated Unreserved Funds. Due diligence has been and will be made to assure use of all current furniture and equipment to the greatest degree possible. Although six FTEs were transferred to the County in the OSSF program, overall headcount of 108 employees was not reduced by the County for financial support for medical insurance. Medical Insurance has been increased from $8,520 per FTE per year to $8,946 effective October 1, 2017 ($46,008 in additional fringe expense, paid for with increased County contribution). Retirement fringe will increase from 13.37% employer contribution to 13.94% effective January 1, 2018 ($30,000 in additional fringe expense). One new position will be added once relocation occurs to the new Round Rock facility: a Customer Service Representative for Program Eligibility and Social Services. This will add $37,936 to salary and fringe expenses. The FY2018 Budget proposes funding for merit salary adjustment up to 2% ($116,816). Page 8 of 39

9 5 OPERATING BUDGET SUMMARY Williamson County and Cities Health District The total operating budget for FY2018 is $8,809,624.The three largest sources for operating funds are the member government contributions to the General Fund, grants from the Texas Department of State Health Services (DSHS), and Medicaid/Medicare payments. FY2018 WCCHD Proposed Operating Budget $8,809,624 Member Government Contributions $3,203,039 DSHS Grants $2,605,840 Medicaid/Medicare $1,431,745 Environmental Health Fees $700,000 St. David's Access to Care $350,000 Non-designated Unreserved $200,000 Clinical Services Fees $140,000 Other Funds $179,000 $- $1,000,000 $2,000,000 $3,000,000 $4,000,000 Page 9 of 39

10 Williamson County & Cities Health District FY2018 Summary Budget FY 2018 FY 2018 FY 2018 PROPOSED ADJUSTMENTS WORKING INCOME SOURCES County Contributions 2,469, ,469,791 City Contributions 733, ,248 Cedar Park 154, ,971 Georgetown 149, ,733 Round Rock 243, ,594 Taylor 39, ,250 Liberty Hill 3, ,264 Hutto 53, ,397 Leander 89, ,039 State Contracts 2,605, ,605,840 Immunizations 475, ,709 IDCU Surveillance 161, ,055 Local Public Health Services 138, ,529 Public Health Preparedness 265, ,370 TB Services (State & Federal) 112, ,346 WIC Nutrition 1,322, ,322,800 Zika 130, ,031 Medicaid 1,431, ,431,745 Medicaid/Medicare Payments 120, , Waiver (DSRIP) 1,311, ,311,745 Other Contracts & Fees 1,369, ,369,000 Access To Care 350, ,000 Environmental Service Fees 700, ,000 Clinical Service Fees 140, ,000 Healthy Williamson - WWA 39, ,000 East Williamson County Collaborative 20, ,000 East Williamson County Needs Assessment 50, ,000 CHASSIS Support/VeritySource 15, ,000 Miscellaneous Income 35, ,000 Interest Income 20, ,000 Non-Designated Unreserved Funds 200, ,000 TOTAL INCOME 8,809, ,809,624 EXPENDITURES Salaries 5,263,302 5,263,302 Benefits 2,113,927 2,113,927 Operating Costs 1,432,395 1,432,395 TOTAL EXPENDITURES 8,809, ,809,624 Page 10 of 39

11 6 LINE ITEM BUDGET BY DIVISION Williamson County and Cities Health District Division 01: Administration and Finance (Includes Information Technology and Human Resources) Proposed Budget: $1,455,118 FTEs: 12 Fund Sources: General Revenue, Local Public Health Services Grant Program: Local Health Department Administration SALARIES $652, FRINGE - TAX, FLEX, RETIREMENT $140, FRINGE - MEDICAL AND DENTAL $143, UNEMPLOYMENT $6, EMPLOYEE TRAVEL $6, STAFF TRAINING/TRAVEL $9, FURNITURE > $5000 $20, SUPPLIES $25, EQUIPMENT < $5000 $4, SOFTWARE < $5000 $5, FURNITURE < $ 5000 $34, CONTRACTUAL $16, LEGAL FEES $12, OTHER PROFESSIONAL FEES $98, POSTAGE, S&H AND COURIER SERVICES $1, PUBLICATIONS - BOOKS, JOURNALS, VID $ SUBSCRIPTIONS, DUES, SUPPORT $57, EQUIP, MAINTENANCE, RENTAL $120, PRINTING / COPY SERVICES $ ADS - JOB RECRUITMENT $1, STAFF LIABILITY INSURANCE $4, GEN LIABILITY & ERROR & OMISSION $19, WCCHD TRAININGS & MEETINGS $2, MISCELLANEOUS EXPENSE $5, SERVICE FEES $ INTERNET OR DATA RELATED $18, REGISTRATION/TRAINING $1, MISC ADVERTISEMENTS $ REGISTRATION/TRAINING $ SALARIES $29, FRINGE - TAX, FLEX, RETIREMENT $6,449 Page 11 of 39

12 Division 02: Clinical Services Proposed Budget: $2,028,121 FTEs: 20 Fund Sources: General Revenue, Incentive Payments, Service Fees, Medicaid Reimbursement, Immunizations Grant Program: Clinical Services Administration SALARIES $470, FRINGE - TAX, FLEX, RETIREMENT $101, SALARIES $12, FRINGE - TAX, FLEX, RETIREMENT $2, FRINGE - MEDICAL AND DENTAL $178, VACCINES $3, OFFSITE LAB $2, REGISTRATION/TRAINING $1, EMPLOYEE TRAVEL $15, STAFF TRAINING/TRAVEL $8, SUPPLIES $13, FURNITURE < $ 5000 $7, LEGAL FEES $ OTHER PROFESSIONAL FEES $5, POSTAGE, S&H AND COURIER SERVICES $2, PUBLICATIONS - BOOKS, JOURNALS, VID $ SUBSCRIPTIONS, DUES, SUPPORT $36, PRINTING / COPY SERVICES $ STAFF LIABILITY INSURANCE $ WCCHD TRAININGS & MEETINGS $1, MISCELLANEOUS EXPENSE $ INTERNET OR DATA RELATED $2,000 Program: Clinical Services SALARIES $478, FRINGE - TAX, FLEX, RETIREMENT $103, SUPPLIES $15, EQUIPMENT < $5000 $15, VACCINES $97, CONTRACTUAL $1, OFFSITE LAB $38, EQUIP, MAINTENANCE, RENTAL $12, BIO WASTE DISPOSAL $10,000 Page 12 of 39

13 Program: Immunizations SALARIES $93, FRINGE - TAX, FLEX, RETIREMENT $20,283 Program: Tuberculosis Control SALARIES $197, FRINGE - TAX, FLEX, RETIREMENT $42, EMPLOYEE TRAVEL $7, STAFF TRAINING/TRAVEL $3, SUPPLIES $8, OTHER PROFESSIONAL FEES $1, OFFSITE LAB $10, OFFSITE XRAY $1, POSTAGE, S&H AND COURIER SERVICES $ SUBSCRIPTIONS, DUES, SUPPORT $3, EQUIP, MAINTENANCE, RENTAL $ PRINTING / COPY SERVICES $500 Page 13 of 39

14 Division 03: Environmental Health Proposed Budget: $978,969 FTEs: 12 Fund Sources: Service Fees, General Revenue, DSHS ZIKA Grants Program: Administration SALARIES $14, FRINGE - TAX, FLEX, RETIREMENT $3, FRINGE - MEDICAL AND DENTAL $107, REGISTRATION/TRAINING $ EMPLOYEE TRAVEL $ STAFF TRAINING/TRAVEL $ SUPPLIES $ FURNITURE < $ 5000 $2, LEGAL FEES $ OTHER PROFESSIONAL FEES $1, POSTAGE, S&H AND COURIER SERVICES $ SUBSCRIPTIONS, DUES, SUPPORT $1, PRINTING / COPY SERVICES $ ADS - JOB RECRUITMENT $ MISCELLANEOUS EXPENSE $ REGISTRATION/TRAINING $800 Program: Retail Food SALARIES $462, FRINGE - TAX, FLEX, RETIREMENT $99, EMPLOYEE TRAVEL $ FUEL & TOLL EXPENSES $4, STAFF TRAINING/TRAVEL $6, SUPPLIES $4, EQUIPMENT < $5000 $3, FURNITURE < $ 5000 $5, VEHICLE & EQUIP MAINTENANCE $3, LEGAL FEES $3, POSTAGE, S&H AND COURIER SERVICES $6, SUBSCRIPTIONS, DUES, SUPPORT $57, PRINTING / COPY SERVICES $2, ADS - JOB RECRUITMENT $ REGISTRATION/TRAINING $3,200 Page 14 of 39

15 Program: Integrated Mosquito Management SALARIES $70, FRINGE - TAX, FLEX, RETIREMENT $13, EMPLOYEE TRAVEL $ FUEL & TOLL EXPENSES $1, STAFF TRAINING/TRAVEL $1, SUPPLIES $1, FURNITURE < $ 5000 $ CONTRACTUAL $5, VEHICLE & EQUIP MAINTENANCE $ LEGAL FEES $ POSTAGE, S&H AND COURIER SERVICES $ SUBSCRIPTIONS, DUES, SUPPORT $1, PRINTING / COPY SERVICES $ ADS - JOB RECRUITMENT $ INTERNET OR DATA RELATED $1, REGISTRATION/TRAINING $575 Program:ZIKA Response SALARIES $5, SALARIES $6, FRINGE - TAX, FLEX, RETIREMENT $ FRINGE - TAX, FLEX, RETIREMENT $1, SUPPLIES $2, EQUIPMENT < $5000 $3, SOFTWARE < $5000 $ VEHICLE & EQUIP MAINTENANCE $2, EQUIP, MAINTENANCE, RENTAL $3, EQUIPMENT > $ 5000 $13, SUPPLIES $10, EQUIPMENT < $5000 $25, CONTRACTUAL $8, REGISTRATION/TRAINING $1,275 Page 15 of 39

16 Division 04: WIC and Nutrition Education Proposed Budget: $1,517,090 FTEs: 23.8 Fund Sources: WIC Grants, Community Garden Fees, General Revenue Program: WIC Administration SALARIES $494, FRINGE - TAX, FLEX, RETIREMENT $105, FRINGE - MEDICAL AND DENTAL $205, EMPLOYEE TRAVEL $12, STAFF TRAINING/TRAVEL $1, SUPPLIES $21, VACCINES $ POSTAGE, S&H AND COURIER SERVICES $1, SUBSCRIPTIONS, DUES, SUPPORT $ EQUIP, MAINTENANCE, RENTAL $44, BIO WASTE DISPOSAL $2, PRINTING / COPY SERVICES $ MISCELLANEOUS EXPENSE $ REGISTRATION/TRAINING $ SALARIES $235, FRINGE - TAX, FLEX, RETIREMENT $49, EMPLOYEE TRAVEL $ SUPPLIES $3, PUBLICATIONS - BOOKS, JOURNALS, VID $ EQUIP, MAINTENANCE, RENTAL $8, REGISTRATION/TRAINING $3, SALARIES $27, FRINGE - TAX, FLEX, RETIREMENT $5, EMPLOYEE TRAVEL $ SUPPLIES $ POSTAGE, S&H AND COURIER SERVICES $ EQUIP, MAINTENANCE, RENTAL $2, REGISTRATION/TRAINING $ SALARIES $117, FRINGE - TAX, FLEX, RETIREMENT $25, EMPLOYEE TRAVEL $3, REGISTRATION/TRAINING $ SALARIES $22, FRINGE - TAX, FLEX, RETIREMENT $4,907 Page 16 of 39

17 EMPLOYEE TRAVEL $ STAFF TRAINING/TRAVEL $1, SUPPLIES $3, EQUIP, MAINTENANCE, RENTAL $2, REGISTRATION/TRAINING $ SALARIES $59, FRINGE - TAX, FLEX, RETIREMENT $12, SUPPLIES $6, SALARIES $9, FRINGE - TAX, FLEX, RETIREMENT $1, SALARIES $11, FRINGE - TAX, FLEX, RETIREMENT $2, STAFF TRAINING/TRAVEL $ REGISTRATION/TRAINING $ SALARIES $ FRINGE - TAX, FLEX, RETIREMENT $ REGISTRATION/TRAINING $715 Program: Community Gardens SUPPLIES $1, EQUIP, MAINTENANCE, RENTAL $900 Page 17 of 39

18 Division 05: Program Eligibility and Social Services Proposed Budget: $878,045 FTEs: 14 Fund Sources: General Revenue, Incentive Payments, Access to Care Program: Administration SALARIES $108, FRINGE - TAX, FLEX, RETIREMENT $23, FRINGE - MEDICAL AND DENTAL $125, EMPLOYEE TRAVEL $1, STAFF TRAINING/TRAVEL $3, SUPPLIES $ FURNITURE < $ 5000 $1, PUBLICATIONS - BOOKS, JOURNALS, VID $ SUBSCRIPTIONS, DUES, SUPPORT $26, MISCELLANEOUS EXPENSE $ REGISTRATION/TRAINING $1, MISC ADVERTISEMENTS $200 Program: County Indigent Health Care Program SALARIES $205, FRINGE - TAX, FLEX, RETIREMENT $44, EMPLOYEE TRAVEL $ STAFF TRAINING/TRAVEL $1, SUPPLIES $2, FURNITURE < $ 5000 $13, OTHER PROFESSIONAL FEES $1, POSTAGE, S&H AND COURIER SERVICES $2, SUBSCRIPTIONS, DUES, SUPPORT $ REGISTRATION/TRAINING $1,000 Program: Eligibility and Patient Navigation SALARIES $144, FRINGE - TAX, FLEX, RETIREMENT $31, SALARIES $99, FRINGE - TAX, FLEX, RETIREMENT $21, EMPLOYEE TRAVEL $3, STAFF TRAINING/TRAVEL $2, SUPPLIES $ FURNITURE < $ 5000 $10,505 Page 18 of 39

19 OTHER PROFESSIONAL FEES $ PRINTING / COPY SERVICES $ REGISTRATION/TRAINING $500 Page 19 of 39

20 Division 07: Disease Control and Prevention Proposed Budget: $933,069 FTEs: 12 Fund Sources: General Revenue, Immunizations Grant, Surveillance Grant, PHEP Grant, ZIKA Grants Program: Epidemiology and Disease Surveillance SALARIES $142, FRINGE - TAX, FLEX, RETIREMENT $30, FRINGE - MEDICAL AND DENTAL $107, EMPLOYEE TRAVEL $1, STAFF TRAINING/TRAVEL $6, SUPPLIES $7, OTHER PROFESSIONAL FEES $ POSTAGE, S&H AND COURIER SERVICES $ SUBSCRIPTIONS, DUES, SUPPORT $5, PRINTING / COPY SERVICES $ STAFF LIABILITY INSURANCE $ MISCELLANEOUS EXPENSE $ REGISTRATION/TRAINING $2, SALARIES $20, FRINGE - TAX, FLEX, RETIREMENT $4, SALARIES $120, FRINGE - TAX, FLEX, RETIREMENT $26, EMPLOYEE TRAVEL $ STAFF TRAINING/TRAVEL $5, SUPPLIES $ SUBSCRIPTIONS, DUES, SUPPORT $1, REGISTRATION/TRAINING $1, REGISTRATION/TRAINING $275 Program: ZIKA Response SALARIES $1, FRINGE - TAX, FLEX, RETIREMENT $ EMPLOYEE TRAVEL $ SUPPLIES $1, CONTRACTUAL $4, SALARIES $2, FRINGE - TAX, FLEX, RETIREMENT $475 Page 20 of 39

21 Program: Immunizations SALARIES $336, FRINGE - TAX, FLEX, RETIREMENT $72, EMPLOYEE TRAVEL $5, STAFF TRAINING/TRAVEL $4, SUPPLIES $14, OTHER PROFESSIONAL FEES $ POSTAGE, S&H AND COURIER SERVICES $2, PRINTING / COPY SERVICES $1, STAFF LIABILITY INSURANCE $ MISCELLANEOUS EXPENSE $ REGISTRATION/TRAINING $625 Page 21 of 39

22 Division 08: Quality and Strategic Management Proposed Budget: $406,154 FTEs: 4 Fund Sources: General Revenue, Local Public Health Services Grant, Incentive Payments, ZIKA Grant Program: Local Public Health Services SALARIES $20, FRINGE - TAX, FLEX, RETIREMENT $4, FRINGE - MEDICAL AND DENTAL $35, EMPLOYEE TRAVEL $1, FUEL & TOLL EXPENSES $ STAFF TRAINING/TRAVEL $4, SUPPLIES $2, SOFTWARE < $5000 $2, FURNITURE < $ 5000 $5, POSTAGE, S&H AND COURIER SERVICES $ ADS - JOB RECRUITMENT $ WCCHD TRAININGS & MEETINGS $ MISCELLANEOUS EXPENSE $ SALARIES $76, FRINGE - TAX, FLEX, RETIREMENT $16, EMPLOYEE TRAVEL $ FUEL & TOLL EXPENSES $ STAFF TRAINING/TRAVEL $2, SUPPLIES $ PUBLICATIONS - BOOKS, JOURNALS, VID $ REGISTRATION/TRAINING $2,000 Program: Quality and Strategic Management SALARIES $54, FRINGE - TAX, FLEX, RETIREMENT $11, SUBSCRIPTIONS, DUES, SUPPORT $ SALARIES $83, FRINGE - TAX, FLEX, RETIREMENT $18, EMPLOYEE TRAVEL $ FUEL & TOLL EXPENSES $ STAFF TRAINING/TRAVEL $1, SUBSCRIPTIONS, DUES, SUPPORT $10, PRINTING / COPY SERVICES $1, REGISTRATION/TRAINING $2,000 Page 22 of 39

23 REGISTRATION/TRAINING $ OTHER PROFESSIONAL FEES $ SUBSCRIPTIONS, DUES, SUPPORT $46,200 Program: ZIKA Response SALARIES $1, FRINGE - TAX, FLEX, RETIREMENT $219 Page 23 of 39

24 Division 10: Marketing and Community Engagement Proposed Budget: $349,789 FTEs: 4 Fund Sources: General Revenue, Incentive Payments, East Williamson County Contracts, ZIKA Grants Program: Local Health Department Administration SALARIES $6, FRINGE - TAX, FLEX, RETIREMENT $1, FRINGE - MEDICAL AND DENTAL $35, EMPLOYEE TRAVEL $1, INTERNET OR DATA RELATED $ REGISTRATION/TRAINING $165 Program: Health Promotion SALARIES $16, FRINGE - TAX, FLEX, RETIREMENT $3, EMPLOYEE TRAVEL $ WCCHD TRAININGS & MEETINGS $1, REGISTRATION/TRAINING $1, MISC ADVERTISEMENTS $ SALARIES $131, FRINGE - TAX, FLEX, RETIREMENT $28, EMPLOYEE TRAVEL $2, STAFF TRAINING/TRAVEL $1, SUPPLIES $5, SUPPLIES $1, FURNITURE < $ 5000 $ SUBSCRIPTIONS, DUES, SUPPORT $ PRINTING / COPY SERVICES $2, WCCHD TRAININGS & MEETINGS $1, REGISTRATION/TRAINING $3, MISC ADVERTISEMENTS $3, WCCHD TRAININGS & MEETINGS $2,000 Program: East Williamson County Collaborative SALARIES $15, FRINGE - TAX, FLEX, RETIREMENT $3, EMPLOYEE TRAVEL $ SALARIES $25, FRINGE - TAX, FLEX, RETIREMENT $5,488 Page 24 of 39

25 EMPLOYEE TRAVEL $2, OTHER PROFESSIONAL FEES $6, WCCHD TRAININGS & MEETINGS $9,000 Program: ZIKA Response EMPLOYEE TRAVEL $ SUPPLIES $ MISC ADVERTISEMENTS $31,000 Page 25 of 39

26 Division 11: Emergency Preparedness and Response Proposed Budget: $263,269 FTEs: 3 Fund Sources: Public Health Emergency Response Grants, General Revenue Program: Public Health Emergency Preparedness FRINGE - MEDICAL AND DENTAL $26, REGISTRATION/TRAINING $ SALARIES $174, FRINGE - TAX, FLEX, RETIREMENT $37, EMPLOYEE TRAVEL $2, FUEL & TOLL EXPENSES $1, STAFF TRAINING/TRAVEL $6, SUPPLIES $3, POSTAGE, S&H AND COURIER SERVICES $ EQUIP, MAINTENANCE, RENTAL $4, WCCHD TRAININGS & MEETINGS $1, MISCELLANEOUS EXPENSE $ INTERNET OR DATA RELATED $2, REGISTRATION/TRAINING $2,085 Page 26 of 39

27 7 APPENDICES Acronyms WCCHD Organization Chart Current Grants Proposed Salary Schedule Current Fee Schedules Page 27 of 39

28 7.1 ACRONYMS Williamson County and Cities Health District CAD CBC CHA CHIP DLT DOT DSHS DSRIP EHS EPR EWCC EWNA FTE FY HCG HIV IDCU OSSF PHAB PHEP PPD STD TB TPPA TSH WIC WWA Computer Aided Detection Complete Blood Count Community Health Assessment Community Health Improvement Plan District Leadership Team Directly Observed Therapy (Texas) Department of State Health Services Delivery System Reform Incentive Payment Environmental Health Services Emergency Preparedness and Response East Williamson County Collaborative East Williamson Needs Assessment Full Time Equivalent Fiscal Year Human Chorionic Gonadotropin Human Immunodeficiency Virus Infectious Disease Control Unit On-Site Sewage Facility Public Health Accreditation Board Public Health Emergency Preparedness Purified Protein Derivative Sexually Transmitted Disease Tuberculosis Treponema pallidum particle agglutination Thyroid Stimulating Hormone Women, Infants, and Children Wilco Wellness Alliance Page 28 of 39

29 7.2 ORGANIZATION CHART Williamson County and Cities Health District MEMBER GOVERNMENTS / PEOPLE OF WILLIAMSON COUNTY WILLIAMSON COUNTY AND CIT IES H EALTH DISTRICT BOARD OF HEALT H HEALT H AUT HORITY / MEDICAL DIREC TOR EXECUTIVE DIRE CTOR DEPUTY DIRE CTOR Clinical Ser vices Quality and Str ategic Ma na gement Disease Control and Preventi on Administration and Financ e Envir onmental Heal th Emergency Preparedness and Re sponse Program Eligibility and Social Services Human Resour ces WIC a nd Community Nutr ition Ma rketing and Communit y Engagement Page 29 of 39

30 7.3 CURRENT GRANTS, Texas Department of State Health Services (DSHS) Mar 01, 2017 through Jul 31, 2018: Executed Total Budgeted Total 2018 Current Contract # CPS-Zika $256,634 $130, Sep 01, 2017 through Aug 31, 2019: IDCU Surveillance $322,109 $161, Sep 01, 2017 through Aug 31, 2019: Local Public Health Services $277,058 $138, Jul 01, 2017 through Jun 30, 2018: Public Health Emergency Preparedness $265,370 $265, (10% Match of $26,537 Required) Sep 01, 2017 through Aug 31, 2018: Immunizations $475,709 $475, ($70,000 estimated Program Income) TB/State $61,912 $61, (20% Match of $12,382 Required) Jan 01, 2018 through Dec 31, 2018: TB/Federal $50,434 $50, (20% Match of $10,087 Required) Oct 01, 2017 through Sep 30, 2018: Women, Infants, and Children (WIC) $1,322,800 $1,322, A Total 2018 DSHS Contracts $2,605,840 Page 30 of 39

31 7.4 CLASSIFICATION SALARY SCHEDULE (Based on FY State of Texas Salary Schedules) FY State Classification Titles Minimum Midpoint Maximum Administrative Assistant I A9 A 23,781 29,320 34,859 Customer Service Representative I M 1,982 2,443 2,905 B-W 915 1,128 1,341 Administrative Assistant II A11 A 26,332 33,844 41,355 Customer Service Representative II M 2,194 2,820 3,446 Medical Technician IV B-W 1,013 1,302 1,591 Administrative Assistant III A13 A 29,439 37,914 46,388 Customer Service Representative III M 2,453 3,160 3,866 B-W 1,132 1,458 1,784 Administrative Assistant IV A15 A 32,976 42,511 52,045 Customer Service Representative IV M 2,748 3,543 4,337 LVN III B-W 1,268 1,635 2,002 Case Manager I B11 A 26,332 33,844 41,355 Human Services Specialist I M 2,194 2,820 3,446 Inspector II B-W 1,013 1,302 1,591 Human Services Specialist II B12 A 27,840 35,819 43,798 M 2,320 2,985 3,650 B-W 1,071 1,378 1,685 Case Manager II B13 A 29,439 37,914 46,388 Human Services Specialist III M 2,453 3,160 3,866 Inspector III B-W 1,132 1,458 1,784 Accountant I B14 A 31,144 40,139 49,134 Human Resources Specialist I M 2,595 3,345 4,095 Human Services Specialist IV B-W 1,198 1,544 1,890 Public Health and Prevention Specialist I Accountant II B15 A 32,976 42,511 52,045 Case Manager III M 2,748 3,543 4,337 Human Services Specialist V B-W 1,268 1,635 2,002 Inspector IV Systems Support Specialist II Page 31 of 39

32 Environmental Protection Specialist I B16 A 34,918 45,024 55,130 Human Resources Specialist II M 2,910 3,752 4,594 Public Health and Prevention Specialist II B-W 1,343 1,732 2,120 Accountant III B17 A 36,976 47,688 58,399 Case Manager IV M 3,081 3,974 4,867 Dietetic and Nutrition Specialist I B-W 1,422 1,834 2,246 Human Services Specialist VII Inspector V Program Specialist I Research Specialist II Sanitarian I Systems Support Specialist III Database Administrator I B18 A 39,521 51,985 64,449 Grant Coordinator I M 3,293 4,332 5,371 Program Specialist II B-W 1,520 1,999 2,479 Public Health and Prevention Specialist III Accountant IV B19 A 42,244 55,602 68,960 Dietetic and Nutrition Specialist II M 3,520 4,634 5,747 Epidemiologist I B-W 1,625 2,139 2,652 Information Specialist III Inspector VI Program Specialist III Public Health Nurse I Research Specialist III Sanitarian II Systems Support Specialist IV Data Base Administrator II B20 A 45,158 59,473 73,788 Grant Coordinator II M 3,763 4,956 6,149 Health and Human Services Program Coordinator II B-W 1,737 2,287 2,838 Program Specialist IV Public Health and Prevention Specialist IV Dietetic and Nutrition Specialist III B21 A 48,278 63,616 78,953 Epidemiologist II M 4,023 5,301 6,579 Information Specialist IV B-W 1,857 2,447 3,037 Inspector VII Program Specialist V Public Health Nurse II Research Specialist IV Page 32 of 39

33 Sanitarian III Grant Coordinator III B22 A 51,614 68,047 84,479 Manager I M 4,301 5,671 7,040 Public Health and Prevention Specialist V B-W 1,985 2,617 3,249 Epidemiologist III B23 A 55,184 72,789 90,393 Information Specialist V M 4,599 6,066 7,533 Manager II B-W 2,122 2,800 3,477 Program Specialist VI Public Health Nurse III Manager III B24 A 59,004 77,862 96,720 M 4,917 6,489 8,060 B-W 2,269 2,995 3,720 Manager IV B25 A 63,104 83, ,491 M 5,259 6,942 8,624 B-W 2,427 3,204 3,980 Advanced Practice Registered Nurse I B27 A 76, , ,137 Director II M 6,363 8,562 10,761 B-W 2,937 3,952 4,967 Director III B28 A 83, , ,052 M 6,999 9,419 11,838 B-W 3,230 4,347 5,464 Director VI B31 A 111, , ,069 M 9,316 12,536 15,756 B-W 4,300 5,786 7,272 Physician III B34 A 148, , ,652 M 12,400 16,685 20,971 B-W 5,723 7,701 9,679 Page 33 of 39

34 7.5 CLINICAL SERVICES FEES Visit Type Williamson County and Cities Health District Fee Preventive with Physician or Nurse Practitioner $30 Tobacco/Alcohol Counseling $0 Evaluation and Management, New Patient, Focused $15 Evaluation and Management, New Patient, Expanded $25 Evaluation and Management, New Patient, Detailed $25 Evaluation and Management, New Patient, Comprehensive $25 Evaluation and Management, Existing Patient with Nurse $15 Evaluation and Management, Existing Patient, Expanded $25 Evaluation and Management, Existing Patient, Detailed $25 Evaluation and Management, Existing Patient, Comprehensive $25 Preventive Medicine, Individual Counseling $0 Immunization Administration $10 Immunization Record Review $5 TB Intake, Initial, with Nurse $15 TB Screening $0 Chest X-Ray, Single View $25 Chest X-Ray, Two views, Front and Lateral $30 TB Established Patient with Nurse $15 TB Lab, T-Spot $50 TB Lab, PPD Placement $5 TB Lab, PPD Reading $0 TB Lab, Quantiferon $40 Sputum Induction/Collection $0 Sputum Specimen Handling $0 TB Culture $0 Directly Observed Therapy (DOT) in clinic $0 Page 34 of 39

35 Visit Type Fee DOT mobile $0 STD Lab, Affirm Vaginal Swab (Candida, bacterial vaginosis, Trichomonas) $45 STD Lab, Syphilis/HIV $20 STD Lab, Chlamydia and Gonorrhea, Urine or Swab $25 STD Lab, Chlamydia Culture $25 STD Lab, Gonorrhea Culture $15 STD Lab, Herpes Culture $30 Hepatitis B Surface Antigen $10 Hepatitis C Antibody $10 HIV 4 th Generation $10 HIV 1/2 Antibody Multispot (Confirmation) $70 HPV by ThinPrep $30 Herpes Simplex VirusSpecific Type I and II $30 TPPA (Syphilis Confirmation) $25 ThinPrep Pap Test $30 Herpes Simplex Typing for Culture $50 Pregnancy Test $5 Urinary Tract Infection, Dipstick $5 Pregnancy, HCG Serum $10 Pregnancy, HCG Quantitative $10 Urinalysis $10 Urinalysis with Reflex Culture $10 Urine Culture $10 Trichomonas Urine Test $40 CBC $5 Hemoglobin A1C $10 Hepatitis Panel $40 Page 35 of 39

36 Visit Type Fee Lipid Panel $10 Liver Function Panel $10 Metabolic Panel, Basic $10 Metabolic Panel, Comprehensive $10 TSH $10 Occult Blood, Fecal Immunoassay $30 Sickle Cell Screen $5 Screening Mammogram $100 CAD, Screening Mammogram $10 Tomosynthesis, Screening Bilateral $20 Immunity Titer, Hepatitis B Surface Antibody, Qualitative $10 Immunity Titer, Hepatitis B Surface Antibody, Quantitative $35 Immunity Titer, Measles/Rubeola, Mumps, Rubella $35 Immunity Titer, Varicella $20 Male Condoms (10) $0 Female Condoms (5) $0 Glucometer $0 Insulin Syringes $0 Glucometer Test Strips $0 Blood Testing Lancets $0 Birth Control Pills $15 Lamictal Level $45 GGT Assay $5 Hep B DNA Quant by PCR $100 RPR Reflex to MHA-TP $10 Carbamazepine Assay $20 Amikacin Trough $20 Page 36 of 39

37 Visit Type Fee Haptoglobin $15 Reticulocyte $10 LDH $10 TSH w/reflex to Free T4 $10 Assay of Free Thyroxine (is a reflex test to 84443) $10 HIV-1, NAA, Quant $115 Pathologist SME $20 RPR+Titer with reflex to TPPA $15 CBC w/ Absolute White Blood Cells $5 Page 37 of 39

38 7.6 RETAIL FOOD PROGRAM FEES Food Establishments Number of employees (1 7) $ Number of employees (8 15) $ Number of employees (16 30) $ Number of employees (31 45) $ Number of employees (46 or more) $ Mobile Food Establishment $ If an application is made after the last day of June of any calendar year for the above types of facilities, the application fee shall be reduced by 50% Temporary Food Establishment $50.00 Daycare Centers Licensed number of children (13 40) $ Licensed number of children (41 100) $ Licensed number of children (101 or more) $ If an application is made after the last day of June of any calendar year for Daycare Centers, the application fee shall be reduced by 50% Delinquency fee upon failure to timely renew permit days after expiration date 20% permit fee More than 60 days after expiration date 50% permit fee Miscellaneous Fees Variance Application Fee $ Food Establishment Plan Review (includes plan review and on pre-opening inspection) $ Fee for additional inspection conducted at request of establishment $75.00 Page 38 of 39

39 Compliance inspection fee $ Permit reinstatement fee following finding of second failure health inspection violation $ Farmer s Market Permit $ Farmer s Market Permit Eggs Only $50.00 Open Records Request Copies $0.25 / Page Page 39 of 39