AGENDA BAY ARENAC BEHAVIORAL HEALTH BOARD OF DIRECTORS FINANCE COMMITTEE MEETING Wednesday, December 12, 2018 at 5:00 pm Behavioral Health Center, Room 225, 201 Mulholland, Bay City, MI 48708 Committee Members: Present Excused Absent Present Excused Absent Others Present: Richard Gromaski, Ch Patrick McFarland BABH: Chris Pinter, Ellen Lesniak, and Thomas Ryder, V Ch Robert Pawlak, Ex Off Sara McRae John Andrus James Anderson, Ex Off Ernie Krygier Richard Byrne, Ex Off Legend: M-Motion; S-Support; MA- Robert Luce Motion Adopted; AB-Abstained 1. Call To Order & Roll Call 2. Public Input (Maximum of 3 Minutes) Agenda Item Discussion Motion/Action 3. 4. 5. 6. 3.1) Investment Earning Reports for November of 2018 Contracts 4.1) Finance December 2018 Contract List Unfinished Business 5.1) None New Business 6.1) McLaren Service Claims Update 6.2) Fiscal Year 2019 Subcontract Medicaid Revenue 3.1) M - S - MA Refer to full Board for information 4.1) M - S - MA Refer to full Board for approval of the Finance December 2018 contract list 6.1) M - S - MA Receive the report 6.2) M - S - MA Receive the report 7. Adjournment M - S - pm MA
Bay-Arenac Behavioral Health Authority Estimated Cash and Investment Balances November 30, 2018 Balance November 1, 2018 5,486,193.52 Balance November 30, 2018 5,475,612.60 Average Daily Balance 4,473,963.79 Estimated Actual/Accrued Interest November 2018 4,862.66 Effective Rate of Interest Earning November 2018 1.30% Estimated Actual/Accrued Interest Fiscal Year to Date 9,887.94 Effective Rate of Interest Earning Fiscal Year to Date 1.32% Note: The Cash and Investment Balances exlcude Payroll and AP related Cash Accounts. Page 2 of 8
Cash Available - Operating Fund Rate Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Beg. Balance Operating Funds - Cash, Cash equivalents, Investments 3,618,076 4,590,868 5,280,042 3,186,356 5,983,324 6,383,453 5,466,960 5,069,055 5,618,332 5,118,384 4,647,780 5,020,038 Cash in 5,466,367 4,379,801 2,036,794 6,606,924 4,436,219 5,545,752 5,254,240 7,594,141 4,104,123 4,101,415 4,635,931 5,043,403 Cash out (4,493,575) (3,690,628) (4,130,480) (3,809,956) (4,036,090) (6,462,245) (5,652,145) (7,044,865) (4,604,070) (4,572,020) (4,263,673) (5,302,718) Ending Balance Operating Fund 4,590,868 5,280,042 3,186,356 5,983,324 6,383,453 5,466,960 5,069,055 5,618,332 5,118,384 4,647,780 5,020,038 4,760,723 Investments Money Markets 4,590,868 5,280,042 3,186,356 5,983,324 6,383,453 5,466,960 5,069,055 5,618,332 5,118,384 4,647,780 5,020,038 4,760,723 90.00 180.00 180.00 270.00 270.00 Total Operating Cash, Cash equivalents, Invested 4,590,868 5,280,042 3,186,356 5,983,324 6,383,453 5,466,960 5,069,055 5,618,332 5,118,384 4,647,780 5,020,038 4,760,723 Average Rate of Return General Funds 0.75% 0.75% 0.85% 0.75% 0.82% 0.86% 0.89% 0.92% 0.95% 0.97% 1.19% 1.19% 0.76% 0.74% 1.19% 0.76% 0.71% 1.19% 1.19% 1.19% 1.19% 1.19% 1.19% 1.19% average 3,868,106 4,221,090 4,014,143 4,014,143 4,633,928 4,738,057 4,774,834 4,859,184 4,882,748 4,863,167 5,020,038 4,890,380 Cash Available - Other Restricted Funds Rate Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Beg. Balance-Other Restricted Funds - Cash, Cash equivalents, Investments 705,314 705,537 705,760 706,924 707,267 707,600 708,977 709,335 709,765 710,196 712,053 712,688 Cash in 223 223 303,289 343 333 1,376 358 430 432 1,857 635 2,202 Cash out 0 0 (302,125) Ending Balance Other Restricted Funds 705,537 705,760 706,924 707,267 707,600 708,977 709,335 709,765 710,196 712,053 712,688 714,890 Investments Money Market 403,412 403,635 403,921 404,264 404,608 404,940 405,298 405,728 406,159 406,710 407,345 407,964 91.00 0.70% 91.00 1.10% - - - - - 91.00 1.15% 302,125 302,125 - - - 91.00 1.35% 303,003 303,003 303,003 90.00 1.70% 304,037 304,037 304,037 304,037 91.00 2.05% 305,343 305,343 270.00 2.65% 306,926 365.00 80.00% Total Other Restricted Funds 705,537 705,760 706,924 707,267 707,611 708,977 709,335 709,765 710,196 712,053 712,688 714,890 Average Rate of Return Other Restricted Funds 0.86% 0.86% 0.88% 0.89% 0.90% 0.91% 0.91% 0.92% 0.86% 0.87% 1.88% 1.88% 0.86% 0.86% 0.95% 0.95% 0.96% 0.96% 0.96% 0.96% 0.30% 0.96% 1.88% 1.88% average 872,300 830,665 806,052 789,475 777,779 769,180 762,530 757,254 752,976 749,566 712,688 713,789 Total - Bal excludes payroll related cash accounts 5,296,405 5,985,801 3,893,280 6,690,591 7,091,064 6,175,937 5,778,390 6,328,097 5,828,580 5,359,833 5,732,725 5,475,613 Total Average Rate of Return 0.79% 0.79% 0.83% 0.78% 0.83% 0.89% 0.94% 0.99% 0.95% 0.94% 1.29% 1.32% Page 3 of 8
Page 1 of 2 Bay-Arenac Behavioral Health Finance Committee Summary of Proposed Contracts December 2018 Old Rate New Rate Term Out Clause? Performance Issues? SECTION I. SERVICES PROVIDED BY OUTSIDE AGENCIES Clinical Services 1 M ABA Providers Revised coding and fee structure eff 1/1/19: Initial assessment (approx 4 hours, 2x year) Functional Behavioral Analysis (FBA) - per 30m/ Now 15m unit code Adaptive Behavior Treatment (ABT) - first 30m/ Now 15m unit code Group ABT - per 30m/ Now 15m unit code ABT clinical observ & direction by ML/BL - first 30m/ Now 15m unit Family behavior treatment guidance - 60-75m event/ Now 15m unit Multiple family behavior treatment guidance - 90-105m/ Now 15m unit Adaptive behavior treatment group - 90-105m/ Now 15m unit Exposure ABT requiring 2+ techs - first 60m/ Now 15m unit Exposure ABT requiring 2+ techs - addtl 30m/ Now 15m unit (State rates Oct-Dec18) $480 ML, $340 BL $60 ML, $42.50 BL $30 ML+BL, $25.00 AL $8.57 ML+BL, $7.86 AL $60 ML, $42.50 BL $120 ML, $85 BL $72 ML, $51 BL $51.43 ML, $36.43 BL $120 ML+BL, $100 AL $60 ML+BL, $50 AL (State rates eff 1/1/19) Same $30 ML, $21.25 BL $15 ML+BL, $12.50 AL $4.29 ML+BL, $3.93 AL $30 ML, $21.25 BL $30 ML, $21.25 BL $18.00 ML, $12.75 BL $12.86 ML, $9.11 BL $30 ML+BL, $25 AL $30 ML+BL, $25 AL 1/1/19-9/30/19 Y 8 Low, 3 New, 1 High* ML = Masters level BL = Bachelors level AL = Aide level ML = Masters level BL = Bachelors level AL = Aide level 2 N CareBuilders at Home CLS to children in Bay and Arenac Co Bay $4.67/unit Arenac $6.85/unit 1/1/19-9/30/20 Y New provider 3 N Compassionate Care Home Help Services, Inc. CLS to adults in Arenac Co. $6.85/unit 1/1/19-9/30/20 Y New provider 4 M BHS ABA (Madison clinic) Add BCBA services and revised coding and fee structure eff 1/1/19: Initial assessment (approx 4 hours, 2x year) Functional Behavioral Analysis (FBA) - per 30m/ Now 15m unit code Adaptive Behavior Treatment (ABT) - first 30m/ Now 15m unit code Group ABT - per 30m/ Now 15m unit code ABT clinical observ & direction by ML/BL - first 30m/ Now 15m unit Family behavior treatment guidance - 60-75m event/ Now 15m unit Multiple family behavior treatment guidance - 90-105m/ Now 15m unit Adaptive behavior treatment group - 90-105m/ Now 15m unit Exposure ABT requiring 2+ techs - first 60m/ Now 15m unit $19.80 AL $5.00 AL (eff 1/1/19) $384 ML, $272 BL $24 ML, $17 BL $12 ML+BL, $9.90 AL $3.43 ML+BL, $2.50 AL $24 ML, $17 BL $24 ML, $17 BL $14.40 ML, $10.20 BL $10.29 ML, $7.29 BL $24 ML+BL, $20 AL 12/22/18-4/30/19** Y Low ML = Masters level BL = Bachelors level AL = Aide level 5 S Harbor Oaks Hospital Inpatient psychiatric services (all inclusive) Adults Specialized Pediatric Unit 6 R MCSI 5th Street SIP $725/day $1,200/day Same 10/1/18-9/30/19 Y Low Enhanced per diem for 1 consumer $81.66/day $184.55/day 9/6/18-7/8/19 Y Low 7 R MCSI Hourly Transition from CLS unit rate to per diem for 2 consumers in shared apartment 8 N North Shore Center, LLC $4.67/unit $173.50/day x 2 1/1/19-9/30/19 Y Low Crisis Residential services (Oscoda, MI) $332/day 1/1/19-9/30/20 Y New provider Page 4 of 8
9 R Paramount Rehabilitation Services Old Rate New Rate Term Out Clause? Page 2 of 2 Performance Issues? OT/PT/Speech for children and adults: OT/PT Evaluation OT/PT Re-evaluation OT/PT Individual Therapy Speech Evaluation Speech Individual Therapy Therapy for function of swallowing Treatment plan monitoring $165/event $150/event $26/unit $165/event $103/event $126/event $80/event $34/unit $107.12/event 12/1/18-9/30/20 Y Low 10 T Ruth Tulloch, RN Termination of OBRA Assessments contract (due to retirement) $0 Eff 12/31/18 Y N Admin/Other Services 11 M New Image Lawn Care & Landscaping Snow & ice removal services, Madison site*** - Snow plowing - De-icing/salting $140/occurrence $125/occurrence $160/occurrence $140/occurrence 11/6/18-4/30/19 Y N 12 R Pitney Bowes Postage machine rental - 1961 Parish Rd, Kawkawlin $441/quarter $443/quarter 7/1/19-6/30/24 Y N SECTION II. SERVICES PROVIDED BY THE BOARD (REVENUE CONTRACTS) 13 N Bay Area Community Foundation Grant to pay for ACT holiday party $1,000 11/13/18-12/31/18 N/A N 14 R Tuscola Behavioral Health Systems Pre-admission screening $414/screen $447/screen 1/1/19-9/30/19 Y N SECTION III. STATE OF MICHIGAN OR MSHN GRANT CONTRACTS 15 R Mid-State Health Network FY19 Medicaid subcontract $44,810,300 $45,190,046 10/1/18-9/30/19 Y N SECTION IV. MISC PURCHASES REQUIRING BOARD APPROVAL 16 S Bay Area Human Services Collaborative Council 2019 membership dues $500 1/1/19-12/31/19 N/A N 17 D Brown & Brown of Michigan, Inc. Workers comp insurance $124,783 $90,249 1/1/19-1/1/20 N/A N 18 R CARF International Survey fee (3 year accreditation) $14,310 $15,180 2/1/19-3/31/19 N/A N R = Renewal with rate increase since previous contract D = Renewal with rate decrease since previous contract S = Renewal with rate as previous contract ES = Extension M = Modification N = New Contract/Provider NC = New Consumer T = Termination Footnotes: * Centria was determined to be a High risk provider in our 2018 Organizational Risk Assessment ** End date contingent upon BHS locating new clinic for ABA services *** Increase due to sale of 900 & 908 North Madison and acquisition of 1000 North Madison. Page 5 of 8
Analysis of McLaren Claims Payments report ran 12/12/18 report ran 12/05/18 report ran 11/26/18 report ran 11/8/18 report ran 10/12/18 MBPA Paid Amount Paid Amount Paid Amount Paid Amount Paid Amount Oct-17 49,321.48 49,321.48 49,321.48 49,321.48 49,321.48 Nov-17 41,740.12 41,740.12 41,740.12 41,740.12 41,740.12 Dec-17 35,572.12 35,572.12 35,572.12 35,572.12 35,572.12 Jan-18 54,398.49 54,398.49 54,398.49 54,453.49 54,453.49 Feb-18 42,103.88 42,103.88 42,103.88 42,103.88 42,103.88 Mar-18 43,273.31 43,305.76 43,305.76 43,305.76 43,305.76 Apr-18 49,999.04 49,999.04 49,949.04 49,899.04 49,899.04 May-18 31,025.51 28,142.71 26,820.95 21,966.86 17,490.30 Jun-18 31,830.61 27,801.84 27,395.90 22,829.10 17,468.05 Jul-18 38,149.90 35,440.73 33,878.54 28,652.04 21,227.75 Aug-18 41,897.46 37,935.46 35,064.64 28,359.42 23,993.75 Sep-18 35,199.96 31,769.99 30,036.23 25,668.85 9,457.20 FY18 494,511.88 477,531.62 469,587.15 443,872.16 406,032.94 FY17 498,281.00 498,281.00 498,281.00 498,281.00 3,769.12 20,749.38 28,693.85 54,408.84 The average for the first 7 months (Oct-Apr) The average for the last 5 45,200.00 45,200.00 45,200.00 45,200.00 45,200.00 months (May-Sep) 35,600.00 32,200.00 30,600.00 25,500.00 17,900.00 Difference 9,600.00 13,000.00 14,600.00 19,700.00 27,300.00 Multiply by 5 months 5 5 5 5 5 Potential outstanding claims (based on ave. for FY18) 48,000.00 65,000.00 73,000.00 98,500.00 136,500.00 Page 6 of 8
FUNDING EXHIBIT Bay Arenac SUBCAPITATION FUNDING METHODOLOGY AND PAYMENTS I. FY2019 Summary of Base Funding Methodology A. Medicaid B and B3 Revenue 29,827,235 B. Medicaid C Waiver Revenue 9,555,205 C. Medicaid DHS Incentive Payment Revenue 120,724 D. Healthy Michigan Plan Revenue 3,665,616 E. Autism Revenue 3,845,988 Unadjusted Total for All Revenue Sources 47,014,767 II. FY2019 Summary of Adjustments for Subcapitation A. PIHP Administration Total 479,673 B. Insurance Provider Assessment (IPA) Total 411,970 Total Adjustments 891,642 III. FY2019 Contract Maximum Obligation* A. Unadjusted Total for All Revenue Sources 47,014,767 B. Total Adjustments 891,642 Contract Maximum Obligation * 46,123,125 IV. Benefit Stabilization Based on budgeted revenues and expenses, additional funds may needed or surplus funds may be lapsed: Recipients of benefit stabilization will receive additional funding up to this maximum amount, paid on a monthly basis net of any projected lapse: ** Planned use of Medicaid Savings per Smoothing Plan 1,669,002 Projected current year need (lapse) - Medicaid (3,149,651) Total projected use of (contribution to) Medicaid Savings (1,480,648) Projected current year need (lapse) - Healthy Michigan Plan 364,097 Projected current year need (lapse) - Autism (26,527) Total Benefit Stabilization Need (Lapse) (1,143,079) V. Program Revenue Resources to maintain capacity for SUD integration in the below areas (includes administrative costs): 210,000 Access, Emergency and Referral Behavioral Health Prevention (SUD specific prevention activities are not included in the behavioral health funding allocation. SUD prevention only would be included in the program contract.) Collaboration with local coalitions to determine local community needs, CMHSP designated point of contact to work with local coalitions and MSHN prevention staff to collaborate and develop behavioral health prevention activities Customer Service and Recipient Rights Contract Maximum Obligation with Benefit Stabilization and Program Revenue 45,190,046 The Contract Maximum Obligation reflects total estimated revenues less adjustments. Actual revenues * may vary based on enrollments. ** Recipients of benefit stabilization funds must have a spending plan to stay within the funding maximum. Contributors of benefit stabilization funds are entitled to the full capitation amount and will receive the full *** amount on a monthly basis. Page 7 of 8
Bay-Arenac Behavioral Health FY19 Subcontract Medicaid Revenue Analysis A B C C-B MSHN Original MSHN Revised FY19 Revenue FY19 Revenue Revenue Estimates Revenue Estimates Projection Projections Over/(Under) Funding FY19 FY19 Based on YTD Nov Revised Estimates Medicaid 37,187,245 38,782,473 38,608,544 (173,929) Medicaid Benefit Stablization 1,669,002 - - HMP 3,173,589 3,494,663 3,451,864 (42,799) Autism 2,950,210 3,845,988 3,441,631 (404,357) SUD 24/7/365 210,000 210,000 210,000 - Total Revenue 45,190,046 46,333,124 45,712,039 (621,085) A B C C-B *BABH FY19 BABH Board FY19 Revenue FY19 Revenue Expense Budget Approved Projection Projections Over/(Under) Funding Submitted to MSHN FY19 Expense Budget Based on YTD Nov FY19 Expense Budget Medicaid + Benefit Stablization 37,301,825 38,023,955 38,608,544 584,589 HMP 3,858,760 4,219,694 3,451,864 (767,830) Autism 3,819,461 3,915,441 3,441,631 (473,810) SUD 24/7/365 210,000 210,000 210,000 - Total Revenue 45,190,046 46,369,090 45,712,039 (657,051) *In line with MSHN's original Medicaid Revenue estimates. Page 8 of 8