COMMITTEE ON BUDGET AND APPROPRIATIONS

MINUTES

NOVEMBER 20, 1996

ATTENDANCE:

B & A MEMBERS: Swanson, Wishnie, Darcy, Delfino, LaMotte, Abinanti

OTHERS: C.E.’s Office: Gina Angiulo, Jamie Hastings; Budget: Joe Phelan, Leslie Bennett, Dianne Kearney, Arthur Vietro; Health Dept: Dr. Adel, Patsy Yang-Lewis, Karen Kelley, Mary Landrigan; Labs & Research: Millard J. Hyland, Tom McGimpsey; Mental Health: Comm. Friedman; PRC Board: George Ilse; Gannett: Laurie Nikolski, Marie Cortissoz; CBAC: George Hosey, Barbara Strauss; LWVW: Harriet Goldberg; BOL: Legislator Carsky, Legislator Bronz, Legislator Stewart-Cousins, Robert J. Boland, Glenn Guzi, Tina Seckerson

Co-Chairs Swanson and Wishnie called the meeting to order at 9:35 a.m.

DISCUSSION: 1997 Proposed Budget:

(There is a cassette tape on file for more detailed information.)

HEALTH:

Education & Transportation: Mrs. Swanson stated that this account had been underfunded for 1996 and asked if it was again being underfunded for 1997. Dr. Adel explained that this is a unique program which is basically an open-ended entitlement program. The Department exerts as much control over spending as they are entitled to. The program has grown despite heroic efforts to provide appropriate services as economically as possible. The program has grown from $21.7 million in 1991 to $52 million projected for 1997. The Department has managed to limit growth in expenses in the Early Intervention Program over the last few years because the County is the first instance provider and as such coordinates the evaluations, program development and service provider rates. On the other hand, the Pre-School Program is coordinated by the State Education Department and the County is mandated to provide payment based on choices made by the state and service providers. Dr. Adel stated that he feels the $52 million figure is sufficient due to recent trends which have indicated a leveling off of the number of recipients of the Early Intervention Program. Mrs. Swanson requested a yearly breakdown, for the past five years, showing the cost of the two programs inclusive of the number of children served, the cost per service per child and the reimbursement received and still outstanding.

Mr. Abinanti asked if the Department’s billing practices were contributory to the tremendous lag in state reimbursements. Ms. Lewis responded that the Department was exceptionally keen in tracking the billing and receivables for the Early Intervention Program. The Pre-School Program is controlled by the State and it is their cumbersome billing methodology that is responsible for the confusion as to what is owed to counties.

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Mr. Boland referenced the Bennett Kielson Management Letter which states that the Department of Health’s reserve estimates could not be statistically supported. He requested Dr. Adel explain the request for $57 million as opposed to the $52 million request. Dr. Adel explained that the $57 million was projected very early in the budget process and was only a projection, a very early estimate. It was decided later in the year that $52 million was a more appropriate number.

TB Control Program: Mr. Wishnie questioned the apparent cut back of dollars in this area for 1997. Dr. Adel explained that the Department’s efforts in this area are not being cut back. They were allowed to fill 17 vacant lines due to a substantial need. Mr. Wishnie questioned ho the Department would be able to fill those 17 lines, service the same amount of people and do it for less money. Ms. Yang-Lewis explained that the higher amount of money in 1996 was due to patient bills coming due during the year.

Mr. Darcy asked why Public Health Nurses are being cut back. Dr. Adel explained that they have been given permission to fill 11 vacancies in this area.

The Committee requested a list of all unfunded positions in the budget.

AIDS: Reduction of 5 lines in the budget due to the termination of a community based program because the same services are now being provided through other programs. The reduction in the AIDS account is attributable to the elimination of the 5 positions that had been associated with this service.

Rabies Program: Mr. Wishnie asked for an explanation of the increase in this program. Dr. Adel explained that rabies spread throughout the northern part of the county during the first two years of the epidemic and through the remainder of the county in subsequent years. As the raccoon population rebounds in the County, a new cycle of rabies is reappearing. During the past two years, rabid animal encounters have once again appeared in the northern part of the County, and have spread throughout the remainder of the County this year. Mrs. LaMotte asked about hunters bringing rabid animals from other parts of the country. Dr. Adel explained that there is and continues to be much public education in this area.

Neighborhood Health Centers: Mr. Wishnie inquired as to why funding was being cut in this area. Dr. Adel explained that there is an issue here of taxpayer equity. For years the centers have been overpaid based on their actual expenses. They are trying to apply a formula that will insure (developed by Peat Marwick) that taxpayers will not pay twice for the same service. The $660,000 reduction in these accounts represents the projected aggregate savings that is anticipated as a result of the application of a rational formula which he stated justifies the dollars expended by the County for the centers. Dr. Adel stated that there are other sources available for funding that the centers should be exploring. Mrs. Carsky asked what these other sources are. Dr. Adel explained that there is an auto-assignment of Medicaid patients to the Neighborhood Health Centers for preventive services which results in a guaranteed increase in reimbursements. He added that the state’s bad debt and charity funding had been expanded which would also supplement the health center’s dollars. Mr. Wishnie stated that there have been some strong arguments that the formula doesn’t work. Mr. Boland pointed out that there are CDBG funds going to some Neighborhood Health Centers also (i.e. Ossining).

 

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Mrs. LaMotte reiterated the benefit of preventive care.

Buildings and Space: Legislator Carsky asked where the Department will be going after vacating its space at the Bradhurst building and when that will occur. Dr. Adel responded that he believes the Department belongs in the center of the County as it is a field based operation. They will be looking for equivalent space (60,000 sq. ft) and it is anticipated that the move will happen by the end of the first quarter of 1997.. RFP’s are out for space and bids are expected to be in shortly. (details of which will be discussed with the Health & Budget Departments)

Data Processing: Mrs. Swanson inquired as to the increase in this area by GS. Ms. Yang-Lewis responded that the Health Department is one of IS’s largest users because of complex programs. She further stated that she believed the projected expenses were based on actual usage.

Mr. Wishnie requested the paper work with regard to 1996 services in this area.

Mr. Abinanti requested an actual to actual (projected against budget) analysis of the capitation receipts.

Mrs. Swanson asked for a breakdown of the Trust Accounts.

 

The Co-Chairs called for a 5 minute recess at 10:55 a.m.

The Co-Chairs called the meeting back to order at 11:00 a.m.

LABS & RESEARCH:

Increase in Budget by 13.4% over 1996 appropriated (+$586,297) amount.

Personal Services: (+4.7%) $214,314: Increase is the result of 6 positions in 1997, 4 from existing federal grants which were not refunded and 2 restored positions previously abolished which were state funded. Dr. Hyland explained that funding for the 4 positions, which were funded all along, has dried up. He stated that these position are fundamental for the running of the lab as they are mandated to provide these services. They were not formally informed of the elimination of the funding until sometime in 1996.

Interdepartmental charges: (-1.9%) $11,158: The decrease is due to the decrease in services by DPW, services by GS-Fleet Management, and services by GS-IS. The decreases are offset by two new accounts, Services by County Road Maintenance and Services by Public Safety as well as an increase in Services by Info Services.

Services to other departments: (-24.2%) $234,255: WCMC decided to contract out for services, which had previously been provided by Labs and Research, with private labs at a lesser rate. To compete the Labs and Research Department reduced its rate to WCMC for these services. Mr. Phelan explained that there will be a commensurate reduction in WCMC’s budget.

Advance to Grants: Projection for 1996 includes paying for 15 months of federal money we didn’t get to make up for the grants and a decrease in positions.

 

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Mr. Abinanti questioned the reimbursement rate by putting the Medical Examiner under the auspices of Labs and Research. Dr. Hyland explained that in the past the Medical examiner was never reimbursed, now receiving 24% reimbursement rate.

Mr. Wishnie asked why the state reimbursement to the DOH had dropped from 40% to 30%. Mr. Phelan suggested that the BOL lobby the state delegation in opposition. Mr. Abinanti requested a list of reductions in state reimbursements to the various county departments.

 

 

MENTAL HEALTH:

The Department’s budget is less than it was in 1996 in expenditures and tax levy mainly due to personnel cuts.

Mr. Wishnie asked for information on vacancies. Commissioner Friedman stated that over the last 2 years staff has gone from 93 to 89, of which 3 were vacancies. Mr. Wishnie asked if there were any vacancies left in the department. The Commissioner responded that there are 2 unfunded vacancies. Mr. Friedman stated that the staffing levels in the department would be sufficient to meet the department’s needs due to a reorganization of how services are provided.

Homeless Assessment Team: Mrs. Swanson asked for an explanation of this account. The Commissioner explained that Mental Health would continue to do the assessments although DSS will now be picking up the expense because it could be reimbursed by the state and federal governments whereas Mental Health relies solely on tax levy.

Mr. Boland asked the Commissioner to respond to an item in Bennett Kielson’s Management Letter of last year with regard to the distribution of payments from NYS. Mr. Friedman explained that the state aid checks go to the Finance Department and then are sent to him fro distribution. They were placed into one island account. Commissioner Friedman stated that he feels that this issue has been completely rectified in that he has worked with Finance on setting up numerous different accounts rather than one island account.

Mrs. Swanson inquired as to why the Alcohol Treatment Initiative was being completely defunded. Mr. Friedman explained that it was a result of the fact that the Alcohol Treatment Centers had been spun-off two years ago to two local hospitals. The County continued to provide them with a modest subsidy over the last two years, slowly weaning them off their reliance on us. 1997 will be the first year they will have to rely solely on other funding sources. Mr. Wishnie recommended the Committee make a note of this and include it with the items being considered as additions to the proposed budget.

Mr. Abinanti requested a written account of trends in waiting lists for group homes and any anticipated state revenue. Mrs. LaMotte questioned whether any of these individuals have ever been placed in foster homes. Mr. Friedman responded that there is some use of family care in these cases but it doesn’t work all that well in Westchester.

 

 

There being no further items for discussion, on motion of Legislator Darcy, seconded by Legislator Abinanti, the meeting was adjourned at 12:00 p.m.