Travis County Commissioners Court
July 6, 2004
Item 5
Five is to consider and take appropriate action on the following for the hospital district. A is Travis County services and transfer to the hospital district. B is Travis County facilities to transfer to the hospital district. C is Travis County funds to transfer to the hospital district. And e is other matters regarding the implementation of the district. I thought we would hold off on a discussion of d until this afternoon and chat with legal counsel first. We have been given five an a and -- 5-a and 5-c.
>> yes.
>> and then you also should have 5-e, which is the other items.
>> and a is the -- are the services that should be transferred to the district by Travis County.
>> yes, judge. Commissioners, this document, pbo and was able to help us with in terms of not only identifying the programs and services, but the accompanying revenue -- the accompanying budget information for each of those programs and services. And if you look towards the bottom of that page, the note sort of explains what each of those programs are. For example, family support services as the emergency assistance program has one f.t.e. That does eligibility for the rmap program, so that's the reason that's listed there. And then the rmap program itself has other f.t.e.'s that do eligibility in the community centers. You also are aware of the people's community clinic contract and also the project access contract, and then the leases for the fqhc buildings. And pbo has indicated that they have extracted out the parts of the lease that would apply to the community centers. So this is, I guess, the first page is somewhat of a summary. The subsequent pages are the line item details that support what you have on the first page there.
>> sherry, is it accurate to say, and I might need leroy's assistance on this one, that on page 2 in the middle we have social service contracts. Right now it's 263 five hundred. And the proposed amount is estimated to be 163500. 163500 represents the people's community clinic contract. And the differential of $100,000 has to do with project access, but what we did is use one-time monies of project access as opposed to that was something built into the tax rate that needs to be accounted for or transferred? Is the idea that one is ongoing and one was a one time only? Help me understand why there's --
>> we want that funding, for example, reserves, any one time funding inside the budget, obviously we would recommend that it not be taken out of the tax rate, that we do a transfer to a hospital district if in fact there's some one-time funding that we would agree needed to go to the district. But obviously any type of expenditures that are inside any of these numbers that are one time, we would recommend just transfer the fund balance.
>> we can -- what about the $100,000?
>> I'm not sure. Unfortunately valerie is out with a sick child today, so I'm kind of hitting for her on this.
>> can you let us know next week or by e-mail between now and then?
>> sure. I can get an answer for you. She should be in this afternoon.
>> and I think what I'm hearing is that if there's a fund balance leftover of the $100,000 of one-time money that we had for project access, of course that gets transferred over. But in terms of what's the ongoing commitment, the only thing we've got in that category under social service contracts is people's and it appropriately is there at 163500.
>> I don't know if that's true. Christian?
>> if project access will need to be a part of the '05 hospital district budget and the hospital board of managers makes that conclusion, then they will need to make that change. What this does is show ongoing commitments for '05. And it is our understanding that that project access number is not an ongoing commitment. There are going to be a dozen issues that the hospital board of managers is going to have to look at for '05 that -- and this may be one of them. Do you want to include it in the '05 budget or not? We are simply trying to show a baseline as advisors and helpers to the hospital district board of managers for this last column, which is the '05 estimated expenditure budget. Now, those were also carefully crafted in our proposed budget, it's not even a preliminary budget because it's not going to be in the county's budget, it will be the hospital board manager's budget.
>> do we say somewhere on this page that the 100,000-dollar difference is because we pulled out budget access?
>> no, but we need to. We need to --
>> we also need to describe in four or five words exactly what that is. That's the county paying for medication for clients that the physicians provide free medical services for. We said we would pick up the pharmaceutical costs if they provide the service. And we budgeted $100,000. Now, we committed to take a look-see at the end of the fiscal year to see what good was resulting, right?
>> I believe that's correct.
>> and my guess is that somewhere in the budget process we need a report back from the physicians to see how many clients they in fact treated, how much money they used, what projections, if any, they have for '05. What you're saying is that at some point we need to get with the district and ask the question, do y'all want to do this? This is what we think the results are? I think we ought to put that in such a way that they understand what project access is and how we got from the 263 down to 163.
>> exactly. We'll do that. But in addition, one of the things I wanted to do was to put a cover letter from me to the court and also cc a variety of other people who are interested in this topic, kind of putting all of these numbers in context and talk about '04 adopted and '04 adjusted, those are pretty straightforward because we're nine months into the fiscal year. We've got a pretty good handle on what '04 will result in from a budget standpoint. '05, I think we need to explain patient load increases, because we do have some projections to show what patient load increases might be, what the capitated rate would be and how some of these '05 numbers came about. It doesn't mean it's right, it means it should be explained so that the board of managers can have a rich discussion soon on what should the '05 budget be. And we'll provide our advice and counsel and they will accept it, reject it, modify it accordingly. And they know their business.
>> judge, were you finished?
>> yes, sir.
>> are we also looking at the possibility of -- especially if they're a joint project that the city and the county also shared in, is the city basically doing something similar as far as what we're doing? I remember this project when it came before us, but I think the city, of course, was also asked at that time to -- to put a certain amount of dollars into it. And I'm just beginning to wonder as we go through this process, are they doing similar to what we're doing as far as what we have here, and I'm saying the city of Austin?
>> are you talking about budget access?
>> yes, sir.
>> I can let you know what their level of involvement in that project is.
>> I know they were asked to participate. And I believe they did. They did not?
>> they didn't have the money.
>> they did not. That answers that question. All right. But a similar situation there that those of us who participated will be good to -- if they can do similar to what we're doing, I guess, if possible. But that's their call, I guess.
>> yeah.
>> our hope was that if there are parts of this that are unclear for whatever reason or if we need to break out what project access is, if there are other things like that that you think we need to make more clear, then we're certainly able to do that.
>> I assume the heading would be services to transfer to the hospital district. Instead of summary of hospital district related budgeting and information. Transfer to the hospital district and budget.
>> I have been trained by counsel to be cautious with the word transfer and that's why it doesn't appear. It may be the right word, I just don't know because I'm cautious about that word.
>> that would make sense to me. What I'm getting at is if I were a new member of the board, I would want to know what programs and services Travis County will not be doing in '05 because it expects the district to do them. And my next question is if I read down this list, do I pick up all of them? I'm seeing five or six, right? (indiscernible). If this would be the services and amounts attached?
>> it does not include administrative costs because no one envisions that administrative costs are going to be transferred to the hospital district.
>> right, which you footnoted.
>> and it does not include mental health and does not include inmate health. It is basically the straightforward, core services and programs. That would be assumed by the hospital district in '05.
>> these programs and services not provided by Travis County. And in '05 we think the district ought to provide them.
>> that's exactly right.
>> pursuant to law and probably some conversations that we had over the last couple of years. But the same thing, this is a discussion document and it may well say we know we have -- if we know -- in our view we have the authority not to take it and we opt to make a decision in six months or something like that. I'm not thinking that the district will just accept this without questions or discussion. They want to make an effort to identify the services that we think we ought to transfer and give the district based on conversations, commitments, what we told voters and what the law says.
>> and fqhc is probably the one area that has it. And there is an assumption in here that fqhc will no longer be a taxing responsibility of Travis County. And that that fqhc staff will be held by the city. That has not yet been finalized, but there are discussions along those lines and at some point you just have to make an assumption that this is what we think and we'll make that explicit. I think there should be a footnote because the rest of it there's never been a discussion of any question that rmap or people's clinic or the family support services would not be the responsibility of the hospital district.
>> I see an adjusted total for general fund and fqhc amount and then I see general fund only, so we just backed out the fqhc fund to get the 9.6 million? That's the difference between the 10.4 and the 9.6?
>> yeah. If you look, the subtotal general fund above under the fy '05, estimated expenditure budget, you will see the 9,006,144 eight. That's the general fund. Fqhc is not in there. To get a grand total, 12,084,000, then you have to back out the fqhc in the transfers.
>> so if we apply our 11% reserve, which one one of these numbers do we apply to?
>> 9.6.
>> well...
>> there are two numbers that were about ready to be provided to you. One was 8.2 million for '04. Am I correct?
>> the correct answer is 8.195752 thousand because -- times 11% because that is what is the '04 projected expenditure from Travis County from which we would be having 11 percent in our unallocated reserve. That 8.2 million then would no loaninger be -- longer be spent and that means we would no longer need that unallocated reserve to be at the amount, but could be reduced by 880,000. Am I correct? [overlapping speakers]
>> to the extent that hhs or the expenditures can stay within the existing 500,000 transfer. We have revised numbers that show that that number may not be sufficient. But it is correct.
>> so then 50 to 60,000 of that.
>> even if we hand this to the board next week, we made need to further adjust this later in the fiscal year.
>> right.
>> and we probably should also mention the 11 percent reserve because that is a one-time amount that will be -- assuming the court agrees with that strategy, that an additional $888,000 would then be added to the hospital district's available resources in '05. And I'm assuming that the city would also follow suit because it's the right thing to do.
>> and the number, which is the right thing to do.
>> and the 11 percent would have to be added to the hospital district's tax rate?
>> no, no.
>> it would not?
>> no. That's not in our tax rate. The 11% is ending fund balance. That's not in our tax rate.
>> okay.
>> so you don't need to reestablish it because it's already there.
>> right.
>> but if you don't transfer that reserve, you actually hold the reserve on the county side, and one would not want that to happen.
>> I think put that reserve in here somewhere.
>> we will.
>> anything further on a and c? We'll look at this and if we have any ideas, we'll get them to you next week and try to review this again. I do think we ought to leave it to next week's court session for the packet of information that we have over there.
>> yes, sir.
>> and on 5-e?
>> on 5-e, what you've been handed, judge and Commissioners, is a contract matrix, basically of the contracts that are within health and human services. And we have actually gone through and indicated yes or no whether we felt those contracts might have some relationship in the future to the hospital district. You will notice that under the program section we have actually shaded in to make it a little easier to identify those that we feel like have some relationship to the hospital district. I do need to call a couple of things to the court's attention. The first thing is on page 4, the first shaded block there that says interlocal between the city health department is in fact public health. A that one was inappropriately shaded. So we tried to mark that for you. And then on the last page of your handout, which is page 21, that shaded block there is the interlocal with regard to hospital and physician services. So I think we kind of tend to refer to that as the interlocal between the city, but it's actually the contract with seton and the daughters of charity. So there it is. So I wanted to point that out. Also in conversations this morning with david lurie with the city of Austin, the ryan white, we may need to get deeper into that because there is a significant portion of that which is public health. So we have been discussing that in the context that funding would be part of the hospital district, but there's a significant amount that we have identified that is public health. The other thing that we'reless wanting to be in receipt of is we do have a maintenance of effort requirement right now which is about 200,000 on the county side. So we feel it's our best guess that we need to make sure that the board of managers understands that maintenance of effort requirement that goes along with the portions of that funding, if any, and it's kind of an if any right now discussion will be transferred. So I wanted to call that to your attention as well.
>> but the money is a requirement and --
>> the federal funding.
>> it's like a local match basically?
>> basically. But it's things that I think we're already doing. We basically agree to continue to have a baseline level of services available.
>> okay. And that's e. So today we don't have anything under 5-b. The facilities.
>> the facilities and equipment agenda item, and we found with the transition committee from things that needed to be added to that matrix that we went over on Monday. So we would respectfully request to bring that forward next week.
>> okay. Let's look at what we plan to take final action on this next week and give it to the new board. And this afternoon let's discuss d in executive session first, then in open court.
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Last Modified:
Friday, October 28, 2005 9:43 AM