Travis County Commissioners Court
September 13, 2005
Item 32
Now, christian smith is involved in two items that we will probably deal with for the rest of the morning. Let's take number 32, the hospital district item. And that is to consider and take appropriate action on the following. A is the Travis County hospital district's fy '06 budget. B is the Travis County hospital district's 2006 tax rate. 32-c is other health related funding matters pertaining to the hospital district. And 32-d is a request to assist with the purchase of mental health services from the children's partnership. County attorney? We have in 32-b, take appropriate action on the Travis County hospital district's 2005 tax rate. I think that needs to be 2006 tax rate. The question is whether we can approve this by making that change verbally?
>> it's actually according to (indiscernible), it's actually the 2005 tax rate. It's a tax rate for the year 2005 that would be effective January 1, 2006. Does that make sense?
>> [inaudible - no mic].
>> not to anyone else. That would be consistent.
>> that's good. The county judge was right again. [ laughter ]
>> morning.
>> morning. Good morning, judge, Commissioners. You have received a package from us that explains the changes from the budget that we presented to you originally in the earlier part of August, and the changes that have been made since then. I would just like to take a couple of moments to walk you through the changes and I値l be happy to take questions about our proposed budget and tax rate. We've made really two changes to our budget. One is simply a presentation change. We've just reordered some line items, some are presented differently. It did not change the numbers, but it made it I think a little bit easier for the reader. We had received some feedback during our public hearing about some confusion about dollars that are really available for the district to send -- spend, versus those dollars that represent pass-through items that kind of flow in and out of our budget. We thought this might be a good step to help the readers understand our budget more effectively. So therefore we have broken out and we stated the fiscal year 2005 budget which you have amended and approved and shown that as compared to the proposed 2006. So we're looking at total expenditures in the 2006 proposed budget of -- total expenditure of 121,178,670, but 47 million of which -- 47,223,527 really are pass-through items. So it's 73,953,113. And if you look up top you can see the associated revenue items with that as well. The main changes between our proposed budget for 2006 and the final have to do with several categories. And we've discussed this in prior meetings about the district's ability to send up funds to the state which then send up the funds to the feds to draw up matching dollars. And we went ahead and increased our budget to reflect the potential total capacity of the district to spend those funds up. What we're trying to do is head off any budget amendments we might need in the coming year. You will call that this year we had to come back to you twice to increase that line item so we could actually send the money up to the state. It's really a formality. It doesn't represent any impact to our budget other than the aikt to send that check. So that amount was increased by $9.7 million, so the total budgeted igt capacity has been increased to $53.7 million, which basically says if the state says send that money up so we can match it with the fed's dollars, we will have the ability to send it. The other changes to operating expenses really involve two to three items. We have increased some of the operating expenses to reflect-- the first item was reflect increases in mileage that we expect to pay to our employees because I think you all have seen that the rates for reimbursement have gone up fairly significantly in the last few months due to gas price increases.
>> we've got a notice from the auditor's office it's going from 40.5 to 48.5.
>> and the 40.5 came very recently itself. So we went ahead, because we are at least trying to budget for the 40.5, so now we're faced with 48.5, so we've increased that. And we've increased one expense category for -- to reflect what is really -- I will call quite an estimate. It's a guess at this point. Let me make sure I don't tell you the wrong line item. For telephone lines at cesar chavez, we're going to invest in some outbound telephone lines and we did not have that line item in the budget when we presented it to you in August. But that would represent -- I would represent that that was an estimate at this point. So the way we ran our expense budget this year was to the extent that of course we're budgeting to our revenues, so our revenues really haven't changed. So to the extent that I increased expenses from one line item, I moved them to another. So what you see here is a reflection of changes between line items. And there's a slight increase in the calculation of the interest that we expect to earn and that has to do with our cash flow calculations. So there's really not anything of substance to change to the budget other than the increasing of the igt capacity, which again has no effect on the bottom line of the district. I do want to point out to you in the line item expenditure control, you will note one difference. And that really is the presentation of the transfer from the county in terms of it was included in one line item and it's now been put into its appropriate line item. Good news, however, for the district's behalf, you're actually going to send out this year. So that will be a budgeted, but nonexistent item for next year. But again, those are the substantive changes. Are there any questions I can answer? Excuse me, I知 so sorry, we're down to the very bottom. Thank you, mr. Young. No relation, by the way. We did make a change. We mentioned when we presented this to you before that we were reconsidering the allocation between the category referred to as allocated reserve and that category unallocated reserve. And we did make a change to that. As you will see the net effect is zero, but we moved another $3.7 million out of the allocated reserve category into the unallocated reserve. So the budgeted unallocated reserve of 13.2 basically represents the totality of the city and the county transfers upon the creation of the district. So that's what the 13.2 represents. Again, no effect to the bottom line reserves. We just move the numbers between the line items.
>> but trish, between the 9.4 on the unallocated reserve, that translates into what magic percentage?
>> the 9.4 originally was 11% of the budgeted operating expenditures. That's laid out in our policy.
>> thank you.
>> sofk you can see that that number takes us up higher than 11%.
>> questions? So that's a, the hospital district's '06 budget. No questions? Move approval.
>> second.
>> discussion? All in favor? That passes by unanimous vote. And in terms of the tax rate?
>> yes, sir. Our proposed tax rate for fiscal year '06 is the same rate for 2005, which is .0779 per hundred dollars of valuation.
>> questions? Move approval.
>> second.
>> discussion?
>> I知 sorry, just in relation to our own discussions this morning, did we have to put certain notices in the paper, yada yada yada just related to hb 18, does that apply to the hospital district?
>> yes. Because the effective tax rate was increased above the effective tax rate, we have complied with senate bill 18.
>> those are the magic words.
>> you're welcome.
>> any more discussion? All in favor? That passes unanimously. And c is other health related funding matters pertaining to the hospital district. Anything under that one?
>> d a request from the Commissioners court to assist with the purchase of mental health services from the children's partnership. And I think that's officially the children's mental health partnership.
>> one other question, judge, under c, were we going to get into a discussion about the sending up of dollars? It seems like there was three options being laid out to us that I thought was the c item related to do we send up Travis County money, do we send up city of Austin money and I think they're interconnected in terms of if we choose a, there may be some consideration in terms of getting to d.
>> I thought trish covered that.
>> let me -- let me give you a status of that situation in terms of the send-up. We have been working with both the city of Austin and with Travis County representatives, and we are still working through both the legal and procedural aspects of that ability for either the city or the county to send up funds on our behalf. As you'll recall, we do have the opportunity to draw down some essential upl dollars from the federal government, so we are trying to figure out how to make that send-up. We do have -- we believe we have the September send-up satisfied in terms of both the district's ability to send up the monies as well as the cash, and what we're focusing is on is the payment that would be required in October. So I guess I could report to you that that's still in process. The discussions are actually more trying to work through both -- we're working through the Travis County attorney's office and also with city representatives on their ability to do -- again, it would only require that one or the other entity be able to do this on our behalf. But we're working through that.
>> okay. We have one resident who has requested to give testimony. And that is mr. Don zimmerman.
>> thank you, judge. Good morning. Yes, I just wanted to -- I may be too late. I got here as fast as I could. I wanted to encourage the court to make sure we didn't have any out of pocket increases on the hospital tax. In my neighborhood in canyon creek, we recently suffered yet another new property tax. We got the a.c.c. Property tax added to our neighborhood. In addition to the m.u.d. Tax that we still have a lawsuit over, an additional tax. So we've seen a brand new property tax come in addition to the regular tax increases. So we were just hoping that for the hospital district you could keep our out-of-pocket expenses the same as last year. That was my request. Have you already voted on it? It sounds like you voted on the tax rate.
>> you realize that if there is any increase in a number of taxes in the community, with the valuations, they will be driven more than -- as you can see, we're signing off on the same tax rate that we had last year.
>> correct. So we're paying more taxes because property valuations have increased. Exactly.
>> I知 not sure that there's always a connect for most people. I mean, even though you get up and you say, well, we're not increasing the tax rate. Unfortunately your appraisals are such that you are going to get -- you are going to get an increase. It would be nice to be able to go to each block in the city of Austin and try and explain that to people because I think people would understand it more, but --
>> and we tried to do that. I should probably let you know that in that election for the Austin community college, a new property tax that was put on the ballot, the ballot language said that for annexation purposes for the junior college or some such language. And so in early voting we said nothing about it, about the a.c.c. Tax. And it passed by a small margin in my neighborhood, in my precinct. On election day I went out with some friend and we educated voters, did you know this is a brand new property tax? And then when we educated them that it was a new property tax, it went down two to one to defeat in my precinct. So I think your point made is when people are educated as to how these property taxes occur and how they go up and we get new ones, they overwhelingly vote against them.
>> but it's important to remember that in your particular area you are still below market and being protected by the 10% cap on prowr appraisals going up every year, you may be seeing those increases. But I can tell you that in my neighborhood at central center, we're already at market rate and everything is flat in my neighborhood. I had a one dollar increase in my appraisal.
>> congratulations.
>> but I got jacked up for five straight years. So it all works out. What it means is you are still being taxed below what your property is truly worth, but you are being protected by how rapid that increase will come. You're just basically getting to where a whole lot of other folks already are in terms of being taxed at full market rate as opposed to being taxed below market rate.
>> thank you.
>> thank you for your time.
>> thank you.
>> d? Children's mental health partnership. We may take 30 seconds and just explain what that is.
>> sherri fleming, executive manager for Travis County health and human services. The children's partnership is a combined initiative between Travis County, Austin isd, juvenile court, many other, manor isd, Pflugerville isd, many of our partners within Travis County, to provide a better way to provide services to families who have children with deep end mental health needs. Previous to the inception of the partnership, families literally had to find their way into systems in order to get the kind of help that they needed for a child with a chronic mental health problem. That would be either the child protective services system or the juvenile justice system. Because as you all know, those services tend to be quite costly. But they continue to be costly not only to the family, but also to our community in that generally county covers are the ones that -- county could havers are the ones that end up bearing the cost of children placed into those facilities. So the cost was changed, system change to have all the of the persons with the -- to have a role in managing children in the community, come to the table and figure out a better way to provide these services so that the children are allowed to remain in the community where it's much cheaper to serve them. We can serve them more holistically and we can also help their parents to understand how to manage them better. And so we have been successful in that systems change, but then also in getting to a place where children who have deep end mental health needs can receive services for an average of $600 a month as opposed to $6,000 a month for residential care. So I could go on and on, but I will stop.
>> answer two questions for me. One is what has been the source of funding historically? And the second one is how much money is needed today?
>> historically the source of funding was a grant from the substance abuse, the mental health services associates? And I think I got that correct. I didn't want to use the acronym. But it was a federal grant that was provided to communities such as Austin-Travis County to affect this systemic change in terms of children's mental health services. There are also personnel that are housed at the various partners that each partner, Travis County for the staff that are housed with Travis County, juvenile court, Austin isd, Pflugerville, those staff are all paid by those partners. So it was a combination of the federal grant in addition to the funding that the partners provided for their individual positions.
>> the federal grant went away.
>> as of August 30th of this year.
>> but the funding that the partners have had is still in place?
>> is still in place and those positions are still in place.
>> how much money do we need today?
>> the request to the court was some $539,000, I believe. To maintain the --
>> how much money do we need?
>> $249,000, sir. That would maintain the team of staff known as parent liaisons and the significance of those staff rest in the fact that these are parents who are now county employees, but have the experience of navigating their child's needs through the mental health system. And so they have been invaluable in helping our county constituents in doing the same thing.
>> how much are they insuring?
>> it's about $248,000.
>> we did not -- it was presented to us in a different fashion. We did not presume at the removal of things that we had always intended was our contribution, and can we say the same thing about Pflugerville and manor and the others? The partnership is still there to bring all the other pieces, we're just focusing on the missing piece because of the fertile ground.
>> and the difference between the 248 and the 500 figure has to do with service dollars and other pieces that we are committing to find other ways to make those happen.
>> so our request to the district is a paltry $248,000.
>> yes.
>> exactly.
>> and we will reconcile that figure so that my memory is not on trial here today. [ laughter ]
>> if I may, I see him here in the audience. Judge herman would you mind covering forward? You're never not one to have something to say. I知 just hopeful that you can also just kind of remind us all that when we all started down this path of a hospital district, there was this thought that there were some things that were real important I know to you and to others related to mental health in terms of trying to get more of a -- I値l put it a foot hold over the hospital district of making more of a statement related to community mental health initiatives. And I was just wondering if you had --
>> I came over here today just to remind the court and the members of the hospital district board, I got involved wanting to have a hospital district because I felt that the city of Austin when it was running the public hospital was doing a disservice to this community by not providing mental health services in some form or fashion to both adults and children. And we're still in that situation, but it's even -- the dire situation that we were in when I started that process a long time ago, it's even gotten worse. We are at a point now I think a week ago, the mhmr, the authority, mental health authority for the county, designated every hospital both public and private's emergency room for the placement of mentally ill people that were picked up under emergency detentions or held there for protective order -- under an order of protective custody because there was no room at the inn, the inn being the Austin hospital so to speak. There has been a realignment in the state system where criminal beds are moving out of the Austin state hospital they're and going down to kerrville. The beds didn't come up here, but the county's came up here. Austin state hospital is losing 43 beds, down from 301 to 361 is what they're anowpsing that they're going to end up with. And it's full. We've got people coming in from hurricane related issues that are out at the state hospital, not just from Travis County, but from the 43 counties it's serving here. We are losing civil beds over here, yet we are totally full. And the Austin police department has said they are no longer going to transport people outside of this county after October 1 to other mental hospitals because they don't have the manpower, money or willingness to do that any more. And we need, like other large metropolitan areas in the state of Texas, brackenridge hospital to have mental health beds, we need every public hospital in this community to have one or two mental health beds because what is going on here is that in large part people end up in emergency rooms and then the sheriff's department or the city's mental health unit ends up being ambulance service to pick them up and take them somewhere. The problem is there's nowhere to take them. And people in the community are calling people, we've gt got this mentally ill person in the house doing something, they're picked up, no place too take them. Haisht has mental -- harris county has mental health beds at ben taub, on hospital property, the hospital district property adiswrai sent to ben taub has has a 24 hour inpatient yiewnt. Only one of the large metropolitan areas that doesn't have beds in a public hospital is Travis County. And we ought to have them. And the thing that's most disturbing to me, the city leased off the public hospital to a private organization some years past and they didn't require that they provide mental health services. The contract says they may provide them. Well, everyone knew where my goal was to have beds over at that brackenridge hospital for both adult and children, some sort of mental health services coming out of there. When seton Austin announces they're going to move out of children's hospital and build their own, which upset me tremendously because I thought we ought to keep children's hospital, but that was allowed to happen. It's my mind that seton hospital new full well the hospital district was coming and they should have made plans for space. I知 starting to hear now that we never knew that we wanted mental health beds over there at brackenridge and that we've already got some new plans to build all these other things at brackenridge, but no mental health beds. And so the space that's going to be freed up when the children's hospital goes to the airport boulevard area is now going to be taken by other things that the community needs. And I say the community needs mental health beds over there, psychiatric emergency services ought to be at brackenridge and these private hospitals ought to have one or two beds in each of them, just like the private hospitals do in harris county, dallas and san antone. They have beds that when a person comes in they can temporarily deal with them there and then when it's time for them to go to longer term commitment we can get them into the state facility.
>> but the focus on the critically of beds available here in Travis County in terms of the idea of children's partnership which can take care of folks in this community as opposed to taking up an expensive bed that doesn't even exist --
>> there needs to be money come frg these services that we can place a person into a lock down juvenile facility which I致e got one out there at the state hospital right now because I知 asked to order some medication for that person. If we can deal with them on the front end at a cheaper rate, that's the way we need to do mental health services. But some of these people are going to need to be in a hospital. And if Austin state hospital -- it says Austin state hospital. It's not Austin's hospital, it's not Travis County's hospital, it serves 43 counties. And it is full now and we may have gone off diversion yesterday, but last week we're on and we're maintaining people in these hospitals. We've got to do something. And I urge the hospital board to get serious with seton hospital and reopen that contract negotiation to put mental health beds over there.
>> I don't know if this is maybe a part of the discussion, but I guess -- you're not only talking about children mental health situation. But the bigger picture also and that's the adult population that we need to look at. I guess my question is how many beds will be made available as far as brackenridge is concerned after the children's hospital is up and running at the airport? I don't know what that answer is.
>> I don't know what the answer is. I know how many it ought to be.
>> pardon.
>> I don't know what the answer is, how many are going to be available. If seton has its way it ought to be zero. But I think it ought to be between 10 and 20 beds ought to be available for adults and some children.
>> okay.
>> now, do the district managers have any response to the request in 32-d?
>> I値l try to take that one, your honor. First of all, we obviously -- there are two members of the board of managers here. We don't have a quorum. I think it is fair to say that the hospital district board of managers wants to be your partner. You've been our partner in everything that we've done. Administratively you've funded us, you've worked with us with us staff has worked with us. And we're going to seriously consider the request with respect to the children's partnership. I think it's also fair to say that we are going to seriously consider, along with you as our partner, what I think is a broader issue, which is the storage of mental health beds in Travis County and the need for a psychiatric emergency facility in Travis County. Which I think are two priorities that we've talked about throughout this year and frankly we did a lot of talking about it during the campaign. Just looking at your request and thinking through our budget, our hope and prayer is that we're going to be blessed with more money than we expected in terms of that part of our rent from seton that is tied to federal disproportionate share dollars. I view those as one-time money. I also view that situation with respect to dsh as being more volatile than ever before, which in my mind creates a need to focus on our reserves in order to -- what you get some years you may lose the next in this dsh business. And I think we need to focus on that. I think we also need to focus on the fact that this money is coming to us as a result of treatment of medicaid patients at brackenridge hospital, and there is going to be a project at brackenridge. I知 not sure what it's going to be, that's going to refit what is now the children's hospital. And that's something that I think the hospital district is going to need to be prepared to invest in. As to the mental health issues, what I would suggest is that in the very short-term here, between now and the end of this month when I understand budgets become final, that we focus on the children's partnership and that we work together through our staffs to come up with a list of priorities for this year with which we can work with you. And all I can speak for is myself, but I personally would be prepared to put some of this one-time money that we've talked about as an investment towards the priorities that the county and the district agree are the best and most important priorities for our community. And then -- I致e talked with you, judge, about the need to broaden our collaboration and our partnership, not just the two of us, but hospital systems, city of Austin, mhmr, frankly everybody that we can find to participate in solving what is a critical community issue. It's a crisis really. And I think we're prepared to do that.
>> you've got listed in terms of even going with the final proposed budget that we just approved a few minutes ago, a very large figure for allocated reserve. And we all call that the spendable reserve as opposed to the not spendable reserve. Did you have any ideas about what kinds of things -- it's not a small number. That gives you the possibility of some very good opportunities to make some really good investments in things beyond what you're already doing. To me it disinlt seem unreasonable if it's going to be 5.5 million -- is that the number for the allocated?
>> yes.
>> 250,000 and then to continue on with discussions with judge herman about the need for permanent mental health beds. It seems like the 250 is not really too high.
>> I think the number is the issue. And I don't mean to say that it is. I do think that strict prioritization, us learning more about the children's partnership, how it relates to what we do. I think there's a process with what we're going to get done between now and the end of the month. The hospital district in concert with you and others needs to come to grips with what its role in mental health is going to be. We received a transfer of zero tax base with respect to mental health. Every cent that we got, as I understand it, was in terms of treatment or other health related programs, but no mental health dollars were transferred into our budget. Now, that's not to say we don't want to play in mental health. And his honor is over here getting ready to work on me real good if I say that, and I don't mean that. But I think we're going to have to be very careful about how we spend dollars, particularly dollars that are not one time dollars, but are commitments to programs where we don't have tax base on a continuing basis to support those programs. And I want to be sure that if we commit dollars to things like the children's partnership that are ongoing -- and I understand the sensitivity, that's something that's been going on that you all are proud of and think is needed, and I want us to take every opportunity to look at that thing. And I知 not telling you that we're not going to fund it, but I can't tell you that we will at this point.
>> but in terms of being a collaborative partner, you still have the collaboration of Travis County, two other school districts who are also saying, we are here to assist you. I think it would be very inappropriate for us to say, oooh, yours, please put it all on your tab. I don't think that's what you're asking. As you go through your discussions, to keep that in mind that we are still talking about a community collaboration related to mental health. And I致e always been one in terms of trying to ooch in that it was one of those things as we went through the hospital district discussions we couldn't make any promises up front because of the magnitude that we were dealing with. But we have seen good things happen in the last year, good planning that's happened in the laugh year, a positive increase may in the tax -- positive increase in the tax base last year. And given what's going on with the home depot data center, freescale and the domain all coming on in the next year and a half and you all will get 100% of what's coming on there, I think we can say that looking ahead it's -- it's okay to start having these discussions about going beyond what we said we were going to do even if no tax base specifically was transferred over. We all knew that this day would come, and it's just I look forward to those discussions.
>> should we have this back on the agenda, say September 20th or 27th? From a county perspective, I think we need to land on it one way or the other before October 1. That gives us two more opportunities, the 20th and the 27th.
>> I would suggest that we make a plan to sort of interface between the district and the court for see how quickly we can move this discussion forward. And then make a decision about which agenda it ought to be on. We've got a meeting posted for September 15 that I don't think has this on it. Our next scheduled meeting will be September 29. That's not to say we can't get there. I think we can.
>> all right then. We'll have it on on the 27th.
>> the county judge is right once again. [ laughter ]
>> thank you very much.
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Last Modified:
Wednesday, September 14, 2005 9:23 AM