Travis County Commissioners Court
August 15, 2006
Item 9
Now, item number 9 is to consider and take appropriate action on proposed interlocal cooperation agreement with the city of Austin for public health and human services.
>> good afternoon, judge, Commissioners. Sherri fleming, executive manager for Travis County health and human services and veterans service. Joining me is david lurie from the city of Austin. Hi. As the court is aware, there have been over the last several years now staff work around the public health and human services interlocal with the city of Austin. I believe that there's been incredible work done on this document on both the county and the city's part, and I believe we are moving toward agreement on this issue; however, there are some outstanding issues that I believe to be policy decisions for the Commissioners court. I know have you received numerous memos and numerous pieces of information by way of backup for this discussion and we will try to be as succinct as we can and also be as clear as we can with the help of legal on what we believe to be the outstanding issues. Basically they fall in two categories basically. The first is the basis for payment for the interlocal agreement. And then the second is related to the social services contracts and the administration of those contracts that we have been previously doing in conjunction with the city of Austin. So in terms of the basis for payment, the city has proposed a a 2lation population based model that county staff agree in certain areas is quite appropriate. We have requested during our negotiations that some services -- and we've given you examples of those services in your backup. It would be helpful to county taf to know the cost of those services to so the court could consider how much of those services you would want to provide. In some cases it's staff's position that while you are statute yearly required to provide those services, the level of service should be at your discretion. City staff have indicated that it's their position that there's a total program, and so a population-based model is from their perspective most appropriate. I don't want to speak for mr. Lurie, but in the interest of trying to clarify our position, that it's a total program and so therefore a population-based program applied across the board is the most efficient way to manage the program. The next issue is related to a request in the document that was provided to legal for full payment in advance. We've had also discussions -- I think legal may have some response to that as well as the auditor's office might have something to say to that. Normally we have a reimbursement system or an invoicing system. Now, we have looked at -- legal has provided us copies of some of the sections from the e.m.s. Interlocal, and that interlocal allows for quarterly payments, and I did provide mr. Lurie copies of those contract sections that describe the quarterly payments and so he and I both have a commitment to getting some questions answered about that, so we may be able to take that back and resolve that particular one.
>> are those quarterly payments made in vance jackson advance?
>> I saw jose here, but I don't see him here anymore? Anymore.
>> that's in the set forth clearly in the contract?
>> the question is if we know the e.m.s. Quarterly payments are in advance or after the fact?
>> the e.m.s. Are on a monthly basis --
>> could you come up?
>> the e.m.s. Payments are done on a monthly basis. They're requested by invoice at the beginning of the month. We issue a disbursement in the middle of the month, but it's a monthly advanced payment to be paid at the beginning of the month. The central booking is from the city of Austin to the county, and we get paid on a quarterly basis at the end of the quarter. So -- which means for October, November, December, we get paid at the end of December and so fortsz at the end of each quarter. That's from the city to the county.
>> so what's the purpose of the request for payment in advance other than early payment, which is obvious. But is there another reason for it? For advanced payment.
>> david lurie. Good to see you all. I think what's important to recognize, judge Biscoe, in term of the proposed agreement, is that this is a fixed price contract. In order, we are agreeing up front to providing for certain services county wide. We've costed out those services, come out with some costing methodology, so the price is fixed. We can both depend on that. It's an exact amount for both budgets, so our thinking is that since that's agreed to, the best spaiment a single payment. You do that up front in advance and we've got the payment part of it settled and then we just proceed with the provision of services.
>> but the same argument can be made for the intook agreement? -- central booking agreement. With some minor change the same as this one f you buy some additional equipment and supplies, you invoice us for that?
>> no, sir, there's no adjustments to the agreement to public health. We are proposing a fixed price, we're committing to providing the equipment, the personnel, services to carry out the responsibilities that we've committed to. So there are no planned adjustments throughout the year.
>> I think you reserve the right to modify payments in two cases. One is if you purchase necessary additional equipment, supplies and if a county person leaves county employment, you replace that person with a city person, if there's a different salary, whatever, the city person fills in, we would be expected to pick up 100% of the salary.
>> that's true. The personnel, we have a limited number of county staff, as they transition out, they would be replaced by city staff.
>> and equipment and supplies.
>> I'm not sure. I don't recall any reference to equipment and supplies.
>> maybe next year the adjustment is made for purchases in the past year, so there's an adjustment, it will be in the next year. There's still additional monies from that year.
>> if I couldious try to clarify, judge, this is looking forward, not backward adjustment. So any changes as far as supplies, equipment needs, personnel add so forth, that would be part of the review we would have in froil the upcoming fiscal year, not adjusting retro actively. The one exception is having to do with personnel. I think we have four or five county direct personnel currently in the department. If any of those folks leave through attrition, we would replace them with city personnel. But we make an offset in term of the county contribution for personnel so. That would just change the amount of offset to the contract.
>> so if you have to purchase 'equipment and supplies, say, during the first year, unexpectedly, the city eats 100% of that cost?
>> that's correct. The only exception to this would be a catastrophic event, a major emergency, at which point we would want to have discussions with city appeared county in terms of what the needs might be. But that -- and there's language under section 6.1, I believe I believe that references that. But other than that as far as regular ongoing operations, that's the point of this. It's fixed price. So if it turns out we need more equipment, we need more supplies or whatever, that's our responsibility.
>> the language is in 6.2.2. The cost of equipment required because of replacement or service fully dmarjd the year replaced, an adjustment shall be made in subsequent renewal of the agreement and subsequent cost to the county.
>> so if we had reached the second year, you would charge us -- I guess if we followed the percentage approach, we would owe 25.5% of the cost of the equipment, it's just that you would delay invoice fog that until the next year.
>> toork, judge. It would be going forward and based on the population formula.
>> I have no problem with trying to figure out a way to get immediate payment for part part you annual cost. I don't know that we have a single contract where we pay the full annual cost up front. Now frks the city and the county want to move to that basis, I think we ought do it across the board and make it reciprocal. But I know at one point there was a question with the timeliness of payment, and I don't know that -- if we're making payments monthly or quarterly, maybe it makes sense to pay them them #- advance for that period. Certainly not for 12 months, though. And even if we could legally do that, we haven't done it before and wouldn't think that would be a good business practice for us to do or to ask others to do.
>> judge, the interest lost lost it that to Travis County would probably be in excess of $120,000, so that's like adding that to the price of the contract.
>> and the taxation, we say a timely taxation, meaning we tax when we need the money?
>> I think I picked that expression up from one of y'all.
>> just in time payment is what we're kind of looking for. So the goal is to get front payment from the city's perspective?
>> that's correct.
>> finally under the discussion about payment is the provision that allows for no true up at the end of the contract period. And during work session with the court several months ago, we discussed that this was a component of the new agreement and that we -- in discussions with the county dmai had been charged to help negotiate this agreement, Commissioner Gomez participated with us, county staff I think pleadly reacted to that issue, and -- I think immediate stied to that issue. And I don't want to speak for auditor, but what we've been told is the county cannot be paid for services it did not receive. So a true up is a way that we ensure that we have paid for services that we have -- that we only pay for services we've received. Then finally, the second issue has to do with separating the social service contract management. As you all know, the city and the county have yointly managed the social service contracts in that our partners submit their invoices to the city and they're processed for performance measurement and various other things, and then the invoice voice, sent over to us. We have separate contracts and make separate payments to our partners. And so we are proposing that we completely separate the functions related to the social services contracts. The new agreement calls for nearly 100% increase in the cost of those services, and staff was not in a position to recommend that the court incur that additional cost. I know that pbo has dplud included in the preliminary budget. Hhs has presented to pbo what we thought would be the cost to assume the functions that are not currently done within our shop. Health and human services has held on to two f.t.e. That are fully funded, but vacant at this time, and then there was an additional $100,000 added in the preliminary budget to health and human services so that we might be able to assume these additional responsibilities. But as we were reminded in a meeting by the judge yesterday that the separating this function is a policy decision for this court.
>> well, it impact a lot of contract agencies also.
>> it does.
>> when we do this, a lot of people thought the biggest advantage was that instead of the contract agencies dealing with two agencies, they would be able to deal with one, which would reduce what a lot of the agencies considered to be hardship for us, a little bit of duplication. But I guess we tried it several years, and if it hadn't worked out as well as we thought, it may make sense to revert back to the old way. If we do that, though, I do think we ought to put the agencies on notice that hence forth they will be required to deal with the city and the county again. Still, it may make sense for us to try to cooperate, collaborate as much as possible to make sure that we reduce as much as possible the work that they have to do in reporting to us and monitoring, evaluation.
>> city and county staff have already had at least one meeting thai know about, and probably a few others, in discussing what a transition might look like, the time period rtion the impact to the agencies. And it is very possible based on what I'm hearing from my staff, that we could continue to use similar documents, so a document could conceivably be prepared one time and just sent to the city and sent to the county. We could conceivably jointly monitor contracts, so there are a lot of things that we can continue to work together on, but in terms of managing the functions of processing the paperwork, tracking performance measures, those types of things, we would be taking those on on our side of the house.
>> sherri, aren't the agencies already getting a separate check from the city of Austin and a separate check from Travis County?
>> that's correct.
>> so really -- and we did that because sometimes when something gets hung up on one side or the other and rather than the other person's money that there were no issues get get he hung up, it's get things separated owvment so why the agencies may have thought they were only dealing with one entity, in reality is the auditor's office has never gone away and therefore even the monitoring may be occurring at the city, there was always full fiscal oversight by the auditor's's #- on behalf of Travis County in terms of looking su those claims. So the reality is it's more about educating them that you always were having two entities taig a look at it even though your point of contact may have been one. And quite frankly I think it will go faster, but if we're going to have to review the blessing by the city staff anyway, if we can cut that out appeared get it straight over to our folk and to the auditor's office, it will go faster, not slower in terms of dealing with these agencies. And it allows for the two governments to have different -- I won't stay sai the word standards, but I will say sensitivities in s in terms of how they handle things. There's nothing wrong with how the city does contracts, but it reflects their organization. And there is nothing wrong with how we do ours and it reflect how we do business around here and the different setup under the local government code. So those two things don't necessarily go together. And what's correct for the city may not work for us and vice versa. We're both correct and I think it is time for us, especially with the doubling of the cost of it, it's time to just take over and do our own business.
>> if it's not working, it's not working. But if you line up the pros and cons, in my view, the cons will more than double the pros. For the agencies out there, you're looking at two visitors instead of one. And we're paying twice. Now, still if it's not working, it's it's 2u work. So I can live with going back the other way. But I have a hard time concluding that 40, 50, kinetic agencies that we contract with will -- 60 agencies will tha we contract with will think that's a good deal because it affects the amount of money that they get to provide services remains the same. The fourth swun is pretty much a done deal.
>> we have agreement I think between city and county staff that in the absence of the court deciding deciding 2 pay the -- deciding to pay the increased cost that this would be the best recommendation.
>> okay. Here's a notion I had. If we look at the proposed agreement, there's a statement of services under each subcategory. And they give the total work put units. And my question to staff was why wouldn't we have a separate line -- if they say 1500 units would be provided for a certain subservice, then why wouldn't that be a separate line to indicate how many were provided for Travis County? The other thing that ms. Lewis said was in April there will be a report generated to cover performance I guess during the first six months. And our interest would be to take that opportunity to look at total services provided, how many of those were provided for Travis County. If this works like a lot of other services, and some will exceed 25% and others we will fall below it. If we fall below it in every category, that leaves the impression that the 25% is a bit high. If we exceed our 25%, we'll just overlook that mistake. But that's my idea. And when we look at these, there are a lot of numbers, and I assume that these numbers indicate the city's attempt to estimate the number of units that are being provided annually, mr. Lurie?
>> that's correct, judge. And so if you go down through here and we see a thousand tests a year, 750 units of a different service, testing and counseling, 2500, what we'd want to know is of that total number that the city believes were provided to Travis County. Now, a lot of these will be provided at places outside the city of Austin, right? So we ought to have a pretty good indication. If they're provided at some of the county facilities, then our personnel would be able to document I guess that some services were provided. But in term of the quantities represented, we at least would have a number. So the advantage is that it at least puts us in a position in April of looking at the performance during the fis part of 2007 and concluding for ourselves whether we think it's a good deal or not a good deal. I mean, the reason we do these is that we think this is a whole lot better than the county and the city doing the same thing. But if we think at some point that that is not so, then we reserve the flexibility to move on our own. And the city made clear that right during my one meeting with them. The thing, though, is this is not something that you would do lightly or overnight. It would take some time to be in place. But if we do it in April, that gives at least six months before the epd of the fiscal year. It still is a big deal, I think, so in my view we should try to collaborate as much as possible. The other thing is that whoever does it incurs some costs and it's kind of difficult to know what it would cost do you a certain service until you've done it awhile. And I don't know that -- from my meeting, the city seems to be basically stuck on doing it based on pop laismghts -- population.
>> based on population.
>> but you will keep these sort of output measures yourself?
>> that's correct.
>> so the question I guess is whether the city can break out the county units in each of these.
>> and what I would say, judge Biscoe, is in those instances where we can or we feel it's appropriate, we've done that in terms of these work statements. I think what's extremely important to recognize here is that we are talking about public health services. We're talking about population based services. What we do is not focused on individuals, but rather protecting the health of the community at large. We happen to have an excellent local health department here. It is an integrated system that's sevenning all the people of Travis County. If you go through these work statements and look at the kinds of services we're talking about and some of the specific examples, for example, when we talk about std services, we share with you what our clinic schedule is going to be wharks the capacity of that system will be in terms of people accessing those services. But then we go on to talk about investigations, follow-up, interviews of people throughout the community up ', further testing at sites beyond where an individual might present. The point being food inspections, for example, the objective there is to prepre1u foodborne outbreaks. So who is actually at that restaurant consuming 1 food is not so much the issue as it is overall the food protection activities within the establishment and how that impacts the community at large. Anyone who comes in to a communicable disease clinic may be getting individualized services, but the reason why that's there and the reason it's part of the health department is because it triggers a whole series of public health interventions and follow-up to contain and prevent the potential outbreak on a wider scale basis within the community. All of what we do around disease surveillance, collecting information on the 50 or 60 reportable disease doesn't matter to us if that person came from the city of Austin or outside of the city of Austin or what school district we're working with. We're collecting that information so that we can determine what's going on in our community appeared again put in place public health interventions. The whole concept of this agreement is that it's in the community's best interest to have a robust, well supported public health system for the protection of all of our residents. We do not in all of these cases have the mechanisms, nor frankly are we interested in accounting for city versus county. What we're more interested in, for example, the whole issue of mosquito control. We're out there monitoring what's going on in terms of mosquitos. The concern again is the diseases associated with that. If we target a certain area, whatever the case may be, it's not of great interest to us from a public health --
>> is this a time for to us ask you to waive a financial contribution from the county?
>> to waive a financial contribution?
>> yes, sir. Just give you a pat on the back and tell you to go ahead and do the right thing.
>> judge, the reason -- [overlapping speakers]
>> the reason it makes sense is have you to do it for the city anyway. You don't have do it for the you don't have do it for the ct. You expect us to pay the county part. We're just saying we're willing to pay for the county part. What is that? And you're saying it's based on population. We're saying in some areas yes, in some areas no.
>> yes, sir, I am saying that.
>> so the leverage the city has, because the program is already in place appeared we've been relying on you to provide them historically. But in truth if in April we conclude that it aibt a good deal for us, then we have to make the call. In truth also it's -- this contract does not stand alone. This contract stands in the context of many other contracts that the city and the county have together. And we argue on the others just like we're fighting about this one. But others have been workogthis deal more than two years. I've had one meeting with the city. The one meeting that I had left me with the impression that the stance the city had taken for two years they didn't plan to change. And I think we ought to ask for information in each category about services provided for the county, and if we don't like the results in April, then we ought to pursue some other option.
>> let me try and ask the judge's question a slightly didn't way because I'm hearing us go back into some language that I thought we had gotten past with us talking about e.m.s. And that is city versus county. And we got to a place where we were talking about system. But in terms of with e.m.s. And certainly with central booking, it isn't city versus county, it's cities versus county. There is not one city in Travis County, there's more than a dozen. And some of them love to talk about how they don't even have property tax because they get enough sales tax to pay for more than everything. And they expect the county to pick up what is an incorporated city's responsibility. And some of those cities have gotten really, really, really big. So on e.m.s., it was cities, including the small cities, that when we finally got together as a system, the only way it worked was city of Austin, Travis County for the unincorporated, and bringing all those small cities and the emergency service districts as part of the solution and part of the funding: so every every 12 we add a new station, the station was added on by the small city. Everybody brought something to the table. I'm not seeing where anybody other than the city of Austin taxpayers and Travis County is doing it on behalf of everyone, but where are the other small cities? Some of these small cities are pretty darn big, and I'm not hearing them being brought into the conversation. On central booking, now that we have the template there on thousand do central booking, we are appropriately talking to some of the small cities who are having a trepd us impact -- tremendous impact on central booking primarily through the dispatch function that it is time to pony up in terms of your share that there are duties and responsibilities and financial responsibilities s that come with me bg an incorporated. So now the time to come talk to us, in the same way that we on behalf of the small cities will contract with them to do their roads. But we don't do their roads for free. They pay us to do that on their behalf. So to me we're never going to get this one solved unless we stop talking city versus county because I understand where the city of Austin thinks it's not city of Austin in Austin, but there are a whole lot of other players here who are not at the table and I don't think we've got a document that's ready that at the point that we have to say turn around to our other city partners to say, and now you get to be brought in to this conversation. We don't have the basis here for it because it's basically city of Austin, and everything else is not us and we're not there yet in my mind as we've don't central booking -- we've don't central booking with an extra year of hard work and where we got to on e.m.s. I don't think we're there yet.
>> mr. Lure snri.
>> a couple of comments, judge. I certainly intend for you thu to be rude vooud awz awe system. When I talk about the public health services county wide and the population basis for those services, I deaf fitly mean to refer to it as a system. It's a public health system that I think needs to be protected and supported for the benefit of everyone in this county. I just want to follow up with an example and then I want to say something about the other municipalities. In the area of tuberculosis, for example, it's extremely important that people are identified, follow through on their therapy. This is how we prevent tuberculosis from spreading. This is how we prevent certain strains or forms of tuberculosis developing that are resistant to our medications. So we actually send people out to directly observe folks taking their medication. It's called directly observed therapy. It would not in our view make a bit of sense for us when someone comes into our tb clinic and is diagnosed and we end up following up with maybe a dozen other people to try to track and account for what jurisdiction those folks are coming from in terms of the city and county and then report it to you in terms of costs. We know that these these diseases don't honor yrd al boundaries. We know again that our point here is that we want a system that responds appropriately, wherever that might take us. That's just one small example. And I could cite for you a whole litany of them in terms of these work statements where again we're talking about a system here and not jurisdictional limitations, boundaries, accountability. That's the philosophy. That's the approach that we think is important in terms of what we're trying to achieve here. And actually, through the work we've done, at one point' we're a half million dollars a part, some of the adjustments we made with regard to social services and food establishments have put us in the place where the dollar dollar u.s.s. Seems to work in term of the county's budget. Now, in terms of municipalities if I could comept. There were services that there were interlocals or agreement water and wastewater municipal agreements primarily in the health arena. You directed us to not have that be part of this interlocal with Travis County. You directed us to go to those municipalities and work out agreements with them in terms of providing those services. We now have interlocals for those services with Sunset Valley, Lakeway, manor, lago vista, Jonestown, Briarcliff, san leeann in a, rolling wood and westlake hills. Is a so those costs are not reflect understand this interlocal. Again, going back to some of your broader population based public services, is disease control and so forth, those were never -- you never had those municipalits responsible for those services. You didn't have us go back and and with those cities for those services. That is a policy decision. If y'all want to decide that Travis County should not be funding or supporting those services in those municipalities, that's your choice. I have some reservations about it and some concerns about further fragmenting our public health system if we have to go back and try ticket-to-work with each of those municipalities for this broad range of public health services here, but that's your follow choice. Gerngs again, I want to emphasize where you've made the choice we've gone to those municipal advertise. And each of those is a fixed price agreement. We give them a menu of options in terms of services, we gave them costs. These municipalities have identified that they want us to provide these services. They've committed to an exact dollar amount that they're paying us. There's no true up. We commit to them that we have created the capacity, we can rely on that income and they're get those services. Now, each year we'll go back and review it and if there's need for adjustment, we'll work that out. That's part of the negotiating process. But it is the exact same model that we're proposing for Travis County.
>> are you trying to say that everything here is for just strictly the unincorporated?
>> no, ma'am. I'm not saying everything in here. I'm saying everything other than those services that you previously had municipalities in effect responsible for, which were environmental health, those were food inspections and I think some nuisance related activities. But the other things we talk about in here, epidemiology, communicable disease control, a lot of the health promotion prevention services, hiv outreach. These are services that are in this interlocal for the entire county, including the municipalities.
>> I would agree that certainly we need a comprehensive public health system. However, where county staff has been unable to agree is, yes, the number works this year. And I believe that the number is a negotiated number, which is the number that what we've done each year under the old interlocal. There's not any -- there's not any certainty thatky give out what the number is going to be for next year. That's been part of the issue for us. Also, I understand certainly mr. Lurie's position about the integrated system; however, there are parts of that system -- and I've consistently used the example of hiv outreach, and I wouldn't want that to be misinterpreted as not being in support of that particular service; however, it's easy for me to cite an example in that area. There's a cost associated with the delivery of an outreach program. And we have asked the city not so much how many county people that you had there versus how many city people, but what is the cost for a public health educator or whoever the staff person is that conducts that service, what is the cost for that person to show up and provide that service? Even if no one is there, there's a cost associated with that person making themselves available to provide that service. And the reason we have asked for that information is that have you have you with other agencies that provide similar services. So at whatever point this Commissioners court were to discuss a policy decision related to other municipalities, you would be able to identify what you would -- what you are statutorily required to do versus what you might want to offer the opportunity to another municipal court mooupty to -- municipality to also provide for their residents and reasonably be ale to tell them what cost of that is. I would use the example of animal control. The city was able to come in and tell you exactly how much a spay and neuter clinic costs. And at that point you made a decision about how many spay and neuter clinics you wanted to take place in the unincorporated areas in a year and directed health and human services to make that fund transfer. We knew how much money we were talking about, how many clinics we were talking about, and it was a slam dunk, so to speak. And that has been the type of information that we have requested. Now, mr. Lurie is correct, the negotiated figure that is on the table now, pbo has included that number in the preliminary budget. The city is apparently satisfied with that number, and the court could approve the agreement based on that number. You do not have the information that county staff believe is critical for not only predicting what your liability will be in terms of costs for the next year, but also you have not had the opportunity to look at the service levels and determine whether the services being provided at the levels they've been provided is agreeable to you in terms of the policy direction you want for this program.
>> that is no didn't from the discussions that we had yesterday with the hospital district that while the costs ofthe city running the m.. Clippings was pretty -- clinics was pretty flat for the first two years, well, year three it's really spiked up. And now they're saying they need to go almost to roll back and there's some new programs in there, but largely that is because we have all of a sudden seen in rear three the cost of the city providing those services to the district, which is their choice, it's a huge spike so. Now they're saying do we contract with someone he will to runs rup those clinics? Perhaps the answer is still the same, the city of Austin. But sherri is correct, we have a lot of soarl service providers who have gained funding and lost funding when we've made strategic on choices. And I'm thinking in the family planning area there were times that we had much higher contracts with planned parenthood to do certain things on our behalf, but when we brought those in-house and had our own clinics doing it, we did so not because we felt any way about that agency, but we could do it at a more cost efficient manner and place by bringing it in-house. We're simply trying to make those same kind of strategic choices about who we choose to do this business on our behalf.
>> [one moment, please, for change in captioners]
>> being able to serve this number within the population, how does it relate to the health status indicators for our community, where are we seeing disparities, where are we seeing spikes in terms of health status and are we targeting our programs toward those -- those areas of those populations in the community. That's where we would like to see the dialogue be. Not how much you are spending per widget. And so that's all that I'm saying. That's the approach. But in those instances where spay and neuter clinics or services out in the county, yes, there's a nobody that's specified going to be provided out in the county. It's a blended model. If the population based approach makes sense, it's because we believe the quality and the quantity services will closely match the percent of the population, right?
>> in total. Again, judge, I want to try to see if we can get away from this concept that everything we do is somehow nicely broken down in terms of -- of the numbers of people served as opposed to looking at having a program that protects this community from potential disease outbreaks, that is focused on the entire community and the commitment of the policy boards is this is important for us to have in place and we are going to invest based on a portion of this community-wide population that resides in our jurisdiction. Not that -- this sort of the of fairness issue of did 25% of this -- people present from this part of the community versus 75 from another, that changes on a daily basis.
>> okay. In our view, what would a good true up be and mean? When we say we need an opportunity to true up exactly what is it that we would like to see?
>> I would say just [indiscernible] the performing measures that they have outlined, the cost to them, see how much the cost versus what we paid them would be reconciled more or less. Would it match the 25% that they are saying, yes, no. What is it according to what they submitted. According to local agreement, the costs associated to the cost benefit of those programs.
>> now, I have thought about this matter seven to 10 days and I have not come up with a better idea than what I was suggesting. I also suggested that we give ourselves a week to come up with a better idea. Maybe cindy can come up with something better, a little hybrid between our position and theirs. Maybe a member of the court coming one a better one. But our recommendation would be approval of the city supported population based strategy. No payment in advance. But quarterly payments after provision of the services. Which meaning we cut a check in January for services provided October and November and December. We would expect something close to a true up in April, which would cover October through March and that would be six months and by that time we would know basically whether we can continue to support what's in place or whether to -- whether we want to push for some modification or try to do better elsewhere. The other thing is that we would approve as a matter of policy Travis County doing ing contract administration for its contract agencies, which apparently manages from both entities of -- of acquiesced into anyway.
>> second.
>> what I was hoping to do was --
>> not ready.
>> take a vote next week. Yeah, I hadn't thought of anything better than that. That's my view. That is a kind of compromise position, but I think to the extent that the county can be protected we are. To the extent that the -- that the city sees good faith as much as compensation can give you, it's there. That's what I would move next week, unless somebody comes in and says hey I got a better idea, what about this?
>> I think that it's a fair plan to move forward, and begin looking at those two -- that's been proposed.
>> the city probably needs an opportunity to think about this, too, right?
>> no time for you to come back with something next week. You have heard what the judge has said, we have had a pretty lengthy discussion today on this. I guess sherri same question to you. Is that enough time because really we need to move forward. We have some -- we have some services out there that we need to deal with. Of course time is of the essence for all parties involved. I am just wondering if [multiple voices] that's enough time for you all to -- we really need to move forward.
>> the committees of people on both sides have worked on this for a --
>> yeah for a while.
>> we need to find some movement here to -- [speaker interrupted -- multiple voices]
>> we need to pose this question to you --
>> commission, these are the remaining points of concern.
>> yeah.
>> so if we -- you know, if the city is able to take back the court's direction, the city will be able to respond and of course staff will do whatever is appropriate to -- to bring that response back to the court in a week it sounds like.
>> okay.
>> okay. I just want to make sure that we -- that you are comfortable with what's been suggested here this morning so we will -- this can expedite and move forward. That's my concern.
>> thank you, Commissioner.
>> and I need to -- to process and kind of think all of this through. But I don't find what we are doing to be inconsistent with what the city of Austin did with its mhmr contract. What we had there was mhmr basically was getting x amount from the city, x amount from the county. But for the most part mhmr was choosing to decide how it was going to spend the money on what was a community-wide issue of mental health. And the city, I think appropriately, said you know what, we choose to have a little bit more say in what we would like to see our investment be spent on as opposed to the other entity deciding. And so they -- they became a little more invested in the process, but the -- the dollar amount didn't change. But they say this is how we would like to have a little more say as to what's being done. I see us in the same way. I don't see us changing our level of investment, but I think we are asking that we have a little bit more say, rather than you saying here's what we do, here's your percentage, we give you more feedback and involvement in terms of here's where we would like to have those dollars spent to still talk about the systemic issues of public health and public safety, et cetera, et cetera.
>> we are complimenting the city.
>> it's all compliment terri, yeah.
>> I have said many times, I hope to keep stressing it, judge. This is a very positive relationship, we have a very excellent system in place, we certainly want to do all we can to sustain and enhance that. Commissioner Sonleitner, sometimes I feel like we say the same thing but it gets interpreted very differently. Our agreement with mhmr as we have redesigned it is trying to focus on more of a population or public health type of model. We are funding prevention, outreach, infrastructure, capacity building within the community as it relates to mental health, we are also providing some funding that they can use for match to draw down federal and state funds. It is a fixed price contract. We are committed to pay them that fixed dollar amount for the mhmr infrastructure for the capacity as it relates to them being our local mental health authority. If I could --
>> but you were very specific about where you wanted your dollar to be spent. Still in the same family of mental health, but you said here's where we want those dollars to be spent, our comfort level is, here's what's consistent with our values at the city of Austin. I agree with you in terms of how you did it as opposed to them saying here's what we want, can we take your money and apply it to all sorts of good things. We are just asking for the same thing, a little bit more say rather than you telling us what we ought to be investing in, getting a percentage, that we want to be more strategic about where we spend our dollars.
>> Commissioner, these interlocals, as you know, have been in place since the early '70s, think we have in excess of 20 interlocals and amendments as it relates to public health and human services. It's a hodgepodge, not clear about expectations, cost methodology is totally inconsistent, outdated. This brings us to a point where we are so much more clear about the services that are going to be available, the capacity of the system, I don't think that I could get much more specific than what we have outlined here. Hours of animal shelters, response in terms of animal control services. Sterilization services. The point being that what we are in fact trying to get to, I think, is exactly the model that you are describing where you have a much clearer indication of the services that are being proposed. You have the flexibility, just as these municipalities did to pick and choose, say maybe you don't want to invest in that, maybe you want to invest in a different type of service. Again, I mean, I can't -- I don't think as I look through these work statements and I hope that you have had time and will have time to take a close look at them, there is a lot of detail and a lot of specificity about the services, about the volume of services, about specifically what people are going to receive in ways that I don't think we have ever clearly laid out or defined for you in the past. Some response to Commissioner Davis, yes, we have wanted to move this forward, our goal this year was to have it in place by October 1 of the new fiscal year. We certainly want to move it along. I think in terms of your action, the one area that I find most problematic to take back to the city, because I don't have a definition is what you mean by true up. Again this is not intended to be a true up. This is intended to look at performance, look at priorities, then negotiate going forward what you would like to see in the next year's contract. If you want to try to apply something retroactively, I don't know what that would look like, I don't know how we would do that for you. It's very difficult for me to present that in terms of --
>> my idea is that in April or October through March, your total units of service and which ones are those are county.
>> judge, given the examples that I described to you, are you suggesting that with these public health interventions we would somehow try to provide for you with each step along the way how many were in the county and then you would be using that in terms of true up?
>> I'm suggesting that if you have a unit of say a thousand that in March, roughly 500 have have been realized, six months, one-half of it.
>> in total.
>> of that 500, roughly how many do you attribute to the county? However you want to break it down. Otherwise there's no way for us to know what we're getting. I'm suggesting that that's pretty important. I have never seen a contract where it was not important. Now, I agree with you, some services probably the best we can do is population based. And hopefully in April we would be able to look at the services and make that determination. But on some of the others, we are just counting. If we know you provided 25 units of service, then I'm suggesting at the time that you -- as you put together the pieces that reach that total, then somebody thinks about okay, how many of these were city, how many were county?
>> and I guess what I would say, judge, when you mentioned earlier about a hybrid, this is a hybrid. We have gone back, we have bone back to the -- gone back to the well several times on this. We have made adjustments, come up with a blended model. We feel like we are --
>> but no agreement.
>> well, sir, I think that we are getting close to the end of that path. And in some of these areas, if we were to expend our time and energy trying to develop the kind of data that I think that you are describing, I just think that it would be overly burdensome. Frankly again, looking at it from a public health perspective, I don't see where that's going to be, you know, particularly informative and how are we going to accident for if we have a full born outbreak, in one part of the county this month, then six months from now it affects two or 300 people somewhere else or in the city or whatever, I mean it's not like we're going to keep adjusting the financial contributions to these programs. We see this as core, community wide services. I know this is a very, very different kind of model, but it is the one that we think in this instance makes good sense and it's going to help us be -- be successful and then those areas where -- where we can get more precise in terms of city and county, we have got, you know, systems to do that, made sense to us. We have offered that in terms of our proposal. I appreciate it. I will take this message back to the city.
>> or if you have a better one, I'm willing to hear it next week. Those are the pieces that I think are important. I think we ought to land on. At the same time keep an open mind between now and next week. If we take final action next week, that will be in advance of the clinic preparation for the --
>> judge Biscoe, what I want to be sure is that we don't commit to something and then disappoint you come April because we can't provide the kind of data that you are asking for. That's why my questions about defining true up, getting very specific in terms of your expectations because I fear in some of these program areas it's not going to be realistic for us to be able to give you that kind of a percentage break down.
>> the true up, on it, as long as I've been here, that has never -- that's always been consistent. You know, and that we have to account for what we spend our money on. And that has never changed as far as I can remember. And we have the auditor's office on the committee to be there to answer the questions as we went along. So that everybody would have an understanding of the kinds of things that the county would need to have provided and -- in a contract. So I don't know -- I guess I'm at a loss to -- that we don't understand what true up is for the county.
>> yeah, again, Commissioner, I mean if we were selling wij jets or if this was a very individualized kind of service like the community care community care clinics or whatever, I understand that. I see the relevancy of it. I think the part that I'm obviously not doing a good job in describing is that when it comes to public health services, and protection of the broader community, not one by one, but interventions that impact hundreds and thousands of people that it's our belief that there's certain services and certain infrastructure that you want to have in place and are willing to -- to invest in and support based on your share of the overall population that's out there that's being protected.
>> some things can be done that way, others cannot.
>> again, Commissioner, what I have tried to do is blend that in terms of this proposal. Our animal services, for example, are based on the level of activity we have got dispatching system, we can track if we are getting calls from outside of the city inside the city. We have broken this down by -- based on the activity level there. We know how many animals we shelter at the shelter. We have built that into this model, for food establishments, we know how many food establishments there are. We have built that into the model. Then there are other areas where we have said in our view that -- that doesn't make sense to us and we don't have the systems and don't frankly want to create the systems, to get sort of overly burdensome in terms of tracking a lot of things like when I said it's going to fluctuate dramatically from day to day or month to month.
>> but you are asking us to pay the amount that you tell us without document being it.
>> judge, our --
>> county has legal responsibility to provide certain services to county residents. City of Austin is providing similar services to city of Austin residents. So we have said basically provide -- since you are providing services through the greater majority of county residents, those that reside in the city of Austin, why don't you provide the same services to county residents for us and we will pay you for that service. But we need to know what the cost is. You are saying you want the right to tell us that you want to -- the right to cost it without telling us -- I find that unacceptable. We have had agreements with the city since I have been a part of the county for 17 or 18 years. In every discussion that we have had, the person providing the service, entity providing the service, has tried to provide some true up opportunity for the other side to -- to make that other side comfortable with the payment that's being made. So the hybrid that I'm recommending is a little bit of what you want, population base to start out, plus something that's real close to our being able to determine what the county is getting. Further, I'm saying let's look at it in April and see where we are with it. Then we may come in April, say we tried to keep that and couldn't. My response would be okay let's see what you have got. If we say we don't have anything because we didn't keep it. I don't think that's in good faith. I don't know y'all have been discussing this two years. I have been working here two weeks, I'm frustrated. It has got to be agonizing over months. So this is a compromise what I'm suggesting. I'm not thinking that the city will be completely happy. But you shouldn't be. We are not -- I won't be happy with this. I will be happy that it's a step forward, though. That it's something that we can put in place and look at it six months down the road and then make the call on where we ought to go. This -- this is not unlike other agreements that we already have in place that involve a lot more money. Millions of dollars more. And on -- in some areas we provide the service and some of the areas we simply pay for the service. So I'm saying -- let's use a similar approach. And some of those are new. In fact two of those contracts are -- looking at the interlocal, we have just adopted last week or the week before, e.m.s. Interlocal in place several months.
>> once a year.
>> one full year.
>> but we spent a year, year and a half negotiating it, too. So --
>> if I could, I'm sorry. If I could respond to your question about the definition of a true up or what it might entail. The county attorney's office did provide, I hope -- I believe we circulated it to the court, examples from the two documents that you are referencing, the e.m.s. Interlocal and the central booking interlocal where there is a definition, surely not the only definition, but a definition of what a true up might look like. As it applies to these -- these agreements and I have provided a copy of that to mr. Lurie so that he could see kind of where we ended up on those two agreements. Certainly staff is willing to sit down and troy to reach a similar place if that's -- if that's -- what sounds like the court's direction is.
>> [multiple voices]
>> I had a question. I know there's some disagreement as to what could be provided. A resident of the county or a resident of the city. Okay? We have our issues on that. Are we able to track costs, say, with the -- with the h.i.v. Or std's, can you, will you have in April a breakdown of what it has costs to provide the total of those services, broken down, yeah, for that service, for the six months? Will that -- will that number be available? Even though you can't maybe you can or can't say and 15 people came in from the county and 63 people came in from the city. But what the cost of that program was so that there would even be a way to true up the 25% of that cost? Close? Will that number be available?
>> again, I think that in terms of the specificity, I don't know.
>> you don't have costs for each program?
>> we have total costs. We have costs for some programs. We may not have costs at a level of detail that I think I'm being asked for.
>> that's just another possibility of getting at least a partial true up would be if we can't track individual clients, can we track programs to see yeah here's the total cost and 25% of this is about this much. So we are pretty close on that, a little more on this one, a little under on this one. If the cost can even be trued up, if not, the direct service delivery participant. The costs could be looked at.
>> I just want to -- you know, the judge suggested that we are not willing to share information. I just want to be clear that our -- you know, we have open books, I mean, we are a public entity. We work closely with p.b.o. And your staff and they are welcome to review all of our budgets, all of the costs to the degree that we have them identified. So, you know, what I can assure you is the amount of detail, a whole lot that's in these work stations, it's our opportunity to provide you that data come April. It has to do with total programs and services, other instances a breakout in terms of city and county. And I don't want to get redundant here, but again when someone has an infectious disease it's not particularly relevant to us whether that person is in or outside of any particular city limits. What is relevant is that we are responding aggressively community-wide to respond and potentially contain outbreaks. And so to -- to I guess think that we are going to have a system down the road, where somehow we are going to true up to that, try to track all of these interactions, make some sort of financial adjustment I think is probably going to be, you know, unrealistic for us. And frankly what you have right now is nothing like that. I mean, what you have right now is a hodgepodge of f.t.e.'s and, you know, different services or line item supplies, et cetera, that you are paying for. So I think that -- I know that what we are proposing here is a major advancement and I'm with you, judge. I hope that we can move on it and that we can continue to refine it, you know, as we go forward. But I'm just wanting to be careful not to create some expectation for you and have you, you know, field disappointed come April. The more we can get clear about, you know, specifically what it is that you want us to track and account for and we let you know how much of that we can do, I think the better off we'll all be.
>> well, I think that you have a good road map of this. I will be real quick. But if you just go to the financial sheet, I mean,, you know, you list everything from, you know, on the public health programs that we have. And, you know, there are projections, I mean, obviously those were predicated on something that we have done in the past. So we have got a pretty good road map here. You have gotten us to the point that [indiscernible] .25, I agree with you, david, hey it's a program come on lop in here somehow this is pretty easy to do, .2525 is about what you got in the county and the whole population. So I think we can buy off on that. But really simply, I think that it's just one of these deals in April we would like to know do you think that, you know, the --, you know, the std's, have we spent about $670,000 to date at that time? That's -- I mean I think that's kind of the thing that we want. It's not like it's going to be kind of funny if all of a sudden you say we have spent 360,000. You say oh, you are going to spend a million in the last half, I mean, that's going to look pretty odd to us because they will say how did you all get all of those people to come in the last half of the year versus the first half. But I think that we are just about there. I mean, obviously what we also wrestle with -- with the auditors, I mean, for good reasons, I mean,. Here's what we pay for. It's not an unreasonable request for us to say to you, say to the city that hey nobody wants to pay a million-six up front, I mean,, you know, the, you know, the use of money. Maybe if we take back to toby, you go hey why don't -- the county says that they will do that if you give them $120,000 up front. So the cost of money we get got that, we can plug it in. I mean, maybe we can move forward on that. It's not more reasonable to ask y'all to do that than it is to ask us to pay for it up front. So ...
>> thank you.
>> thank you.
>> it will be back on the agenda next week.
>> thank you.
>> thank you.
>> thank you all. Thank you, sherri.
>> put your creative juices to work. If you come up with a better idea, anybody, I would be happy to look at it.
>> April sounds good.
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Last Modified:
Tuesday, August 16, 2006 12:08 PM