Travis County Commissioners Court
Tuesday, August 3, 2010,
Item 11
Number 11 is to consider and take appropriate action in response to request from austin-travis county integral care center board of trustees, formerly austin travis county mental health mental retardation board regarding board composition. And we have mr. Evans here, executive director of the integral care. What's the request, mr. Evans?
>> thank you for considering the request of the board at austin travis county integral care to consider an appointing process that would allow for central health to make appointments to the board of trustees. Just very briefly, in february the board launched into a strategic planning process. One of the questions that came up at the very beginning was aligning any strategic relationships all the way from the top of the organization to point of service with consumers. Staff provided the board an environmental scan in may. That environmental scan noted two significant differences. The articles of organization that currently structure the governance and the appointing authorities from you as a county to make four appointments, the city of austin to make four appointments, and aisd to make one appointment, that those articles of organization were filed with the state in 1982. In the last few years things have changed dramatically in our world of delivering behavioral health and services to persons with developmental disabilities. One of those is the passage of health care reform. We believe that virtually everyone we serve today will be covered by insurance by the year 2014 with medicaid going to 133 percent of poverty, we may have over 50,000 additional individuals in travis county eligible for medicaid services and our safety net program and services we believe will be strained and will be tested over the future. Second of all, in 2004 with the formation of our health care district, and with assets and health care going over to the health care district, we saw within our funding and services and planning a new alignment with central health and with their existence making progressive and instead gains in the delivery of our mental health services. On june the 24th our board passed a resolution that said it would be, quote, appropriate and hesirable for central health to make appointments on to our board. We have precedent. Central health currently makes two appointments on the community care or clinic services, and another example example within the state is in bexar county. Bexar county commissioners court makes five appointments. The health care district makes four appointments to that nine-member board. Last thursday -- well, subsequent to our board's resolution of central health in july passed somewhat of a mirror resolution saying that they believed that it was appropriate also for their organization to make board appointments. Last thursday the city of austin considered resolution to give one of their four appointments over to central health to be able to make to our board and that resolution passed with them. And i'm here today to discuss with you a realignment of you considering a resolution to give to central health the ability to make an appointment on to our board.
>> so that's what this is all about, you trying to encourage -- try to persuade this commissioners court to allow central health district to go ahead and appoint persons to the board that we have formerly had that type of authority to do that. That's what you're trying to bring up here? Because you did mention the city council doing what they did as far as allowing you to align themselves to -- i wouldn't say opt out, but allowing the health district or the health center, whatever you call it there, to actually make the appointment to the board that we appoint these persons to. I'm just asking you why? What's significant about you doing it other than me making the appointment on the person i feel who would be adequately can conserve on the board? What make you think that your judgment as far as who serves on that is better than mine?
>> yeah, i wouldn't make that leap.
>> that's what you're asking, though.
>> let me answer your question, please. I serve as the executive director to a board of trustees, and that board on june 24th -- i'll quote the resolution. The board of directors supports the addition of central health as a governing agency of atcic and as a local agency pursuant to chapter 534 of the texas health and safety code, and let it be further resolved that the board of trustees authorizes the executive director to do any acts necessary to affect the foregoing: i did want to follow through with our board resolution and act on their behalf to present to you or answer any questions you would have about this process. And i really respect that it's your decision tuesday whether or not you would like to make that change.
>> right. But i guess my point is this: right now currently -- under the current format, i believe (indiscernible), the city of austin, aisd, and also travis county had started to appoint -- i guess it was travis county mental health and mental retardation, and my first thought was that the health care folks would want to be added to that list of those that are already currently making appointments. But what i'm hearing here today is that the other governmental entities be added to that list to make appointments, but what i'm hearing today is you said the city of austin a passed a resolution where they just relinquished their authority to appoint to this board. And so it still comes back to what i'm asking is this what you are asking travis county to do?
>> no. I must have gone past this too quickly. The city of austin made -- passed a resolution that would move from making four appointments to the board, to continue to make three appointments to the board and then allow for one appointment to go over to central health.
>> the proposal is still -- the proposal by the board itself is to have still a nine-member board, but instead of four city, four county, one aisd, the proposal of the board itself is to have three city, three county, three health care district. Community care.
>> yes. And then a process of letting each of the governing agencies like yourself make their decision as to whether or not that makes sense for an alignment and then to express really what our community wants in the way of the configuration of our mental health board.
>> and then with regard to the financial resources and interests for the city of austin, travis county, and central health, can you -- can you explain on our backup for a moment? Because it's fairly persuasive with regard to the financial resources and the interests among those three.
>> yes. Back in may when we took a look at a current taxing authority and relationships to the center, at that point the city of austin had in an interlocal agreement with the center, over three million dollars, really aligning with their interest in housing, wellness, homelessness, planning and prevention. Travis county at that time, $3,949,771, and those services really aligned with our juvenile probation, impact on jails, youth services and public safety. The school district currently doesn't fund this under an interlocal agreement, but we serve under an access grant as a provider for them at 36,350, three dollars annually. This is part of the safe schools ready to learn graduation rates. And central health to date has really led an effort that has two psychiatrists and some 13 bilingual clinicians in each of the clinics, and we have an annual contract of 1,149,949. Medications offset were able -- we have joint patients for the mental health center and the clinics to bill under their best value 340-b pricing and the value that is estimated at about $850,000. Central health is also really stepped up to provide hospital beds at shoal creek and at the lakes, and there were currently estimating -- at the time that this was done about $5,200,000. Since then the health care district has passed some additional resources for hospitalization that is approximately $6 million of hospital beds, and then those are dedicated to individuals with severe psychiatric illnesses that would either be in the state hospital or in the past would be charged back to us as an agency.
>> is it fair to characterize that table as central health is really probably financially into integral care for nearly twice as much as travis county and the city of austin is into?
>> i believe that that's fair. I think since their inception in 2004 we've made progressive and steady improvements in our delivery of safety net mental health services.
>> can we have another week on this, judge?
>> okay. Mr. Reeferseed?
>> thank you. This is largely still unpopular shakeup of our entire health care delivery system, our health scam. I'm here to express caution about -- for one, it's surrendering authority from the county and our funds to this board because today -- today the supreme court allowed at least one state formally objecting to this scheme because it's unconstitutional to demand any citizen to buy any such product just to live or risk punishment. This is a form of slavery, people.
>> (indiscernible). Anything related to this item?
>> this happened today?
>> is there anything related to this item.
>> this happened today and that's why i'm expressing caution.
>> it's not -- what you just said is not related to this. Make it relevant.
>> but it is in that it's about this health scam, and a state --
>> the question here is whether we go from making four appointments to three. What's your position on that and why?
>> well --
>> thank you very much. We'll take action next week. Commissioner davis needs another week to mull over this.
>> thank you. Appreciate your work.
>> thank you. And that's august 10th.
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Last Modified:
Tuesday, August 3, 2010, 2010 12:30 PM
