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HEALTH AND HUMAN SEFOICES COMMITTEE
MISCELLANEOUS RESOLUTION NO. 89023 February 9, 1989
BY= HEALTH AND HUMAN SERVICES COMMITTEE - SUSAN KUHN, CHAIRPERSON
IN RE: DEPARTMENT OF INSTITUTIONAL AND HUMAN SERVICES -
COMMUNITY MENTAL HEALTH ADULT DAY PROGRAM/JEWISH
VOCATIONAL SERVICE REORGANIZATION
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS:
Mr. Chairperson, Ladies and Gentlemen:
Whereas the Community Mental Health Services Board wishes to maximize
Federal Medicaid revenues and to this end proposes to reorganize its
directly operated Adult Day Program, and contractual Jewish Vocational
Service, to qualify as "Type A" rather than "Type B" day programs under
Medicaid guidelines; and
Whereas this change would require added staffing in the two programs
to meet Federal requirements, this cost of which would be more than offset
by the increased Medicaid revenues generated; and
Whereas for the Adult Day Program the change would require adding two
positions (one Program Specialist I and one Typist I) as well as upgrading
one Training Leader to Program Specialist I and providing funds for
contractual occupational, physical and speech therapy services and
substitute Training Leaders -- the new positions and upgraded position
being subject to the approval of the Personnel Committee; and
Whereas the annual increase of $519,609 in Medicaid revenue for the
two programs would be used by Community Mental Health to defray the costs
of reorganizing the programs according to Medicaid requirements, with the
balance reducing the matching State and County funding obligation for the
total program:
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of
Commissioners approve the Community Mental Health Adult Day Program/Jewish
Vocational Service Reorganization as proposed by the Community Mental
Health Services Board.
BE IT FURTHER RESOLVED that one (1) Program Specialist I and one (1)
Typist I position be created in the Community Mental Health Division; and
that one (1) existing Training Leader position be upgraded to the
classification of Program Specialist I.
Mr. Chairperson, on behalf of the Health and Human Services
Committee, I move the adoption of the foregoing resolution.
REPORT
BY: Personnel Committee, John P. Calandro, Chairperson
TO: The Oakland County Board of Commissioners
IN RE: DEPARTMENT OF INSTITUTIONAL AND HUMAN SERVICES - COMMUNITY MENTAL
HEALTH ADULT DAY PROGRAM/JEWISH VOCATIONAL SERVICE REORGANIZATION
Mr, Chairperson, Ladies and Gentlemen:
The Personnel Committee, having reviewed Miscellaneous Resolution
#89023 titled "Department of Institutional and Human Services - Collmunity
Mental Health Adult Day Program/Jewish Vocational Service Reorganization",
reports with the recommendation that the resolution be adopted with the
following changes:
1) That the sixth paragraph be deleted, and replaced with:
BE IT FURTHER RESOLVED that the following personnel
changes be implemented within the Adult Activities unit of
Mental Retardation:
, a) Establish one (1) additional governmental position of
Program Specialist I - CMH - U.
b) Upgrade existing Training Leader position #03619 to
Program Specialist I - CMH - U.
c) Establish one (1) governmental position of Typist I.
d) Establish two (2) part-time/non-eligible 1,000 hour
governmental positions of Training Leader - U.
2) That the following be added as a final paragraph:
BE IT FURTHER RESOLVED that the approved positions would
be discontinued should Medicaid revenues be insufficient to
meet position costs.
Mr. Chairperson, on behalf of the Personnel Committee, I move
acceptance of the foregoing report.
February 23, 1989
PERSONNEL COMMITTEE
OAKLAND COUNTY COMMUNITY MENTAL HEALTH
SERVICES FOR THE DEVELOPMENTALLY DISABLED
ADULT DAY PROGRAM/JEWISH VOCATIONAL SERVICE REORGANIZATION
The Problem
The directly operated Adult Day Program for developmentally disabled
adults age 26 and older is located in the Oakland Community Mental Health
Center and has two major components, vocational activities and adult daily
living skills training. Federal Medicaid is a major source of reim-
bursement for the program, which is classified as a "Type B" day program
by Medicaid- Because of Community Mental Health's need to maximize
Federal revenues it would be desirable to qualify the Adult Day Program as
a 'Type A" program, since the Type A Medicaid rate is considerably higher
than the Type B rate.
Proposal
The program has traditionally emphazized vocational activities, due to the
importance which remunerative work holds for the clientele. (Work is
sub-contracted from local businesses and manufacturers, and clients
receive wages on a piecework basis.) However, to meet Federal eligibility
standards as a Type A day program, we need to de-emphasize vocational
activities and place greater emphasis on the daily living skills component
of the Adult Day Program, so that clients spend more than 50% of their
time in this area of training. To qualify CMH must also increase the
staff-to-client ratio by adding one Recreational Therapist (Program
Specialist I) position to the program. One of our existing Training
Leaders has earned her degree in Recreational Therapy, and we propose to
upgrade her to Program Specialist I as well. Availability of occupa-
tional, physical and speech therapy is required by Medicaid, and necessary
0.T., P.T. and speech therapist services would be secured for clients
through professional service contracts.
One more clerical position would be required under this proposal, to
handle the extraordinary amount of additional paperwork required for
billing. Finally, since Community Mental Health can only bill Medicaid
for actual days when the required level of service is provided, it is
imperative that we have 2,000 hours per year of substitute Training Leader
time available to cover for staff vacations and illnesses.
The added staffing to qualify the Adult Day Program for Medicaid Type A
reimbursement will cost $172,413 per year, a cost which will be more than
offset by the additional Federal revenue to the program.
Jewish Vocational Service
Community Mental Health's contractual Jewish Vocational Service, also
serving developmentally disabled adults, proposes a similar change from
Medicaid Type 8 to Type A reimbursement, with corresponding staffing
additions. The annual cost increase of $91,976 to the program will be
offset by the added Federal revenue. Since this is a contractual CmH
service, no new County positions are required.
Net Result
The total added cost of $264,389 in the two programs to qualify them for
Medicaid Type A reimbursement will be offset by a projected $519,609 in
additional Federal revenue_ The difference of $255,220 will be used to
offset the State and County obligation for the Community Mental Health
program.
$433,008
(191,415)
( 21,268)
$220,32
$519,609
(229,698)
(
$264,389
OAKLAND COUNTY COMMUNITY MIEN . AL HFA1TH SERVICES BOARD
PROGRAM MODIFICATION OF ADULT ACTIVIllES
AND JEW [SO VOCATIONAL SLRV10ES
Adult Activities
Additional resources required to modify program scope from a Type B to a
Type A Medicaid provider.
1988 Cost Full
Effective Year
MOAT.Pb_l_z_M? CoPt__
Personnel
Program Specialist I
Upgrade Training Leader to
Program Specialist I
_Training Leader Substitute
Hours @ $10/hr.
Typist I
$21,110
1,667
16,667
12,550
$25,332
2,000
20,000
15,060
Fringe Benefits(41%) j,444 _17.„381
Total Personnel 66,478 79,773
Clinical Services _77,200 92 640
(Occupational, Speech
and Physical Therapy)
Total Incremental Costs $143,678 $172,413
,qt.9.b_AkIcaign41SErY1Pqs
Additional resources required to modify program scope from a Type B to a
Type A Medicaid provider.
1988 Cost Full
Effective Year
March_1_,1989 Cost__
Total Incremental Costs
(Client Services)
Total Incremental Costs
(Adult JVS)
REVENUE
Additional Federal Medicaid
State Match Adjustment
County Match Adjustment
Total Incremental Revenue
$76,647 $91,976
$220,325 $264,389
$ 49,663
15,493
77,200
1,095
333
February 23, 1989
FISCAL NOTE
BY: FINANCE COMMITTEE, Dr. G. William Caddell, Chairperson
IN RE: DEPARTMENT OF INSTITUTIONAL AND HUMAN SERVICES—COMMUNITY
MENTAL 'HEALTH ADULT DAY PROGRAM/JEWISH VOCATIONAL SERVICE
REORGANIZATION, MISCELLANEOUS RESOLUTION #89023
TO the Oakland County Board of Commissioners
Mt. Chairperson, Tadies, and Gentlemen:
Pursuant to Rule XI-G the Finance Committee has reviewed Miscellaneous
Resolution #89023 and finds:
1) The resolution expands the Adult Activities and Jewish Vocational
Services programs to qualify for additional Federal Medicaid
revenue;
2) The expansion creates one Program Specialist I, one Typist I, two
PTNE Training Leaders, and upgrades one existing Training Leader
to a Program Specialist I; also, additional costs are required for
contractual services and operating expenses (see attached
schedule);
3) On an annual basis, the additional Medicaid revenue would be
$519,609 Which would offset the increase in expenditures of
$264,001 and also reduce the County's 10% match for the total CMH
program by $25,561 and the State's 90% match by $230,047;
4) For the remainder of 1989, the additional Medicaid revenue would
be $433,008 to offset expenditures of $221,097 and to reduce the
County's match by $21,191 (for return to contingency) and the
State's match by $190,720;
5) The 1989 Budget should be amended as follows:
Revenues
3-22200-166-01-00-2528 Medicaid $433,008
3-22200-166-01-00-2589 State Match (190,720)
Total Revenues $242,288
Expenditures
4-22200-166-24-0071001 Salaries
4-22200-166-24-00-2074 Fringe Benefits
4-22200-166-24-00-3041 Clinical Services
4-22200-166-24-00-5998 Capital Outlay
4-22200-166-24-00-6640 Equipment Rental
333
333
76,647
$221,097
Total Expenditures $242,288
4-22200-166-24-00-6670
4-22200-166-24-00-6750
4-22200-166-74-00-3042
Statibnery Stock
Telephone
Client Services
Subtotal
4-10100-909-01-00-9900 Contingency (county Match) $ 21,191
FINANCE CONNITTEE
$433,008
(190,720)
(21,191)
---------
$221,097
$519,609
(230,047)
(25,561)
---------
$264,001
$21,110 $25,332
8,655 10,386
12,550 15,060
5,146 6,175
14,400 17,280
1,243 1,491
FINANCIPLANALYSTS
COMMUNITY MENTAL HEAL
PROGRAM MODIFICATION, ADULT ACTIVITIES AND JEWISH VOCATIONAL SERVICES
REMAINDER OF
1989
(3/1-12/31)
FULL YEAR
ONGOING
INCREASE IN FEDERAL MEDICAID
REDUCTION IN STATE MATCH, 90%
REDUCTION IN COUNTY MATCH, 10%
TOTAL ADDITIONAL
EXPENDITURES
ADULT ACTIVITIES (UNIT 24)
ADDITIONAL PERSONNEL:
1 PROGRAM SPECIALIST I, PEN
FRINGE BENEFITS (41% OF SALARY)
1 TYPIST 1, FIE
FRINGE BENEFITS (41% OF SALARY)
2 TRAINING LEADERS, 1000 HOUR PTNE
FRINGE BENEFITS (863% OF SALARY)
UPGRADE EXISTING TRAINING LEADER TO
PROGRAM SPECIALIST I 1,603 1,923
FRINGE BENEFITS (28% OF INCREASE) 449 538
TOTAL PERSONNEL COSTS $65,156 $78,185
OPERATING COSTS:
FURNITURE $1,095 $0
EQUIPMENT RENTAL 333 400
OFFICE SUPPLIES 333 400
TELEPHONE 333 400
ODNTPACIUAL SERVICES 77,200 92,640
TOTAL OPERATING COSTS $79,294 $93,840
$144,450 $172,025 TOTAL IN ADULT ACTIVITIES UNIT
JEWISH VOCATIONAL SERVICES (UNIT 74):
INCREASE IN CLIENT SERVICES
TOTAL ADDITIONAL EXPENDITURES
PREPARED BY BUDGET DIVISION
LU 2/9/89
$76,647 $91,976
$221,097 $264,001
RESOLUTION # 89023 February 23, 1939
Moved by Susan Kuhn supported by Moffitt the report containing an amendment,
be accepted.
A sufficient majority having voted therefor, the report was accepted.
Moved by Susan Kuhn supported by Wolf the resolution be adopted.
AYES: Hobart, Jensen, Johnson, R. Kuhn, S. Kuhn, Luxon, McConnell,
McCulloch, McPherson, Moffitt, Oaks, Olsen, Pappageorge, Pernick, Rewold, Skarritt,
Wolf, Aaron, Calandro, Chester, Crake, Gosling. (22)
NAYS: None. (0)
A sufficient majority having voted therefor, the resolution was adopted.
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I, Lynn D. Allen, Clerk of the County of Oakland and having a seal, do
hereby certify that I have compared the annexed copy of the attached resolution,
adopted by the Oakland County Board of Commissioners at their regular meeting
February 23, held on F , 1989 with the original record thereof now remaining
on file in my office, and that it is a true and correct transcript therefrom,
and of the whole thereof.
In Testimony Whereof, I have hereunto set my hand and affixed the seal
of said County at Pontiac,Michigan this 2?4d day of rebmArY , 1989
-1442:
LYNy'D. ALLEN, County Clerk
Register of Deeds