City Council

AGENDA Newport News City Council Work Session September 11, 2018 10th Floor Conference Room City Hall 3:15 p.m. I. Closed Meeting 4:30 p.m. II. Leadership Development Academy Graduates: Litter Presentation 4:45 p.m. III. Hampton-Newport News Community Services Board (H- NNCSB) State Biennial Fiscal Year (SFY) 2019 Budget and Fiscal Year 2019-2020 Performance Contract Briefing 5:15 p.m. V. Noise Ordinance Amendment Briefing 5:30 p.m. VI. Comments/Ideas/Suggestions VII. Adjourn 6:00 p.m. VIII. Dinner  9/6/2018 Hampton-Newport News Community Services Board State Fiscal Year 2019 Budget/Performance Contract Review Newport News City Council 1 Presentation Agenda Performance Contract Budget Principles Budget Highlights Concerning Budget & Environment Trends/Challenges Value Added Services Action Request 2 1  9/6/2018 Strategic Commitment Continuing to be THE premier provider of behavioral health care and intellectual and developmental disability services. Continuing to be recognized throughout Virginia for our leadership, excellence, and commitment to service. 3 Hiring the Best People for the Job 879 Total Workforce Clinical Staff  710 Full-Time ■ 9 Full and Part-Time Psychiatrists  136 Part-Time ■ 3 Part-Time Primary Care Physicians  23 On-Call ■ 5 Full and Part-Time Licensed Nurse  10 Interns and Volunteers Practitioners ■ 14 Full and Part-Time LCSWs ■ 3 Full-Time LCPs ■ 26 Full and Part-Time LPCs HNNCSB is one of the Premier ■ 16 Full and Part-Time RNs Employers on the Peninsula, providing almost $45,521,000 in salaries and ■ 24 Full and Part-Time LPNs benefits to staff who reside in our communities ■ 17 Full-Time CSACs 4 2  9/6/2018 Comprehensive System Of Care • Early • Case Management • Creative • Southeast Family • LIPOS Intervention • Individual and Family Options – DD Project (Inpatient Services Counseling • Psychosocial • Waiver Group purchase) • Parenting • Emergency Services Day Program Homes • Inpatient Resources and • PACT • Deaf Services • ICF - DD Psychiatry Support Groups • In-Home • Therapeutic • MH Supervised • Psychiatric • After-school and • Partners in Recovery Day Treatment Residential Consultation Recreational • Mobile Crisis – • MH Supported and Liaison Programs Children, Adult, IDD Living • Substance • Medications • MH Crisis Abuse Management Stabilization Prevention • Comprehensive • DD Crisis • Educational Outpatient Services Stabilization Services • Peer Recovery Services • Adult DD Respite • Mentorship • Opioid Replacement • Homeless Outreach • Drug Court • Juvenile Justice • Jail Based Services • Virginia Veteran and Family Support • Behavioral Health Docket • Forensic Services 5 Committed to Service to Our Communities Residents Served NN by Disability Hpt 38% DD 41% 8% Residents Served by SA Locality – FY 2018 17% MH 75% Other 21% 6 3  9/6/2018 Strategically Placed  HNNCSB is in EVERY school in Newport News  HNNCSB partners with SEVHS to offer integrated primary health and behavioral health services on-site and with Genoa to provide an on-site pharmacy  HNNCSB offers full continuum of Juvenile Justice Services – including Juvenile Drug Court, Clinical Services, Juvenile Detention  HNNCSB trains Newport News First Responders through Crisis Intervention Training, CIT  HNNCSB offers a full array of housing options from homelessness to permanent supported housing to integrated housing  HNNCSB partners with NN Healthy Families for Case Management  HNNCSB administers the NN Drug Court and new Behavioral Dockets  HNNCSB provides Emergency and Crisis Intervention, Mobile Crisis services and Crisis Stabilization  HNNCSB continues to provide uncompensated services to NN residents without third party payors. 7 FY2019 Strategically Moving Forward As The Premier Provider Of Behavioral Health Applying resources to strategic areas that improve provision of behavioral health Maximizing revenue and  Implementation of Same Day Responding effectively to changes Access Mental Health Screening in the operating environment: Services  Implementation of Medicaid  Analysis of Data through utilization of Operational Expansion Dashboards  Commonwealth Coordinated  Implementation of Phase II of Care Plus Program (CCC+) employee compensation study Managed Care process  Independent Assessment,  Changes in payor regulations and Certification and Coordination billing processes Team (IACCT) – supporting our localities in assessing children for admission to residential treatment 8 4  9/6/2018 Annual Operating Budget and Performance Contract  Parties: HNNCSB and the Department of Behavioral Health and Developmental Services (DBHDS)  Describes: Our commitment to  The individuals we serve  Cities of Newport News and Hampton  Primary accountability and funding mechanism between DBHDS and the HNNCSB  Budget requires formal approval of the HNNCSB Board of Directors and the City Councils of Newport News and Hampton 9 FY2019 Performance Contract New Requirement  The FY2019-20 Performance Contract now requires all operating CSBs to maintain an operating reserve sufficient to cover at least two months of personnel and operating expenses and ensure that the CSB’s financial position is sound.  Based on the current HNNCSB budget, this would equate to approximately $11.6 M.  The HNNCSB currently has a cash operating balance of $7.8 M.  In order to meet the new Performance Contract requirements, we are requesting an increase to the current line of credit from $3,000,000 to $5,000,000. This will ensure that we are in compliance with the new state requirements. 10 5  9/6/2018 Medicaid Expansion Impact on Budget  Medicaid expansion goes into effect January 1, 2019 and provides an opportunity for an estimated 400,000 Virginians to gain access to healthcare, approximately 13,000 are living in Hampton and Newport News. We anticipate that a portion of our clients will be eligible for Medicaid with the new guidelines.  To fund the expansion, a portion of the MH General Funds that CSBs receive will be reduced. DBHDS is currently reviewing ways to equitably reduce the funds across the 40 community services boards. The total amount of required funding is $11.1 M across the state.  One proposal is to reduce funding based on the number of uninsured clients receiving Mental Health Case Management services at each board.  The reduction in funds begins April 2019, with all funds being reduced by the final June 2019 state warrant payment, which equates to approximately $500,000 based on current methodologies.  This reduction in revenue may be offset by Medicaid covered services provided by HNNCSB, however, this is not guaranteed. 11 Budget Principles  To the extent possible, programs should be self- supporting, maximizing earned revenue  Programs should economically and efficiently apply capital, human and support resources, and eliminate or reduce expenses where possible  State and local funds and excess program revenue should support services for individuals with no payor source  Programs/services are monitored and right-sized to assure that there is sufficient revenue to cover the cost of services 12 6  9/6/2018 FY2019 Budget – Highlights  Staff Compensation  2% Cost of Living salary increase for staff  Payroll lag at 2%  Implementation of Phase II of the compensation study recommendations. This ensures that all Employees with 3 or more years of service in their position are at market rate salary based on study recommendations  Fringe Benefits:  Re-evaluate health insurance to balance required savings with staff impact and maintain reserve for health insurance  Enhance wellness plan  Merger of Next Step and Bright Beginnings day programs into one Psychosocial Program 13 FY2019 Budget – Highlights Continued Strategic Plan Initiatives  Increased Workforce Development – Recruitment, Retention, and Training  Continue Outcome Measurement/Best Practice Development based on data-driven decisions  Implementation of Same-Day Access Model to increase access to care  Funds Capital Requirements for vehicles & equipment & maintenance  Maintains clinical and administrative programs/services Level State and Federal Funding  Medicaid Expansion impact on State Funding to CSBs Local Funding  Increased $30,000 to support Hampton Drug Court Veteran’s Track  Increased $125,000 for Newport News Behavioral Health Docket Attainable/conservative fee revenue 14 7  9/6/2018 Changes in State, Federal, Local and Earned Revenue Revenue by Source FY2018 FY2019 Change State $ 24,013,073 $ 22,172,209 $ (1,840,864) Federal $ 3,901,063 $ 3,849,611 $ (51,452) Local** $ 3,238,185 $ 3,268,185 $ 30,000 Fee $ 35,745,766 $ 33,727,581 $ (2,018,185) Other $ 2,708,907 $ 2,185,765 $ (523,142) Total Revenue $ 69,606,994 $ 65,203,351 $ (4,403,643) **Local Funds to increase by $125,000 – Newport News Behavioral Health Docket 15 FY2019 Core Programs Revenue by Source Other, 2,185,765 State, 12,878,467 4% 23% Federal, 3,849,611 7% Fee, 33,146,298 Local, 3,268,185 6% 60% Core Programs do not include the regional projects for which HNNCSB is the fiscal agent 16 8  9/6/2018 Concerning Budget & Environment Trends/Challenges  A decline in fee revenue based on regulatory and fee structure changes, as well as a decrease in referrals  Recent changes in the operating environment have highlighted the importance of recruiting and retaining licensed and credential-able clinical staff including QMHPs (Qualified Mental Health Professionals) and CSACs (Certified Substance Abuse Counselors)  Ensuring that our salaries remain competitive within the field  Effect of Medicaid Expansion on State General Funds  Increase in the Aging Population  Continued focus on ESH Census Reduction  Focus on implementing Same Day Access Mental Health Screening Services model to increase access to care  Focus on the Opioid Crisis 17 Budget Summary The FY2019 budget maintains high quality community programs that are responsive to our communities within available funds. The FY2019 budget continues to improve the financial health of the HNNCSB and recognizes changes to service delivery models. The FY2019 budget continues stewardship of public resources by providing effective and efficient services in a challenging financial environment. 18 9  9/6/2018 Action Request The HNNCSB Board of Directors and staff respectfully request the City Council to approve by resolution:  FY 2019 Budget  FY 2019 Performance Contract  Increase the Line of Credit from $3,000,000 to $5,000,000 to ensure compliance with the state Performance Contract 19 10