Joint Committee Meeting

1. Joint Committee Meeting March 23, 2011 Joint Committee Meeting

2. State Budget ConceptsFY 12-13 • In Summary: • Budget addresses $8B deficit without raising taxes • Of 59 state agencies, 44 saw decreases, 7 were flat funded and 8 saw increases, and one new agency was created (Office of Health Transformation) Joint Committee Meeting

3. State Budget Concepts Cont. • Budget Elevates MCD match responsibility to the state. • Boards will continue admin function in FY 12 • In FY 13 full integration of MCD into ODJFS. • MCD match in FY 12 will come from the Boards’ state allocation. • MCD match in FY 13 will come from the state line item 525. Joint Committee Meeting

4. State Budget Concepts Cont. • Traditional line items have been re-aligned,created and in some areas eliminated (i.e. 408) • State funding for Non-MCD, at the state level remains small • The departments have not touched local levy funds, however significant reductions to tangible personal property tax replacement fund (TPP) will impact levies Joint Committee Meeting

5. Evaluation • Board Association lobbied for a three step platform • Elevate MCD and fund through line item 525 • Fully fund state line items (505,408, and 401) • Hold levy funds harmless Joint Committee Meeting

6. How did we fare? • MCD will be elevated beginning FY 12 and match will come from line item 525 in FY 13 • The departments show a net gain in GRF but: • Line items have been altered • Allocation methodologies appear to shift from per capita to utilization Joint Committee Meeting

7. How did we fare? Cont. • Reduction in TPP/Commercial Activity Tax negatively impact levies • Both departments now acknowledge implications Joint Committee Meeting

8. Language and Policy • Budget Language not yet published, but expected in 2 weeks. Joint Committee Meeting

9. What do we know: Mental Health • Emphasis- direct service to individuals with Severely Mental Ill • Continued Department operation of Six Psychiatric Hospitals • Continue Medication subsidy at a lower allocation due to generics • GRF non-MCD subsidy for local priorities Joint Committee Meeting

10. Major Reforms • MCD responsibility is shifted to state level (funding and management) • FY 12 MCD cost containment strategies based on data • MCD benefit package in FY 13 • Service utilization will be limited • Payment modifications beginning July 1, 2011 (Scope, Cost and Duration) Joint Committee Meeting

11. Major Reforms Cont. • Children entitled to all medically necessary services per MCD - Early and Periodic Screening, Diagnosis and Treatment (EPSDT) • Treatment services outcome measures • Physical/Behavioral Health integration • Care Coordination by Office of Health Transformation September 2012 Joint Committee Meeting

12. Major Reforms Cont. • Core Focus Populations: MCD/Medicare dual enrollees and individuals with Severely Persistent Mentally Ill (SPMI) (MCD redesign FY 13) • Hospital, MCD and Non-MCD new line items • Block grant reformed to emphasized direct services. Joint Committee Meeting

13. Major Reforms Cont. • Funding Proposal FY 12/13 • Line item eliminated and created –KG • Departments will allocate sufficient dollars to meet Boards MCD obligation (MACSIS utilization trend) plus 8% growth • MCD Allocation will include cost containment rules and focus on high priority areas Joint Committee Meeting

14. Major Reforms Cont. • Boards to process MCD as in the past for FY 12 but Department will impose a reconciliation policy • Boards will be held harmless for MCD match i.e., levy, non-MCD funds and block grant • ODJFS to pay providers MCD in FY 13 Joint Committee Meeting

15. Major Reforms Cont. • Hospital line item 412 (NEW) • Civil & forensic • The Boards allocation of funds from 412 are to purchase hospital beds or alternate services • Department may opt for a pay as you go method on 412 funds or quarterly allocation with reconciliation • Department will push for regional planning of bed days Joint Committee Meeting

16. Major Reforms Cont. • Community Service 505 • Focus on Non-MCD services • Allocation designed to bring each Board as close to FY 11 Non-MCD GRF • Priority setting for these funds up to Board Joint Committee Meeting

17. Major Reforms Cont. • Departments will encourage these services: • Emergency service and crisis intervention • Housing • Children's Services • Consumer returning to Community from Hospital Joint Committee Meeting

18. What do we know- ODADAS • MCD elevation - same related issues as ODMH e.g., Cost Controls and Utilization Management • Revised Non-MCD allocation procedures for FY 13 • Emphasis on the department and RSC State Wide Project. • Top Priority is the Opiate Addicted Joint Committee Meeting

19. What do we know-ODADAS Cont. • Other Priorities: Young Adults with dual diagnosis • Severally Mentally Ill • Offender re-entering communities • Vets • Driver Intervention Program Offenders MUST pay ½ of cost Joint Committee Meeting

20. ODADAS Funding Joint Committee Meeting

21. ODMH Funding Joint Committee Meeting

23. Joint Committee Meeting

24. Joint Committee Meeting

25. Tangible Personal Property Tax Replacement While more language and details will need to follow, the initial news is not good. Boards and other local governments have been held harmless from the loss of tangible personal property taxes as a result of tax reform. Two state revenue distribution funds (see details below) and a transfer of GRF have been used to hold local governments harmless. The Administration proposes to redirect CAT revenues and kilowatt hour tax to the GRF, thus reducing funds to reimburse local governments. The Local Government TPP Replacement Fund (Fund 7081) has traditionally received funds from Commercial Activity Tax to help replace revenue to local governments. SFY '11 SFY '12 SFY '13 $414,000,000 $291,000,000 $181,000,000 -30%-38% Joint Committee Meeting

26. Fund 7054 is used to reimburse local governments for property tax revenue lost due to reductions in 2001 in assessment rates on tangible property owned by electric and natural gas utilities. SFY '11 SFY '12 SFY `13 $90,000,000 $16,000,000 $11,000,000 -82%-31% Joint Committee Meeting

27. Property Tax Rollback Reimbursement (110901) This line item is used to reimburse local governments other than school districts for losses incurred as a result of the 10% and 2.5% "rollback" reductions in real and manufactured home property taxes and as a result of the "homestead exemption" reductions in taxes. SFY '11 SFY '12 SFY '13 $592,463,014 $610,900,000 $616,000,000 +3% +1% Joint Committee Meeting

28. Joint Committee Meeting

29. FY12 Tasks & Timeframe

30. Task Categories • FY12 New Services • Description of need, service, outcomes, costs • E.g., Hospital Liaison, behavioral health/criminal justice integration • FY12 Outcomes • Measurements, frequency, and reporting • Contract language/costs • FY12 Board Budget (admin/special projects) • F12 Service purchasing & System Budget • Usual and Customary Rates • New/expanded projects • FY12 Contracts • FY 12-13 Community Plan

31. April Transition Meetings • FY 12 Provider Budget Development • Work with Providers on usual and customary rate reductions • New or enhanced programming • Outcomes measurements implementation • Provider and Board Staff priority list for Board review in May Joint Committee Meeting

32. April - Other • Contracts • Conversation/advice from Molly Mack • Termination needed? And if so, implications • Outcomes language coming • Length of contract term • Data Reports • Costs, Utilization, Trends • Community Plan work • Hospital Utilization Management Bed day planning

33. April – Committees • Program • Program changes for FY12 • New programs, expansions, modifications • Outcomes measurement • State budget updates • Health Officer designation • Finance • UCC reduction plan/proposals • Outcomes costs • State budget updates • Executive • FY12 Contract Issues Discussion • FY12 Board Officers

34. Timeframe: Scheduled Meetings • June Board Meeting – June 28th • Exec 6/15 (third Wednesday) • Prog 6/13 (second Tuesday) • Fin 6/8 (second Wednesday) • May BdMtg – May 23 • Exec 5/18 • Fin 5/11 • Prog 5/10 • April BdMtg – April 25 • Exec 4/20 • Fin 4/13 • Prog 4/12 NOTE: Joint Meetings may be required

35. May Transition Meetings • Unfinished business from April • Community Plan • Budget development/service purchasing Joint Committee Meeting

36. May - Other • Finish Outcomes language with Outcomes workgroup • Finish Contract with Molly Mack

37. May - Committees • Program • Final report on agency proposals • Data reports • Community Plan • Health Officers • Finance • FY12 Board Budget • Utilization Reports • Agency’s proposed FY12 Budgets • Community Plan • Executive • Contract Work (term, outcomes, other) • Board Budget • Community Plan • Executive Director Contract • Nominating • Board Appointments

38. June - Decisions • Program • Recommendations to Board on Programming • Discussion/recommendations on Contracting language • Finance • Recommendations on • Board Budget • Including rental agreement • System Budget • Executive • Contract Recommendations • Delegation of Authority recommendations