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Staff report

Finance Committee Summary
July 9, 1998

The meeting was called to order at 4:30 PM P.M. A quorum was present. Proper
notice of the meeting had been given.
May Financial Statement

Marion Jackson briefly reviewed and discussed the Board‟s May Financial Statements
(See Attachment A).
Cash receipts for F/Y ‟98 with the possible exception of Federal Reimbursement (Title
XX) and miscellaneous should be in line with budgeted amounts.
Over all cash disbursement for the Board for F/Y ‟98 should range between $2.4 and
$2.5 million dollars.
This information was presented for information only and no action was required.
Approval of June Committee Meeting Summary

**
David Ames moved that the Finance Committee approve the Finance Committee Summary for the June 17, 1998 meeting as mailed. Ron Hill seconded. Motion carried unanimously. F/Y ’99 Central Pharmacy and Methadone Allocations

Marion Jackson reported that the Ohio Department of Mental Health (ODMH) has
awarded the Alcohol, Drug Addiction and Mental Health Services Board for
Montgomery County $286,493 of funding to cover a portion of the psychotropic
medication (Resperdol, Prozac, Lithium, Clozaril) and $14,962 of funding to cover a
portion of the methadone needs of indigent clients served by our system. Our F/Y ‟99
funding increased $64,621 and $4,943 for psychotropic medication and methadone
respectively.
In addition to the above funding, the Board has earmarked $50,000 to reimburse
ODMH should the system spending for psychotropic medication and methadone
exceed the $286,493 and $14,962 respectively for F/Y ‟99.
Below is a breakout of our vendors F/Y „98 funding level and F/Y ‟99 proposed funding
for psychotropic medications and methadone:
Vendor
F/Y ’99
F/Y ’98
Proposed
Psychotropic Medications
Day-Mont West
Treatment and Counseling Center South Community, Inc. Methadone
Project C.U.R.E., Inc.

When developing the F/Y ‟99 proposed funding amounts for our vendors, Board staff
reviewed utilization levels through the end of April. Based on each vendor‟s utilization,
the following amount represents Board staffs projection of each vendor‟s F/Y ‟98
Psychotropic medication utilization:
Vendor
F/Y ’98 Projections
Good Samaritan Treatment and Counseling Center Committee members are concerned that with Pharmacy costs going up on a continuing basis, that more individuals will be accessing these funds in the future and want to be certain there are enough funds available in the budget to cover these increased costs. ** Marcia Emanuel moved that the Finance Committee recommends that the Alcohol, Drug Addiction and Mental Health Services Board for Montgomery County approve F/Y ‟99 Central Pharmacy and Methadone allocations and contracts with the following vendors: 1) Day-Mont West, Inc. $83,942; 2) Eastway Corporation $170,051; 3) Good Samaritan Hospital and Counseling Center $4,500; 4) South Community, Inc. $28,000; and 5) Project C.U.R.E., Inc. $14,962. Further, that the Executive be authorized to sign the agreements. David Ames seconded. Motion carried unanimously.
Grace House 1996 Audit Report

Marion Jackson reported that in June, ADAMHS Board received Grace House‟s 1996
Audit Financial Statement and Report on Internal Controls. Grace House, which is a
Medicaid only contract agency of the Board, received a Disclaimer of Opinion because
of significant deficiencies in the design and operation of the internal control structure
(See Attachment B) and the organization was insolvent at the end of 1996.
When examining the organization‟s liabilities at the end of 1996, staff pointed out the
fact that accrued and withheld payroll taxes represents unpaid payroll taxes from the
fourth quarter of 1995 and all of 1996 and does not include any potential penalties the
government might levy on Grace House. In addition, the accrued contract service fees
represent Medicaid services performed by contract clinicians in their offices on behalf of
Grace House. There is a potential payback to the State associated with these billings.
Given the above, Board staff will be taking the following action:
 Legal counsel will contact the Attorney General‟s office to determine what, if any
liability the Board has relative to potential Medicaid payback  Board staff will be sending a copy of Grace House audited financials and an outline of issues associated with the possible closing of Grace House to the Ohio Department of Mental Health Issues/concerns:  Responsibility/cost associated with completing final report (financials as well as  Medicaid reconciliation and possibly payback to State/Federal government  The fact that the agency is financially insolvent  State should develop guidelines/policies for Boards contracting with Medicaid only  Issues associated with Grace House contract services. Grace House had a meeting scheduled with the Internal Revenue Services to address the accrued payroll taxes issue, however the IRS representative did not show for the meeting and the meeting has been rescheduled. When additional information becomes available regarding this situation staff will update the Finance Committee Committee members expressed concern regarding the welfare of the clients should the doors to Grace House be closed and instructed staff to discuss this issue with the Manager of Services & Planning to see if there are other agencies in the area where these clients could access services and if this issue should be discussed in further detail during a future Mental Health Services Committee meeting.
On page three (3) in the Report on Internal Control it was requested that the first
paragraph under item three (3) be corrected to read “a-Finding: The Corporation did not
make timely payment of payroll taxes….” before the report is distributed with the
summary to other Board Members.
Committee members expressed concern that Grace House has failed to respond to
staff‟s request to reply to the issues addressed in the Report on Internal Control and
Financial Statement Report and would like to receive this information so the response
could be discussed at a meeting prior to the July 22, 1998 Board meeting.
**
Ron Hill moved that the Finance Committee recommend that the Alcohol, Drug Addiction and Mental Health Services Board for Montgomery County direct staff to send a registered letter to the Executive Director and/or Board Chair of Grace House requesting a response to the Audit Reports and that an Action Team be created to develop a Plan of Action to be received prior to the July 22, 1998 Board meeting. David Ames seconded. Motion carried unanimously.
Proposed Board Policies

Dick DeLon reported that the Proposed Board Policies (Attachment C) that were included in the
mailing to Finance Committee members were discussed in great length at the June 7, 1998
committee meeting and then presented to the Board for the first reading. These policies are
now being presented to committee members for the second reading and approval from the
Board at the July 22, 1998 Board Meeting.
It should be noted that any changes to these policies, which was discussed at the June 7th
meeting was made prior to tonight‟s meeting.
A summary of these proposed policies follows:
ADAMHS Board will be responsible for payment of members; charges that are unpaid 90 days after delivery of services. ADAMHS Board will reduce subsequent year Medicaid match and Medicaid payments to satisfy prior year claims resulting from year-end cost reconciliation The ADAMHS Board will provide financial subsidy to members who qualify for subsidy based on our countywide subsidy schedule. Members will be responsible for payment of the total price for services received. However, they may be eligible for Board subsidy. The ADAMHS Board will use the same service rates for Medicaid and non-Medicaid members when pricing vendor‟s claims. David Ames moved that the Finance Committee recommend that the Alcohol, Drug Addiction and Mental Health Services Board for Montgomery County hear the second reading and approve Proposed Board Policies #‟s 205, 206, 207, 208, and 209. Marcia Emanuel seconded. Motion carried unanimously. F/Y ’99 Title XX Contracts

Marion Jackson reported that the Ohio Department of Mental Health (ODMH) has
awarded the Alcohol, Drug Addiction and Mental Health Services Board (ADAMHS) for
Montgomery County $615,067 in Title XX funds for F/Y ‟99. This amount is a reduction
of approximately 25% (or $205,022) from our F/Y ‟98 funding level ($820,089).
Title XX funding is awarded for the provision of eligible services (pre-hospital screening,
medication/somatic, diagnostic assessment, etc.) to indigent clients of Montgomery
County.
Historically, the Board has divided our Title XX funding equally between Day-Mont
West, Eastway Corporation and Good Samaritan Hospital and Counseling Center.
Those mental health agencies which do not receive Title XX funding receive other
board funding.
Given the service providers utilization in F/Y ‟98, Board staff recommends continued
funding of Day-Mont West and Eastway in F/Y ‟99 at their F/Y ‟98 level and funding
Good Samaritan Hospital and Counseling Center at $62,639.
The difference between Title XIV and Title XX is that Title XX is for individuals who
have a Medicaid card and services are provided by an eligible clinician who is licensed
and the clients receive certain services. Title XIV is for individuals who are indigent (do
not have a Medicaid card), qualification requirements are different for the individual
providing the services and services received can be different.
**
David Ames moved that that the Finance Committee recommend that the Alcohol, Drug Addiction and Mental Health Services Board for Montgomery County approve F/Y ‟99 Title XX contracts between the ADAMHS Board and the following agencies for the indicated amount: 1) Day-Mont West $276,214; 2) Eastway $276,214; and 3) Good Samaritan Hospital and Counseling Center $62,639. Further, that the Executive Director be authorized to sign the agreement. Virginia Kober seconded. Motion carried unanimously.
F/Y ’98 Title XX Reallocation

Marion Jackson reported that the Alcohol, Drug Addiction and Mental Health Services Board for Montgomery County has received $820,089 in Title XX funding for F/Y ‟98 and awarded Day-Mont West, Eastway and Good Samaritan Hospital Title XX contracts in the amounts of $276,214, $276,214 and $267,661 respectively. Good Samaritan Hospital has informed ADAMHS Board that they have insufficient demand of clients meeting Title XX guidelines to utilize all of the Title XX funding ($267,661) that we awarded them for F/Y ‟98. The Title XX funding represents part of the total funding that was earmarked for the support of CrisisCare and the children‟s program at Good Samaritan Hospital. In order to retain in our system those Title XX funds that Good Samaritan cannot bill, we must reallocate and apply these dollars against excess Title XX billings that Day-Mont West and Eastway have agreed to submit to the Board. Board staff proposes reducing Good Samaritans F/Y ‟98 Title XX funding ($167,661) and increasing their F/Y ‟98 master contract amount $167,661, reducing Eastway and Day-Mont West‟s F/Y ‟98 master contract amounts $117,661 and $50,000 respectively and increasing their F/Y ‟98 Title XX contracts by corresponding amounts. Committee members wanted it to be noted that the total aggregate funding for each of these agencies does not change and is still subject to review of meeting IRC. Following is a breakout of the reallocation of funding for F/Y ‟98. F/Y ’98 TITLE XX REALLOCATION
Original
Allocation
Allocation
NOTE: Good Samaritan Master Contract does not reflect the increase being proposed by the Finance
Committee.
**
David Ames moved that the Finance Committee recommend that the Alcohol, Drug Addiction and Mental Health Services Board for Montgomery County approve the reallocation for F/Y ‟98 contracts and amounts between the ADAMHS Board and the following agencies: 1) Reduction of Good Samaritan F/Y ‟98 Title XX contract amount from $267,661 to $100,000, reduction of Day-Mont West and Eastway master contract amount $50,000 and $117,661 respectively; 2) Increase Good Samaritan F/Y ‟98 master contract amount $167,661, Day-Mont West and Eastway F/Y ‟98 Title XX contract amounts $50,000 and $117,661 respectively; 3) further that the Executive Director be authorized to sign the agreements. Virginia Kober seconded. Motion carried unanimously.
Good Samaritan Hospital F/Y ’98 and F/Y ’99 Funding

A revised page 25 was at Committee Members places with changes in bold and
underlined.
Marion Jackson reported that when we initially signed the contract for the Request For
Proposal (RFP) for CrisisCare, ADAMHS Board and Good Samaritan Hospital staff
estimated how much in Medicaid dollars we expected to collect ($500,000 in Medicaid
revenues) based on the number of units of services in various categories. This review
was based on the percentage of Medicaid clients we had in our system. The
contractual agreement between the ADAMHS Board and Good Samaritan (CrisisCare)
specifies that a year-end cost reconciliation will be preformed and funds will be returned
to the ADAMHS Board in instances where we over funded or the Board would
reimburse for cost in excess of revenue.
Based on financial statements provided by Good Samaritan Hospital, the first full year (F/Y ‟97) of operation of CrisisCare resulted in a net loss of $64,536. There were delays during F/Y ‟97 in getting the CrisisCare site certified by the Ohio Department of Mental Health (ODMH) and as a result, they were not able to bill Medicaid for services provided during this period. Based on service utilization data for F/Y ‟97 and F/Y „98, the majority of clients being seen by CrisisCare are alcohol and substance abusing clients. Beginning 7/1/96 almost all AoD individuals, who refused on going substance services, became ineligible for SSI and Medicaid services. Beginning 7/1/97 AoD and substance abusing individuals became ineligible for SSI and Medicaid benefits. The above factors are expected to result in F/Y ‟98 Medicaid revenue for CrisisCare being less than $100,000 versus our projection of $500,000. Additionally, F/Y ‟98 Medicaid revenue from Good Samaritan‟s Adult General Mental Health and Children and Youth programs increased substantially resulting in a ($206,165) increase in match requirement for F/Y ‟98. Good Samaritan Hospital has requested the ADAMHS Board to increase their F/Y ‟98 funding to cover their projected loss of $610,087 from operations for F/Y ‟98. The following is a summary of F/Y ‟98 projected loss from operations: CrisisCare Medicaid revenue being less than projections Adult General Mental Health and Children and Youth services increased Medicaid match requirement in F/Y „98 Other $610,087
Good Samaritan Hospital has also requested that the above amount become part of their base funding for the agency. Good Samaritan Hospital has submitted their F/Y ‟99 budget request and they are seeking an increase of $906,271 over their F/Y ‟98 adjusted funding level. The increased funding is needed for the following reasons: Additional staff (6.5 FTE) effective 7/1/98 (Juvenile Court Intervention Center and Children and Youth Manager) Positions added during F/Y ‟98 and inflationary increase Total F/Y ’99 Funding
$4,991,951
Board staff recommends increasing Good Samaritan Hospital F/Y ‟99 funding by the above amount with the following stipulation: 1. That ADAMHS receives quarterly statements of Revenue and Expenses for CrisisCare. That ADAMHS Board requests the Executive Director to go to the county to bring in a consulting firm such as of A.T. Hudson to review CrisisCare‟s operations. That ADAMHS Board only provides Medicaid match funds for the Adult General Mental Health and Children and Youth Services programs. In addition, that the Medicaid match contract for Adult General Mental Health and Children and Youth Services program be separate from the CrisisCare contract. That prior to the beginning of the next contract year, Good Samaritan management meets with Board staff prior to their budgeting their staff increases. That a proposal be executed and the Executive Director go before Levy Council and request additional funding due to these unforeseen circumstances. Committee chair reminded members that these issues have been presented to the Board in January and notified that these requests would be presented at future committee and board meetings. The total funding request is for $610,087 for F/Y ‟98 and an additional $1.5 million for F/Y ‟99 for a total funding request of $2.1 million over the next two years. ** David Ames moved that the Finance Committee recommend that the Alcohol, Drug Addiction and Mental Health Services Board for Montgomery County 1) approve increasing Good Samaritan Hospital‟s F/Y ‟98 master contract amount $610,087; 2) approve a F/Y ‟99 contract between the ADAMHS Board and Good Samaritan Hospital in the amount of $4,991,951; 3) allocate and approve Medicaid matching funds for Good Samaritan Hospital for their Adult General Mental Health and Children and Youth program of $337,000; 4) the five (5) stipulations noted above be met; and 5) that the Executive Director be authorized to sign the agreements. Ron Hill seconded. A roll call vote was taken: D. DeLon – yes; V. Kober – yes; R. Hill – yes; D. Ames – yes; M. Emanuel – no. Motion carried. Next Meeting
Next meeting will be Wednesday, August 13, 1998 beginning at 4:00 PM. This will be a
workshop/retreat meeting to look at ADAMHS Board‟s financial planning from a
systems standpoint in light of health insurance issues, MACSIS Implementation,
Recovery Model, Children & Youth Crisis Program, and the any willing provider
concept. Staff and committee members need to start looking at how ADAMHS Board is
going to start addressing these issues and receive additional resources from the county
and if there are no additional resources available, how is ADAMHS Board going to
prioritize what services get funded.

Adjournment

**
David Ames moved that the July 9, 1998 meeting of the Finance Committee be adjourned. Ron Hill seconded. Motion carried unanimously. Meeting was adjourned at 5:25 PM.

Source: http://www.adamhs.co.montgomery.oh.us/pubinfo/minutes/FinanceCommitee/1999/07099.min.pdf

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