Follow Up Budget Briefing and Questions Submitted

By Mental Health Task Force

In July, the Mental Health Task Force and Make It Work Milwaukee hosted a briefing on the 2015 Milwaukee County Budget department Requests. We had submitted questions about the DHHS/ BHD budgets in advance of the briefing. Please see the attached document which provides answers to many of the questions – we want to thank Director Colon and other staff for the time they took to respond to the questions – we very much appreciate their responsiveness. If there are any clarifications or follow up that you would like the Task Force to request, please share with our co-chairs Mary Neubauer or Martina Gollin-graves, or respond to this email. This document was shared at Tuesday’s Task Force meeting but our time for the budget discussion was very short as we “ran over” on other items, and we were not able to discuss the responses.

Also attached is an alert asking you to contact County Executive Abele to support the many positive initiatives in the BHD and DHHS budgets, and ask him to include some other investments recommended by the Task Force and by the Make It work Milwaukee Coalition budget papers - both are attached for your review. Please send your communications to the County Executive now as the budget will be finalized shortly. Our budget discussion at the Task Force was very rushed and we were not able to provide the budget overview that we planned on. I wanted to apologize for failing to give credit where credit is due to the community initiatives in the DHHS/BHD budgets. It takes a lot of work by staff to get these in the budget and we strongly support these investments and have encouraged the County Executive to include them in his budget. I want to thank Director Colon and other staff for their work on these initiatives. I have copied below for your reference some of the community initiatives in the budget which we have strongly supported – and hope you will include these in your communications. Our position papers also include these.

Support the BHD Community Services Budget Request including the following:

  • $1.5 million to restore funding for AODA services. This will partially replace the loss of $3.6 million in federal funds. .

  • Support investment of $2,326,200 to develop and fund community services and placements for at least eight Central clients. The timeline for closing Central and Hilltop must be in alignment with development of community capacity. It may need to shift if residents have not yet moved.

  • Support creation of Care Coordination Unit and related staff, and quality assurance staff for community programs.

  • Support development of additional residential capacity as funded in the budget, with a priority given to smaller less institutional settings.

Support these additional investments in the DHHS budget:

  • Support the addition of a second Community Intervention Specialist, as proposed by the Housing Division. .

  • Support Investment in the Harm Reduction Model, which will serve individuals with severe alcohol addictions, who have not been successful in traditional housing or in current treatment models.

  • Support the establishment of the Disability Services Crisis Resource Center (CRC). As originally proposed in the 2014 budget, funding was not adequate. Access to crisis services for people with intellectual disabilities is essential key to supporting Hilltop residents in the community and must be adequately funded.

Barbara Beckert, Milwaukee Office Director DISABILITY RIGHTS WISCONSIN
6737 W. Washington St., Suite 3230 Milwaukee, WI 53214
414–773–4646 Ext 15 Voice
414–773–4647 Fax
barbara.beckert@drwi.org


2015 BHD and DHHS County budget questions updated 8/11/14

Drafted from discussion /input from the Mental Health Task Force Steering Committee

BUDGET SUMMARY QUESTIONS

The 2015 budget summary notes an increase in Direct Revenue of $1,627,667. What is the source of this increased revenue? The budget narrative mentions new revenue of $250,000 related to the ACA. What are the other Direct Revenue sources? Direct Revenue consists of all sources of Patient Revenue, Rental income, WIMCR and DSH payments from the state.  Increase is due to DSH funds $775,000, estimated ACA Revenue increase $250,000 and a net increase in patient revenue of $600,000.

WIMCR: what will change to WIMCR mean to your bottom line? WIMCR is budgeted to decrease by $303,000

ADULT CRISIS SERVICES -

  • Mobile Crisis Team service hours have historically been limited to Monday through Friday from 9 a.m. to midnight and on Saturday, Sunday and holidays from 11:30 a.m. to 8 p.m. and staffing levels limit the ability to respond to calls during these hours.. The 2014 budget had an investment to provide 24 hour coverage through a contract. This has not yet been implemented. The budget project a small increase in the number of mobiles for 2015. Given the significant additional coverage, wouldn’t there be a more significant increase in number of mobiles for 2015?
The contract for the third shift expansion of Crisis Mobile Team has been awarded to LaCausa Inc. Currently the agency is hiring staff to complete the mobiles and planning for implementation in September.
Historically, the need for mobile services on third shift has been relatively small (this has been piloted in the past). Due to this, a significant increase in mobiles was not identified for 2015.

  • In addition to law enforcement, who requests the other mobiles?
These mobiles will be completed in the community with law enforcement and in area hospitals. The mobiles will be dispatched by PCS staff members who answer the Crisis Line during those hours.

  • Please provide the activity date broken out by year (2013, 2014, and 2015) and program for Crisis Resource Centers and Crisis Stabilization Centers. Are there waiting lists for these programs?
Crisis Resource Center: 2013–303 2014 YTD-206
Crisis Stabilization Houses: 2013–309 2014 YTD-239
There are no waiting lists.

  • The 2015 budget does not reflect an increase in the number of clients who will be transferred to private facilities from PCS. Given that more clients are now insured and that there has been a strategy of having more people transferred to private hospitals, why isn’t there an increase?
The 2014 budgeted performance measure for clients transferred from PCS is not an increase in the number given that PCS admissions continue to decrease. Instead, the performance goal is an increase in the percentage of clients transferred.

Access Clinic -

  • What is the future of the access clinic? In the past, it has only served uninsured individuals. Many more people now have access to insurance – Badgercare or insurance on the exchange. The projected numbers to be served in 2015 are the same. Is the plan to continue to limit service to uninsured?
The Access Clinic will continue to serve uninsured individuals at this time.

  • Can a specific breakout be provided for the new Southside Access Clinic – ie how many people is it expected to serve in 2014? 2015?.
The number served at Access Clinic South will depend on what percentage of individuals chooses to seek services at that location rather than the current clinic. This can be estimated after the service has been established.

  • Are there plans for a Northside Access Clinic?
A Northside access clinic will be considered in future budgets?

INPATIENT SERVICES -

  • The new nurse staffing model will “insure 24-hour coverage of shifts”. Isn’t that already the practice – ie to provide 24 hour coverage of shifts? How will this differ from the current staffing model? Does “nursing” refer to only RNs or to RNs and CNAs.
The practice has been to cover 24 hour shifts, but the budget was understated and did not reflect non-productive time off for staff or one on one coverage. Nursing refers to RN and CNA staff.

  • Is the creation of 19.6 FTE of Nursing Asst (p. 8) and 2,2 FTE RNs expected to eliminate the reported current practice of heavy reliance on mandatory overtime?
Yes, the expectation is that by increasing staff, accounting for non-productive time and one on one coverage in the budget that OT will be greatly reduced.

  • 2015 budget has significant increased expenditures for inpatient services (approximately $5 million increase for inpatient). Given the commitment to downsizing inpatient and expanding community services why is there such a significant increase for the inpatient services?
Inpatient census is projected to remain at 2014 actual run rate numbers, which are greater than the 2014 budget. In addition, $1M was added to adequately support clinical labor in the units. The 2015 budget also includes an additional $4.9 million investment in community services.

  • Revenue is projected to increase by $3.6 million – what is the source. The only new revenue mentioned is ACA of $250,000.
Largely due to census increase over 2014 budget. Census in 2015 budget is in line with 2014 actual trend.

  • Still the possibility of bed reduction depending on study findings. Is there also an option to contract with private providers for hospital beds?
Yes, at the August MH board meeting a contract was approved to transfer Patients without insurance to Rogers Hospital.

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Last edited by Tyler Schuster.   Page last modified on September 12, 2014

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