HomeMy WebLinkAboutMINUTES - 05071984 - 2.1 a,is
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THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Order on May 8, 1984 by the following vote:
AYES: Supervisors Powers, Fanden, Schroder, McPeak, Torlakson
NOES: None
ABSENT: None
ABSTAIN: None
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SUBJECT: Analysis of Health Services Department
Budget Projections
The Board on April 24, 1984 requested the County Administrator
to provide an analysis of budget projections fbr the Health Services
Department for the 1983-1984 fiscal year and the 1984-1985 fiscal
year.
In a report dated May 7, 1984 (copy -of which is attached
hereto and by reference incorporated herein) , C. E. Dixon, Interim
County Administrator, provided detailed information relative to
budget projections for the Health Services Department. He presented
a list of recommendations for the Board to consider which included
direction to the Acting Health Services Director to submit a budget
indicating the Board' s intent to provide a 40 percent match for AB-8
County Health Services funds during the 1984-1985 fiscal year; the
separation of the Alcohol, Drug Abuse and Mental Health Division
from the (Hospital) Health Services Enterprise Fund (0540) and
returning it to the General Fund in Budget Unit 0467; dividing the
County contribution to the (Hospital) Health Services Enterprise
Fund (0540) between 0540 and the Contra Costa Health Plan (0860) so
that it is clear how much County money is going to the Health Plan;
and confirmation of the target figures for the budget of said
department subject to certain modifications.
In response to a question from Supervisor McPeak, Mr. Dixon
advised that even though he is aware of the need to remodel the
electrical system and repair the roof at the hospital, priority has
been given to implementation of a computerized billing system to
expedite the recovery of costs for patient care.
Board members commented on the need to acquire all pertinent
information relative to the cost effectiveness of the County Health
Plan.
Supervisor Torlakson commented on problems encountered by
Alameda County and Fresno County in the provision of health care to
the indigents and the current limitations on revenue/expenditures
imposed by the State. He proposed renegotiating the Medically Indigent
Adult and Medi-Cal rates with the State as a means of seeking a more
equitable compensation for the services rendered.
Mr. Dixon responded that improved recovery of costs from the
State has been under discussion with Nu-Med, but prior to initiating
any action with the State on this issue, Nu-Med would first like to
have a complete cost assessment of the services provided and the .
population .served.
Supervisor N. C. Fanden inquired as to the feasibility of
increasing fees, particularly hazardous waste inspection fees. Mr.
Dixon advised that staff will be reviewing fee schedules for services
rendered by the County and the feasibility of increasing same.
U
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Henry L. Clarke , General Manager, Contra Costa County Employees
Association, Local 1, expressed concern with respect to the proposed
reduction in mental health services. Mr. Clarke suggested that the
remaining deficit be made up throughout the County and not just
restricted to the Health Services Department; expressed- his continued
support for the County Health Plan and endorsed an aggressive marketing
plan; and also requested consideration be given to making the needed
repairs at the hospital as soon as possible.
Larry Aulich, representing the. Deputy Sheriff' s Association,
expressed the opinion that even though he recognized the need for the
new computerized billing system, he urged that priority be given to
repairing the roof and electrical system at the hospital.
Mr. Dixon responded that although he recognized the need for
for repairs as noted, the top priority is to maximize revenues, which
can be accomplished once the new billing system is in place. Supervisor
Fanden concurred.
Board members having discussed the matter, IT IS ORDERED
that the recommendations of the County Administrator are APPROVED.
IT IS FURTHER ORDERED that the Finance Committee (Supervisors
Schroder and McPeak) is REQUESTED to review issues noted above, i.e. ,
operation and cost of the Contra Costa Health Plan, the elimination
of the remaining $3. 6 Million deficit in the current fiscal year , the
feasibility of renegotiating reimbursement rates with the State
applicable to Medi-Cal patients, and the County match with respect
to AB 8 funds to the extent the County Administrator requires such
additional clarification.
I hereby certify that this is a true and correct copy of
an action taken and entered on the minutes of the
Board of Supervisors on the date shown.
ATTESTED: Je,- /fJ04 —
J.R. OLSSON, COUNTY CLERK
and ex officio Clerk of the Board
By , Deputy
cc: County Administrator
Acting Health Services Director
Finance Committee
r. Board of Supervisors
County Administrator Contra ist Districttrs
^C
County Administration Building Nancy C.Fanden
v`JJt� 2nd District
Martinez, California 54553
(415) 372-4080Coup/ Robert I.Schroder
County 1J 3rd District
C.E. Dixon Sunne Wright
McPeak
Interim County Administrator 4th Districts
Tom Torlskson
5th District
May 7, 1984 ; RECEIVED
Board of Supervisors J. R. OLSS-''J
OF
Administration Building CLERCONTjBOAPOSTAPcCQ-
RVISORS
651 Pine Street sv- .-�' •. °ems'
Martinez, California 94553
Dear Board Members:
I .
Re: Analysis of Health Services
Department Budget Projections
A. INTRODUCTION:
On April 24, 1984 your Board referred to our office for review and
report to your Board the budget projections dated April 13 which
were presented to the Finance Committee April 16 and to your Board
April 17 by the Health Services Department. These budget projections
included projections for the 1983.-1-984 fiscal year and the 1984-1985
fiscal year.
Since April 17, both the Health Services Department and our office
have undertaken an intensive review of these projections; have
produced numerous working documents to supplement Dr. Walker's
April 13 memorandum, and have met together on several occasions to
review the figures. As a result of this review, we are making the
following recommendations for your! Board' s consideration. Following
our recommendations are several factual conclusions we have reached
regarding the Department's projections, some background material to
supplement and document our conclusions and recommendations, and
revisions to the charts included in the Department's April 13
presentation.
B. RECOMMENDATIONS:
1 . Acknowledge receipt of this report.
2. Endorse the conclusions reached which are presented below and
direct that they form the basis from which the 1984-1985
Budget Message for the Health Services Department will be
prepared subject to continued review and refinement by this
office.
1
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Board of Supervisors
May 7, 1984
Page 2
B. RECOMMENDATIONS: (continued) '
3. Indicate the Board's intent to set June 19, 1984 at 2:30 p.m,
for another "Beilenson"Hearing on any program reductions which
are needed to balance the 1984-1985 Health Services Department
budget and direct our office and the Health Services Department
to return to the Board May 15, 1984 with the necessary notice
detailing such reductions, as well as those reductions which do
not require a "Beilenson" hearing.
4. Indicate the Board's intent that the County provide only a 40%
match for AB-8 County Health Services funds during the 1984-1985
fiscal year and direct the Acting Health Services Director to
submit a budget to our office which will accomplish such a 40%
match within the budget targets identified in No. 5 below.
5. Confirm the following target figures for the Health Services Depart-
ment, subject to the transfers identified in No. 6 and No. 7 below:
Budget Unit Name County Cost Target
450 Public Health $ 4,747,450
452 Environmental Health 854,240
460 California Children' s Service 601 ,450
465 County Cost--Hospital Care 14,800,000
467 Alcohol , Drug Abuse, Mental Health
470 State Hospital Care 600,000
TOTAL $21 ,603,140
To be transferred from 0465. Exact amount is
unknown at this time.
6. Direct our office, in preparing the Budget Message for 1984-1985,
to split the Alcohol , Drug Abuse, Mental Health Division off from
the (Hospital ) Health Services Enterprise Fund (0540) and return it
to the General Fund in Budget .Unit 0467.
7. Direct our office, in preparing the Budget Message for 1984-1985, to
split the County contribution to the (Hospital ) Health Services
Enterprise Fund (0540) between 0540 and the Contra Costa Health Plan
(0860) so that it is clear how much County money is going to the
Health Plan. Likewise all revenue used to support enrollees in the
Health Plan should be reflected directly in the Health Plan's Budget
rather than going through the (Hospital ) Health Services Enterprise
Fund first.
Board of Supervisors
May 7, 1984
Page 3
B. RECOMMENDATIONS: (_continued)
8. Reflect in the Budget Message the amount of AB-8 revenue
received from the State .as an offset to the net county cost
of County Health Services.
C. CONCLUSIONS:
1 . For the 1983-1984 fiscal year for the combined Enterprise Funds,
the Department projects net expenditures of $68.6 million and
non-County revenue of $46.9 million, leaving a net county cost of
$21 .7 million, which includes AB-8 revenue of $10,599,378. The
Department projects that by the time the Auditor closes the books
on the 1983-1984 fiscal year they will have been able to reduce
this net county cost by $2,000,000 through a combination of expenditure
reductions and revenue increases. This will leave a net county cost
of $19.7 million. There is currently $15,218,782 in County dollars
budgeted. When the deficit from 1982-1983 is added, the projected
year-end deficit is proposed to be as follows:
Expenditures- $68,600,000
Non-County Revenue 46,900,000
DIFFERENCE $21 ,700,000
Reductions 2,000,000
BALANCE $19,700,000
1982-1983 Deficit 3,282,000
TOTAL NET COUNTY COST $22,982,000
Currently Budgeted 15,218,000
NET DEFICIT 7,764,000
Our office concurs in this analysis. The net deficit will be covered
before the end of the fiscal year by transferring the proceeds of the
refinancing of County buildings to the (Hospital ) Health Services
Enterprise Fund.
2. For the 1984-1985 fiscal year for the two Enterprise Funds, the
Department projects that, in the absence of any actions to further
reduce expenditures and increase revenues, expenditures would total
$72.1 million. and non-County revenue would total $47.2 million, for
a net county cost requirement of $24.9 million. The expenditure level
needs to be increased by $500,000 to cover the cost of the new data
processing system. Since the Department's target for net county cost
is $14.8 million, there would be a deficit of $10.6 million. The
County will also receive approximately $10,839,000 in AB-8 revenue.
The Department proposes to cover this deficit as follows:
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Board of Supervisors
May 7, 1984
Page 4
Initial Deficit $10,600,000
Revenue Increases* 3,580,000
BALANCE 7,020,000
Expenditure reductions* 420,000
BALANCE 6,600,000
Additional Expenditure 1 ,500,000
reductions**
BALANCE $ 5,100,000
Reductions in Social 900,000
Service Charges
BALANCE $ 4,200,000
Reductions in Data Processing 500,000
Charges
REMAINING DEFICIT $ 3,700,000
Reductions to be recommended 3,700,000
for implementation during
June, 1984, a portion of
which requires a "Beilenson"
hearing
REMAINING DEFICIT -0-
Per Pat Godley' s April 20 memo amending page 4
of April 13 memo (See Attachment 1 )
**Per page 4 of April 13 memo (See Attachment 2)
These figures appear to be generally reasonable. However, see
several cautions regarding the Medi-Cal and Medicare assumptions
in the section below on revenues. We cannot comment on the extent
to which the final $3. 7 million in reductions is reasonable or
achievable until we have an opportunity to review the specific
reductions being recommended. In addition, see the comments on the
conclusion regarding AB-8 revenue below.
Finally, we feel that the salary and benefit cost-of-living estimates
may be somewhat on the high side and that those expenditures may
not be as large as the Department is projecting.
3. AB-8
The Department has submitted a revised page 6 for their April 13
memo. (See Attachment 3) Based on this updated information, it
appears that the County will be able to meet its 60/40 match require-
ment. Whether or not the County is able to make a 50/50 match will
depend on how the remaining $3.7 million deficit is removed from the
budget. Once those decisions have been made, the AB-8 match will be
recalculated to insure that the County is, in fact, able to maintain
at least a 60/40 match as is required by law.'
Board of Supervisors
May 7, 1984
Page 5
C. CONCLUSIONS (continued)
4. Reductions in Interdepartmental Charges to Health Services
The Department is proposing $1 .4 million in reduced charges from
other departments: $900,000 from Social -Services and $500,000
from Data Processing. The saving in Social Services will be
achieved by having Health Services take over all aspects of the
eligibility determination process other than for Medi-Cal beneficiaries.
This will be done by the financial counselors now being put in place
by Health Services. The Social Service Department will attempt to
reassign the current eligibility staff over a period of time as
vacancies occur. It is hoped that through attrition all Social
Services staff can be absorbed without any layoffs. Whether or not
this can actually be achieved will depend on turnover in the Social
Service Department. Data Processing can absorb the $500,000 loss of
revenue from Health Services by reducing overtime and taking other
actions which should avoid the layoff of any of their personnel.
5. Revenues
Attached is a summary of our revenue analysis showing the amount
budgeted for this year, the amount credited through February 29, the
amount credited in March, 1984, the total through March 31 , the
Department's projections for the full 1983-1984 fiscal year, the
Department's projections for 1984-1985," and our recommended revenue
estimates for 1984-1985 (See Attachments 4, 5, and 6). We are
essentially agreeing with the Department's estimates at this time,
but will continue to monitor the figures on a monthly basis.
Specific comments need to be made on the Medi-Cal and Medicare
estimates. The revenue estimates for both the 1983-1984 year-end
totals and the projections for 1984-1985 appear high. The Department
explains this by noting that with the use of financial counselors
they expect to identify significantly more potential Medi-Cal and
Medicare patients who have not previously been identified, or who
have refused in the past to apply for Medi-Cal and Medicare. In
addition, with their new data processing system, they expect to speed
up the submission of bills and reduce the number of bills that are
rejected for technical reasons.
We hope this is true and will monitor actual performance on a monthly
basis to -insure that these revenue estimates are achieved. If they
are not achieved, the Department has identified a contingency plan
calling for the cancellation, effective November 1 , 1984, of the
equivalent of 21 additional positions for each $500,000 in unrealized
projected revenue.
Board of Supervisors
May 7, 1984
Page 6
5. (continued)
In addition, the Department has not provided for any adjustment
of Medicare revenue for the implementation ofDRG' s (diagnostically
related groups) effective July 1 , 1984. The Department hopes to be
able to make some estimates of how much of an impact this may have
within a few weeks. We will adjust the projected revenue figures
when we review the Budget Message with the Finance Committee in July,
if necessary. The projected revenue figures do not anticipate any
increases which might be provided for in the State Budget. Again,
once the State Budget is approved, we will adjust revenue figures to
reflect any necessary changes.
Finally, the revenue estimates do not assume any decrease in inpatient
census below current levels.
Recognizing these potential problem areas which we will have to
continue to monitor closely, and refine as necessary, we are prepared
to support the proposed revenue estimates.
6. Contra Costa Health- Plan (CCHP) ,
For the 1983-1984 fiscal year, the budget for the CCHP was set up
in such a way that it is difficult to determine how much County money
is being contributed to the CCHP, or for which groups of enrollees
it is being contributed. All CCHP revenue is first credited to the
(Hospital ) Health Services Enterprise Fund (0540). A premium,
referred to as a "mixer premium" is then calculated for each group
of enrollees consisting of the non-County revenue for that group plus
the amount of County money required to cover the estimated full cost of
services to that group. The (Hospital ) Health Services Enterprise Fund
(0540) then purchases. coverage for each group of enrollees by
transferring this "mixer premium" to the CCHP (0860). The "mixer
premium" appears as an expenditure in 0540 and as revenue in 0860.
The original non-County revenue has already been shown as revenue
in 0540, of course. As medical services are provided to CCHP
enrollees, either by the County Hospital and clinics or outside
providers, CCHP pays for the services utilizing the revenue from the
"mixer premium". For services provided by non-County providers, the
payment simply appears as an expenditure in 0860. For services provided
by the Health Services Department, the payment appears as an expenditure
in 0860 and as revenue in 0540. The payment comes from the "mixer
premium" and includes both county and non-county revenue.
In preparing the 1984-1985 budget, we are proposing to change this
method of budgeting. Non-county revenue will not be credited to the
(Hospital ) Health Services Enterprise Fund (0540). All such revenue
156 _Cr-
Board of Supervisors
May 7, 1984
Page 7
6. (continued)
will be credited directly to CCHP and will be broken down by
category in considerably more detail than has" been true in the
past. In this way, it will be clear how much non-County revenue
is being received fro AFDC, Aged, Blind, Disabled, Medically Indigent
Children, Medically Indigent Adults, Medfcare and private enrollees.
In addition, the General Fund, through Account 0465, will directly
contribute the amount of County money to the CCHP needed to keep
the Health Plan solvent. This will be done by estimating the cost
of care for each category of enrollees, subtracting the non-county
revenue available for that category, and determining the balance which
will need to be made up by the County. In this way, our office, the
Board of Supervisors, and the general public will be better able to
evaluate the cost-effectiveness of the Health Plan.
We are currently evaluating the cost effectiveness of the Health Plan
as compared to fee-for-service medicine in the rest of the Health
Services Department and will include recommendations in the 1984-1985
Budget Message. In addition, we are evaluating the administrative costs
of the Health Plan and will also offer comments in this area in the
Budget Message. Finally, we are reviewing the financial advisability
of leaving the former Medically Indigent Adults in the Health Plan and
will offer recommendations in this area in the Budget Message.
D. SUMMARY:
In summary, we are recommending the following changes to the projections
presented by the Health Services Department in their April 13 memorandum:
1 . Increase the Public Health Division' s target for 1984-1985 by
$600,000 to compensate for the transfer of the Miller Centers and
other Developmental Disability Programs to the Public Health Division.
2. Reduce the Public Health Division target by $125,000 and transfer
these funds to the Environmental Health Division to compensate
Environmental Health for the anticipated revenue from a Hazardous
Waste Inspection Fee which was anticipated in 1983-1984, but which
the Board of Supervisors declined to impose.
3. Increase the Enterprise Fund target by $500,000 for the purpose of
acquiring the necessary data processing system to improve the billing
and collection systems, with the understanding that to the maximum
extent possible acquisition will be handled in such a way as to make
the funds eligible for AB-8 matching purposes.
160 ��
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Board of Supervisors
May 7, 1984
Page 8
D. SUMMARY: (continued)
4. Concur with the. Department's revenue projections for 1983-1984,
subject to the cautions noted above.
5. Concur with the Department's revenue projections for 1984-1985
except as noted above and with the cautions noted above.
6. Concur in the revised method of balancing the 1984-1985 budget
presented in the Department's April 20 revision to page 4 of the
April 13 memo.
Respectfully,
cer•61-1—
C. E. DIXON
INTERIM COUNTY ADMINISTRATOR
CED:clg
Attachments:
1 . Memo from Patrick Godley to C. E. Dixon
dated April 20, 1984, subject: 1984-85 Budget
2. Page 4 as attached to April 13 memo from William
B. Walker, M.D. to Supervisor Robert Schroder,
subject: 1984-85 Budget
3. Memo from Patrick Godley to C. E. Dixon dated
May 6, 1984, subject: AB-8 (with attachments)
4. Chart laying out summary revenue projections
for 1983-84 and 1984-85
5. Memo from C. L. Van Marter to C. E. Dixon
dated April 27, 1984, subject: Health Services
Department Revenue Estimates
6. Chart dated April 24, 1984 entitled: 1983-84
Year-End Revenue Projections, E.F. I & II
7. Revised page 1 from April 13 memo entitled:
1984-85 Budget Analysis
B. Revised page 2 from April 13 memo entitled:
1984-85 Budget Analysis Enterprise Fund I & II
Board of Supervisors
May 7, 1984
Page 9
Attachments: (continued)
9. Revised page 3 from April 13 memo entitled:
1984-85 Budget Analysis, Enterprise Fund I & II,
Full Year Projection '
10. Revised page 4 from April 13 memo entitled:
1984-85 Net Increase/Decreases
11 . Revised page 5 from April 13 memo entitled:
Net County Cost Budget Comparison
12. Revised page 6 from April 13 memo enti:tled:'
1984-85 Budget Analysis, AB-8 Review
cc: Clerk of the Board
Acting Health Services Director
Auditor-Controller
County Counsel
Nu-Med Medical , Inc.
166 - J�
'- ATTACHMENT
=� CONTRA COSTA COUNTY Contra Costa Count-
HEALTH SERVICES DEPARTMENT RECEIVE[)
APR 2 5 1984
Office of
Count.; Administrator
Charles E. Dixon, Interim
To: County Administrator pate: April 20, 1984
From: Patrick God1ey, Department
Subject:
Fiscal Officer 1984/85 BUDGET.
1
Attached as requested is a detailed -listing of the $4 million item
identified in the Department 's 1984/85 budget projection. You will note in
your review that the major element of the revenue increases relates to an
improvement in 'program' eligibilities. This increase will be achieved
primarily through the use of on-site financial counselors, currently esti -
mated at 10 F.T.E . 's, who will be agyressively pursuing all payment sources
' for each inpatient admission and outpatient encounter at the time service
is rendered .
I have discussed the content of the attached schedule with Marilyn Burke.
Please advise if additional information or clarification is required . In
the event your review takes place over the weekend, I can be reached at
(408) 943-1312 to answer your questions .
PG:cbc
Attachment
cc : Gordon Soares
William B. Walker, M.D.
C.L. Van Marter
fo - K
A-41 84-856
1984/ 5 NET INCREASE/DECREASE
- Increase in Eligibilities
(Medi-Cal/Medicare) $ 2.8
- Insurance followup .08
- Identification and Billing of Crossover Claim; .2
- Deposit Schedule for Elective Admissions ' open
- Profe-ssional Component Billing & Fee increase .2
Medicare Bad Debts open
Increase in Chargeable Items due to ne,ri
automated system .3
Subtotal Revenue Increase 3.58 .
t - Purchasing Contract. Savings .3
1 - Business Office Staff R�drrction . 12
Subtotal E>:p, nd i ture Dr_creasc, .42
Total Impact: $ 4.0
Note:
( 1 ) Above items are not cash flow projections
( 2) Revenue items will be generated uniformly throughout the fiscal period
with the exception of the "Increase in Chargeable Items" line. Charge-
able items increase will materialize during the month of Auqu;t and aril ?
be realized uniformly thereafter.
(3) The "open" 1tenlS listing are pOt:ential -evonue sources , ro o,jections are
not attached at this time pending further analysis .
(4) Business staff reductions will occur throunh t.hr, roloac.r, of trinporary
employees durinca the month of August. or Septe inher .
fig.•r",. N t -t'
4J
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ATTACHMENT 2
1984/85 BUDGET ANALYSIS
BUDGET BALANCE PLAN
Revenue: Impact:
-Increase in eligibility
-U/R TAR improvement
-Install new automated system
-Professional component billing
-Insurance followup
-Purchasing contracts
-Establish bed control system
-Revise census verification
Total : $ 4.0
Expenditure Reductions:
-Reduce HMO out-of-plan expenditures $ .5
-Reduce registry usage .05
-Reduce overtime .1
-Eliminate contracts .l
-Modify dietary contract .08
-Reduce management and administrative cost@ .35
-Implement productivity charges .3
Total : $ 1 .5
Other County Departments:*
Total : $ 1 .4
Program Curtailments:
-Hospital/Clinics Layoffs =
-Finance 101 F.T.E.
-Mental Health
Total : $ 3.7
@ Will result in elimination of eight F.T.E. positions.
* (1) May result in layoffs; (2) Requires installation of new automated system.
84-85BUD3 4/13/884
-4- `56' PA`
a u e
ATTACHMENT 3
CONTRA COSTA COUNTY
HEALTH SERVICES DEPARTMENT
To: Charles E. Dixon, Interim Date: May 6, 1984
County Administrator s
From: Q�J�N.. Subject:
Patrick Godley, Chief AB-8
Financial Officer
Department of Health Services
As I had advised you on May 1st, an additional $2.2M in allowable County
contribution is required to insure full maximization of AB-8 revenue.
Based upon the target allocation the initial alternatives were to either
(1) increase the County contribution or (2) curtail non-AB-8 services; i .e.
Mental Health.
Over the past week, .we have been reviewing the details of prior AB-8 plans
and submissions. Although few work papers exist and those that do are
incomplete we believe we have the basis for increasing the "allowable" por-
tion of AB-8 cost beyond the target allocation without the need for
increased contributions; specifically, the areas where additional costs are
claimable are as follows:
(1) Detention Facility - During the base year 1977/78, the cost associated
with the detention facility were not claimed. Commencing with
the 1982/83 fiscal period the cost for this activity was included
within the AB-8 plan and claim and was apparently approved by the
State as reimbursable. Impact: $1 .5 million.
(2) Depreciation - The target allocation does not include a line item
for depreciation. Depreciation is an AB-8 allowable expense and as
such should be claimed. By utilizing the Auditor's "printout", on
both equipment and building depreciation, additional cost can be
identified. Impact: $500,000.
(3) New Computer System - By "rewriting" the preliminary contract with
Professional Hospital Services, items which formerly would have
been capitalized can be expensed in the year of acquisition.
Impact: $350,000.
(4) Allocation Method - Through modification of our original allocation
basis; i .e., COLA; step advances, other county department reductions,
etc., we can shift cost back to the AB-8 allowable category.
n A^I !��
I .
-2-
Based upon the above and assuming the entire $4.4 million shortfall was
taken against AB-8- allowable cost the following would result:
- ;50/50 match requirement $18.9
AB-8 claimable 17.1
Undermatch 1.8
- 60/40 match requirement $16.2
AB-8 claimable 17.1
Overmatch T--9
Attachment I identifies the match requirements at the 50/50 and 60/40 ratio.
Attachment II identifies the minimum AB-8 funding level for Enterprise
Funds I & II .
Attachment III identifies the anticipated expenditure levels for Enterprise
Funds I & II .
Attachment IV identifies the claimable vs. required match amounts.
I are recommending that the above information be incorporated with your
report to the Board on the Department 's budget projections.
CLVM:PG:cbc
Attachments
cc: Stu McCullough
Gordon Soares
William B. Walker, M.D.
George Riesz
C.L. Van Marter
Frank Fernandez
Attachment I
AB-8 Match Requirements
AB-8
Per Capita Grant $ 2,823,744
State Share s 8,,015,304
$10,839,048
50/50 Match Requirements
Maximum State Share $ 8,015,304
Required County Share 8,015,304
State/County Sharing .-Base $16,030,608
Per Capita Grant 2,823,744
Required County Expenditures $18,854,352
60/40 Match Requirements
Maximum State Share $ 8,015,304
Required County Share 5,343,536
State/County Sharing Base 13,358,840
Per Capita Grant 2,823,744
Required County Expenditures $16,182,584
AB-8-2
l5°-P
Attachment II
AB-8 Allowable Cost
Public Health Target $4,747,450
Less Miller Centers/D.D. Contracts <$600,000>
AB-8 Allowable $ 4,147,450
Environmental Health Target 854,240
California Children 's Services 601 ,450
Detention Facility 1,500,000
Depreciation 500,000
Total excluding E.F. I & II (a) $ 7,603,140
Required Match at 50-50 (b) $18,854,352
(See Attachment I)
Minimum Required E.F. I & II $11 ,251,212
AB-8 Allowable Funding (B-A)
Required Match at 60-40 (c) $16,182,584
(See Attachment I)
Minimum Required E.F. I & II $ 8,579,444
AB-8 Allowable Funding (C-A)
Note: Completion of Full AB-8 Plan has not been done. Projections
of AB-8 allowable cost are felt to be substantial correct
but may change upon further analysis.
AB-8-3
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Attachment IV
Hospital/Clinics/HMO
Anticipated Expenditure Level $ 13.22
(from Schedule 'III)
Allowable AB-8 cost
excluding E.F. I & II 7.6
(from Schedule II)
Total Claimable 20.82
AB-8 cost
Less: Shortfall <3.7>
Total Claimable
AB-8 cost 17.12
50/50 Match Requirement
(Schedule I) 18.9
60/40 Match Requirement .
(Schedule I) 16.2
AB-810
5/6/84
160 -�"
Schedule A
County Dollars in A/DA/MH Programs
1983/84
Mental Health Drug Alcohol Total
Total County Contribution
SMA 2,765,963 -0- -0- 2,765,963
Overmatch 237,027 64,310 692,266 993,603
Required Match 684,591 128,384 141 ,908 954,884.
Total $3,687,581 $192,695 $834,174 $4,714,450(1)
Contracts
SMA 386,992 -0- -0- 386,992
Overmatch 91 ,333 23,442 510,310 625,085
Required Match 183,889 83,346 104,695 371 ,930
Total $ 662,214 $106,788 $615,005 $1,384,007
I & J Wards
SMA 299,359 -0- -0- 299,359
Overmatch 27,028 -0- -0- 27,028
Required Match 216,960 -0- -0- 216,960
Total $ 54� $ -0- $-0- 543934
Clinic, etc.
SMA 2,079,612 -0- -0- 2,079,612
Overmatch 118,666 40,868 181 ,956 341 ,490
Required Match 283,742 45,039 37,213 365,994
Total $2,482,020 $. 85;907 $219,169 $2,787,096
Numbers are preliminary; subject to change
(1) Maybe understated by $300,000-$500,000
5/2/84
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' ATTACHMENT 5
OFFICE OF COUNTY ADMINISTRATOR
CONTRA COSTA COUNTY
Administration Building
Martine:, California
.To: C. E. Dixon, Interim Date: April 27, 1984
County Administrator
Claude L. Van Marter, Assist Health Services Department
From: Subject: Revenue Estimates
Administrator--Human Service
The following is a description of the revenue estimates made by the
Health Services Department for 1983-1984 and 1984-1985.
9781 - Medicare-Mental Health
Actual 1982-1983 $ 984,003
Budget 1983-1984 1 ,040',000
Actual through 3/31/84 579,247
Department Projection 6/30/84 713,315
Department Proposed 1984-1985 713,315
Comment:
This account includes Medicare revenue for Mental Health patients.
Projections for 1983-1984 are probably on the conservative side.
Straight-line projection from 3/31 actual shows $772,329. Depart-
ment has requested exemption from Medicare DRG rates. If granted,
revenue should not be limited by DRG rates. Suggest revenue target
for 1984-1985 of $750,000.
9782 - Private Pay-Mental Health
Actual 1982-1983 $ 328,869
Budget 1983-1984 583,000
Actual through 3/31/84 222,711
Department Projection 6/30/84 336,450
Department Proposed 1984-1985 336,450
Comment:
This account includes fees paid by mental health patients plus any
insurance proceeds. The projections for. 1983-1984 seem reasonable.
1` Efforts by financial counselors may impact this account by shifting
some revenue to Medicare and Medi-Cal , but should also improve private
pay collections. Suggest approving department's target for 1984-1985.
C. E. Dixon
April 27, 1984
Page 2
I
9784 = Indigent-CMCP-Mental Health
Actual 1982-1983 $ 12,506
Budget 1983-1984 i 4,000
Actual through 3/31/84 1 ,821
Department Projection 6/30/84 14,000
Department Proposed 1984-1985 -0-
Comment:
This account is supposed to contain county funds used to underwrite
the share of cost written off as a part of the CMCP program. I am not
convinced it has ever been accurate. Suggest use of the account be
abandoned in 1984-1985. Funds previously budgeted here should be
reflected as a part of the county contribution in Account 9865.
9816 - Medicare-Regular Health
Actual 1982-1983 $4,504,395
Budget 1983-1984 5,440,000
Actual through 3/31/84 2,749,013
Department Projection 6/30/84 4,485,338
Department Proposed 1984-1985 5,285,338
Comment:
This account contains all Medicare revenue except for the mental health
revenue contained in 9781 . The department expects that the use of
financial counselors should be able to qualify more people for Medicare
and improve the speed with which billings are submitted. The implemen-
tation of DRG's July 1 , 1984 may have an impact on this account. The
1983-1984 projections, while looking somewhat optimistic at this point,
may be achievable. Taking 3/31 actual ,and adding the March receipts
for the balance of the year shows revenue of $4,019,378. We should
probably go along with the 1984-1985 projections at this time, but
monitor actual billings closely to determine whether they are achieving
the level of revenue they project.
9817 - Medi-Cal-Regular Health
Actual 1982-1983 $10,260,087
Budget 1983-1984 8,610,386
Actual through 3/31/84 4,998,742
Department Projection 6/30/84 6,302,121
Department Proposed 1984-1985 8,702,121
C. E. Dixon
April 27, 1984
Page 3
9817 - Medi-Cal-Regular Health (continued)
Comment:
This account contains all Medi-Cal revenue other than the mental
health revenue contained in Account 9852. 'The department's
1983-1984 projections appear to be somewhat conservative. Straight-
line projections from 3/31 actual show revenue at $6,664,989. The
use of financial counselors, clearing out backlogged billings and
improved eligibility processing should make the 1984-1985 projection
achievable. In addition, there may be some rate increases and an
opportunity to renegotiate our inpatient contract with the State.
9818 - Private Pay-Regular Health
i
Actual 1982-1983 $2,778,361
Budget 1983-1984 2,640,000
Actual through 3/31/84 2,228,985
Department Projection 6/30/84 2,908,614
Department Proposed 1984-1985 3,288,614
Comment:
1983-1984 projections appear conservative, as do 1984-1985 projections.
The use of financial counselors should improve collections. Straight-
line projection from 3/31 actual shows 1983-1984 revenue at $2,971 ,980.
We should agree with department's projections for 1984-1985.
9819 - Interdepartmental-Regular Health
Actual 1982-1983 $10,391 ,828
Budget 1983-1984 80,000
Actual through 3/31/84 56,657
Department Projection 6/30/84 83,338
Department Proposed 1984-1985 83,338
Comment:
In 1982-1983, this account included revenue for patient services
provided to the Health Plan. This revenue was shifted to Accounts
9825 and 9826 in 1983-1984, leaving charges made to the Sheriff
and Probation Department for medical care provided at the work furlough
. program,. Juvenile Hall , and Ranch. Projections for 1983-1984 and
1984-1985 appear reasonable.
C. E. Dixon
April 27, 1984
Page 4
9820 - Indigent-CMCP-Regular Health
Actual 1982-1983 $ 497,571
Budget 1983-1984 280,000
Actual through 3/31/84 175,190
Department Projection 6/30/84 280,000
Department Proposed 1984-1985 +-0-
Comment:
Use of this account should be discontinued as per comments above
regarding 9784 and funds transferred to County subsidy Account 9865.
9821 - MIA State Premium
Actual 1982-1983 $6,567,249
Budget 1983-1984 8,850,000
Actual through 3/31/84 5,161 ,436
Department Projection 6/30/84 8,848,181
Department Proposed 1984-1985 8,848,181
Comment:
Revenue in this account represents the payment from the State for
MIA's and is entirely dependent on the appropriation made by the
Legislature. The program was in effect for only eight months in
1982-1983. The 1983-1984 projection is accurate in that it represents
the amount contained in the agreement in the Board agenda for May 1 .
The department is projecting the same level of funding for 1984-1985.
Receipts since January have been suspended until the agreement is
signed by the Board. We should then receive payments for February,
March, and April . The department' s. projections should be approved
at this time and adjusted once the State budget is signed.
9822 - Drinking Drivers' Program Fees
Actual 1982-1983 $ 394,434
Budget 1983-1984 522,000
Actual through 3/31/84 332,088
Department Projection 6/30/84 443,613
Department Proposed 1984-1985 443,613
Comment:
Revenue in this account comes from fees charged for alcoholism
counseling sessions authorized by SB 38 (.Chapter 890, -Statutes of
1977). The fees are set by the Board of Supervisors with the approval
of the State Department of Alcohol and Drug Programs. The current fee
is $855, effective July 1 , 1982. The department's projections for
C. E. Dixon
April 27, 1984
Page 5
9822 - Drinking Drivers' Program Fees (continued)
1983-1984 appear accurate. Consideration should be given to
increasing the fee schedule effective July 1 , 1984 in order
to insure that the program remains self-supporting. The program
is currently authorized by Chapter 9, Part% 2, Divisi-on 10.5,
Health and Safety Code, as added by Chapter 679, Statutes of
1979, and as amended most recently by Chapter 1338, Statutes of
1982.
9823 - Alcoholism Counseling Fees
Actual 1982-1983 $ 133,589
} Budget 1983-1984 110,000
Actual through 3/31/84 191 ,595
Department Projection 6/30/84 262,497
Department Proposed 1984-1985 262,497
Comment:
This account includes revenue from the AIRS counseling fees.
These fees are also set by the Board of Supervisors. The fees
are currently $60.00 per session for individual counseling and
$15.00 per session for group counseling. The current fees were
effective July 1 , 1982. Consideration should be given to increasing
the fees effective July 1 , 1984. The projections for 1983-1984
appear reasonable as do the 1984-1985 projections, in the absence
of a fee schedule increase.
9824 - Interdepartmental-Detention Facility
Actual 1982-1983 $1 ,478,834
Budget 1983-1984 1 ,500,000
Actual through 3/31/84 1 ,142,100
Department Projection 6/30/84 1 ,515,487
Department Proposed 1984-1985 1 ,515,487
Comment:
This revenue account covers the cost of medical services provided to
the Sheriff-Coroner for the detention facilities operated by the
Sheriff-Coroner. The revenue is based on an interdepartmental
agreement under which the Sheriff pays .a fixed daily fee for each
prisoner in the detention facilities. Revenue varies with changes
in the population in the facilities. The projections for 1983-1984
and 1984-1985 appear sound, assuming the Sheriff-Coroner continues
to use the Health Services Department. Some consideration has been
given to contracting out the medical care at the detention facilities
to a private firm.
C. E. Dixon
April 27, 1984
Page 6
9825 - Interdepartmental-Health Plan-MIA's
Actual 1982-1983 N/A
Budget 1983-1984 $6,556,000
Actual through 3/31/84 5,875,562
Department Projection 6/30/84 ?
Department Proposed 1984-1985 ? '
Comment:
This account reimburses Enterprise Fund I for the cost of health
care provided to MIA' s who are enrolled in the Contra Costa Health
Plan. To avoid duplication of revenues, this account must be dropped
out since this revenue is also reflected in Account 9821 . The depart-
ment has made no 6/30 projection nor a projection for 1984-1985
since these figures will have to be derived from the expenditures
being made by Enterprise Fund II. A straight-line projection from . . .
3/31 actual would show revenue at $7,834,083, substantially above .
the amount budgeted. This figure will , however, have to be verified
with the department. This account was not used in 1982-1983 since
this revenue was shown in 9819.
9826 - Interdepartmental-Health Plan-Other
Actual 1982-1983 N/A
Budget 1983-1984 $6,964,000
Actual through 3/31/84 6,039,993
Department Projection 6/30/84 ?
Department Proposed 1984-1985 ?
Comment:
This account reimburses Enterprise Fund I for the cost of health care
provided to all enrollees of the Health Plan other than the MIA's. As
with Account 9825, this account duplicates revenue already accounted
for in revenue accounts 9847, 9849, 9853, 9854, and 9855 and must be
dropped out in looking at real -net revenue. The department has made
no 6/30 projection nor a projection for 1984-1985. These figures
will be derived from the expenditures being made by Enterprise Fund II.
A straight-line projection from 3/31 actual would show revenue at
$8,053,324, substantially above budget.. This figure will , however,
have to be verified with the department. This account was not used
in 1982-1983 since this revenue was shown in 9819.
C. E. Dixon
April 27, 1984
Page 7
9.845 - Regional Developmental Disability Programs
Actual 1982-1983 $ 361 ,450
Budget 1983-1984 N/A
Comment:
This account reflects revenue used to support the George Miller,
Jr. Centers. It includes revenue from the Regional Center of the
East Bay and the County Superintendent of Schools. The Developmental
Disabilities Programs were transferred to the Public Health Division
during the 1983-1984 fiscal year and will now be reflected in
Budget Unit 450 in the General Fund.
9846 - NIMH Grant
Actual 1982-1983 $1 ,867,724
Budget 1983-1984 1 ,400,000
Actual through 3/31/84 952,003
Department Projection 6/30/84 1 ,428,000
Department Proposed 1984-1985 1 ,428,000
Comment:
This revenue account reflects federal revenue for this County's
Community Mental Health Center grant, now a part of the federal
mental health block grant. The projection for 1983-1984 is confirmed
by our State mental health allocation letter. The level of funding
for 1984-1985 is dependent on Congressional appropriations and the
State's process of allocating the funds. The 1984-1985 projection
should be monitored closely as federal and state decisions become
clearer. This revenue'supports the majority of the County's mental
health programs in west County.
9847 - Contra Costa Health Plan Premiums
Actual 1982-1983 N/A
Budget 1983-1984 $ 550,000
Actual through 3/31/84 449,283
Department Projection 6/30/84 587,230
Department Proposed 1984-1985 587,230
Comment:
This revenue account reflects premiums paid by private groups and
individuals who are enrolled in the Health Plan, other than Medicare,
Medi-Cal , and MIA's. During 1982-1983, .this revenue account
appeared only in Enterprise Fund II and was structured in s.uch a
C. E. Dixon
April 27, 1984
Page 8
9847 - Contra Costa Health Plan Premiums (continued)
way as to make comparisons with 1983-1984 impossible. The
projections for 1983-1984 and 1984-1985 appear sound. Consideration
should be given to increasing the premiums, charged to reflect
cost-of-living increases.. The 1984-1985 revenue estimates could
then be increased.
9848 - Drivers' Fines AB 2086
Actual 1982-1983 $ 311 ,391
Budget 1983-1984 300,000
Actual through 3/31/84 225,490
Department Projection 6/30/84 323,632
Department Proposed 1984-1985 323,632
Comment:
This revenue account includes revenue from two programs--the $50 fine
per conviction of certain specified vehicle code violations related
to drunk driving (AB 2086, Chapter 661 , Statutes of 1980) and fees
received from the First Offenders Program pursuant to AB 541 , Chapter 940,
Statutes of 1981 . The AB 2086 fine revenue must be dedicated to
alcohol programs and has been dedicated by the Board of Supervisors to
the construction and operation of the Central County Detoxification
Facility. The fees from AB 541 go to support the First Offender
Alcoholism education and counseling program authorized pursuant to
Vehicle Code Section 23161 . These fees are set by the Board of
Supervisors. The current fees are $5.00 per session for alcohol
education and $15.00 per session for alcoholism treatment. Considera-
tion should be given to increasing these fees which were effective
July 1 , 1982.
9849 - Health Partnership Premiums
Actual 1982-1983 $ 24,705
Budget 1983-1984 200,000
Actual through 3/31/84 115,045
Department Projection 6/30/84 118,285
Department Proposed 1984-1985 118,285
Comment:
This revenue account includes payments by MIA enrollees in the Health
Plan who have a share of cost for their care. Because the MIA program
was in effect for only part of the 1982-1983 fiscal year, comparisons
are not valid with 1983-1984. The 1983-1984 projection and 1984-1985
C. E. Dixon
April 27, 1984
Page 9
9849 - Health Partnership Premiums (continued)
projection appear on the low side. A straight-line projection
from 3/31 actual shows revenue to be $153,393.. The projections
for 1984-1985 are probably on the low side by a corresponding
amount.
9851 Regular Short-Doyle
Actual 1982-1983 $5,289,134
Budget 1983-1984 4,860,000
Actual through 3/31/84 3,429,368
Department Projection 6/30/84 5,144,057
Department Proposed 1984-1985 5,144,057
Comment:
This account includes State revenue used to support the County's
mental health program. These funds are fixed by an allocation from
the State based on how much has been approved in the State Budget.
A portion of the Short-Doyle funds are allocated to Account 9852
to provide the required State match for federal Medi-Cal funds
received for mental health services provided to eligible Medi-Cal
beneficiaries. The balance of the funds are assigned to this account.
We have asked the department staff to verify that the 6/30 projections
for this account, 9852 and 9857, are within our allocation letter.
Assuming for the moment that they are, the projections are acceptable.
The department has projected no increase in 1984-1985 for this
account. There is a strong likelihood that the County will receive
an increase in Short-Doyle funds of between 6-1/2% and 12-1/2%.
Actions on the State Budget should be monitored closely and this
L account should be adjusted to reflect the actual allocation.
9852 - Medi-Cal Mental Health
Actual 1982-1983 $4,473,491
Budget 1983-1984 4,140,000
Actual through 3/31/84 2,651 ,402
Department Projection 6/30/84 3,951 ,152
Department Proposed 1984-1985 3,951 ,152
Comment•
This revenue account reflects Medi-Cal eligible services provided to
Medi-Cal eligible individuals. This account reflects both the federal
Medi-Cal dollars and the portion of the County's allocation of State
Short-Doyle dollars the County has used to purchase federal Medi-Cal
dollars. The federal government presently pays approximately 48.5%
of the cost with Short-Doyle paying about 51 .5%. The amount the County
C. E. Dixon
April 27, 1984
Page 10
9852 - Medi-Cal Mental Health (continued)
is reimbursed for these. services, as well as those in Account
9851 , is capped at 125% of a base year statewide average cost
as is permitted by Welfare & Institutions Code Section 5705 as
amended by AB 799 (Chapter 328, Statutes of 1982)
%
Because of this cap, there is a strong incentive to reduce the
cost of services. Since the available Short-Doyle dollars go
nearly twice as far if eligible to Medi-Cal , there is also a strong
incentive to identify every Medi-Cal eligible person. There will
probably not be a large rise in this account since it is more
related to the number of Medi-Cal eligibles served than it is to
the number of available Medi-Cal dollars. Assuming this account
is within the 1983-1984 allocation letter, the 1983-1984 and
1984-1985 projections appear acceptable.
9853 - HMO Program Payments
Actual 1982-1983 $1 ,608,100
Budget 1983-1984 2,190,000
Actual through 3/31/84 482,754
Department. Projection 6/30/84 506,631
Department Proposed 1984-1985 506,631
E
Comment:
This account includes revenue from the federal government to provide
premiums for Medicare individuals enrolled in the Health Plan. The
department's 6/30 projection seems conservative, as does the 1984-
1985 projection. Straight-lining the 3/31 actual would show revenue
at $643,672. The revenue in this account is entirely dependent on
the number of enrollees who are eligible to Medicare.
9854 - HMO Private Pay Premiums
Actual 1982-1983 $ 176,845
Budget 1983-1984 415,000
Actual through 3/31/84 260,663
Department Projection 6/30/84 358,186
Department Proposed 1984-1985 358,186
Comment:
This account includes premiums paid by Medicare enrollees in the
Health Plan who are not eligible to Medi-Cal . The premiums they
pay cover the cost of their Medicare co-insurance and deductib.les
only (low option) , or bring their coverage up to Medi-Cal standards
(high option). The department's projections appear appropriate:
C. E. Dixon
April 27, 1984
Page 11
9855 - PHP Medi-Cal Premiums
Actual 1982-1983 $4,119,421
Budget 1983-1984 4,070,000
Actual through 3/31/84 3,422,670
Department Projection 6/30/84 4,772,197
Department Proposed 1984-1985 4,77,2,197
Comment:
This revenue account includes state and federal Medi-Cal funds
paid to the County in the form of premiums for Medi-Cal enrollees
in the Health Plan. It varies with the number and category of
enrollees and the premium level paid by the State. The 3/31
actual does not include the premium rate increase for 1983-1984.
If those funds, which will average $50,000 per month are included,
straight-lining the 3/31 actual would show revenue of $5,163,560.
The department's 1984-1985 projection is also conservative since
it is reasonable to expect a rate increase for 1984-1985.
9856 - Alcohol Program Payments
Actual 1982-1983 $1 ,474,623
Budget 1983-1984 1 ,330,000
Actual through 3/31/84 666,220
Department Projection 6/30/84 1 ,355,700
Department Proposed 1984-1985 1 ,355,700
Comment:
This revenue account includes state and federal funds to support the . :
County's alcoholism programs. This revenue is dependent on the level
of funds in the State Budget. The projections for 1983-1984 are
consistent with the County' s allocation letter. The 1984-1985
proposed figure reflects no increase from the State. Actions on
the State Budget should be closely monitored to determine whether
any additional funds are approved, in which case this account should
be adjusted accordingly.
9857 - SRS Continuing Care
Actual 1982-1983 $ 365,243
Budget 1983-1984 380,000
Actual through 3/31/84 296,514
Department Projection 6/30/84 444,031
Department Proposed 1984-1985 444,031
Comment•
This revenue account includes State funds. provided to the County for
the transfer of the Continuing Care function which-.has previously
C. E. Dixon
April 27, 1984
Page 12
9857 - SRS Continuing Care (continued)
been a State responsibility. These funds are provided as a
part of the Short-Doyle allocation. We have requested
information from the department on whether their 1983-1984
projections are within the allocation letter.
,
9858 - Drug Abuse-Short-Doyle
Actual 1982-1983 $ 623,354
Budget 1983-1984 750,000
Actual through 3/31/84 310,611
Department Projection 6/30/84 688,176
Department Proposed 1984-1985 688,176
Comment:
This revenue account includes State Short-Doyle funds used to
support the County's drug abuse prevention and treatment programs.
The level of funding is dependent on the State Budget. The
1983-1984 projections are consistent with our allocation letter.
The 1984-1985 proposed level of funding presumes no cost-of-living
increase. Action on the State Budget should be monitored closely
and this account adjusted to correspond to the level of funding
provided by the State.
9859 - Drug Abuse Grant Programs
Actual 1982-1983 $ 200,948
Budget 1983-1984 350,000
Actual through 3/31/84 128,972
Department Projection 6/30/84 363,749
Department Proposed 1984-1985 363,749
Comment:
This revenue account includes federal funds from the "Jobs Bill"
one-time allocation and from .the federal block grant for drug
programs. It also includes grants from the State for contracts
with the Center for Human Development. The department's 1983-1984
projection appears to slightly exceed the State allocation letter.
In addition, the 1984-1985 proposed level includes continuation of
the "Jobs Bill" funds of $22,053 which we understand to be one-time
funds that are not likely to continue into the 1984-1985 fiscal year.
More refinement is needed in this account before agreeing to a
1984-1985 funding level .
C. E. Dixon
April 27, 1984
Page 13
9860 = Other Grants and Donations
Actual 1982-1983 $ 593,407
Budget 1983-1984 940,000
Actual through 3/31/84 154,546
Department Projection 6/30/84 231 ,819
Department Proposed 1984-1985 231 ,819
Comment:
This revenue account includes an OCJP grant to the jail medical
program ($142,000) and grants from U. C. Davis for the family
practice residency program. Some other miscellaneous grants are
also included. Since funding levels depend on annual grants for
various purposes comparisons between years are difficult to make.
Further documentation will be needed to support the 1984-1985
proposed level of funding.
9861 - Cafeteria Receipts
Actual 1982-1983 $ 190,924
Budget 1983-1984 -0-
Actual through 3/31/84 6,776
Department Projection 6/30/84 8,483
Department Proposed 1984-1985 -0-
Comment:
During the 1983-1984 fiscal year the food service was contracted
out to a private firm. Cafeteria revenue is now deducted from the
contract payment made to the firm rather than being shown as revenue;
hence, the zero budget for 1983-1984 and 1984-1985. The actual
receipts apparently represent some residual payments made during
the year, but should not be anticipated to continue.
9862 - Medical Records/Abstracts
Actual 1982-1983 $ 16,606
Budget 1983-1984 17,000
Actual through 3/31/84 17,902
Department Projection 6/30/84 22,645
Department Proposed 1984-1985 22,645
Comment:
This revenue account includes money received from duplicating
medical records or abstracts for attorneys, insurance companies,
or individuals. Fees are charged based on fees approved by the
Board of Supervisors. The department's projections for 1983-1984
J.
C. E. Dixon
April 27, 1984
Page 14
9862 - Medical Records/Abstracts (continued)
and 1984-1985 are, if anything, conservative. Straight-lining
actuals for 3/31 show revenue to be $23,869. The fee schedule
should be reviewed to insure that it contihues to be competitive
with similar charges made by other institutions.
9863 - Occupancy Rent
Actual 1982-1983 $ 205,790
Budget 1983-1984 79,000
Actual through. 3/31/84 79,219
Department Projection 6/30/84 105,648
Department Proposed 1984-1985 35,000
Comment.:
This revenue account includes charges to the Social Service Depart-
ment for the use of trailers for the eligibility staff. This revenue
is not expected in 1984-1985 because the department has planned to
take over the eligibility function themselves. In 1982-1983, this
account also included revenue from the Superintendent of Schools for
rent of space in the Miller Centers. This revenue has now been
transferred to 450 in the General Fund. The only revenue anticipated
to continue in 1984-1985 is for the rent to Bi-Rett of the County
facility in Concord for the Central County Detox facility. The
proposed budget for 1984-1985 is acceptable.
9864 - Other Revenue
Actual 1982-1983 $ 427,257
Budget 1983-1984 200,000
Actual through 3/31/84 311 ,599
Department Projection 6/30/84 111 ,717
Department Proposed 1984-1985 111 ,717
Comment:
This revenue account includes a variety of miscellaneous sources of ..
revenue which are not appropriately included elsewhere. This includes
the sale of silver from X-ray negatives, interest charged by collec-
tion agencies on accounts and shared with the County, -revenue from
pay phone on the hospital grounds, and reimbursements for personal
telephone and postage used by employees. In 1983-1984, the one-time
revenue from National Medical Enterprises for the sale of County Hospital
beds was also credited here. The department has not taken credit for
this revenue in their 1983-1984 projections. The proposed level for
1984-1985 appears accurate.
C. E. Dixon
April 27, 1984
Page 15
9865 County Subsidy
Actual 1982-1983 $14,856,880
Budget 1983-1984 14,384,782
Actual through 3/31/84 9,585,365
Department Projection 6/30/84 14, 84,782
Department Proposed 1984-1985 14,250,000
Comment:
This revenue account includes all county funds contributed to
the Enterprise Fund by the General Fund except for accounts
9784 and 9820 which are being recommended be combined with
this account beginning in 1984-1985 and account 9866 which
contains funds to pay for the county share of the .State alcohol ,
drug abuse, and mental health allocations. These accounts,
taken together, must balance to account 465 in the General Fund.
The department's projection for 1983-1984 does not include
covering the projected deficit for 1983-1984. Therefore, the
figure is likely to end up more in the area of $22. 3 million
when the entire deficit is paid off. The proposed figure for
1984=1985 is the target of $14. 3 million set by the Board plus
$500,000 for capital expenditures minus the $550,000 contained
in account 9866.
9866 - Alcohol/Drug Abuse/Mental Health County Share
Actual 1982-1983 $ 574,800
Budget 1983-1984 550,000
Actual through 3/31/84 412,502
Department Projection 6/30/84 550,000
Department Proposed 1984-1985 550,000
Comment:
This revenue account contains the statutorily mandated county share
for alcohol , drug abuse, and mental health expenditures. The local
share is 10% for outpatient expenditures and 15% for inpatient
expenditures. This account does not include the 15% match for
state hospital care which is contained in account 470 in the General
Fund. It is unclear whether sufficient funds were budgeted in this
account. The department has been asked to determine how much is
actually required for this account and adjust their 1983-1984
projections accordingly. The 1984-1985 'figure is probably also too
low, particularly if any additional state funds are appropriated in
the 1984-1985 State Budget since an additional match will be
required for any such funds. Any transfers into this account for
1984-1985 should be made from Account 9865 rather than from the
General Fund.
C. E. Dixon
April 27, 1984
Page 16
9867 - Other Interdepartmental Charges
Actual 1982-1983 $ 561 ,642
Budget 1983-1984 367,000
Actual through 3/31/84 122,991
Department Projection 6/30/84 168,516
Department Proposed 1984-1985 168,516
Comment:
This revenue account includes miscellaneous charges to other
departments and to other units of the Health Services Department
which are not reflected elsewhere. Among these items are charges
to the Social Service Department for Security Guard services
provided to Social Services and charges to Public Health for
their use of the Contracts and Grants Unit. The projections
for 1983-1984 and 1984-1985 appear appropriate.
9868 - Special Clinic Fees
Actual 1982-1983 $ 20,236
Budget 1983-1984 -0-
Actual through 3/31/84 26,911
Department Projection 6/30/84 26,910
Department Proposed 1984-1985 -0-
Comment:
This revenue account contains revenue from some special clinics
which have since been discontinued. The revenue shown for 1983-1984
is actually a carryover from prior years and will not be repeated
in 1984-1985. The proposed budget of zero is appropriate.
9869 - Education and Training Charges
Actual 1982-1983 $ 9,453
Budget 1983-1984 12,000
Actual through 3/31/84 2,636
Department Projection 6/30/84 2,636
Department Proposed 1984-1985 . 2,636
Comment:
This revenue account contains fees from employees and non-employees
for training sessions operated by the department. More classes were
originally .planned for 1983-1984 than were actually carried out.
While firm plans for 1984-1985 have not been completed, the current
projections appear appropriate.
CLVM:clg
' ATTACHMENT 6
1983-84 YEAR-END REVENUE PROJECTIONS E.F. I & II
Dept.
Projected , Straight Line Straight Line March Y-T-D
Revenue through from from plus
Account 6/30/84 2/29/84 3/31/84 3 X March
9781 $ 713,315 $ 717,267 $ 772,329 $ 882,454
9782 336,450 336,448 296,948 217,947
9784 4;000 4, 107 s 2,428 - N/A
9816 4,485,338 3,488,335 3,665,351 4,019,378
9817 6,302,121 6,700,248 6,664,989 6,594,472
9818 2,908,614 2,908,614 2,971 ,980 3,098,712
9819 83,338 83,338 75,542 59,951
9820 280,000 239,329 233,586 222,101
9821 8,848,181 PER STATE ALLOCATION LETTER
9822 443,613 443,613 442,783 441 ,129
9823 262,497 262,498 255,460 241 ,373
9824 1 ,515,487 1 ,516,320 1 ,522,800 1 ,535,760
9846 1 ,428,000 PER FEDERAL/STATE ALLOCATION LETTER
9847 587,230 587,232 599,044 622,668
9848 323,632 283,246 300,653 335,464
9849 118,285 118,285 153,393 223,609
9851 5,144,057 5,144,052 4,572,490 3,429,368
9852 3,951 ,152 3,977,103 3,535,203 2,651 ,402
9853 506,631 1 ,160,446 1 ,089,641 948,031
9854 358,186 358,186 347,550 326,279
9855 4,772,197 4,129,569 4,117,590 4,093,634
9856 1 ,355,700 PER STATE ALLOCATION LETTER
9857 444,031 444,031 395,352 297,993
9858 6.88,176 465,916 414,148 310,611
9859 363,749 172,782 171 ,962 170,324
9860 231 ,819 231 ,819 206,061 154,546
9861 8,483 8,482 9,034 10,139
9862 22,645 22,647 23,869 26,314
9863 105,648 114,435 105,625 88,006
9864 111 ,717 111 ,117 316,162 1 ,022,965
9865 14,384,782 DEPENDENT ON BOARD APPROPRIATION
9866 550,000 DEPENDENT ON CLAIMABLE EXPENDITURES
9867 168,516 168,516 163,988 154,932
9868 26,910 40,367 35,881 26,911
9869 2,631 3,946 3,515 2,651
County Administrator's Office
April 24, 1984
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ATTACHMENT 10
1984/85 NET INCREASE/DECREASE
- Increase. in Eligibilities
(Medi-Cal/Medicare) $ 2.8
- Insurance followup .08
- Identification and Billing of Crossover Claims , , .2
- Deposit Schedule for Elective Admissions open
- Professional Component Billing & Fee Increase .2
-Medicare Bad Debts open
- Increase in Chargeable Items due to new
automated system .3
Subtotal Revenue Increase 3.58
- Purchasing Contract Savings .3
- Business Office Staff Reduction .12
Subtotal Expenditure Decrease .42
Total Impact: $ 4.0
Note•
(1 ) Above items are not cash flow projections
(2) Revenue items will be generated uniformly throughout the fiscal period
with the exception of the "Increase in Chargeable Items" line. Charge-
able items increase will materialize during the month of August and will
be realized uniformly thereafter.
(3) The "open" items listing are potential. revenue sources; projections are
not attached at this time pending .further analysis.
(4) Business staff reductions will occur through the release of temporary
employees during the month of August or September.
84-85 NI-D
5/4/84
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ATTACHMENT 12 .
1984/85 Budget Analysis
AB-8 Review
Per Capita Grant 2,823,744
State Share 8,015,304
Total 10,839,048
Required AB-8 Allowable
County Contribution at
50-50 ratio 18,854,352
Required AB-8 Allowable
County Contribution at
60-40 ratio 16,182,584
EF I County Contribution
excluding Mental Health 8,360,000
Public Health 4,272,450
Environmental Health 729,240
California Children's Services 601,450
AB-8 Allowable 13,963,140
Note: Preliminary Data subject to. review
*Based upon C.A.O. target allocation 4/30/84
84-85BUD4