MCHENRY COUNTY MHB FINANCE & AUDIT

AGENDA ● AUGUST 20, 2019

Public Meeting Mental Health Board - Main Floor Conference Room 5:00 PM 620 Dakota Street, Crystal Lake, IL 60012

McHenry County Page 1 Updated 8/16/2019 12:48 PM

I. CALL TO ORDER Roll Call

II. PUBLIC COMMENT III. APPROVAL OF MINUTES - FOR ACTION

Minutes of the July 16, 2019 Finance and Audit Committee

IV. TREASURER'S REPORT - FOR DISCUSSION / RECOMMENDATION Treasurer's Report for the Period Ending July 31, 2019

V. OLD BUSINESS - FOR DISCUSSION / RECOMMENDATION / APPROVAL A. ERP Update Report Building

VI. NEW BUSINESS - FOR DISCUSSION / RECOMMENDATION / APPROVAL A. FY19 Funding Revision

FY19 Budget Revision

B. Clearbrook CILA and DDMI Clinic Start Up Funding Clearbrook CILA and DDMI Clinic Start Up

C. ABBH Youth Partial Hospitalization Program Expansion Funding Alexian Brothers Behavioral Health Child PHP/IOP Expansion Funding

D. FY20 Budget Summary Revisions FY20 Budget Summary Revisions

VII. PUBLIC COMMENT VIII. ADJOURN

McHenry County Mental Health Board

MHB Finance & Audit Committee

July 16, 2019 ● 5:00 p.m.

Held at: Mental Health Board, 620 Dakota Street, Crystal Lake, IL 60012

Committee Members present: Mike Baber, Tracy Champion, Sam Melei, Paula Yensen (5:06 p.m.)

Committee Members absent: Rachel Boldman

Others present: Bobby Gattone, Holly Puchner, Scott Block, Jane Wacker, Terry Braune, Pat Peterson

I. CALL TO ORDER – Sam Melei called the meeting to order at 5:02 p.m. Roll Call was taken.

II. PUBLIC COMMENT – None.

Bobby Gattone, CCCS - informed members of new projects their agency is focusing on. Their Building

Financial Literacy workshops in collaboration with other agencies (Rosecrance, ND, TLS, HOS, etc.) has been

most successful, 72 have been held over a 12-month period. Of the clients attending, 60% report reduced anxiety

and 96% say that the workshops provide good tools to build financial success. Bobby noted that they have noticed

a good fit with SUD clients and will continue to work with transitioning Rosecrance clients and others in similar

agencies. As a result of discontinued funding from the Community Foundation they will be increasing funding

requests in FY20.

Holly Puchner, Turning Point - thanked the Committee for the Board’s reallocation of their funding to PAIP.

III. APPROVAL OF MINUTES - FOR ACTION

Mike Baber motioned to approve the Minutes of the June 18, 2019 Finance and Audit Committee Meeting.

Seconded by Paula Yensen. A VOICE VOTE WAS TAKEN. All in favor. Motion carried.

IV. TREASURER'S REPORT - FOR DISCUSSION / RECOMMENDATION

Jane Wacker provided a review of the Treasurer's Report for the Period Ending June 30, 2019.

The Balance Sheet being satisfactory; Jane reviewed packet page 6:

Telecommunications reflects a larger number due to County billing of fiber optics

Building Repair and Maintenance is related to plumbing issues

Computer Program Maintenance is Policy Tech program and Adobe programming

Meeting Expense has a negative dollar amount due to credit card hotel payment refund

Computer Equipment line related to wireless project

Pp. 7 - many agencies are caught up so percentages are much closer to what they should be. Thresholds is

projecting overutilization. Scott noted discussion with McHenry County Director who foresees a FY20 request

increase now that they are projecting to over-utilize FFS funds. He anticipates a request of about $700,000 for

their FFS programs next year. Allowing other overutilizing agencies to use funds from other underutilizing

agencies may be a consideration this year. As an example A Way Out program was underutilizing so $13,000 was

reallocated to provide for funding of the AmeriCorps SUD Allies program.

Pp. 10 - New Directions and Pioneer Center numbers have not been entered yet. This is for the $475,000 for

homeless shelter and potential $200,000 more if New Directions meets Zoning Board approval. As an update, the

Zoning Board heard the testimony but because only five of seven members were present, the vote for ZBA

funding has been held until their July 31st meeting in order to get seven members in attendance. The shelter can be

completed for the $475,000 but having the $200,000 will make a supportive difference. If not approved by the

ZBA, the MHB would not provide the $200,000 in funding.

Pg. 12 - Jane noted:

Thresholds non-Medicaid projecting $730,000, which would be over utilization at $350,000 for the year

Turning Point’s $30,000 reallocation has not yet been recorded as contracts are pending

Pp. 13 - projected yearend is -$2.4M does include amounts that can be capped and if you add these back in, it is at

-$2M. Scott reminded the Committee members that in the past there was a FFS set aside. In recent years the

Board has elected not to do this. This causes dollars to roll over, which gives the appearance there are dollars

available.

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Mike Baber motioned to recommend approval to the full Board of the Treasurer's Report for the Period

Ending June 30, 2019. Seconded by Tracy Champion. A ROLL CALL VOTE WAS TAKEN. Mike Baber –

Yes, Tracy Champion – Yes, Sam Melei – Yes, Paula Yensen – Yes. All in favor. Motion carried

V. OLD BUSINESS - FOR DISCUSSION / RECOMMENDATION / APPROVAL

A. ERP Update

Jane reported that the County is moving forward into a support stage. They have completed implementation and

are now doing updates. There is a stage 2 for creation. Two items in this were of interest to MHB staff: a data

warehouse to access data for reporting and a dashboard so that staff can pull up information quickly.

Staff were having an issue with one report and just recently were able to convey the problem to county staff. Jane

reported that this has always been what the MHB needed and the County now understands the situation. The

County will review it and provide options.

The relationship between the audit and the system was discussed. Jane continues to be on the core team for the

ERP.

VI. NEW BUSINESS - FOR DISCUSSION / RECOMMENDATION / APPROVAL

A. Mid-year Reconciliation Summary

A handout was provided. Scott noted that the mid-year report is intended to provide preparation for the year-end

report allowing providers to receive feedback. It also allows for agencies to see how they are spending and allows

the MHB to see grant opportunities at mid-year and determine why agencies are underutilizing.

Jane reported generalities noted on the handout:

20 agencies submitted reconciliation

Reconciliation is needed for Grant or POP

Gold highlighted boxes were considered late

3 rejected because of no client counts (not historically rejected mid-year but done due to repetition of

notice)

3 rejected due to non-MHB funds or non-MHB programs added to program columns

A few reported exactly ½ of budget as expense, this was pointed out to them

1 agency client count was only 23% of clients but agency had used 35% of expenses

Committee members can see how much was unspent for each agency

Jane reviewed line-by-line issues, with follow-up needed on specific agencies:

Community Health Partnership

Epilepsy Foundation

Harvard Community Senior Center (PEARLS)

Live4Lali

Paula asked about the impact on Options and Advocacy based on Service Inc. taking over as the ISC. O&A is

rethinking their mission and are changing to accommodate an Autism Resource Center.

Bottom line shows $207,304 of possible ½ year reconciliation. Potential reallocation to other programs within

agencies can be reviewed by staff and recommended to help MHB manage the dollars. Staff will follow up with

each agency that reported erroneously to correct the issue. This will allow for proper year-end reports.

The Board submitted feedback on their annual surveys. Some reported receiving little exposure to specific details.

Much of this is due to Committee assignment of each Board member. Committee members receive detailed

information with the highlights then provided through Committee Reports at the Board meetings.

VII. PUBLIC COMMENT – None.

VIII. ADJOURN - Paula Yensen motioned to adjourn. Mike Baber seconded. A VOICE VOTE WAS

TAKEN. All in favor. Motion carried. The meeting adjourned at 6:18 p.m.

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201908-52 FY19 Budget Revision

McHenry County Mental Health Board

Decision Memorandum

Background:

At present, only one program participant remains active in the MHB’s Psychiatric Loan

Recognition program. Including the last partial payment for Dr. Blackmon and the

remaining 5 months of payments due for Dr. Fuqua, the utilization of Psychiatric Loan

Recognition Program funds projects at $106,173 out of a budget of $183,204. This leaves

and underutilization of funds at $77,031.

MHB Executive Director recommends reallocating said underutilized funds making them

available for alternative projects per MHB direction and as allowable within the

Contractual Relationships – Funding Allocations Policy.

FY19 Budget Impact

Proposed reallocation and budget revision as follows:

Decrease the FY19 Psychiatric Loan Reimbursement program line item to

$106,173.

Offsetting dollars of $77,031 will be added to Direct to Providers section, Client

Services line item.

Recommendation and Motion:

The McHenry County Mental Health Board, Board of Directors directs the Executive

Director to make revisions to the FY19 Budget as presented.

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Clearbrook CILA and Clinic Start-Up

McHenry County Mental Health Board

Decision Memorandum

Background:

As the MHB seeks to manage available funds in order to maximize utilization for purposes consistent

with the Community Mental Health Act, MHB mission and Three-Year Plan, the MHB Executive

Director proposes the following consideration for Board dialogue and approval. Approving this MHB

directed Funding Allocation in FY19 will allow the MHB to maximize current fiscal year funds and

decrease Clearbrook funding requests in FY20, thus prioritizing FY20 funds in other priority areas. Each

proposed start-up program is sustainable through state billing sources once established.

According to the Illinois Department of Human Services Division of Developmental Disabilities,

Community Integrated Living Arrangements (CILA) are a community living arrangement for adults (age

18 and older) in a group home, family home or apartment where eight (8) or fewer unrelated adults with

developmental disabilities live under supervision of the community developmental services agency.

Residents receive complete and individualized residential habilitation, personal support services and

supports under the direction of a community support team within the local agency.

Clearbrook operates approximately 50 (CILAs) throughout 22 communities and the City of Chicago.

Currently, Clearbrook operates two fully functioning CILA homes in McHenry County and they are

preparing to open a third in MHB’s FY20. The Mental Health Board has allocated funding to assist in the

start-up of the first two operational homes and Clearbrook has requested similar start-up funds during the

MHB’s FY20 Application process.

In seeking to serve the community through filling service gaps and being mindful of long-term

sustainable payer sources, Clearbrook also requested FY20 MHB funding to implement and develop a

clinic for individuals dually diagnosed with Developmental Disability and Mental Illness. Per the FY20

funding application and corroborated by previous dialogue at the DD Taskforce level: Per NADD (an

association for persons with developmental disabilities and mental health needs), "The mental health

needs of persons with intellectual or developmental disabilities have been increasingly recognized in

recent years. Mental health problems are severe disturbances in behavior, mood, thought processes

and/or interpersonal relationships." In response to a significant unmet need in McHenry County,

Clearbrook is proposing to develop and sustain a Behavioral Health Clinic. It will operate out of a

facility close to where Clearbrook's CHOICE Program is located (Crystal Lake Plaza), and will serve

individuals with a dual diagnosis of Intellectual and Developmental Disabilities (I/DD) and Mental

Illness (MI).

Of note, under Strategic Initiative #1 – Strengthen the Recovery Infrastructure in the MHB’s 2018-2020

Three Year Plan, Goal 1.1: is as follows: Increase community-based and supported living opportunities

for McHenry County residents with mental health, substance use and intellectual and developmental

disability related needs.

Goal 1.2: is as follows: Leverage federal and state dollars available to support mental health, substance

use and intellectual and developmental disability related services and community needs.

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FY19 MHB Budget Impact

Unallocated Funds Available = $120,596

Proposed Grants for Clearbrook Start-Up CILA and DD/MI Clinic = $43,000

(to be applied to furnishings and facility build-out/renovations)

Unallocated Funds Remaining = $77,596

(Any capital equipment purchased with MHB funds will be subject to reconciliation and tied to a special

condition, which protects the MHB’s investment as follows: The Provider agrees to keep all equipment

purchased through this Agreement free and clear of any security agreements or liens. If Provider becomes

or is close to becoming insolvent, Provider shall notify the Board immediately. If Provider becomes

insolvent or intends to close its operations in McHenry County, Provider shall transfer all remaining

assets purchased with Board funds to another tax-exempt organization operating within McHenry

County.)

Recommendation and Motion The McHenry County Mental Health Board, Board of Directors directs the Executive Director execute a

FY19 grant agreement with Clearbrook for $43,000 to support expenses related to the CILA and DD/MI

Clinic start-up.

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Youth Partial Hospitalization Program Expansion

McHenry County Mental Health Board

Decision Memorandum

Background

As the MHB seeks to manage available funds in order to maximize utilization for purposes consistent with

the Community Mental Health Act, MHB mission and Three-Year Plan, the MHB Executive Director

proposes the following consideration for Board dialogue and approval. Approving this MHB directed

Funding Allocation in FY19 will allow the MHB to maximize current fiscal year funds and decrease the

Alexian Brothers Behavioral Health (ABBH) funding request in FY20, thus prioritizing FY20 funding in

other priority areas.

In FY17, the Mental Health Board (MHB) contracted with Smart Policy Works (SPW) to conduct an

analysis of Youth Behavioral Health services in McHenry County. Based on the analysis of the Psychiatric

Services for Children and Adolescents in McHenry County Report completed in June of 2017 by SPW, one

of the recommendations was the need for access to a local Youth Day/Partial Hospitalization (PHP) program.

After receiving and reviewing the Psychiatric Services for Children and Adolescents in McHenry County

Report, per Board direction, the MHB ED approached several potential providers to gauge interest in and

capacity to develop a Youth PHP in McHenry County. Alexian Brothers Behavioral Health (ABBH) and

Horizons Behavioral Health emerged as the two providers’ best situated to collaboratively develop the

program. Due to volume and ability to meet growing psychiatric capacity needs, ABBH and Horizons have

amicably agreed to severe the partnership needed to get the program off the ground. ABBH is now providing

psychiatric care with internal psychiatrists for youth aged 12 and up.

As need to meet the mental health needs continues to grow, ABBH and the Mental Health Board have been

in discussions about expansion of the Youth Partial Hospitalization to include children aged 8-11, leading to

a FY20 ABBH reflecting said expansion. Of note, the need to serve this population was corroborated at the

April 26, 2019 School Professionals and Behavioral Health Provider Meeting facilitated by the MHB. If

funding permits, ABBH projects a start date of October 7, 2019 and anticipates approximately 150 unfunded

PHP visits for youth aged 8-11 before November 30, 2019.

Note: the MHB’s 2018-2020 Three Year Plan references the following in Strategic Initiative #2 – Improve

Access to Care: Goal 2.4: Develop school-based or targeted interventions and services for McHenry County

youth.

FY19 MHB Budget Impact

Unallocated Funds Available = $77,596

Proposed Grant for ABBH Youth PHP/IOP Expansion IT/Infrastructure/Furnishing = $25,000

Increase FY19 Pay-for-Performance Grant = $20,000

Unallocated Funds Remaining = $32,596

(Any capital equipment purchased with MHB funds will be subject to reconciliation and tied to a special

condition, which protects the MHB’s investment as follows: The Provider agrees to keep all equipment

purchased through this Agreement free and clear of any security agreements or liens. If Provider becomes or

is close to becoming insolvent, Provider shall notify the Board immediately. If Provider becomes insolvent or

intends to close its operations in McHenry County, Provider shall transfer all remaining assets purchased

with Board funds to another tax-exempt organization operating within McHenry County.)

Recommendation and Motion:

The McHenry County Mental Health Board, Board of Directors directs the Executive Director execute a

FY19 grant agreement effective September 1, 2019 with Alexian Brothers Behavioral Health for $25,000 to

support infrastructure expenses related to the Youth PHP/IOP expansion and increase the existing Pay-for-

Performance grant by $20,000 effective September 1, 2019.

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FY20 Budget Summary Revisions

McHenry County Mental Health Board

Decision Memorandum

Background:

Based on review of the FY20 Funding Applications, the MHB Executive Director

proposes the following revisions to the MHB FY20 Budget in order to maximize fund

utilization:

Decrease the A Way Out line item to $20,000, a utilization based projection.

Decrease the Psychiatric Loan Reimbursement program line item to $60,990 to

cover fixed costs of the remaining program participant. Of note, three providers

are requesting FY20 funds to expand psychiatric services through tele-psych

programs and the Board will receive funding recommendations for each program

during the FY20 allocations process.

Decrease the Behavioral Perspectives Inc. line item to $128,500, a utilization

based projection.

Offsetting dollars of $153,010 will be added to Direct to Providers section, Client

Services line item.

Recommendation and Motion:

The McHenry County Mental Health Board, Board of Directors directs the Executive Director to

make revisions to the FY20 Budget Summary as presented in background information.

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