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Eight-county mental health and disabilities region formed

Hawk Eye, The (Burlington, IA) - 3/23/2014

March 23--MOUNT PLEASANT -- Eight county elected officials breathed life into what was a concept by passing several motions Friday, and the regional mental health and disabilities service organization was born, state approval notwithstanding.

It was born fully formed, like Athena from Zeus' head, because the eight-county central point coordinators constructed the guts and mantle of the organization over the preceding two years.

Regionalization of services was mandated two years ago by the state, and the deadline for forming a region is July 1.

Most regions probably will be formed earlier, however, because the state required regional management plans to be submitted by April 1, and to approve that plan, a governing body has to be formed prior, which has approval authority.

Ryanne Wood, Lee County central point coordinator and newly appointed regional chief executive officer, said the Department of Human Services overlooked that requirement.

Although the state gave July 1 as the deadline to form 28E sharing agreements among local governments, which includes forming a governing board, its formation had to precede the regional management plan, Wood said.

Eight area counties passed the 28E agreement March 5 forming the Southeast Iowa Link or SEIL. It states the governing board will be comprised of one county supervisor from each of the eight counties.

The chairman is to be selected by the members from among the members. The chairman's county central point coordinator will be the chief executive officer of the regional mental health and disabilities service organization.

On Friday, the eight county supervisors demonstrated they were more interested in providing the best service rather than gathering laurels. They considered who was the best CPC for the job and then nominated the chairman based on where she is located.

Wood was selected CEO unanimously. Lee County Supervisor Rick Larkin, therefore, became chairman of the SEIL governing board. Both accepted the position.

SEIL vice chairman will be Washington County Supervisor Jack Seaward.

All positions are two-year terms.

Should Wood leave or be removed from her position, Washington County CPC Bobby Wulf will take her place, although the governing board may chose another CEO, voted the governing board.

An advisory board to the governing board is to be formed, comprised of clients, providers and guardians of clients, with one governing board member. The governing board unanimously voted to install Jefferson County Supervisor Becky Schmidt.

After a lengthy discussion, the governing board approved the regional management plan with amendments. After incorporating changes, the document will go to the state for approvals.

Forming the region has been done while awaiting firm definitions and state funding guidelines, which trickled in over the intervening months. Wood said parts of the regional management plan are "best guesses based on what we know today."

Senate File 2315 dismantled the state/county nexus two years ago that formerly delivered mental health and disability services.

The legislation also gave the state the authority to deliver services Medicaid covers, which the counties used to deliver.

Second, the state law mandated counties form regions to provide mental health and disability services not covered by Medicaid but by county tax dollars.

Third, prior state law gave counties the authority to levy property taxes just for these services and defined who is eligible and how the money is to be distributed. The new legislation redefined services and eligibility into two basic categories: core services and core populations and other-than-core services and other-than-core populations.

The new state law mandated the regions must provide core services first. The state's major dividing line between core services and other is IQ. Those with an IQ of less than 70, give or take five points, are considered core population.

Fourth, the new state capped how much counties can tax for these services. The revenue generated by the property tax for mental health and disabilities services cannot exceed $47.28 per capita.

If a county is taxing less, the state will backfill that amount, but the Legislature historically has stopped backfill payments, usually after two years or so, leaving the taxing cap and mandates in place, burdening and hamstringing the county.

During this legislative session, the state will decide further if it will require a "claw back" from counties. The theory is the counties should have some cost savings since the Medicaid switch went into effect last July.

The Department of Human Services has developed a formula for calculating these savings, according to Wood.

The Iowa State Association of Counties is working as liaison between the state and counties carrying the message, which is, according to Wood: If there is to be a claw back, let it be based on actual demonstrated savings, not a formula. If savings are found, and if the money goes back to the state, don't put the claw back money into the state's general fund, put it back into mental health and disabilities services.

The state's supposed goal, in revamping the mental health and disabilities legislation, was to "equalize" services provided. But Wood points out the same per capita tax is not being imposed among counties. If a county was not taxing up to $47.28 per capita, it is not allowed to raise taxes, which it may need to meet the state's new demands and if the state abandons its backfill promise.

If a county was taxing at greater than $47.28, it had to lower its tax. That didn't level the playing field, it just imposed a ceiling, Wood said.

Wood said Gov. Terry Branstad vetoed line items in SF 2315 that guarantee lower property taxes but do not guarantee equalized service.

Wood noted the regionalization of services does not increase services, and it doesn't spread them more evenly. If a county didn't offer the service before, it can't introduce a new service.

Rural counties with scattered populations and smaller tax bases used to contract with providers in other counties to deliver services and will continue to do so, Wood said.

Providers will not move into rural areas because of this supposed equalization but will continue to be in areas with sufficient population that provide them with sufficient wages, Wood said. Therefore, rural clients still will have to travel to get services, she said.

The difference is a county won't determine if it's too burdened to take on a client outside its boundary. The regional CEO will and must deliver the service, Wood said.

To refine this point, Wood said counties used to form wait lists if they ran out of money. Now, the whole region must exhaust its resources before the region can form a wait list for services.

In addition, the region will have an auditor who has an overview and oversees county mental health and disability funds and spending. Wood points out that the legislation has added a whole layer of bureaucracy, which could be good and could be bad.

Locally, eight counties voluntarily allied to form a region. Moving east to west and then north to south, those counties are: Louisa, Des Moines, Lee, Washington, Henry, Keokuk, Jefferson and Van Buren.

Counties, while waiting for definitions and funding guidelines, feared other-than-core services would have to be cut. On Friday, Wood said the counties will be able to fund everything funded previously.

The state has mandated any leftover funds be used to increase services, while holding the threat of claw backs over regions' heads. Wood said any extra funds will go to creating crisis intervention services and jail diversion services, which is a decision reached by consensus among regional members.

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(c)2014 The Hawk Eye (Burlington, Iowa)

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