McHenry Times

McHenry County Board of Health met May 22.

Here is the minutes provided by the Board:

Board Members present: Mike Baber, Cathy Ferguson, Lynn Kasicki, Sam Melei, Connee Meschini, Dawn Pruchniak, Paula Yensen

Board Members absent: Sarah Wilson

Others present: Cindy Sullivan, Kathy Anes, Scott Block, Terry Braune, Jane Wacker, Pat Peterson and other interested parties

1. Call To Order – Connee Meschini called the meeting to order at 6:00 p.m. Roll Call was taken.

2. Public Comment –

Cindy Sullivan – Options & Advocacy, thanked Board Member Dawn Pruchniak for visiting Options & Advocacy. Cindy asked the Board to consider not increasing the rent for McCAP as they are a group of parents with no state funding.

Kathy Anes – President of McCAP, told the Board about their serving 12 adults with developmental disabilities and significant needs for assistance with activities of daily living. She noted that it would be a hardship to come up with additional funding for increased rent payments and may have to research finding different facilities if this happens.

3. Approval Of Minutes - For Action

Sam Melei motioned to approve the Minutes of the April 17, 2018 Regular Board Meeting, Minutes of the May 3, 2018 Town Hall Meeting, and the Minutes of the May 8, 2018 Town Hall Meeting. Paula Yensen seconded. A Roll Call Vote Was Taken. Mike Baber – Yes, Cathy Ferguson – Yes, Lynn Kasicki – Yes, Sam Melei – Yes, Connee – Meschini – Yes, Dawn Pruchniak – Yes, Paula Yensen – Yes. All in favor. Motion carried.

4. Reports

A. President's Reports - C. Meschini

i. Board Member Interviews

ii. Officer Elections – please see Connee if you are interested in an officer position

iii. Board Evaluations – please complete and will review next month

iv. Town Hall Meeting Evaluation Results – these are in your packet for review.

v. Events and Announcements – Connee encouraged attendance at the 4th Annual Behavioral

Health Resource Fair and the McHenry County Suicide Prevention, Mental Health Wellness & Recovery Conference.

B. Director's Report - S. Block

GEFCC now providing Telepsychiatry and medication assistance including Vivitrol.

MHB ED & representatives from Options & Advocacy toured the Alexian Brothers Autism Resource Center in Hoffman Estates. The tour and meeting revealed many similarities between the Options & Advocacy Autism Support Program and the Alexian Program as well as some potential collaborative training and direct service opportunities. A rebranding of O&A and early results of the Autism Study services were mentioned.

Thresholds is moving from the Jefferson Street location in Woodstock to a stand-alone facility at 2030 Seminary Ave. (Rt. 47) in Woodstock next to Family Alliance.

With all the rain, the basement has had no leaking with the construction work done on basement.

The Centers for Medicare & Medicaid Services (CMS) approved Illinois' 1115 Waiver demonstration. Of note, 9 of the 10 approved pilots are to be implemented “less than statewide and may institute annual enrollment limits” which suggests limited impact on the McHenry County providers and system. Network Council will monitor the implementation and seek McHenry County opportunities if available.

The Illinois Department of Human Services Division of Alcohol and Substance Abuse (DASA) has formally changed its name to the Division of Substance Use Prevention and Recovery (SUPR).

The Substance Abuse and Mental Health Services Administration (SAMHSA) released a funding opportunity announcement for fiscal year 2018 Certified Community Behavioral Health Clinic (CCBHCs) Expansion Grants. SAMHSA anticipates awarding 25 eligible providers up to $2,000,000 annually to increase access to and improve the quality of community behavioral health services through the expansion of CCBHCs. CCBHCs provide a comprehensive collection of services that create access, stabilize people in crisis, and provide the needed treatment and recovery support services for those with the most serious and complex mental and substance use disorders. CCBHCs integrate additional services to ensure an approach to health care that emphasizes recovery, wellness, trauma-informed care, and physical- behavioral health integration. Network Council is reviewing the potential for a McHenry County applicant. AID might be the main agency of 7-8 core providers. McHenry County does have all the pieces needed but it is just a matter of putting them all together. MHB may use some contractual funds to hire a grant writer on behalf of a collaboration of agencies. AID would have a grant writer to assist. The application deadline is in July.

C. Finance and Audit Committee - S. Melei

Lynn and Sam met with MHB staff. No formal action was taken as there was no quorum. The Treasurer’s Report, ERP, and Budget summary were discussed. Most items are on agenda this evening.

D. Network Council - C. Ferguson

No report.

E. Board Site Visit Report(s)

i. Dawn Pruchniak

A. New Directions

• Felt supported by the MHB especially during Tile Line Road issues

• Could use access to grant writer or help with grant writing

• Wait list

• Would like to expand Connect to Recovery, a volunteer peer network for clients in the ER, in order to get them into recovery and work to transport them to services

• MHB funding of case manager is critical to their success

B. Options and Advocacy

• Early Intervention 500 in program, 60-80 newborns, biggest need is speech development

• One of 25 in State, rated the best

• Appreciate use of space at MHB

• Need trainings: CPI for agencies and families, social thinking, rights laws, parenting for families

• Service gaps: Before and after care, non-severe care, Medicaid and providers

C. Pioneer Center for Human Services

• Biggest challenge is state funding reduction

• Appreciate space available for use at MHB

• New reporting is easier and more relevant

• Wondering if reconciliation is as efficient as good as possible, it takes a long time to complete

• Like being a part of Network Council

D. Rosecrance Inc.

• Therapists are all in group setting

• Do provide transportation to residential programs in Rockford

• Provide SASS at MHB

• Fastest growing are the MH clients

• Schedule meetings and data

ii. Paula Yensen

A. Greater Elgin Family Care Center

• Patient demographics include Latino(a), female, uninsured

• Best served in other language

• 86 % of clients are from our area

• April 16 start Telepsychiatry

• Would like to maintain funding

• Believes current capacity of psychiatry is meeting the community needs

• Has seen improvements in MHB process

• Staff and facility are professional and an asset to our county

B. Harvard Community Senior Center

• 7 referrals to PEARL from MERCY serving McHenry County.

• Expected more from Harvard, Richmond,

• Currently 19 on caseload as of April, but expecting an increase

• Strengths staff professional, intake meeting

• Self-care workshop with humor as means for training was suggested

• MHB assist in funding staff to provide intake

• Psychiatry and transportation were noted as issues

C. Youth and Family Center of McHenry County (f/k/a Garden Quarter NRC)

• Afterschool programs, information and referral.

• New facility allows for private counseling and expansion into mental health

• Transportation is an issue for getting children to services

• Value partnering with Girl Scouts, FHPC, initiated Family Council

• Needs more Outcome training that is EB driven

• Need therapist for groups and increased need for individual therapy

• Would like MHB to help them develop meaningful consumer survey

• McHenry schools do supply 6 buses for school programs, MHB provides funds for summer transportation

iii. Mike Baber

A. Horizons Behavioral Health

• Met with Tom Dattalo a consultant that oversees the functions of Horizons

• 6 Psychiatrists own the organization and are involved in the PHP funded by MHB

• Reached capacity and now have waiting list

• Relationship between Horizons and Alexian is going well

• Mindfulness Yoga is used to deal with SA and MH

iv. Connee Meschini

A. Aunt Martha's

• Building has empty space and includes a pharmacy

• No waitlist; walk in care

• 5 Psych, 1 Gynecologist 1, phlebotomist, NP and nurses, 3 counselors including a bilingual

• Tele-psych room

• Need for child psychiatrist

• Serve 560 clients a month and waiting room was filled

• Biggest problem is no show rate (as with Mathers) - Mike suggested phone number is issue 

v. Lynn Kasicki

A. Mathers Clinic

• Dr. Vemuri ensures that no one is left out

• Passed Audit with no findings

• Psych Express well utilized but has issues with transportation, billing and no-shows

• Serve clients with Schizophrenia, Depression, ADD, ADHD,

• Need child psychiatrist to diagnose and medicate a child

• Feel McHenry County is not adequately represented in DHS Region 2 for state funds. Network Council discussed this and has addressed their primary concern

• In relation to providers that provide psychiatry, Terry and Scott met with P4P programs and require they tell MHB how they use funds to address no-shows

• Scott mentioned the “Just-in-Time” program

B. Northern Illinois Special Recreation Association (NISRA)

• Staff is proud of their state-of-the-art facility, especially the cooking area

• Also have art room and music room

• Many sport activities provided

• One of the biggest problems is cost for parents; certain communities do not participate which raises cost

• MHB could provide funding for Respite care; it is in their budget but is getting cut due to State budget

vi. Cathy Ferguson

A. Centegra Health System

• Wide variety of services from crisis to inpatient

• Uninsured issues and this year’s chronic traumas in Wauconda

• They did not feeling that Lake County was reciprocating the work that McHenry County puts in and are feeling a need to develop a team to deal with these chronic issues

B. Consumer Credit Counseling Service

• Not a direct provider but adjunct to one

• They do screenings for mental health and anxiety and will serve anyone

• Involved in Network Council and CoC

• They are a free initial service and use sliding scale

• They have hired a grant writer.

• Concern: smaller agencies are not able to provide healthcare for employees and wonder if there is a way to pool resources to provide this service for staff

5. Consent Agenda - For Action

A. 201805-29 Treasurer's Reports for the Period Ending April 30, 2018

B. 201805-30 MHB Monthly Bills - $813,919.15

C. 201805-31 Vendors/Categories pre-approved for check release (revised 5/1/18)

Consent Agenda item C. was pulled for discussion. Cathy Ferguson motioned to approve Consent Agenda Items A and B. Seconded by Dawn Pruchniak. A Roll Call Vote Was Taken. Mike Baber – Yes, Cathy Ferguson – Yes, Lynn Kasicki – Yes, Sam Melei – Yes, Connee – Meschini – Yes, Dawn Pruchniak – Yes, Paula Yensen – Yes. All in favor. Motion carried.

After noting the addition of Canyon Contracting to the Vendor list, Dawn Pruchniak motioned to approve Consent Agenda Item C. 201805-31 Vendors/Categories pre-approved for check release (revised 5/1/18) with the addition of Canyon Contracting. Sam Melei seconded. A Roll Call Vote Was Taken. Mike Baber – Yes, Cathy Ferguson – Yes, Lynn Kasicki – Yes, Sam Melei – Yes, Connee – Meschini – Yes, Dawn Pruchniak – Yes, Paula Yensen – Yes. All in favor. Motion carried.

6. Old Business - For Discussion/For Action

A. FY19 Draft Budget

Scott reviewed changes to FY19 budget adding $60,000 to line items for a psychiatric program for Mathers. He will be meeting with Dr. Vemuri and has not received a commitment. By adding this amount, if MHB does not utilize the funds for this purpose they are in 4000 account budget lines and funds will be available for community services. Mike Baber motioned to approve the FY19 Draft Budget as revised. Lynn Kasicki seconded. A Roll Call Vote Was Taken. Mike Baber – Yes, Cathy Ferguson – Yes, Lynn Kasicki – Yes, Sam Melei – Yes, Connee – Meschini – Yes, Dawn Pruchniak – Yes, Paula Yensen – Yes. All in favor. Motion carried.

7. New Business - For Discussion/For Action

A. Salary Administration Policy

Scott reviewed packet page 50 for the salary policy completed as shown in accordance with legal counsel review. The County Board Chairman is in favor of the MHB adopting this policy. There are still some things that entail more discussion with counsel but this allows MHB merit and budget to be controlled by the MHB. With this, the MHB does not need to ask County approval as it has statutory authority to determine staffing patterns and salaries. The MHB is the arbiter of final decisions of Salary Administration. Scott supports the policy but believes it will conflict with duties awarded to the Associate County Administrator of Finance through the County Budget Policy but Connee stated she believed those conflicts can be overcome. Mike Baber motioned to approve the salary administration policy as presented to update the decision memo of the salary study results shown. Lynn Kasicki seconded. A Roll Call Vote Was Taken. Mike Baber – Yes, Cathy Ferguson – Yes, Lynn Kasicki – Yes, Sam Melei – Yes, Connee – Meschini – Yes, Dawn Pruchniak – Yes, Paula Yensen – Yes. All in favor. Motion carried.

B. MHB Facility

Use Scott outlined information, beginning on packet page 62, noting that the Memo included in the packet outlined much of the information on the current use, structure, sq. footage, numbers, office use, recovery zone information, and background of the facility. The MHB has expressed a desire to pay off the building, and has to make the final debt payment on December 15 and after that will be able to pay off remaining debt. It will be a multiple step process. He is waiting for confirmation from the County. The Intergovernmental Agreement with the County treats this as a County debt. As such, the County Board needs to adopt a Resolution that states they are going to satisfy the debt. MHB needs to queue them by way of a Decision Memo stating that the MHB has designated these dollars. This then triggers the County Board to enter the Resolution.

Part 2 is to draft plans for the facility once the payoff is made. Additional information is included in the packet regarding this topic. Scott met with a commercial broker to discuss fair market rent and the market. The broker’s opinion was that the potential for a sale of the building would result in a significant loss due to its size, lack of visibility, and the current market saturation. Rezoning of front CRC was mentioned as stand-alone sale but this creates many problems including loss of control of the building, parking areas, signage, and property.

The broker’s advice was to work with current occupants based on a current market rate of up to $18/sq. ft. A rate of $12/sq. ft. is below market value for rent and the $12/square foot rate has been communicated to current occupants to allow for FY19 budget projections. The reason for discounted rate was based on the broker’s suggestion due to building visibility and all the other available office space, but it also is intended to incentivize current tenants. The real estate agent is not taking into consideration the limited type of tenant that would be interested in the Mental Health Board facility. McCAP has voiced concern over an increase in monthly rent. Some Board members feel that the rent for agencies such as McCAP and NAMI (agencies that do not generate billable income to State Medicaid, MCOs, or private insurance), should remain at $6/square foot.

Cathy addressed the additional issue of tax exemption status. By renting the facility, the MHB may lose the tax exemption for certain portions of the building that generate income. MHB has to ensure that amount charged for rent covers the loss taken by tax exemption.

Legal counsel opines, on packet page 64, a loss of tax exempt status if leased to for-profit or not-for-profit. The final figure is at the discretion of the County Assessor and Illinois Department of Revenue. Draft numbers shown in the packet show:

$211,000 budgeted building expenses

$110,000 rent if generating cash flow

$27,000 potential tax liability (pp. 67) leaving MHB with a net of +$75-80,000.

Presently the MHB generates about $53,000 on the $6/sq. ft. Essentially, this increases to about $30,000 more per year.

Cathy expressed caution regarding the loss of tax exemption. Sam asked if the Broker ran numbers for “triple net lease” wherein the tenant would be responsible for taxes, insurance and maintenance. Scott stated that the $12/square foot rate is gross. NAMI and McCAP have no billable income generated from State Medicaid, MCOs, or private insurance, and should be considered differently. MHB felt a gross number is more appropriate because MHB covers all these costs. Scott talked with legal counsel about triple net lease and thought this may cause agencies to consider leaving and would be more difficult to execute should there be increased tax liability. Both legal counsel and MHB staff suggested MHB should come in with a gross dollar amount figure for tenants. Scott is currently working with legal counsel to develop language for the lease to assist with recovery of some capital costs for long term tenant’s wear-and-tear on the MHB facility.

Packet page 69 shows entire budgeted MHB building expenses at approximately $211,000. If the tenant cost is increased the MHB could generate about $110,000 but would potentially lose tax exemption of about $27,000. Cathy’s concern is that the tax hit could be bigger than originally worked out on paper. The total square feet of the facility is 30,000 including common areas--the non-owner occupied area is only 9,200 sq. ft. The loss of the tax exemption would not affect the space occupied by the MHB or its other not-for-profit tenants if they do not generate income for the MHB.

If the Board does consider not increasing building occupant payments for certain occupants the Board would have to have an objective reason. The ability of an agency to generate income through billing for services to State Medicaid, MCOs, or private insurance would be considered an objective reason. Of the eight agencies, only two generate funds from billing outside funding sources: Thresholds and Rosecrance (about 5000 sq. ft.) – neither have voiced concern over the proposed increase in rent. Other agencies are; MCVC, EDC, McCOG, NAMI, McCAP. As currently understood, if the MHB maintains the $6 rate then there is no tax liability because no income is generated--only money received is for actual occupancy cost. Scott will redraft and talk again with the McHenry County Assessor, Bob Ross, and the Illinois Department of Revenue about the tax status of changes. Cathy suggested any profit from building occupancy should be earmarked for capital improvements.

All building occupants pay a portion of utilities and vendor services, in accordance with the Intergovernmental Agreement for County Maintenance. This is working well and is included in the figures shown on packet page 68.

Scott noted that the MCCF is leaving on June 12 and the County is interested in those four offices as of December 2018. From June – December the offices will be empty.

Consideration for providing one to three year lease agreements to current building occupants provides consistency which is important in the rental market at a reasonable rate. The current makeup of the building use includes upstairs occupants that do not see extensive public or client traffic. The new leases should include language in to recoup capital expenses for those occupants remaining long term. The Board held discussion regarding Rosecrance use of the building and the groups that meet in the evening, and it was recommended that the MHB include including a clause or special condition in their lease which would require them to add staffing for reception and supervision of adolescents in order to limit MHB liability and maintain safety for program participants and guests.

Dawn reminded everyone of the MHB mission to allocate tax dollars and that the MHB is not in the rental business. The Community Mental Health Act allows for rental money made to offsets facility costs. Any rent collected will be earmarked to help with capital expenses, which based on the 2017 facility assessment, includes carpet replacement and painting within the next few years.

The Board concurred on a two-tiered provision for MHB supported agencies with objective reasoning for tiers. Tier 1: Agencies that do not generate revenue through billing activities, currently NAMI and McCAP, should be charged $6/sq. ft., with possible increase over time. This causes no tax exemption loss for MHB as the rate paid offsets MHB cost. The 2nd tier, all revenue generating agencies through billable service activities, $12 with rolling terms. Long term agreements could remain at $12 with special conditions regarding capital costs (carpet, parking lot, etc.). Profit generated off rent should be earmarked for capital improvements.

8. Presentation – None

9. Members' Comments

Paula noted no connectivity in transportation within the County. The Committee is redoing ordinances and have included Sober Living facilities in group home designation.

Cathy brought in a book from the National Council re: Sober living homes and what is being done in other states.

10. Public Comment – none.

11. Adjourn

Dawn Pruchniak motioned to adjourn the meeting. Seconded by Mike Baber. A Voice Vote Was Taken. All in favor. Motion carried. The meeting adjourned at 8:17.

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