HomeMy WebLinkAboutRes2018-067Sponsored by: Administration
CITY OF SEWARD, ALASKA
RESOLUTION 2018-067
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SEWARD,
ALASKA, APPROVING THE 2019 FEDERAL GRANT YEAR BUDGET FOR
THE SEWARD COMMUNITY HEALTH CENTER AS REQUIRED BY THE
CO -APPLICANT AGREEMENT BETWEEN THE CITY OF SEWARD AND
THE SEWARD COMMUNITY HEALTH CENTER
WHEREAS, the Seward City Council enacted Ordinance 2010-008 on December 13, 2010,
establishing the powers and duties of the Governing Board of Directors ("Governing Board")
charged with oversight of the Seward Community Health Center, as amended by Ordinance 2013-
013 on December 16, 2013, which agreement expires January 31, 2019; and
WHEREAS, the City of Seward ("City") and the Seward Community Health Center
("SCHC") are co -applicants as a federally qualified health center in accordance with Section 330 of
the Public Health Service Act (42 U.S.C. §254b); and
WHEREAS, the City and the SCHC entered into a Co -Applicant Agreement dated February
20, 2014, and the City Council authorized submission of the previous Service Area Competition
Grant application via Resolution 2015-080 approved on September 2, 2015, wherein the parties
agreed that the SCHC budget would be submitted to the City Council after approval by the
Governing Board and providing that "the City Council may not unilaterally revise a budget approved
by the Governing Board or approve an alternate budget for the Health Center without review and
final approval by the Governing Board, with subsequent follow-up by the City Council"; and
WHEREAS, the Governing Board of the SCHC approved the 2019 Seward Community
Health Center Section 330 (Year 5) grant budget at a board meeting held on July 26, 2018, and the
Coordinating Committee ("Committee") of the CHC met to review the grant budget, and both the
Governing Board and the Committee recommend approval by the Seward City Council
f
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIIIOF THE CITY
OF SEWARD, ALASKA that: <
Section 1. The Seward City Council hereby approves the 2019 budget of the Seward
Community Health Center ("SCHC"), representing the Year 5 grant budget for Section 330 funding
through the Health Resources and Services Administration.
Section 2. The Seward City Council approved a contribution in the amount of $200,000
for the 2019 grant year when it approved the City's 2018/2019 Biennial Budget.
Section 3. This resolution shall take effect immediately upon its adoption.
CITY OF SEWARD, ALASKA
RESOLUTION 2018-067
PASSED AND APPROVED by the City Council of the City of Seward, Alaska, this 131n
day of August, 2018.
THE CITY OF SEWARD, ALASKA
Gx US A
David Squires, May
AYES:
Seese, Towsley, Casagranda, Keil, Horn, McClure, Squires
NOES:
None
ABSENT:
None
ABSTAIN:
None
ATTEST:
Brenda J. Ballou, MMC , „ 9 c , y c / e x
City Clerk
(City Seal)imab,= S ,
69
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1
COUNCIL AGENDA STATEMENT
Meeting Date: August 13, 2018
From: Eddie Athey, Acting City Manager
Agenda Item: Council Co -Applicant approval of Section 330 Seward Community Health
Center 2019 Budget
BACKGROUND & JUSTIFICATION:
The Seward City Council authorized the creation of the Seward Community Health Center ("CHC") and
Board when it enacted Ordinance 2010-008 in December, 2010, formalizing the powers and duties of the
board of directors charged with overseeing the Seward Community Health Center.
The City of Seward and the CHC are co -applicants for Section 330 federal funding to operate a federally
qualified health center in Seward; together, the entities comprise "the Health Center". The parties
entered into a Co -Applicant Agreement ("Agreement") on February 20, 2014 approved by Council
Resolution 2014-018, and subsequently amended in Resolution 2017-006 approved on January 23, 2017.
This Agreement requires that the CHC budget be approved first by the Governing Board and then by the
City Council, and includes the following language:
§3.2.4 "The Governing Board shall approve the annual operating and capital budget in
accordance with Section 330 requirements and City policies. The overall plan and budget
shall be prepared under the Governing Board's direction by the Health Center's
management team and the Finance Committee of the Governing Board. "
§3.2.5 "The Governing Board shall submit an annual budget for the health center to the
City Council for approval., as a co -applicant requirement of Section 330. The Board shall
submit the budget no later than October I of each year, for the following year. If the Board
unreasonably fails to approve an annual budget, the City may still submit the annual
funding request under Section 330 of the Federal Public Health Service Act. No budget
shall become effective without City Council approval. "
§4.2.4 "The City Council shall be responsible for adopting the Health Center's annual
operating and capital budgets as finally approved by the Governing Board; the City
Council may not unilaterally revise a budget approved by the Governing Board or approve
an alternate budget for the Health Center without review and final approval by the
Governing Board, with subsequent follow-up by the Council in accordance with Seward
City Code 2.40.030(a), "
In accordance with Section 5 of the Agreement, the parties also agree to participate in a Coordinating
Committee comprised of one member each of the Governing Board, the City Council, the Health Center
executive director, and the City Manager or his designee. This group did not meet to review the
proposed 2019 Seward Community Health Center budget due to staff turnover at the City, but the City
administration has reviewed and recommends its approval.
Further, Health Resources & Services Administration ("HRSA") issued Policy Information Notice 2013-
01 on March 18, 2014, requiring that health centers prepare and submit grant applications that contain a
Kea
total budget for the health center scope of services for 12 months, and the budget must include a separate
budget breakdown for the section 330 funding proposed for the application period, showing costs
supported by the grant and costs supported by other sources of non-HRSA-grant funds (i.e. patient
service revenue, City grant fundiniz, other funding).
CONSISTENCY CHECKLIST:
Yes
No
N/A
I .
Comprehensive plan (document source here):
2.
Strategic Plan (document source here):
3
Other (list): Co -Applicant Agreement dated 212012014; RES 2017-006; HRSA PIN
2013-01 . 5-6
X
ATTORNEY REVIEW: Yes X No
FISCAL NOTE:
The City of Seward's 2019 Budget includes $200,000 in funding for the Seward Community Health
Center. The current HRSA funding for the CHC for the year ending 1/31/19 is a base grant of
$1,196,128 plus a Mental Health & Substance Abuse grant in the amount of $174,955. These funds will
help to provide lower -cost primary healthcare services to Seward residents, helping to divert patients
from much higher cost of care in the hospital emergency room. These healthcare dollars coming from
outside the community provide significant economic benefits to Seward and its residents, as well as
improved access to primary healthcare for our uninsured and under -insured residents. As federal grant
funding increases, it is expected that the CHC will become less reliant on City funding for operations. T
Approved by Finance Department: Y*w M "`c�u7
RECOMMENDATION:
Council approve Resolution 2018- approving the 2019 Seward Community Health Center budget.
33
SEWARD COMMUNITY HEALTH CENTER
Board of Directors
August 1, 2018
Action Item
Topic: 2019 Federal 330 Grant Budget Approval
Recommended By: Finance Committee and Executive Director
Action Requested: The Board of Directors is requested to approve the 330 Grant
Budget for grant year 2019 and recommend approval to Seward
City Council.
Discussion:
Every three years 330 grantees are required to submit a rigorous set of application
materials through a funding announcement called a Service Area Competition (SAC).
Our last SAC was submitted and approved in 2015 for the three year "Project Period" of
February 1, 2016 through January 31, 2019. Each of these three grant years is called a
"Budget Period." One major part of this multi -part renewal is our proposed 330 grant
budget for the upcoming budget period. Our report is due to be submitted no later than
August 15, 2018.
Our Co -Applicant Agreement requires that the City Council approve the annual federal
grant budget after it has been approved and recommended by the Board. The Finance
Committee has reviewed, and our board approved the 2019 grant budget prepared by
Administration and is recommending approval to the City Council.
There are some unique requirements for submitting federal 330 grant budgets. The 330
grant budgets must achieve a $0 bottom line
[2018 GRANT BUDGET HIGHLIGHTS AND ASSUMPTIONS FOLLOW]
34
2019 330 Grant Budget Hi2hli2hts and Key Assumptions
SUMMARY:
Following the required federal grant budget format, there are two sections/columns to the grant
budget which when combined make up the total budget:
• HRSA (Federal) 330 grant revenue $1,255,701 and
• Other (Non -Federal) revenue of $1,396,052
The budget includes a breakdown of source for Revenue & Expenses.
• Revenues [$2,651,753]
o HRSA 330 Budget $1,255,701
o City of Seward contribution $200,000
o Patient Revenue $1,026,052
o Other/In-kind revenue $170,000 ($110k for 340B and $60,000 in -kind rent)
• Expenses [$2,651,753] - Note: HRSA grant budgets require that expenses equal revenues
o HRSA 330 used entirely for salaries $1,255,701
o Non -Federal Expenses (includes some salaries/benefits & operating) $1,396,053
■ Salary & Benefits $827,191
Operating Costs $568,862
KEY ASSUMPTIONS:
Patient volume totals 5,042 billable encounters. This begins with our targeted projection of
unduplicated patients for 2019 which is 2,325. This is 75.0% of our HRSA target which is
contained in our SAC application or 3,086 patients. This is a decrease from our prior budget and
will accompany a reduction in our HRSA request of 2%. This decrease is based on our historical
projection. The number of patient's assumption is then multiplied by an average of 2.17
visits/encounters per patient per year for a total of 5,042. Through June of 2018 we are
averaging 7.5 patients per provider day worked. Our 2019 projection will increase this metric by
17% to 8.8 patients per provider day worked.
Patient revenue/payer mix is based on estimated billable encounters per payor from our actual
billing history and net income through June of 2018 (gross charges less discounts and
allowances) per visit as follows:
• 53% of encounters are Private Insurance @ $205. (Down from 55%)
• 16% are Medicaid @ $310. (Down from 20%)
• 20% are Medicare @ $181. (Up from 18%)
• 11% are Self -pay @ $77. (Increase from 7%)
The Staffing Profile, which includes 1.23 physicians, 2 mid -level (PA, NP), and 1 FTE for new
grant funded Behavioral Health provider brings our FTE's. to (18.4) projected for 2019. This is
an increase of (0.4) FTE's from the 2018 budget. These changes and a reduction in health
insurance costs resulted in a 2% increase or $31,000 in salary and benefit costs over the 2018
budget. The increase is offset by the $83,000 additional grant funds for behavioral health.
FTE's include:
0 4.13 providers (1.13 physicians, 2 mid -level and 1 BH clinician.
0 4.80 clinical support staff (RN's, medical and nursing assistants)
W
0 3.1 front desk staff (registration, billing & medical records)
0 1.0 health educator/case manager/ clinic nurse
0 2.3 outreach & enrollment (1 social worker/1 coordinator)
0 3.1 admin staff (Executive Director, Accounting specialist, Executive Asst.)
Usual and customary non -personnel expenses include:
o Revenue Cycle manager services ($10,800) Billing services moved in-house
o Electronic Health Records System and IT Support fees ($25,497)
o CHC CFO/fiscal management oversight services ($10,800) — Private contractor
o Independent Audit ($24,000) based on 2017 annual audit expenses
o CHC technical consultation ($13,000) — Suzanne, 340B, APCA, others)
o Travel for staff and board ( $35,500) for 4 provider, 8 staff and 4 board trainings and
conferences (approx. $2,000/trip). Includes contract provider travel.
o Utilities & Services from Providence ($43,685) 10% inc over 2018
o Liability insurance packages (16,137) 0% increase
o Medical, pharmaceutical and office supplies ($113,549) 12% inc over 2018
o Community Outreach and Enrollment ($13,800)
o Minor equipment ($50,784) — this is where we adjusted expenses to get bottom line
to zero per HRSA.
o Training and education ($10,500) — (4 provider, 8 staff conferences and trainings @
$875/ea.)
Q.
Seward Community Health Center, Inc.
2019 Budget Draft
WORKING BUDGET - NOT FOR SUBMISSION
Year 1
HRSA
Other
TOTAL
Federal
Non -Federal
Volume:
# of Patients
2,325
Patient Encounters
5,042
Revenue:
Federal BPHC 330 Grant
1,255,701
1,255,701
Applicant
-
State / Local
-
200,000
200,000
Other Federal Funding
-
Other
-
170,000
170,000
Program Income (Net Patient Revenue)
-
1,026,053
1,026,052
TOTAL REVENUE
1,255,701
1,396,053
2,651,753
Expense:
Personnel - Refer to Form 2 Staffing Profile
Administration / Management
217,659
23,997
241,656
Facility and Non -Clinical Support Staff
181,863
-
181,863
Physicians
52,158
238,636
290,794
NP, PA, and CNMs
277,077
-
277,077
Medical
328,451
-
328,451
Dental
-
-
-
Enabling Services
126,402
-
126,402
Other Programs and Services
-
-
-
Total Salary Expense
1,255,701
262,633
1,518,334
Fringe Benefits:
Health Insurance
-
382,963
382,963
Housing Allowance
4,000
4,000
Medicare/SS
6.71%
101,814
101,814
AK SUI
0.97%
14,674
14,674
Retirement
3.00%
-
45,550
45,550
Workers' Compensation
quote
-
15,557
15,557
Total Fringe Benefits
10.67%
-
564,558
564,558
Subtotal Personnel and Fringe
1,255,701
827,191
2,082,892
Travel:
Providers and Staff
-
21,500
21,500
Board
-
10,000
10,000
Other - Contracted Physician
-
4,000
4,000
Subtotal Travel
-
35,500
35,500
Supplies:
Pharmacy / Medications
$ 13.33
-
67,203
67,203
Medical Supplies
$ 6.15
31,015
31,015
Office
-
15,330
15,330
Minor Equipment (<$5,000)
-
50,784
50,784
Subtotal supplies
-
164,332
164,332
Contractual:
37
Seward Community Health Center, Inc.
2019 Budget Draft
WORKING BUDGET - NOT FOR SUBMISSION
Patient Related/Contractual
Non -Patient Care:
Accounting
Audit
Billing & Coding
Legal
Services - Electronic (HIT)
Technical Assistance / Consulting
Subtotal Contractual
Other:
Bank Fees
Communications
Dues & Subscriptions
Equipment Maintenance
Facility Janitorial Contract/PSMC
Insurance - Malpractice Gap Coverage
Insurance - Property
Insurance - D&O
O&E Supplies
O&E Advertising/Promotion
O&E Postage
Patient Transportation
Postage / Freight
Rent: Clinic
Repairs & Maintenance
Training
Utilities
Community Health Education
Subtotal Other
TOTAL DIRECT COSTS
Indirect Cost
TOTAL EXPENSE
Must = 0 for balanced budget
Year 1
HRSA
Other
TOTAL
Federal
Non -Federal
22,740 22,740
- 10,800
10,800
24,000
24,000
10,800
10,800
25,497 25,497
23,000 23,000
116,837 116,837
6,000 6,000
26,760 26,760
- 12,500
12,500
- 1,000
1,000
10,560
10,560
- 10,414
10,414
1,741
1,741
3,982
3,982
1,800
1,800
10,000
10,000
2,000
2,000
1,200
1,200
- 1,000
1,000
- 60,000
60,000
- 42,651
42,651
- 14,500
14,500
- 43,685
43,685
- 2,400
2,400
- 252,193
252,193
1,255,701 1,396,053 2,651,753
0.00% - - -
1,255,701 1,396,053 2,651,753
0 0 0
38
40**
aCOMMUNiTY
l EALTH
KENTER
July 31, 2018
City of Seward
City Council & City Administration
PO Box 167
Seward, AK 99664
City of Seward Representatives,
SEWARD COMMUNITY HEALTH CENTER
PO Box 2895 / 417 First Avenue — Seward, AK 99664-2895
PHONE (907) 224-2273
FAX (907) 224-8501
www.sewardhealthcenter.org
During its regularly scheduled monthly meeting on July 26, 2018, the Seward Community Health Center
Board of Directors voted unanimously to authorize application to HRSA's Service Area Competition as a
co -applicant with the City of Seward. We look forward to continuing to work with the City of Seward in
ourjoint effort to expand and improve healthcare offerings in our community.
Sincerely,
7:
..-
Richard Cruse
Board Chair
Where your health matters