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Home My WebLink AboutRes2021-092City Council Agenda Statement Meeting Date: August 23, 2021 To: City Council From: Janette Bower, City Manager Agenda Item: Resolution 2021-092: Approving the 2021 Grant Year Budget for the Seward Community Health Center (SCHC) as Required by the Co-Applicant Agreement Between the City of Seward and SCHC Background and justification: Ordinance 2010-008 authorized creation of the Seward Community Health Center (SCHC) and governing Board. The City of Seward and SCHC are co-applicants for Section 330 federal funding to operate a federally qualified health center in Seward. The parties entered into a Co-Applicant Agreement February 20, 2014 approved by City Council Resolution 2014-018, and subsequently amended it in Resolution 2018-067, approved on August 13, 2018. The co-applicant agreement requires City Council approval of the annual federal grant budget after it has been approved and recommended by the SCHC Board. The SCHC Board approved the 2022 budget on August 9, 2021. The SCHC Administration and Board recommend City Council approval of the budget. SCHC Budget 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 $1,468,419 and Other (Federal & Non-Federal) revenue of $2,603,526 The budget includes a breakdown of source for Revenue & Expenses. Revenues \[$4,071,945\] o HRSA 330 Budget $1,468,419 o Other Federal Awards $444,625 o Patient Revenue $1,989,581 o Other/In-kind revenue $169,320 ($75k for 340B; $60,000 in-kind rent; $19,400 USAC Program; $14,920 Misc Fee Agent, Interest, Etc) Expenses \[$4,071,945\] - Note: HRSA grant budgets require that expenses equal revenues o HRSA 330 used predominantly for salaries $1,312,809 vs $155,611 Operating Costs o Non-Federal Expenses (includes some salaries/benefits & operating) $2,603,526 Salary & Benefits $1,744,512 Operating Costs $859,014 Consistency checklist: Comprehensive Plan:Effective, accessible, affordable healthcare Strategic Plan: Maintain and enhance medical services Other: Co-applicant agreement dated 2-20-14 Fiscal note: There is not a fiscal impact to the City and does require any type of funding. Finance Department approval: Attorney Review: Yes No Not applicable Recommendation City Council approve Resolution 2021-092. SEWARD COMMUNITYHEALTH CENTER BoardofDirectors August9, 2021 ActionItem Topic:2022Federal 330 Grant BudgetApproval Recommended By:Finance Committee and Executive Director Action Requested:The Board of Directors is requested to approve the 330 Grant Budget for grant year 2022and recommend approval to Seward City Council. Discussion: Every three years 330 grantees are required to submit arigorous set of application materials through a funding announcement called a Service Area Competition(SAC). Our last SAC was submitted and approved in 2018for the three year “Project Period” of February 1, 2019,through January 31, 2022. Each of these three grant years is called a Budget Period.”Due to COVID, HRSA has extended our grant period by one year to February 1, 2023.One major part of this multi-part renewalis our proposed 330 grant budget for the upcoming budget period.Our report is due to be submitted no later than September10, 2021. Our Co-Applicant Agreement requires that the City Council approve the annual federal grant budget after it has been approved and recommended by the SCHC Board. The thFinanceCommitteehasreviewed,and our board approved the 2022 budget on August 9, 2021.The SCHC Administration andthe Board is recommending approval to theCity Council. There are some unique requirements for submitting federal 330 grant budgets. The330 grant budgets mustachieve a $0 bottom line 2022GRANT BUDGET HIGHLIGHTS AND ASSUMPTIONS FOLLOW\] 2022330 Grant Budget Highlights and Key Assumptions SUMMARY: Following the required federal grant budget format, thereare two sections/columns to the grant budget which when combined make up the total budget: HRSA (Federal) 330 grant revenue $1,468,419and Other (Federal & Non-Federal) revenue of $2,603,526 The budget includes a breakdown of source for Revenue & Expenses. Revenues \[$4,071,945\] oHRSA 330 Budget $1,468,419 oOther Federal Awards $444,625 oPatient Revenue $1,989,581 oOther/In-kind revenue $169,320 ($75kfor 340B;$60,000 in-kind rent; $19,400 USAC Program; $14,920 Misc Fee Agent, Interest, Etc) Expenses \[$4,071,945\]-Note: HRSA grant budgets require that expenses equal revenues oHRSA 330 usedpredominantlyfor salaries $1,312,809 vs $155,611 Operating Costs oNon-Federal Expenses (includes some salaries/benefits & operating) $2,603,526 Salary & Benefits $1,744,512 Operating Costs $859,014 KEY ASSUMPTIONS: Patient volume totals 6,510 billable encounters. This begins with our targeted projection of unduplicated patients for 2022 which is 2,367. Through June of 2021 we are averaging 9.0 patients per provider day worked. Our 2022 projection will increase this metric by 11% to 10.0 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 2021 (gross charges less discounts and allowances) per visit as follows: 54% ofencounters are Private Insurance 23% are Medicaid 18% are Medicare 5% are Self-pay COVID-19 Supplemental awards account for $414,625 in other federal funding. The Staffing Profile, which includes 1.08physicians,2.20mid-level (PA, NP), and 1.17FTE for Behavioral Health provider brings our FTE’s. to (22.56) projected for 2022.This is consistent with 2021 budget FTE’s (22.56). Increases in wages are offset with decreases in benefit premium contributions for a net of (17,511) from 2021 Budget. FTE’sinclude: o4.44providers (1.08physicians,2.20mid-level and 1.17BHclinician. o7.28clinical support staff (RN’s, medical and nursing assistants) o5.49front desk staff (registration, billing & medical records) o1.0 health educator/case manager/ clinic nurse o1.0outreach & enrollment (coordinator) o3.35 admin staff (Executive Director, Finance Director, Revenue Manager, Administrative Services Manager) Usual and customary non-personnel expenses include: oContractual expenses (418,170) decreased by 14.3% over 2021 Budget and include ElectronicHealth Records System and IT Supportfees ($68,550) Independent Audit ($33,000)based on 2021annual audit expenses Behavioral Health prevention and screening services provided under contract 145,000) COVID-19 related contract project management services (57,000) oTravel for staff and board(27,608) for 4provider, 6staff and 4 board trainings and conferences(approx. $2,000/trip).$5k increase over 2021 budget. oUtilities & Facility Services ($96,950) 8% inc over 2020 oLiability insurance packages (24k) 15% increaseover 2020 oMedical,pharmaceutical and office supplies ($66,408) 11% decreaseover 2020 oCommunity Outreach and Enrollment ($10,450) oMinor equipment ($89,650) –$85k allocated for COVID-19 related special projects oTraining and education ($12,350) –(4 providers, organizationaltraining resources) Seward Community Health Center, Inc.GY2022 2022 Budget Period Progress ReportHRSAOtherTOTAL Budget Narrative - H80CS26600330 Federal Volume: of Patients2,367 Patient Encounters6,510 PerForm 3, line 6 Revenue: Federal BPHC 330 Grant1,468,419-1,468,419 Anticipated grant amount based onhistorical awards (Includes IBHS Rollover Award $145k) State / Local--- Other Federal Funding-444,625444,625 COVID-19H8F Award = $414,625 + Anticipated Quality Award = $30k Other-169,320169,320 In-kindrevenue from City ofSeward forrental value ofclinic space = $60kand USAC Program $19,400; 340B Program Revenue $75k; Misc Income (Fee Agent, Interest, Donations, etc) = $14,920 Program Income (NetPatient Revenue)1,989,5811,989,581 PerForm 3, based onhistorical reimbursement information TOTAL REVENUE1,468,4192,603,5264,071,945 Expense: Personnel: Administration/Management249,219250,571499,790 Facility & Non-Clinical Support Staff172,912125,659298,571 Physician174,107142,087316,194 NP, PA, and CNMs184,727160,627345,354 Medical353,398270,340623,738 General Practitioners / Supervising Physicians4,8482,9527,800 Behavioral Health (Mental Health & Substance Abuse)40,209109,485149,694 Enabling Services30,54323,76854,311 Total Salary Expense (Includes PTO Expense)1,209,9621,085,4892,295,451 Fringe Benefits: Health Insurance (Includes Med/Den/Vis/LTD/STD/Life)-508,049508,049 Cell / Housing / Travel Allowance-1,5001,500 Medicare/SS90,74763,494154,241 AK SUI12,1008,46620,566 Retirement-60,99460,994 Workers' Compensation-16,51916,519 Benefits calculated asa % ofsalary expense based onactual costs except housing allowance, workcomp and health insurance Total Fringe Benefits102,847659,023761,870 Budget Justification Page1of4 Seward Community Health Center, Inc.GY2022 2022 Budget Period Progress ReportHRSAOtherTOTAL Budget Narrative - H80CS26600330 Federal Subtotal Personnel and Fringe1,312,8091,744,5123,057,320 Travel:- Providers and Staff-21,49721,497 2staff @ $2,000 tolower48 + 4staff @ $2,500 to lower 48 + 4staff @ $1,500 forCME Travel + 4 staff @ $375 ea.forAnchorage trainings Board-5,5005,500 2Board @ $2,000/triptolower48; 4Board @ $375 ea. forAnchorage trainings Other - Local area Mileage611-611 Staff reimbursement forlocal travel@ $.55/mile Subtotal Travel61126,99727,608 Supplies: Medical Supplies/ Medications-69,85069,850 Medications at $3.69/encounter + medical suplies at $6.97/encounter from2022 budget + vaccines @ 500 Office Supplies5,00016,05921,059 4kperquarter estimated for 2021projection + 5kallowance forprogram specific supplies Subtotal supplies5,00085,90990,909 Contractual:- Patient Care:- Patient-related/Contractual145,00032,320177,320 Contracts forafter hoursnurse call/triage and follow-up / reminder services @125/month + client transportation services @ $135/month + PRN Translation services @ $600 + $145k/yrbehavioral health service contract + $28,600/yr340B program initiatives Non-Patient Care:- Accounting, Auditing, and Billing Services-101,850101,850 Includes $33k forannual audits; $850/mocontract forstatement & collection services; $2,575/mo contracted payroll & benefit administration services; 2,500 Medicare Cost Reporting Consulting; 1,200/mo340B administration services; $7,500 Software conversion support; $3,350 Other reviews 401k, charge master, etc) Legal-2,5002,500 10hours @ $250/hour above current probono contribution Information Technology-68,55068,550 Budget Justification Page2of4 Seward Community Health Center, Inc.GY2022 2022 Budget Period Progress ReportHRSAOtherTOTAL Budget Narrative - H80CS26600330 Federal Community Connect/EPIC annual support feesfor E.H.R. $6,240/Qtr; ConstantlyOn ITServices contract $2,730k/mo; Contracted ITsupport for COVID-19related special projects $10,830 Contracted Facility Services-10,95010,950 Janitorial provided byPSMC; $912.50/mnth Other-57,00057,000 COVID-19 related contracted project management support services Subtotal Contractual145,000273,170418,170 Other:- Training-12,35012,350 Professional Membership Renewals $4,350/yr; Foraker Trainings $2k/yr; 4@ $1,500 CME Educational Allowance In-Kind Facility Expenses: Rent + USAC Telecom-79,40079,400 In-kind expense forvalue ofdonated rental ofclinic space $5k/mo; USAC Telecom Contribution 4,850/qtr Utilities-39,00039,000 Utility cost-sharing arrangement withPSMC based onsq. ft. @ (+/-) $3k/mo.; $250/month forutilities foradministrative modular building. Minor Equipment / Furniture-89,65089,650 ITEquipment Replacements $4,800 (laptops, Ipads, etc); $84,850 COVID-19 related Telemed & ITSystem update projects Repairs & Maintenance-47,00047,000 Facility repair, maintenance, snow removal, and groundskeeping costs paid toPSMC per cost- sharing agreement @ (+/-) $3,500/mo; $5,000 Mobile Clinic project maintenance items Tele-Communications-36,30036,300 Includes phone @ $1,775/mo; Internet @ 1,250/mo Dues & Subscriptions-89,87389,873 Technical subscriptions / software licenses / web hosting / etc@ $44,523k/yr; Software feesrelated toCOVID-19telehealth projects $25,260; employee- related memberships and license renewals @ 4,820/yr; General business / Chamber of Commerce / Newspaper / etc @ $13,270/yr; Vaccine Assessment @ $2k/yr. Postage / Freight-2,6502,650 Shipping and miscellaneous postage costs@ 2,650/year based on2021 projection Budget Justification Page3of4 Seward Community Health Center, Inc.GY2022 2022 Budget Period Progress ReportHRSAOtherTOTAL Budget Narrative - H80CS26600330 Federal Bank Fees-8,0958,095 Credit card processing fees @ $460/month estimated based oncurrent charges; Bank Fees @ 2,575/yr Equipment Maintenance / Lease-3,8713,871 Equipment lease forpostage machines @ 1670/yr; Repair and maintenance ofcopiers, fax machines, laptops and medical equipment estimated @ $550/qtr. Recruiting & Retention5,00029,70034,700 Recruiting ads @ $750/qtr; License/Credential renewals, salary scales, certifications $7,775/yr; New hire testing, background check, setup @$1,925/yr; $5,500/qtrSHARP for providers; Insurance - Malpractice Gap Coverage/Property/D&O-24,00024,000 Premiums estimate based on2021 contract Outreach and Enrollment10,45010,450 Outreach supplies average $1,125 perquarter; media communications for outreach and enrollment program @ $1,250; outreach postage costs are 500; $4,200 general advertisements Subtotal Other5,000472,938477,938 TOTAL DIRECT COSTS1,468,4192,603,5264,071,946 Retained Earnings--- TOTAL EXPENSE1,468,4192,603,5264,071,945 Budget Justification Page4of4