HEART OF IOWA COMMUNITY SERVICES SERVING THE CITIZENS OF AUDUBON DALLAS GUTHRIE COUNTIES ANNUAL SERVICE AND BUDGET PLAN APRIL 1, 218 Approved by HICS Region Governing Board on March 19, 218 FY 18/19 Annual Service and Budget Plan Page 1
Table of Contents II. ANNUAL SERVICE AND BUDGET PLAN FOR FY 18/19 A. Access Points & Care Coordination Agencies... 3 B. Case Management... 4 C. Crisis Planning... 4 D. Scope of Services & Expenditure Budget... 6 E. Revenue & County Tax Levy Information... 12 F. Financial Forecasting Measures...12 G. Provider Reimbursement Provisions... 12 Providers..13 FY 18/19 Annual Service and Budget Plan Page 2
II. ANNUAL SERVICE AND BUDGET PLAN FOR FY 18/19 Heart of Iowa Community Services exists to support improved access to health care and to promote full citizenship for people with mental illness, intellectual disabilities, or developmental disabilities. This plan assumes that the state will not mandate expansion of initial core services or creation of additional core services without additional funding. This plan covers the period from July 1, 218 through June 3, 219. A. Access Points & Care Coordination Agencies An access point is a part of the Heart of Iowa regional service system that is trained to complete the MH/DD regional applications and forward them to the local Community Services Office. HICS has designated the following access points: Access Point Address Phone number Adel Mental Health 39 S. 7 th Street, Suite C, Adel, IA 53 (515) 993-1919 Audubon County Community Services 318 Leroy Street, Audubon, IA 525 (515) 336-4864 Audubon County Memorial Hospital 515 Pacific Avenue, Audubon, IA 525 (712) 563-2611 Audubon County Jail 318 Leroy St. Ste. 4, Audubon, IA 525 (712) 563-2631 Dallas County Community Services 52747 N Avenue, Suite D, Adel, IA 53 (515) 993-5869 Dallas County Hospital 61 1 th Street, Perry, IA 522 (515) 465-3547 Dallas County Jail 21 Nile Kinnick Dr. N, Adel, IA 53 (515) 993-5815 Eyerly Ball Community Mental Health Services 131 Center Street, Des Moines, IA 5139 (515) 243-5181 Genesis Mental Health 61-1 th Street, Perry, IA 522 (515) 465-7541 Guthrie County Community Services 2 N. 5 th Street, Guthrie Center, IA 5115 (515) 336-4864 Guthrie County Hospital 71 N. 12 th Street, Guthrie Center, IA 5115 (641) 332-221 Guthrie County Jail 2 N. 5 th Street, Guthrie Center, IA 5115 (641) 747-2214 Hope Wellness Center 76 Cedar Avenue, Woodward, IA 576 (515) 438-2331 Zion Recovery 39 S. 7 th Street, Ste. B, Adel, IA 53 (515) 993-5243 FY 18/19 Annual Service and Budget Plan Page 3
B. Targeted Case Management HICS offers access to cost effective, evidenced based, conflict free Targeted Case Management as described in IAC 441-25.21(1)g. Designated Case Management agencies serving the HICS must be accredited according to the rules of the Department of Human Services. Targeted Case Managers meet the qualifications as defined in IAC 441. Targeted Case Management and Service Coordination Services meet the following expectations: Performance and outcome measures relating to the safety, work performance, and community residency of the individuals receiving the service. Standards including but not limited to social history, assessment, service planning, incident reporting, crisis planning, coordination, and monitoring for individuals receiving the services. Methodologies for complying with the requirements of sub rule 441-25.21 g, which may include the use of electronic recording keeping and remote or internet based training. The HICS Administrative Team evaluated interested agencies and made recommendations to the Regional Governance Board, who designated Targeted Case Management agencies to offer services to individuals enrolled in the Medicaid Program. HICS has identified and designated the following providers for case management in the HICS region: TCM And Service Coordination Contact Information Dallas County Community Services Service Coordination Only DHS Case Management DHS Case Management DHS Case Management Address 25747 N Avenue, Suite D Adel, IA 53 116 N. Market Street Audubon, IA 525 2 N. 5 th Street Guthrie Center, IA 5115 114 N. Chestnut Jefferson, IA 5129 Phone number (515) 993-1722 (712) 563-46 (641) 747-83 (515) 386-473 *Please contact your assigned MCO for additional case management options. C. Crisis Planning Crisis prevention, response, and resolution are embedded in the treatment and support plans that are prepared by Network Providers, Targeted Case Management, IPR, and Service Coordination. When these plans are developed, the goal is to figure out an environment and support structure that works for a person to mitigate the triggers that lead to crisis. Some agencies specifically use a Wellness Recovery Action Plan (WRAP) that complements the coordination plan. Much of the prevention, response, and resolution of crisis is handled through the normal services and supports people receive. The Mobile Crisis Response Team is another option that is specifically designed to deal with mental health crises that are identified by law enforcement and can be dealt with through therapeutic intervention rather than a criminal justice intervention. The Mobile Crisis Response Team is currently available throughout the region. The region currently working with ITP (Integrated Telehealth Partners) and has telehealth in all county hospitals in the region for committal and emergency pre-screen to assist with stabilization and resource/referral. FY 18/19 Annual Service and Budget Plan Page 4
The Region also provides a 24 hour crisis phone line through Hope Wellness Center (844-428-3878) available to assist residents with their immediate needs. The HICS Region added ITP Telepsych to the Hope Wellness Center (HWC) program in February, 217 in order to accommodate the medical clearance process. Individuals may be brought to Hope Wellness by Mobile Crisis, Law Enforcement, and First Responders without first having to have medical clearance through the Emergency Department. HWC has a 9 bed crisis stabilization unit available 24 hours a day. The goal of HWC is to engage people at an earlier stage of crisis to avoid more intensive services. We believe it will also help with preventing law enforcement intervention. The HWC is specifically targeted as a diversion service from inpatient hospitalization and jail. Hope Wellness Center has also partnered with Zion Recovery to have substance treatment and evaluations available onsite. Zion co-located and office at Hope Wellness in July 217. This has been an extremely valuable partnership. The HICS Region also developed a partnership with Zion Recovery in October 217 which allows individuals in need of inpatient treatments with co-ocurring issues to access an inpatient bed almost immediately. Also available at HWC is a transitional housing unit that houses 7 studio apartments with onsite kitchen and laundry. The goal of this housing unit is to assist people in transitional phases of their lives by providing stabilization, assessment, intensive outpatient treatment (both SA and MH), skill building and planning, to prepare that person for reintegration into the community. The chart below is a listing of current Heart of Iowa Regional crisis services. Emergency Crisis Line Service Crisis Function Provider Provide support during a crisis from a licensed mental health practitioner Contact Information Hope Wellness Center (844) 428-3878 Mobile Crisis Response Team Police based mental health support for diversion from hospital and jail Hope Wellness Center (844) 428-3878 Hope Wellness Center Crisis Stabilization/Residential Crisis assessment, stabilization and referral Genesis Mental Health Zion Recovery ITP (515) 438-2331 (515) 993-5243 (855) 27-3625 Hope Wellness Center Transitional stabilization and community based assessment, readiness and treatment unit Up to 18 day center for continued crisis stabilization, treatment engagement and preparation for permanent housing and support solutions Genesis Development Zion Recovery ITP (515) 438-2331 (515) 993-5243 (855) 27-3625 FY 18/19 Annual Service and Budget Plan Page 5
D. Scope of Services and Budget The annual budget and planning process is utilized to identify and implement core disability service improvements. The Heart of Iowa Region collaborates with stakeholders to assess need and to advocate adequate funding for services and supports in the initial core and additional core service domains. The Heart of Iowa Region funds services not otherwise provided by insurance and Medicaid programs. By combining regional (pooled county dollars) individuals can be empowered to reach their fullest potential by accessing a combination of supports. The Heart of Iowa Region is responsible for services that are authorized in accordance with the Regional Management Plan and within the constraints of budgeted dollars. Services funded by HICS are subject to change or termination with the development of the annual budget each fiscal year. The Regional Management Plan Policy & Procedure Manual addresses mandated services access standards. Annually, the Heart of Iowa Region reviews actual expenditures and services provided, stakeholder input and participation, quality assurance implementation findings, waitlist information, progress toward goals and objectives, and, if any, appeal type and resolution to determine if gaps in services or barriers to services exist. In December of each year, this review is submitted to the Department of Human Services. The chart below represents the core services as described in 441-25.1(331) and additional services offered in HICS. A description of the service is included as well as the projected funding need for Fiscal Year 218. When there is a $ projection, this indicates that the region does not expect any expenses in this area since they are covered by other funding sources, however should a need arise in these service domains, funding will be made available for those core services not covered. Access standards in IAC 441-25.3(331) have been considered in the formation of the budget and are based on the projected need in the region. It is felt that access standard will be met based on the number of providers, their locations, historical data and input from stakeholders. HICS is the funder of last resort. An individual is expected to utilize all other federal, state, and private insurance coverage before the region will be considered as a funder for any available service. By utilizing all available funding sources, it is the intention of HICS to effectively, responsibly and efficiently utilize its resources in order to cover as many individuals as possible and provide a wide range of MH/DS services. Funding for the disability category of Developmental Disabilities and Brain Injury will be provided based on other funding streams availability, individual need and the Region s ability to fund. FY 18/19 Annual Service and Budget Plan Page 6
FY 219 Budget EXPEND- ITURES COA HEART OF IOWA MHDS Region MI (4) ID (42) DD (43) BI (47) Admin (44) Total Treatment CORE DOMAINS 4331 Assessment & evaluation 1, 1, 4235 Mental health outpatient therapy 2, 2, 4236 Medication prescribing & management 3, 3, 71319 Mental health inpatient therapy- MHI 6, 6, 73319 Mental health inpatient therapy 2, 2, Basic Crisis Response 32322 Personal emergency response system 7,5 8, 5 16, 4431 Crisis evaluation 1, 1, 4435 24 hour access to crisis response 12, 12, Support for Community Living 3232 Home health aide 5 5 32325 Respite 1, 1, 2, 32328 Home & vehicle modifications 32329 Supported community living 13, 1, 1, 15, Support for Employment 5362 Prevocational services 2, 2, 5367 Day habilitation 3, 3, 5364 Job development 42, 42, 5368 Supported employment 84, 84, 5369 Group Supported employment Recovery Services 45323 Family support 45366 Peer support Service Coordination 21375 Case management 24376 Health homes Core Evidenced Based Treatment 4422 Education & Training Services - provider competency 32396 Supported housing 42398 Assertive community treatment (ACT) 45373 Family psychoeducation Core Domains Total 513, 19, 1, 5 542,5 MANDATED SERVICES 46319 Oakdale 72319 State resource centers 74XXX Commitment related (except 31) 79,5 79,5 75XXX Mental health advocate 3,8 3,8 Mandated Services Total 19,58 19,58 State or Other Funding Sources to be Used to Meet Service Need FY 18/19 Annual Service and Budget Plan Page 7
FY 219 Budget HEART OF IOWA MHDS Region MI (4) ID (42) DD (43) BI (47) Admin (44) Total ADDITIONAL CORE DOMAINS Comprehensive Facility & Community Based Crisis Services 44346 24 hour crisis line 3, 3, 44366 Warm line 4437 Mobile response 15, 15, 4432 23 hour crisis observation & holding 44312 Crisis Stabilization communitybased services 44313 Crisis Stabilization residential services 227, 227, Sub-Acute Services 6339 Subacute services-1-5 beds 6439 Subacute services-6 and over beds Justice system-involved services 4635 Mental health services in jails 45, 45, 25xxx Coordination services 88,883 88,883 46422 Crisis prevention training 1, 1, 46425 Mental health court related costs 7431 Civil commitment prescreening evaluation 1, 1, 46399 Justice system-involved servicesother 25 25 Additional Core Evidenced based treatment 42397 Psychiatric rehabilitation (IPR) 5, 5, 42366 Peer self-help drop-in centers Additional Core Domains Total 386,133 386,133 OTHER INFORMATION SERVICES 3371 Information & referral 4372 Planning and/or Consultation (client related) 4377 Provider Incentive Payment 4429 Planning and Management Consultants (non-client related) 1, 1, 4399 Consultation Other 5373 Public education 1, 1, Other Informational Services 2, 2, Total OTHER COMMUNITY LIVING SUPPORT SERVICES 6399 Academic services 22XXX Services management 381,66 381,66 23376 Crisis care coordination 23399 Crisis care coordination other 24399 Health home other 31XXX Transportation 7,5 21, 7,5 1, 1, FY 18/19 Annual Service and Budget Plan Page 8 State or Other Funding Sources to be Used to Meet Service Need
FY 219 Budget HEART OF IOWA MHDS Region MI (4) ID (42) DD (43) BI (47) Admin (44) Total 32321 Chore services 32326 Guardian/conservator 5, 5, 32327 Representative payee 7 5 1,2 32399 Other support 75 25 1, 32335 CDAC 3333 Mobile meals 5 2, 2,5 3334 Rent payments (time limited) 12, 1, 1, 1, 15, 33345 Ongoing rent subsidy 33399 Other basic needs 3,5 1, 5 5, 4135 Physiological outpatient trt 2,25 2,25 4136 Prescription meds 1,2 1,2 4137 In-home nursing 1,5 1,5 4138 Health supplies 41399 Other physiological treatment 4239 Partial hospitalization 1, 1, 4231 Transitional living program 25,55 25,55 42363 Day treatment 1, 1, 42396 Community support programs 1, 4, 5, 42399 Other psychotherapeutic trt 43399 Other non-crisis evaluation 4434 Emergency care 44399 Other crisis services 45399 Other family & peer support 5361 Vocational skills training 5365 Supported education 5399 Other vocational & day services 63XXX RCF 1-5 beds 63XXX ICF 1-5 beds 63329 SCL 1-5 beds 25, 25, 63399 Other 1-5 beds Other Community Living Support Services Total 731,56 27,75 8,5 4,5 771,86 OTHER CONGREGATE SERVICES 536 Work services (work activity/ sheltered work) 64XXX RCF 6 and over beds 245, 245, 64XXX ICF 6 and over beds 64329 SCL 6 and over beds 64399 Other 6 and over beds 1, 1, Other Congregate Services Total 246, 246, ADMINISTRATION 11XXX Direct Administration 46,765 46,765 12XXX Purchased Administration Administration Total 46,765 46,765 State or Other Funding Sources to be Used to Meet Service Need FY 18/19 Annual Service and Budget Plan Page 9
FY 219 Budget HEART OF IOWA MHDS Region MI (4) ID (42) DD (43) BI (47) Admin (44) Total State or Other Funding Sources to be Used to Meet Service Need Regional Totals 2,5,769 46,75 18,5 5, 46,765 2,536,784 (45XX-XXX) County Provided Case Management (46XX-XXX) County Provided Services Regional Grand Total 2,536,784 Transfer Numbers (Expenditures should only be counted when final expenditure is made for services/administration. Transfers are eliminated from budget to show true regional finances) 13951 Distribution to MHDS regional fiscal agent from member county 2,536,784 14951 MHDS fiscal agent reimbursement to MHDS regional member county 875,281 FY 18/19 Annual Service and Budget Plan Page 1
FY 219 Budget REVENUES HEART OF IOWA MHDS Region Projected Fund Balance as of 6/3/18 3,415,991 Local/Regional Funds 2,29,143 1XX Property Tax Levied 2,29,143 531 Client Fees 12XX Other County Taxes 16XX Utility Tax Replacement Excise Taxes 4XXX-5XXX Charges for Services 6XX Interest 6XXX Use of Money & Property 25XX Other Governmental Revenues 8XXX Miscellaneous 92XX Proceeds /Gen Fixed assests sales State Funds 21XX State Tax Credits 22XX Other State Replacement Credits 225 MHDS Equalization 24XX State/Federal pass thru Revenue 2644 MHDS Allowed Growth // State Gen. Funds 2645 State Payment Program 29XX Payment in Lieu of taxes Federal Funds 2344 Social services block grant 2345 Medicaid Other Total Revenues 2,29,143 Total Funds Available for FY19 5,76,134 FY19 Projected Regional Expenditures 2,536,784 Projected Accrual Fund Balance as of 6/3/19 3,169,35 FY 19 COUNTY LEVY INFORMATION County 216 Est. Pop. Regional Per Capita FY19 Max Levy FY19 Actual Levy Actual Levy Per Capita AUDUBON 5,678 25.84 146,72. DALLAS 84,516 25.84 2,183,893 2,183,893 25.84 GUTHRIE 1,625 25.84 274,55 16,25 1. HEART OF IOWA Region 1,819 2,65,163 2,29,143 22.72 FY 18/19 Annual Service and Budget Plan Page 11
E. Financial Forecasting Measures Throughout the year, HICS staff and stakeholders identify unmet needs and areas for service development, which are incorporated into subsequent strategic plans and budgets. Strategic plan priorities are identified in the areas of system infrastructure, community living, employment, and treatment. The HICS Region will continue to work with stakeholders to enhance the system with the development of the following programs which have been identified as needs. It is projected that these enhancements would take place over the next years. These expenses are not projected in the included budget, however, the projected fund balance of $3,169,35 will allow for the addition of such expenditures. Strategic Plan Priority Area FY 17/18 Strategy Projected Cost Education and Resource Implement education and resource strategies regarding regionalization 15, Community Living Implement incentive payments for Community Living Providers 5, Prevention Children s Wrap Around Program/Prevention Services 15, F. Provider Reimbursement Provisions Heart of Iowa Community Services will contract with MHDS providers whose base of operation is in the region. Heart of Iowa Community Services may also honor contracts that other regions have with their local providers, or may choose to contract with providers outside of the Region. A contract may not be required with providers that provide one-time or as needed services. A fee for service approach will be utilized in most provider contracts outlining the services to be provided and the rate of reimbursement. All payments will be based on a pre-authorized request for service authorization with the exception of court ordered payments, such as civil commitment costs. As described above in Scope of Service and Budget Financing Provisions, HICS provides funding by incorporating all available funding and insurance resources in its system of care. The region may also utilize block grant payments when a service does not fit the traditional methods of payment based on a pre-approved individual service request. Requests for grant funding opportunities may also be offered by HICS based on an assessed community need in order to engage providers in Evidence Based Practices. When a non-traditional provider arrangement is more appropriate than a fee for service approach with a contracted provider, Service Coordinators will work with the region s CEO to request such arrangements. These arrangements will be based on a fee according to the individual s need with written expectations of goals and outcomes for the individual. Each service provider shall provide monthly billing invoices within 6 days of service provision, and other information requested of the provider for utilization review. The monthly billings shall include the following information: Name and unique identifier of each individual served during the reporting period. Dates of service. Number of units of service delivered to each individual served. When requested, attendance records. Unit rate and total cost of the units provided to each individual. Copayments or other charges billed to other sources shown as deductions on the billing. Actual amount to be charged to the Region for each individual for the period. FY 18/19 Annual Service and Budget Plan Page 12
HICS staff shall review the billings and additional utilization information in comparison with service funding authorizations in place. Non-emergency services delivered without service funding authorization shall be deducted from the billing. All eligible bills shall be paid within 6 days of receipt of required documentation unless unforeseen circumstances exist. No billings received more than 6 days after the close of the fiscal year in which the service was provided shall be considered for payment by HICS unless there is a statutory obligation. Fiscal year for HICS is July 1 June 3. Heart of Iowa Community service contracts require that all providers meet all applicable licensure, accreditation or certification standards; however HICS makes serious efforts to stimulate access to more natural supports in its service provider network. Successful attainment of positive outcomes, consumer and family satisfaction, and cost effectiveness measures are the most important factors in continued network participation. HICS has identified access points within the provider network to assist individuals or their representatives to apply for services. *Core services underlined. HICS Regional Network of Providers Provider Contact Information Funded Programs in the HICS Region Adel Mental Health ChildServe Community Options Dallas County Hospital DHS Case Management Central Iowa Juvenile Detention Center 39 S. 7 th Street Adel, IA 53 (515) 993-1919 546 Merle Hay Rd Johnston, IA 5131 (515) 727-875 61 1th Street Perry, IA 522 (8) 543-3546 ext. 35 116 N. Market Street Audubon, IA 525 (712) 563-46 2 N. 5 th Street Guthrie Center, IA 5115 (641) 747-83 2317 Rick Collins Way Eldora, IA 5627 (641) 858-3852 Outpatient Therapy CDAC, Supported Community Living, Home and Vehicle Modification, Respite, Child Care Center, Interim Medical Monitoring & Treatment HHA, Nurse, Nursing Care Service, Day hab, Day Health Program, TCU and CCU Personal Emergency Response Case Management Transportation (Committal and non) Children & Families of Iowa Cross County Transportation Country View Estates Diamond Cab Express 1111 University Avenue Des Moines, IA 5314 (515) 288-1981 15668 Quilan Avenue Bouton, IA 539 (515) 868-2997 157 State Street Guthrie Center, IA 5115 (641) 755-2125 128 58 th Street West Des Moines, IA 5266 (515) 782-217 Representative Payee Transportation Supported Community Living Transportation FY 18/19 Annual Service and Budget Plan Page 13
HICS Regional Network of Providers Provider Contact Information Funded Programs in the HICS Region Easter Seal Society of Iowa Eyerly-Ball Community Mental Health Services Family Resource Center Genesis Development Genesis Mental Health Home Care Services, Inc. Home Instead Senior Care Hope Wellness Center Joy Ride Mainstream Living Optimae Plains Area Mental Health Region 12/Western Iowa Transit System REM Iowa Community Services The Respite Connection PO Box 42 Des Moines, IA 5333 (515) 274-1529 945 19 th Street Des Moines, IA 5314 (515)241-982 52 West 7th Street Carroll, IA 5141 (515) 523-1611 2111 West Greene St. Adel, IA 53 (515) 993-5986 41 West McKinley Street Jefferson, IA 5135 61 1th St Perry, IA 522 (515) 465-7541 11 North 9th Street Adel, IA 53 (515) 993-4531 214 N. Warrior Lane, Suite B Waukee, IA 5263 (515) 978-7991 76 Cedar Avenue Woodward, IA 576 (515) 438-2331 3 Justin Drive Urbandale, IA 5322 (515) 331-11 211 Lucinda Perry, IA 522 (515) 465-8199 516 Nile Kinnick Drive South, Suite B Adel, Iowa 51 (515) 993-4974 318 S. Maple Street Suite 1 Carroll, IA 5141 19 E. Anthony Street Carroll, IA 5141 (712) 792-9914 4436 114th St Urbandale, IA 5322 (515) 278-4914 2469 16th Street Urbandale, IA 5322 (515) 277-15 Day Habilitation, Supported Community Living, Pre-Vocational services, Supported Employment, Respite, Interim Medical Monitoring & Treatment, Assistive Technology Outpatient Psychiatric and In-Office Clinical Treatment & Evaluation, Senior Outreach Counseling Integrated Health Home - Intensive Care Coordination Supported Community Living CDAC, Home and Vehicle Modification, IMMT, Respite Supported Community Living, Supported Employment, Adult Day Care, Day Hab, Pre Voc, RCF/ID, Payee Outpatient Therapy, Medication Management, Psychiatry CDAC, Transportation Respite Transportation, CDAC, Supported Community Living Respite Crisis Stabilization, Transitional Living, Mobile Crisis, 24 Hour Crisis Line Transportation Day Habilitation, Supported Community Living, Home and Vehicle Modifications, Transportation, Pre-Vocational Services, Supported Employment, Respite Supported Community Living, Home and Vehicle Modification, Supported Employment, Respite, Adult Day Care, Day Hab Outpatient Therapy, Psychology, Psychiatry, IHH, Outreach Programs, Clubhouse Transportation Day Habilitation, Pre-Vocational Services, School Transition Services Supported Community Living-Daily Supported Community Living, Home and Vehicle Modifications, Respite FY 18/19 Annual Service and Budget Plan Page 14
HICS Regional Network of Providers Provider Contact Information Funded Programs in the HICS Region Sisters Transportation Southwest Iowa Mental Health System Trans Iowa Universal Nursing Service Of Iowa 11 5th St Ste. A West Des Moines, IA 5265 (515) 277-696 151 East 1 th street Atlantic, IA 522 (712) 243-325 155 E. Army Post Rd Des Moines, IA 532 (515) 256-45 115 North Warrior Lane Waukee, IA 5263-8197 (515) 987-7717 Transportation Outpatient Therapy, Medication Management, Psychiatry Transportation Home Health Aide, Respite, Interim Medical Monitoring and Treatment, Nursing FY 18/19 Annual Service and Budget Plan Page 15