11 12 03 Meeting Info & NotesTO:
JEANNE F. SCHNEIDER
CITY CLERK
YOU ARE HEREBY DIRECTED TO CALL A SPECIAL SESSION OF THE CITY
COUNCIL TO BE HELD ON WEDNESDAY, NOVEMBER 12, 2003, AT 5:30 P.M., AT
DUBUQUE GREYHOUND PARK AND CASINO FOR THE PURPOSE OF HOLDING
THE ANNUAL LEGISLATIVE DINNER.
MAYOR
Legislative Dinner -- Nov. 12, 2003
~ene Mantemach
~Mike Connolly
/Pat Murphy
~Pam Jochum
~'Bob Osterhaus
~/Steve Lukan
~Roger Stewart
Ci .ty:
~/Ferry Duggan
~/Ann Michalski
~/Dan Nicholson
.~Roy Buol
./'John Markham
~'~Pat Cline
~Joyce Connors
cdViike Van Milligen
~,42indy Steinhauser
~Barry Lindahl
-./Jeanne Schneider
~Bill Baum
c/Pauline Joyce~g
~2Susan Gwiasda
Holy Family
Mike Eulli-~ an
~"Dnn Miller
Dubuque Community
WTed Stieber
~qKaren Behr
[~'Donna Bauerly
~Doug Horstmann
,-~John Burgart
~--Cammie Dean
~tcvc llo~lge
CZRnn Holm
~Betty Hogan
t-4<2ris Hall
.~-B°ard of Supervisors
Donna Smith
t/Jim Waller
~Eric Mantemach
,/Jan Hess
'-~Vlary Ann Specht
LEGISLATIVE DINNER MEETING
WEDNESDAY, NOVEMBER 12, 2003 t~ 5:30-7:30 P;M.
DUBUQUE GREYHOUND PARK AND CASINO
1. Welcome/Introductions - Terry Duggan
5:30p. m.
2. Dinner Served
3. Call to Order- Terry Duggan
6:00p. m.
4. Overview of the City's Legislative Issues
for the 2004 Legislative Session
6:00-6:l S p. m.
Comments from Dubuque County
Representative
6: l S-6:30 p. m.
Comments from Dubuque Community
School Board Representative
6:30-6:45 p. m.
7. Comments from Holy Family Catholic Schools
Representative
6:45-7:00 p:m.
8. Comments from Legislative Delegation
7:00-7:30p. m.
9. Open Discussion 7:30 p.m. ~
City Of Dubuque
State Legislative Issues
For The 2004 Session
State Bud.qet
In response to a revenue shortfall during last session the State of Iowa
implemented across-the-board cuts in expenses. Some of these cuts reduced
revenues to cities, with no relief to cities for state-mandated programs. Concerns
remain over the impacted of the reduced revenue to cities and that similar action
will be taken in the 2004 session.
Requested Action: The state should restore revenues to cities that Were cut
last year in an effort to make cities whole.
Fundin,q of Maior Transportation Projects
The State of Iowa has used a strategy of allocating funds for completing the
major transportation projects in the state as opposed to using a piecemeal
approach. This strategy has been successful with extensive work being
completed on major corridors. The same strategy should be used for major
projects in larger cities, which require significant funding commitments for
completing the projects in a reasonable amount of time. Examples include the
Southwest Arterial, the Julien Dubuque Bridge and U.S. 20/Dodge Street.
Requested Action: Support efforts to continue the strategy for funding major
transportation projects throughout the state.
Fully Fundin.q Enrich Iowa Pro.qram
Enrich Iowa is a state aid program for Iowa's libraries. Until recently, Iowa was
one of 8 states without direct state aid to libraries. Current state funding is at $1
million statewide versus the recommended $3 million for full funding. If Enrich
Iowa were fully funded, the Carnegie-Stout Public Library could realize at least
$100,000 a year in state aid.
Requested Action: Support efforts to fully fund the Enrich Iowa program at $3
million statewide.
Set the rate for State Tax on Gamin,q Revenue~
Requested Action: Enact Legislation that sets the tax rate at a lower
percentage, as close to 20 % as possible for small gaming operations like
Dubuque Greyhound Park and Diamond Jo Casino and a graduated tax rate for
larger gaming operations.
Rescind House File 324
In the 2001 General Assembly House File 324 (HF 324) was enacted. This law
set up numerous new requirements for cities concerning bidding for street, bridge
and culvert projects involving construction, reconstruction and improvements
costing over $25,000 ($50,000 for cities over 50,000 in population).
One requirement was a new report that is labor intensive and taxing to City
public works departments. In addition to the report that cities currently submit
on street receipts and expenditures using road use tax funds, the new report
requires cities to provide detailed cost accounting for all projects within 90
percent of the bid threshold. The report also includes a statement of the cost
of purchasing, leasing, or renting construction or maintenance equipment.
Since the repor[s are extremely detailed and some cities do hundreds of street
projects annually, this new requirement will entail a city needing additional
resources. HF 324 did not charge the Iowa Department of Transportation to
use this new report for any specific state purpose, resulting in 950 cities
expending resources that could be used elsewhere. This becomes particularly
onerous for small cities that publicly bid the majority of street projects.
Requested Action: Support effort to rescind HF 324 and allow cities to use
own workforce on public improvements and reduce reporting requirements.
Enterprise Zone Incentives
The Enterprise Zone legislation was written to promote private investment in
economically distressed areas of a city or county. To assist new employees of
companies locating in enterprise zones, the legislation provides for employers to
establish a capital fund for down payments or rental subsidies. The business
funds this program through a credit from state withholding taxes, based on the
wages paid to the participating employees. An amount equal to 1.5 percent of
the gross wages paid by the employer is credited from the payment otherwise
withheld, and used to capitalize this fund.
This feature of the legislation has not been utilized to date. One reason is that
the credit produces so little capital for the housing assistance program. For an
employee earning $10 per hour, the credit equals approximately $300. Typically,
· down payment assistance programs offer $3,000 to $5,000; rental subsidy
programs average $2,500 to $3,000 annually. In order to make this program
effective, the credit for withholding should be increased.
Another option is to allow the credit to be "pooled,~ to be made available to all
eligible employees. As the legislation currently is written, the 1.5 percent credit is
made available on the basis of withholding from individual employees -for the
benefit of only that employee. If the credit could be aggregated, a larger capital
2
fund could be established, from which all employee purchasing or renting
housing in the enterprise zone could access funds for their housing needs.
Another reason for lack of employer participation in this program is that the
legislation requires the employer to choose between use of the tax credit for job
training or for providing a housing assistance program. Employers to date have
chosen to use the credit to pay for training new employees.
Requested action: The legislation should be amended to provide the credit for
both job training and employee housing assistance and to "pool" the funds. This
will increase the tax credit and increase interest in the program by employers.
Property Tax
The current tax structure for state and local governments is a mix of tax laws,
rates and policies that do not provide for a fair and consistent tax system. It is
the result of many years of adopting tax changes that may or may note be
consistent with previous laws or tax policies. Often, the tax policies are
contradictory, such as the residential rollback's shift of tax burden from
residential to commercial and industrial property owners, and the elimination of
machinery and equipment tax, which shifts the tax burden from industrial to
residential and commercial property owners.
Requested action: Perform a comprehensive review of the entire tax structure
of the State of Iowa and design a tax structure that provides tax equity and
policies that are consistent with an overall direction for state and local
government taxation. Place a freeze on the residential rollback at no lower than
50% during the review, ensure full funding of state property tax exemption and
update the sales tax distribution formula.
Military Tax Credit
The State of Iowa provides for veterans to receive a military tax credit on their
property taxes. The credit reduces their City property tax by the levy rate of the
City, which is $10.76 per $1,000 of valuation. The State, however, reimburses
the City at a much lower rate, which potentially will be reduced again. This
leaves a substantial deficit for other property owners to pay.
Requested action: Enact legislation to fully reimburse cities for the State of
Iowa's military tax credits.
,Expand Cities' Extraterritorial Jurisdiction
Cities have extraterritorial jurisdiction (ET J) for up to two miles from their
corporate limits for subdivision review and approval only if the County has zoning
for the rural areas. Extending the cities' ETJ to include review and approval of
zoning changes would facilitate planned and managed growth. Legislation
should provide incentives for governments to voluntarily plan together, and
3
identify recommended land use impact to be considered during the planning
process. The League supports legislation that expands land management
practices such as ETJ of cities to include review and approval of zoning changes.
Requested action: Support legislation enabling cooperative planning and
effective land management practices.
Eliminate the "20% Objection Rule" for Rezonings
Section 414.5 of the Iowa Code requires a favorable vote by three-fourths of the
City Council members - a 6 to 1 vote - to approve a rezoning request over the
wdtten objections of 20 percent or more of the owners of the property being
rezoned, or 20 percent or more of the property owners within 200 feet of the
subject property. The concepts that nearby property owners have a say in
rezoning cases is valid; however, this must be balanced against the needs of the
entire community. At 20 percent, a minority of property owners can dictate the
outcome of community development, especially when one property owner with a
large tract of land can constitute the entire 20 percent.
Requested action: Raise the "objection percentage" of owners of property
within 200 feet from 20 percent to a simple majority (51%); or require a favorable
vote by two-thirds of the City Council members, or a 5 to 2 vote, when the
objection threshold is reached.
,Property Owners on Historic Preservation Commissions
Section 303.34 of the Iowa Code requires that: "At least one resident of each
designated area of historical significance shall be appointed to the commission."
This requirement is problematic for the City of Dubuque's Old Main Historic
District, which is primarily commercial. It would be beneficial for the City in the
recruitment and retention of commissioners to be able to appoint property owners
to represent historic districts. Furthermore, since historic preservation
regulations apply to the rehabilitation, renovation and restoration of property,
allowing property owners to serve on the commission would be appropriate.
Furthermore, some Iowa cities are experiencing burgeoning commissions as
historic districts are designated and representatives of each district are
appointed. To avoid "over-populating" a commission, allowing a majority of the
districts to be represented on a historic preservation commission would be
appropriate.
Requested action: Enact legislation allowing property owners to represent
historic districts on the Historic Preservation Commission.
Appeal of Actions by Historic Preservation Commission
Section 303.34 of the Iowa Code states that an aggrieved party may appeal the
action of a histodc preservation commission to the City Council, and then to
district court. The City Council, like the court, has to consider whether the
commission exercised its powers and followed the guidelines established by law
and ordinance, and whether the commission's action was "patently arbitrary and
capricious." This process places the City Council in the difficult and
uncomfortable position of interpreting technical guidelines and determining their
appointees "arbitrary and capricious." The City Council would support an
alternative process.
Requested action: Consider legislation providing an alternative appeals
process regarding an action of the historic preservation commission.
State Mandates
Cities are often faced with implementing mandates from the state and federal
governments without receiving the necessary funds for implementation
Requested action: Enact legislation that exempts local government from
providing any new service or engaging in any new activities if the state does not
provide full funding,
5
IOWA LEAGUE OF CITIES
2004 LEGISLATIVE PRIORITIES
Efficient Government.
Priority: Seek financial and legislative incentives that encourage regional
planning and service sharing arrangements among governments including
cities, counties, schools and state government.
Background: While making reductions to cities in 2003, legislators called for
increased efficiency of local governments. Cities must proactively demonstrate
efficiencies in place and seek legislative incentives for future sharing and
consolidation. For example, land management legislation should offer financial
incentives for regional planning. Barriers to service sharing should be removed
to allow for more flexibility between local governments.
City Revenues
Priority: Support legislation expanding Home Rule options for city revenue
sources to cover critical services to ensure safety and quality of life for
residents. Revenue alternatives contribute to reduction of reliance on property
taxes and include but are not limited to municipal fees, local income taxes,
increased sales and hotel/motel taxes and new funding options for public safety.
Background: As legislators focus on property tax reform in the upcoming year,
some interest groups will advocate that reform should result in reduction. State
funding to cities and counties was permanently reduced by approximately 25
percent in the 2003 session. To avoid greater dependence on property taxes,
alternative revenue sources should be explored. Alternatives will allow cities to
provide the services requested by or mandated for citizens.
Mandate Relief
Priority: Support legislati°n calling for relief from mandates that negatively
impact the ability to provide city services. Examples include but are not limited
to setting a percentage for taxation of residential property, increasing the public
bid threshold, streamlining the municipal bond financing process, reducing
publication costs and addressing rising employee benefit costs.
Background: The costs of providing city services are exacerbated by unfunded
mandates. In 2004, legislators should address the increased flexibilities for
· luded in the 2003 "reinvention" process.
cities that were proposed for but not ~nc
Economic Development and TIF_
Priority: Support initiatives that provide tools for cities to serve as economic
catalysts for iowa. This includes enhancement of tax increment financing (TIF)
through minimal changes, and continuation and expansion of the Community
Attraction and Tourism (CAT) program beyond 2004.
Background: This priority includes agreement to change TIF law to gradually
eliminate the state appropriation that reimburses the $5.40 per $1,000 uniform
levy to schools. The Community Attraction & Tourism program will end in 2004
unless additional funding is appropriated.
distdct court. The City Council, like the court, has to consider whether the
commission exercised its powers and followed the guidelines established by law
and ordinance, and whether the commission's action was "patently arbitrary and
capricious." This process places the City Council in the difficult and
uncomfortable position of interpreting technical guidelines and determining their
appointees "arbitrary and capricious." The City Council would support an
alternative process.
Requested action: Consider legislation providing an alternative appeals
process regarding an action of the historic preservation commission.
State Mandates
Cities are often faced with implementing mandates from the state and federal
governments without receiving the necessary funds for implementation
Requested action: Enact legislation that exempts local government from
providing any new service or engaging in any new activities if the state does not
provide full funding.
IOWA LEAGUE OF CITIES
2004 LEGISLATIVE PRIORITIES
Efficient Government
Priority: Seek financial and legislative incentives that encourage regional
planning and service sharing arrangements among governments including
cities, counties, schools and state government.
Background: While making reductions to cities in 2003, legislators called for
increased efficiency of local governments. Cities must proactively demonstrate
efficiencies in place and seek legislative incentives for future sharing and
consolidation. For example, land management legislation should offer financial
incentives for regional planning. Barriers to service sharing should be removed
to allow for more flexibility between local governments.
City Revenues
Priority: Suppod legislation expanding Home Rule options for city revenue
sources to cover critical services to ensure safety and quality of life for
residents. Revenue alternatives contribute to reduction of reliance on property
taxes and include but are not limited to municipal fees, local income taxes,
increased sales and hotel/motel taxes and new funding options for public safety.
Background: As legislators focus on property tax reform in the upcoming year,
some interest groups wilt advocate that reform should result in reduction. State
funding to cities and counties was permanently reduced by approximately 25
pement in the 2003 session. To avoid greater dependence on property taxes,
alternative revenue sources should be explored. Alternatives will allow cities to
provide the services requested by or mandated for citizens.
Mandate Relief
Priority: Support legislation calling for relief from mandates that negatively
impact the ability to provide city services. Examples include but are not limited
to setting a percentage for taxation of residential property, increasing the public
bid threshold, streamlining the municipal bond financing process, reducing
publication costs and addressing rising employee benefit costs.
Background: The costs of providing city services are exacerbated by unfunded
mandates. In 2004, legislators should address the increased flexibilities for
cities that were proposed for but not included in the 2003 "reinvention" process.
6
Economic Development and TIF
Priority: Support initiatives that provide tools for cities to serve as economic
catalysts for Iowa. This includes enhancement of tax increment financing (TIF)
through minimal changes, and continuation and expansion of the Community
Attraction and Tourism (CAT) program beyond 2004.
Background: This priority includes agreement to change TIF law to gradually
eliminate the state appropriation that reimburses the $5.40 per $1,000 uniform
levy to schools. The Community Attraction & Tourism program will end in 2004
unless additional funding is appropriated.
7
Vision
Adopted by City Council
September 2003
A City of...
· History
Beauty
· Opportunities
· Excitement
Masterpiece on the Mississippi
Adopted by City Council
September 2003
DUBUQUE VISION 2020
"CITY OF DUBUQUE IS A GROWING CITY WITH A STRONG
BALANCED ECONOMY AND CONNECTIONS TO THE WORLD. THE
DUBUQUE COMMUNITY TAKES PRIDE IN OUR HISTORY AND
HERITAGE AND HAS ACTIVELY PRESERVED OUR PICTURESQUE
RIVER AND COMMUNITY. DUBUQUE CITIZENS HAVE CHOICES OF
QUALITY LIVEABLE NEIGHBORHOODS AND FUN THINGS TO DO,
AND ARE ENGAGED IN THE COMMUNITY. DUBUQUE CITY
GOVERNMENT IS FINANCIALLY SOUND AND PROVIDING SERVICES
WITH CITIZENS GETTING VALUE FOR THEIR TAX DOLLAR"
CITY OF DUBUQUE IS A GROWING CITY WITH A STRONG
BALANCED ECONOMY AND CONNECTIONS TO THE WORLD
IS A GROWING CITY -
People investing in Dubuque's Future
· Job Opportunities with good wages
· Attracting young adults to live here to raise their families
· Growing while preserving Dubuque's "small town" character and
charm
· Quality education throughout life
WITH A STRONG BALANCED ECONOMY - · Balance based on: Regional retail center, High-Tech business center,
Tourist destination center, Manufacturing center, Financial center,
Colleges and University/High education center, Medical and Health
Service center
· Retention and growth of current businesses
· Venture capital to grow the economy
· More jobs creating economic opportunity for citizens
· Opportunities to start and grow a business
· Attracting businesses to locate in Dubuque
· Diverse economy with multi "Economic Engines"
AND CONNECTIONS TO THE WORLD -
Four-lane links to six interstate and major highway systems
· Quality air service to major hubs for business and leisure
· Telecommunication infrastructure and services through the city
· River transporting goods and product
· Efficient street system for moving within the city
· Band width
Adopted by City Council
September 2003
THE DUBUQUE COMMUNITY TAKES PRIDE IN OUR HISTORY AND
HERITAGE AND HAS ACTIVELY PRESERVED OUR PICTURESQUE
RIVER AND COMMUNITY
TAKES PRIDE IN OUR HISTORY AND HERITAGE - · Revitalized historic downtown
· Preservation of historic buildings and homes
· New infill development and public projects consistent with the
character of the downtown or neighborhood
· Community event and festivals celebrating our heritage and
remembering our historical roots
· Community support for culture, arts and museums
AND HAS ACTIVELY PRESERVED OUR PICTURESQUE RIVER AND COMMUNITY · Maintaining the views and vistas
· Beautiful streetscapes and gateways
· Beautiful riverfront with public access and use
· Buildings that are architectural statements
· Recognition: one of the "Prettiest places in the world:
DUBUQUE CITIZENS HA VE CHOICES OF QUALITY LIVEABLE
NEIGHBORHOODS AND FUN THING TO DO, AND ARE ENGAGED IN
THE COMMUNITY
HAVE CHOICE OF QULITY LIVABLE NEIGHBORHOODS - · Quality streets and infrastructure
· Older homes renovated and up to code
· Strong sense of neighborhood pride and responsibility
· Opportunities for homeownership
· People are safe at home and in the neighborhood
AND FUN THINGS TO DO - · Variety of parks and trails
· Quality restaurants
· Choice of entertainment venues
· Center for culture and arts activities and opportunities and museum
to visit
· Activities for families
· Variety of shopping choices
AND ARE ENGAGED IN THE COMMUNITY -
Adopted by City Council
September 2003
· Quality education throughout life
· .Involved in Community and Service organizations
· Participate in neighborhood associations
· Participation in City Governance - boards, commissions and task
forces
· Contributing timeand money
· Volunteering to serve
DUBUQUE CITY GOVERNMENT IS FINANCIALLY SOUND AND
PROVIDING SERVICES WITH CITIZENS GETTING VALUE FOR THEIR
TAX DOLLAR
IS FINANCIALLY SOUND - · Diverse and expanding tax base and revenues
· Well maintained city assets: Infrastructure and Facilities
· Fiscally responsible reserves and debt
· Strong partnerships with others for better services
· Efficient city operation looking for better services
· Efficient city operation looking for better ways to service, less costly
methods
· Competitive tax rate and fees
AND PROVIDING SERVICES WITH CITIZENS GETTING VALUE FOR THEIR TAX
DOLLAR -
· Customer friendly employees, facilities and processes
· Excellent city services, tops quality city products and facilities
· High level of customer satisfaction
· Well trained city staff that takes a problem solving approach
· Services responsive to the citizens need
· Effective use of technology to serve citizens to inform citizen, to
increase productivity
Adopted by City Council
September 2003
Dubuque 2008: Our Goals
Improved Connectivity:
Transportation and Telecommunications
Planned and Managed Growth
Diverse, Strong Dubuque Economy
Riverfront Developed
Partnering for a Better Dubuque
POLICY AGENDA 2003 - 2005
TOP PRIORITY
Southwest Arterial
Stormwater Projects
Street Projects
Zoning Ordinance Update
Erosion Control Policy and strategy
HIGH PRIORITY
Telecommunications Strategy
Annexation: Policy and implementation
Riverfront Development Projects
Federal Strategy
Five Flags: Evaluation
Budget: Service Inventory, Cost of Services, Tax Rate
CARRYOVER PRIORITY 2002 - 2004
Downtown Master Plan
Adopted by City Council
September 2003
MANAGEMENT AGENDA 2003 - 2005
Julien Dubuque Bridge
River Valley Initiative
State Grants
Industrial Park Development: Next Phase
Riverfront Master Plan: Implementation
Star Brewery Lease
Adams Company: Acquisition, Relocation
Capital Improvement Program: New and Maintenance
MAJOR PROJECTS 2003 - 2004
Stormwater: Carter Road, 32nd Street Detention Acquisition
Highway 20 Improvement Project
Adopted by City Council
September 2003
PHONE: 563-589-4441
FAX: 563-589-7884
EMAIL: brdofsup@dbqco.org
COURTHOUSE
DUBUQUE, IOWA 52001-7053
DONNA L. SMITH
JIM WALLER
ERIC MANTERNACH
PRIORITIES
2004
12, 2003
The Dubuque County Board
your assistance in the past.
session for the well-being of Dubuque
1. Southwest Arterial
This is an urgent request for'
Project alive.
Harkin. We are currently ~
environmental
pro j,
· thanking you for
work together during the upcoming
~ the Southwest Arterial
ect, thanks to Senator
the
given us some assurance that
Transfers of Jurisdiction for County Roads
During the 2003 session of the Legislature, Senate File 451 was enacted, which resulted
in communications 15om the Department of Transportation in forming us that tran_sfers o£
jurisdiction would occur on the former Iowa 386, Iowa 955 and Iowa 963, a total of 7.5
miles of road.
We immediately object to this transfer because Dubuque County and the Iowa
Department of Transportation had previously signed a Transfer of Jurisdiction Agreement
for transfer of these roadways under the terms and conditions of Iowa Code Section
306.8. We are asking that the existing agreements be honored and that the transfers of
jurisdiction are made in accordance with those agreements.
County Engineer Mark Jobgen has est/mated that the State will provide an additional
$90,793 per year for 10 years to bring these roads up to standards, when in actuality he
has estimated that it will cost Dubuque County in excess orS million to improve the
condition of these roads.
We are asking that the existing Memoranda of Understand be honored, that these roads be
transferred according to the previously established timetable, and that the State of Iowa
bring the roads up to acceptable standards prior to the transfer.
Copies of our correspondence with the Department of Transportation are attached to this
presentation.
Farm to Market Roads into cities with populations under 500 will also be transferred to
the County beginning July 1, 2004. There are 14 cities within Dubuque County with
populations under 500, according to the 2000 Census. This is a double-edged problem in
that if the roadways are transferred to the County, the small cities will lose road use tax
money to counties, losing a significant part of their income, and the County will need to
maintain roadways outside the jurisdiction of the Secondary Road Department and the
Rural Fund.
Road Use Tax Fund
Current studies show that all road entities lack sufficient resources to maintain their
existing road and street system. However, neither the Department of Transportation,
cities nor counties should be allocated less than their current share of revenue sources
mak/ng up the Road Use Tax Fund. Additional dollars are needed by all to make needed
safety improvements and to respond to economic oppommities. WE oppose any
diversion of income to other uses and away from all of the entities. The Quadrennial
Needs Study should be retained until a more fair and equitable process of allocating he
county Road Use Tax Fund share can be developed.
Page 2
o
Budget Schedule & Unfunded Mandates
Counties in Iowa are required by law to certify budgets by March 15, 2003. When the
legislature adopts new legislation after that date, local governments cannot respond,
whether for a new mandate which is unfunded, or new cuts in programs that result in
counties losing revenue or gaining new services.
Please remember when the legislature changes the rules resulting in mandates to county
government, adequate state funds must be provided to pay for it.
Please also remember that property tax limitation proposals that limit counties' revenues
at a time when the legislature and governor are expecting us to provide additional
services places us in a position of having to eliminate services that are not mandated,
services that the people of Dubuque County have elected us to provide.
Tax Credits and Exemptions
During the legislature's special session last year, decreases to the Homestead Property
Tax Credit and other credits resulted in hardship for senior citizens and others on fLxed
incomes, who had to pay more in property tax to make up the difference. We are asking
you to fully fund the Homestead Credit, Veterans' Exemption, Family Farm Tax Credit
and Elderly and Disabled Credit.
Dubuque County removed Machinery & Equipment dollars during budget deliberations
for Fiscal Year 2004. So that $800,000 was absorbed at that time, and the county is not
reacting to it now. Now that we will be receiving 50% of the M & E funding, or
approximately $400,000, that will offset the $399,000 personal property cut..
We as a County have tried to deal the problems of elderly and disabled people who are
receiving only a portion of the Elderly and Disabled Credit because of legislative action
in the 2003 session. We have encouraged them to apply for a property tax suspension to
offer some relief, but that is not a satisfactory solution to many.
Environmental & Zoning Issue
We continue to ask that the legislature define the agricultural exemption for zoning
purposes. There are many definitions in the Code for a "farm," but none of them
addresses the zoning issue and under what circumstances corporate commercial animal
confinement facilities fit within the agricultural exemption for zoning purposes.
With de£mitions that would disqualify these confinement facilities from the agricultural
exemption, counties could gain some control over the siting of these facilities.
Page 3
9. Franchise Tax Recodification
We are asldng for the recodification of 2003 Code Sections 405A.10 and 422.65, which
would some of the franchise tax be returned to state and local governments. We are ask
that you look at Iowa Code Section 422B under which the City of Dubuque imposed a
Franchise Tax on utilities in July, 2003, immediately depriving the smaller cities in
Dubuque County, the School Districts, and Dubuque County of revenue from the local
option tax for Fiscal Year 2003, money that was already budgeted as revenue, at a time
when the legislature had already affected revenues for this fiscal year.
10. Juvenile Detention, Shelter Care and Foster Care
The state-mandated cap on foster care for juveniles and the inequitable formula for
allocation of foster care beds has resulted in children from Dubuque county waiting much
longer in detention or shelter because fewer foster care beds are allocated for foster care
treatment for them, a shift to property tax.
In the first place, the state should be budgeting sufficient funds to cover the costs of youth
shelter. For fiscal year 2004, the state capped per diem at $83.69 per day, but raised the
allowable statewide average from $127.35 to $130.34 per day, so the cost to the property
tax payer has increased _ % Detention costs and lengths of stay are also rising, a 100%
cost to counties.
All this is going on at a time when the Public Strategies Group is working with the
Department of Human Services to take another $10,000,000 from the child welfare
system.
We are asking that the legislature carefully consider proposals about child welfare to look
for shifts fi:om state to property tax funding prior to enacting them.
11. Mental Health Parity
Iowa needs to require that health insurance policies cover treatment of inpatient and
outpatient mental illness and chemical dependency at the same level and with the same
annual and lifetime limits as physical illness. Only the legislature can amend the Code of
Iowa to include an insurance parity law that requires insurance cam2ers and self-fimded
insurance to use the equal co-pays, deductibles and aunual and lifetime limits for these
illnesses. This discrepancy is discriminatory and needs to be corrected.
12. Mental Health Funding
The best possible solution to the Iowa dilemma for services to the Mentally Ill, Mentally
Retarded and Developmentally Disabled is for the State to follow almost all other states
Page 4
13.
and assume responsibility for this entire system. One way to do this would be for the
State to assume the system, in which case the concept of "legal settlement" could be
discontinued and clients could move more freely through the system and be placed in
appropriate settings closer to their homes.
We have suggested in the past that counties could agree initially to pay to the state an
amount based on current tax levies to match federal dollars. Ultimately that amount
would decreased each year until the county property tax responsibility would be gone.
This change could maximize federal money, abolish legal settlement issues and end
fragmentation of services caused by having 99 different management plans in each
county, and would provide equity for "state cases." This would benefit the consumer and
lower property tax permanently.
Managed Mental Health Provider
We know that the State of Iowa Departments of Human Services and Public Health are
currently seeking bids for a managed care provider.
We are very concerned that the provider who is selected will work with counties and will
not be shifting costs for the mentally ill, developmentally disabled and substance abuse
consumers to counties.
One issue in particular is commitment costs for mentally ill and substance abusers who
come to Dubuque hospitals from Wisconsin and Illinois. As you know, the costs of
commitment for these "state cases" are bom by Dubuque County unless individual
consumers are committed to an Iowa State Institution. With the reduction in beds at the
mental health institutes, it is almost impossible to obtain a bed at an MttI. Dubuque
County therefore continues to pay for commitments for "state cases".
We also provided written testimony to the Managed Care & Clinical Services Department
of the iowa Department of Human Services, as!ring that the plan be modified to be more
accessible to consumers. Dubuque County has exper/enced numerous instances of
consumers who have been denied services through the pre-certification process for
inpatient services that Dubuque County has subsequently paid for. The Managed Care
system also excludes access to providers who are unable to accept the lo~v rates
negotiated by the Managed Care Provider administering the plan, resulting in no choice at
all for those consumers.
14. Medicaid Rates
Providers in Dubuque County have not been able to provide services to Medicaid
consumers because the rates established for the services by the Department of Human
Page 5
Services are too low. Particularly in the area of dental care, poor and needy people
cannot fred providers who are willing to provide care. Please work with the Department
of Human Services to assure that dental and medical services are available for this
population.
15. Mental Health Funding to MH/DD Providers
16.
The experience counties in Iowa have had with assuming responsibility for rate-setting
services whose rates have previously been set by the State has been interesting. When the
State of Iowa Department of Human Services informed counties that their workers would
no longer establish Purchase of Service Rates with providers, counties banded together to
form the County Rate Information System (C.R.I.S.) and retained the Eide-Bailly
accounting firm to gather necessary information on actual costs of service.
Prior to the formation of C.R.I.S., Dubuque County granted rate increases to providers
whose rates had been frozen by the legislature for 10 years. In the middle of fiscal year
2000, rate hucreases were designed specifically to pay for staffraises. During that fiscal
year provider raises ranged from 3% to 11%, in response to pleas for enough money to
raise staff wages. In fiscal year 2002, raises to former State Purchase of Service
providers were 5%, and for fiscal year 2003, based on C.R.I.S. information, they were
3.5% in addition to recommended C.R.I.S. rates, based on provider costs.
We are expecting that C.R.I.S. information for fiscal year 2004 will support a raise for at
least one of our largest providers of 12.5% for fiscal year 2004, an increase in expenditure
exceeding $300,000 for one of many providers.
MH/DD Property Tax Replacement Fund and Growth Fund
For fiscal year 2003, the current year, the State reacted to its budget crisis by reducing
amounts that Counties received for property tax replacement. In Dubuque County, the
state reduced our property tax replacement fund by $543,796 and our growth fund by
$205,232, based on ending balances. In all, 46 counties experienced reductions in these
funds. Also for fiscal year 2003, Dubuque county reduced the property tax asking from
$4,658,280 to $2,708,406 in order to reduce our ending balance.
In order to restore that fimding, we increased the tax asking to 70% for fiscal year 2004, a
State requirement, and continued to budget responsibility for the MI-!-DD fund. It is very
difficult to budget for this fund because of the variables in numbers of consumers and
unknown increases from providers.
We suggest that the State needs to respond to the needs of counties and to find a way to
progress toward a time when revenues to counties are predictable at the time that the
County is preparing its budget.
Page 6
17.
Mental Health Restructuring
It is our understanding that the ISAC-supported restructuring of the Mental Health-
Developmental Disabihties Fund wii1 be before this session of the legislature.
This plan will abolish "legal settlement" and counties will pay for services based on
residency. As a county rich in providers, we oppose this concept until all services are
paid for by the State of Iowa. Providers in Dubuque County furnish services to
consumers fi:om many other counties, and currently the other counties pay for those
services.
18.
19.
Another consideration is staffing of our Central Point of Coordination, if that office is
expected to manage many more cases and consumers. Please consider the needs of
Dubuque County on this issue.
MR Waiver Services
A legislative change must be made to an Administrative Law Judge's interpretation of
eligibility for the MR Waiver. It is our understanding that a ruling has been made that
residential facilities for the mentally retarded are "Medicaid" facilities, and that
consumers living in those facilities are ineligible for 1VIR Waiver Services.
In fact, those facilities are not Medicaid facilities; their fimding comes entirely from State
Supplemental Assistance and county funding. We estimate that if the ruling stands,
Dubuque County stands to lose $200,000 at current provider rates for individuals needing
pre-vocational and adult day care services who live in residential facilities.
Another issue is that the allowed rate for Enclaves under the MR Waiver. We have
multiple enclaves who meet criteria but because of the low hourly rate that has not been
increased since 1996, the provider can't "afford" to utilize that fund. Instead, the
provider relies on county funds at 100%. We are asking that the county- contracted per
diem under C.R.I.S. be utilized for the Enclaves under the Waiver.
Adult Rehabilitative Option
For fiscal year 2001, when the State began to reduce funding for Mental Health-
Developmental Disabilities, Governor Vilsack encouraged providers to participate in the
then-new Adult Rehabilitative Option Medicaid Program, shifting costs to a Federal-
County parmership for services provided.
Providers in Dubuque County have participated in ARO for three years and while
consumers have enjoyed more services as a result of the program, the program is not
Page 7
20.
21.
saving Dubuque County sufficient funding to make up for the loss of state funding.
Consumers are receiving more services at a higher rate, which is a wonderful thing. But
it is not a justification for shifting costs from the state to the counties.
Judicial Advocate Position
The Jndicial Advocate position continues to be a problem for counties. These individuals
are appointed and supervised byjudges. Counties were mandated to pay IPERS for
advocates appointed under Iowa Code Section 229.19 in December of 2000.
Advocates appointed under 229.19 are not county employees, nor are they state
employees. We object to paying for the advocates; it is philosophically a bad idea
because advocates are paid to represent consumers, while the County pays for Targeted
Case Management to make those determinations. And we also object to paying rates over
which we have no control as they are set by the Chief Judge of the Judicial District, who
also supervises their work.
Case Management
Attached to this presentation is a copy ora letter the Board of Supervisors sent to
members of the Administrative Rules Committee about proposed changes to rules for
Targeted Case Management, changes processes for eligibility for Targeted Case
Management services. This is a vital service that consumers must have to move from the
most restrictive setting to lesser-cost community-based services, at lower cost. At the
present time, consumers are referred to the Iowa Foundation for Medical Care often
because of a complicated pre-authorization process. This creates a cumbersome system
for deserving Medicaid recipients and those who have not yet qualified for Medicaid.
22. Unmet needs in Substance Abuse
We continue to hear from our constituents about unmet needs for Substance Abuse
clients. Although the legislature agreed to provide appropriate treatment for these
consumers, Dubuque County has had to budget $75,000 in the general fund to provide
residential services to Substance Abusers at the Julien Care Facility because no other
placement is available, although no substance abuse trealrnent is available there. There is
a transportation problem for consumers who should be receiving that treatment with the
Substance Abuse Services Center.
The original thinking about the transfer of substance abuse services ~vas that the State of
Iowa receives the revenue from the liquor tax and should therefore pay for these services,
including comm2tment costs, which counties continue to pay.
Page 8
23.
24.
Clozaril at Mental Health Institutes
The Deparlxnent of Human Services must continue with their plan to stock and administer
the drug "ClozariF' at the Mental Health Institutes. Currently, the MHI's contract with a
private provider, and under that arrangement third party insurance is not billed for the
drug. We have been informed that the Department is working toward the goal of
including Clozaril in their array of services, which would save the counties the separate
cost of the drug in many cases.
"812" Commitments
The Dubuque County Management Plan for Mental Health and Mental Retardation does
not include payment for services for defendants in the criminal justice system include
commitments under Chapter 812 of the Code. This consumer is ineligible for Social
Security Disability Benefits and therefore Medicaid Insurance. Other states include
eli~bility for Medicaid for these individuals and we encourage you to do so in the State's
plan, which would alleviate the financial burdens for counties placed either in a
community-based setting, or at an MHI or Oakdale under an "812" commitment.
25. Medicare Inequity - Public Health Nursing and Home Care Aide funding
26.
This is a leadership issue. We must work together with Federal Legislators to modify the
current inequality of payment to providers under the Medicare System. The disparity in
Medicare payments across the nation has resulted in hardship not only for providers of
Medicare services, i.e., hospitals and doctors, but it has forced Iowa providers into a
history of lower wages for hospital staff and impossible recruitment issues.
It has also impacted Dubuque County because of our public health nursing program.
Although in-home services are less costly alternatives to nursing homes, Medicare
changes in payment for in-home nursing services means that more of your money and
ours is being paid to the Visiting Nurse Association for public health nursing services
under their contract ~vith the County. We greatly appreciate the grant money we receive
from the Iowa Department of Public Health to at least partially defray increased costs for
these services. However, we need to work to change Medicare and Medicaid payment
arrangements so that these vital services are funded through those programs. We also
need to increase the amount of funding available for in-home services so that the waiting
list for the "fragile elderly" who qualify for these progams can be eliminated.
Lease costs for Department of Ituman Services Administration
When the Department of Human Services was reorganized, counties who housed the Area
Administrative Costs, basically rent, to the other counties in the area. We have
repeatedly billed the other 8 counties in the Northeast Area for their share of this lease
Page 9
cost, and they have repeatedly refused to share this cost because it is not mandated
anywhere. We ask that you mandate that the other counties in the areas pay for their
share of rental cost for the area administration.
We thank you for your leadership and support in the past. Let's work together to
solve the problems and issues that face all of us today.
Attachments (9)
Page 10
Dep d:men of Transpo ation
District,6 Office 319-364-0235
438 SixLeenth Avenue SW FAX: 319-364-9614
P.O. Box 3I 50
Cedsr Rapids, IA 52406-3150
August i2,2003
Ref:
733.20I
Dubuque Coumty
Jim Waller, Chair
Dubuque County Board of Supervisors
Dubuque County Courthouse
720 Central Avenue
Dubuque, IA 52001
SUBJECT: Transfer of Jurisdiction
Dear Chairperson Waller:
Mark Wandx'o askeu that I respond to your August t, _00~ letter concerning the transfer of certain
primary roads to Dubuque County under the terms of Senate File 451. As you know, (his bili was
enacted into taw during the regular legislative session that ended at the be~rming of May 2003.
Your request to exempt the transfer of former Iowa 586, Iowa 955 and Iowa 963 from the provisions
of S.F. 451 because of the prior e.'dstence of the Memorandum of Understanding (MOU) for Urban
Pr/mary Road Service is noted. However, S_F. 45t is a legislative mandate that supercedes the MOU
signed in 1993. Had there been a formal agreement implementing the transfer of these routes signed
by the state and county, prior to January 17 2003, the legislation would not have applied. However,
this was not the case. Only a framework for their transfer existed at that time, namely the MOU.
Thus, these routes were transferred according to law effective July i, 2003.
With regard to the concern about transferring the routes outside the provisions of Ioxva Code Section
306.8. the legisladon provides for the transfer o£ ~nds in pe~emity to compensate for the additional
costs to the county to maintain these routes. As part of this initiative, ail counties receive additional
Punds and those accepting the transfer of routes as part of S.F. 451 receive an increased share of the
added funds dzrough June 30, 2013.
[ hope this answers an).' outstanding questions and addresses your concerns, r am xviiting to discuss
this matter with you ~rther but please understand that the language of S.F. 451 allows me no
discretion to reverse the transfer of these routes as implemented on July t. 2003.
Veu, '~ruly yours.
Ricixard E. Kautz. P.E.
District Engineer
........ ?,' ,,,,~,", Du'ector. ~owa Department or Transt~orrauon..-kmes. h-k 500 L0
PHONE: S63-589-444I
FAX: E63-SS9~7884
EMAIL: brdofsup@dbqco.org
COURTHOUSE
DUBUQUE, IOWA 52001-7053
DONNA L SMITH
JIM WALLER
ERIC MANTERNACH
August
Ma~k F. V~aud~o, Director
Iowa Depa~imen~ of Trauspo~ation
200 Lincoln Way
Ames IA 50010
L'z response to your letter al July I0, the Dubt~ C6~ Board of Supervmors asks KTat you
refer to the formal sig2ed contracts undeE~bk)~8~ y{;~feviously forwarded to you which
require that dm rowa Department of Tra~5;Fra23n trar~"~e 7.5 relies o£road accordint to the
terms and conditions of Iowa Code Section 306.8:2
As you kmow. Section 306.8 hay/rig jurisdiction place a road
or street mhd any strttct~.n-es thereo.n_ in. good repair p~or to:the change ,,~;,,,4~,~;~,4,,,,
We are asking that the existing agreements be honored and that the trmnsfers bfjudsdiction are
made in accordance wflh the terms ofthose, a~eements. Thar2c yom
Sincere{y,
DU~BUQDT COL~'TY BOARD OF SU2?E~VISORS
Waller. Chairperson
ih
lowa Departmen Transportation
800 Lincoln Way, Ames, IA 50010 515-239-I 11 I
FAX: 515-239-t639
July 10,2003
Jim Waller, Chair
Dubuque County Board of Supervisors
Dubuque, IA 52001-7053
Dear Mr. Waller:
Thank you for your June 23 letter regarding transfers of jurisdiction of primary roadways to
local jurisdictions.
The ciW of Dubuque, Dubuque County and the Iowa Department of Transportation (DOT) have
a long and positive h/stow of parmering on projects that have benefited not only the local area,
but also the state and region as a whole. Our collective efforts on U.S. 15I, U.S. 6i, U.S. 20,
the N.W. Arter/al and the Julien Dubuque Bridge have resulted in a renaissance of the area--
something we all can be yew proud of.
I'm excited about highway projects we have pending not only in eastern Iowa, but throughout
the state. However, the DOT carmot continue to increase the number of miles of roadway under
our jurisdiction and also be in a position to provide the transportation system essential to our
state's ~t~e grow~&. Consistent with the intent of fine legislation passed by the General
Assembly in 2003, we need to let cities and counties be responsible for roadways that primarily
serve their area. Transferring these roadways will give local officials complete authority to
make decisions that best serve their citizens.
Prior to becoming Director of the DOT, I served as the assistant county engineer of Polk County
for 10 years. ~ am very familiar w/th the issues counties regularly face. As a result of the
legislation, Dubuque County will receive approximately $900,000 over the next 10 years for the
repair and maintenance of 7.5 miles oflocal roadway. Based on my experience, th/s is a fair
a~d equimble exchange.
I'm appreciative of the outstanding relationship the DOT has had with the city of Dubuque and
Dubuque County, and I look forward to wor_king together in the ~ture.
Sincerely, ~ /
Mark F. Wandro
Director
PRONE: 563-589-444'/
PAX: 563-589-7884
EMA[L: brdefsup@dbqco.or~t
COURTHOUSE
DUBUQUE, IOWA 5200%7053
fune 23, 2003
DONNA L SMITH
JIM WALLER
ERIC MANTERNACH
Mark Wandro, Director
Iowa De?arrment of Transportation
800 Lincoln Way
Ames IA 50010
Dear Mark:
The Dubuque Coun~ Board of Supervisors has received a letter from the Department of Transporranon
explamm~ the transfer of Junsa~ctmn of primary roadways to local j~msdictions.
Om: situation is that Dubuque County has sigmed a~eemenrs for transfer ofjm:isdicfion of the named
roads, with snpulafions a~eed to by both the D~parm:ent of Transportanon and the Couaty.
::'": :7:; ;,:;.4,
As recently as May 29 of 2001, we a_m-eedto ~e~d the t~r~e~Jbl/~ ~r Dubuque County's acceptance of
Iowa 386, Iowa 953 and Iowa 955 when the So(/thwesr 'gxLleria]Lis complete.
We are filing objections to these mmsfers of conditions ~,~ + '
a~e~ ~o oy r2qe Iowa
Department of Transportation are met.
We are mso objecting to the. language 0fthe law which dimmates the mandated transfers' from the terms
and conditions provide in Iowa Code Skcrion 306.8 ander which we..have operatediin goock faith when
Wansfers of jurisdictions happen.
It is our understanding that the Street Consmtcuon Ftmd'Disrnbutibn Advisory ¢' ' ~
emanng a~eemenrs 15er~veen_ urisdictions tike ours and the Depm:rmenr of TrausporTanon taro
consideration.
are asking that these exzsnng ag~-.eemenrs be honored and rhar the transfers )fjurisdzcnons happen
only wi:eh the condiaons of the a~eemenrs are met. ~mmc you.
L-;~CU~,U a CO~:~' TTy BOAiLD 0~' SUP~R\GSORS
Jim Waller. Chz~erson
May 29. 2003
owa Department of Transportation
District ~ Off[ce 319-$6~3235
43~ Sixteenth Avenue SW FAX: 319-364-9~14
F,O. Box 3158
Cedsr Rapids, iA 52406-3150
733.201
Jkn Waller, Chair
Dubttque Coun~ Board of Supervisors
720 Central Avenue
Dubuque, 7iA 52001
SUBJECT: Traast'er o f Jurisdiction
Dear Nfl-. Wailer:
Pursuant to section 3 of Senate Pile 451, jurisdiction and controI of certain primary roadways wit1 be transferred to local
jurisdictions effective July i, 2003. %~e a~achraent describes the roadway segments based dn data as of Janum~' I, 2002,
which will be transferred to local jurisdictions. On JuIy I', 2003, by operation of law, iocaI jurisdictions must assume ail
further responsibility for these road~vays. An implementation meeting will be held on June 9, 2003 as noted in the
attached agenda.
For cities under 500 population, the state highway that is transferring to their jurisdiction on July t, 2003, will transfer to
the ~spective counties on July I, 2004, along with any farm-to-market extensions that pass through the cities.
For routes that are transferring to the county, it is the county's responsibility to apply for farm-to-market classification if
so desired. This application process is documented in County Engineers Instructional Memorandum 4.2I.
The department intends to subsequently tramsfer by quitclaim deed its tkte and interest in the right-of-way of the public
road segments described in the attachment. If the state has acquired access rights for the public road segments described
in the attachment, you shall not, within 150 feet of any intersecting primary, highway, either alter those .rights or allow- -any
new access. In all other cases, you should not allow any new access within I50 feet of any intersecting primary highway.
As soon as practical, the following items wilt be forwarded to you:
1. Right-of-way strip map, if available
2. Appiicablepermits and resolutions
3. Construction plans for roadway, bridges, and culverts, if wcaliable
4. Specific bridge information, such as inventory data and safew inspection items
5. Any other correspondence that may pertain to the affected road~vay section.
:~ ;.,, · ' . ,4 = ,, ,.t ~,- 4 o::mo,,~ as appropriate, wi!! be provided by this office. Any fuwbar questions or
A:~ :~ms hstea above. ~n~ _n. ~h~. ~o ......... s. .. _ .-
correspondence regarding the transfers of jurisdiction should be directed to me or Assistant District Engineer. Jim
Schnoebeien.
Very truly yours.
Richard E. Kaurz. P.E.
Attachment
cc: Jim Schnoebe!an. P.E.. {ssistant District En, ginee2 [owa DOT. 430 lo~ Avenue
Cadar Rapids. ~A 51406-3 i50 l ia-ld4-02SE
F
/URBANA
l BENTON iVAN HORNE
FBENTON
IBENTON
Summary of Routes To Be Transferred to E~ective July I, 2003
0.251
2.571
1311 ECL BELLE PLAINE TO JCT US 30
198/NCL GARRISON TO JCT US 2!8
199[ECL'vAN HORNE TO JCT US 218
200/JCT US 35 TOSCL KEYSTONE
201 !ECL NORWAY TO JCT US 30
~O SCL ATKINS
2.671 8 iVAN HORNE ~
1.831 ~
7.281 6 ~BUCHANAN
I tNDEPENDENCE I ~DBNCB WCL INDEPENDENCE
~NCB (~EGIN SKIP)
IQUABQ UETON I 282 BE~~
BUCHANAN
BUCHANAN
BUCHANAN
9391JCT IA 282 TO WCL WINTHROP
BUCHANAN WINTHROP
BUCHANAN W~NTHROP
BUCHANAN ~
BUCHANAN [
BUCHANAN T
BUCHANAN ]
NAN I
~ IOURAN~
C~DAR IDUFLANT
~B r
FD,-~AWAR E ~-YAN
~ IDUBUQUE
~BUCHANAN
0.23
SUCHANAN
! ~.~31
j 0.45
I ~ iWINTHROP
SummaP/of Routes To Be Transferred to Local Jurisdictions iFt District
Effective July J, 2003
~ACKSON
Segmemt Descdption
428iJCT US 81 TO MAQUGRETA CAVE STATE PARK
Miieage! Distdct
o.12I 8
Shared Judsdic-don with
Adjacen Governme~q[(s)?
(sEe foomo~e)
IACKSON 954[BEG OF ROUTE TO JCT US 31
iACKSON 95~iJCT US 61 TO SCL MAQUOKETA 0.851 6 MAQUOKETA
:ACKSON I 985J S JCT US 52 TO N JCT US 52 1.93j 6
OHNSON I CO P,.ALV] LLE 0.641 B
9651P1 180 INTCH TO ENO DIV SECT
965J ENO DiV SECT TO NCL C'ViLLE/NUAL IA CITY
9211 SCL IOWA CITY TO BEG CQNC SECT
OHNSON 'CORALVILLE I
JOHNSON I
JOHNSON
IIOWA CITY j 9211BE CONC SECT TO BEG ASPH SECT
OHNSON IIOWA Ch'~Y I 9211EEG ASPH SECT TO SEG D[V SECT
OHNSON IIOWA Ci~t' I 9211BEG DIV SECT TO JCT US 8 & IA 1
JOHNSON ILONETREE I 4051NCLLQNETREETOJCTIA22
JOHNSON IQXFORD
.JOHNSON IOXFORD
JOHNSON tOXFORD t
SOLON
SOLON
~OHNSON
1091BEGiN IA 109 TO WILSON ST
109tWILSON STTO BEG 22 FT SECT
t091 BEG 22 FT SECT TO NCL OXFORD
/~rCL SOLON TO N WEST ST
WEST STTO JCT IA 1
JOHNSON
109JNCL OXFORD TO JCT US 8
3821 LAKE MACBRIDE ST PK TO WCL SOLON
JOHNSON 4051NCL LONE TREE TO JCT iA 22
JOHNSON
JOHNSON
921 I JCT US 2~ 8 TO JCT JA 923 (R/U}
JOHNSON
JOHNSON 921 IJCT IA 923 TO SCL IOWA CiTY (R/U)
JOHNSON
[OHNSON
JOHNSON
JOHNSON
JOHNSON
JOHNSON
JOHNSON
JOHNSON
JOHNSON
LiNN ;EDAR RAPIDS
L~NN CEDAR RAPIDS
L[NN
L[NN
L!NN
9231WASHINGTON CO LINE TO CO RD F62 (S iNT)
9231CO RD F62 (S iNl~ TO SUAL iOWA CITY
9231SUAL iOWA CiTY TO JCT IA 921 (R]U)
9851BEG 24 FT SECT TO BEG CONC SECT
9651BEG CQNC SECTTO BEG ASPHALT SECT
;07~p, .E~O ASPHALT SECT TO UNN CQ LiNE
¢C ~ [~80 T~O BEGIN ASPHALT SECT
979 BEGIN ASPHALT SECTTO CEDAR CO LiNE
94/BEG '-WAY NB/JCT 'A 922 TO W iNT F AVE NW
8~-IiNT FAVE NW TO SUMMER ST
SUMMER ST TO ELLIS BLVD/END 1-WAY NB
94!BEG 1-WAY sB~rELLtS/F AVE TO INT 3RD ST NW
9413RD ST NW TO CEDAR RIV SR
94 ICEDAR RIV BR TO INT E AVE NE/A AVE NE
CEDAR RAPIDS
CEDAR P,.&Pf D B
CEDAR
9411NT E AVE & A AVE NE TO JCT IA 92NEND RTE
0.271 8
LiNN CEDAR RAPIDS
LiNN ICEDAR P~a,P!DS
L~NN iCEDAR RAP[DS
0.27[
0.191
013
o.321
ox31
4.291
JOHNSON
' LO N E TREE
0.37
0 @0
3.03
4.11
0.34
0.33
2.47
STa
O.B4J
0.37
o.o~1
o.~81 6
LiNN [
4.8~l 6
LiNN I 9201NCL CENTER ?O}NT TO BENTON COUNTY LiNE
PHONE: 563-589-4441
FAX: S63-559-7884
EMAIL: brdofsup@dbqco.org
oar / o/ _ t jJerui or
COURTHOUSE
DUBUQUE, IOWA 52001-7053
DONNA L. SMITH
JIM WALLER
ERIC MANTERNACH
Au~onst 11, 2003
Senator M/kc Connolly
3458 Daniels
Dubuque LA 52001
Dear Mike:
As you know, the City of Dubuque has
themselves fi:om a severe bud
in order to extricate
In researching
this move on the City's part
also know that when Dubuque Count
unincorporated areas of the
of Iowa in 1999 which facilitated
paragraphs I and 3. We
a Local Option Tax in the
were exempt.
The City of Dubuque's action has
Local Option Tax. dedicated to kb~
County, long after
the County's
in the
We have always a s local
option tax, in Dubuque
Count) City. be
amende~to allow cities in enact the F/:anchise,Fee s, *zith6ixt affecting
the distribution oft!ie Ibcal option taxes for other cities, the counties, and the school distr/ct~
We w/l[ sincerely appreciate your help with this; people who voted fox the locat opffon tax in
these other jmisdictions and who do most of their'shopping in Dubuque have expressed
resentment because the City s action has caused these budget:reductions. Thank you.
Sincerely,
/0
PHONE: 583-589-4441
FAX: 58S-SB9-TSS~
EI~AIL: brdofsup@dbqco.org
August 2I, 2003
Senator Iulie Flosch
22852 Butterfteld Road
Cascade IA 52033
COURTHOUSE
DUBUQUE, IOWA 52001-7053
DONNA L. SMITH
JIM WALLER
ERIC MANTERNACN
Dear Jul/e:
As a member of the North Iowa Juvenile Deteixti6n Ser%ces Board of Directors. representing
Dubuque County on this 20-County 28-E Orgapjzafior/z,~ I am writing to object To the change in
the allocation rocess for foster group care resot/fc~s :!: :.
The Department of t-iuman Se~wices has ~pi~m~ted ~,~e~;, and, in our view, inequitable
formula for allocation of foster care beds ko'ich rewards ~mportionately high users of foster
grOllp care. :-:;-
population and 15% h/storical: USe~ The new formula reverses those ~ercenmgea
The result of the change in formula for our dis~ct is that children from Sur comities must wait
for much longer period of t/me in detention becans'e far fewer bed slots' are alIocated for foster
care treatment' f6r them:
Clearly this is a shill in costs because counties must pay for detentionbeds at a rate of $125 per
child per day for a longer period of r/me;
Sincerelv.
Donna L. Smith
Dubuque County.- Superx,isor
jh
cc: She~? Marnke, Chairperson. NIFDS Commission
PHONE: 319~589-4441
FAX: 319-589-4478
COURTHOUSE
. ~uul-Tu5o
uuBUQu=.
ApdI9,200t
DONNA L SMITH
ALAN R. MANTERNACH
JIM WALLER
The Honorable Bob Osterhans
Iowa State House of Representatives
Statehouse
Des Moines IA 50319
Dear Bob:
It is with peat disappointment that we read that the Governor has proposed a revised fiscal year 2002 budget
showing that counties will lose S 18 million in the ~ow~h fund for mental health and developmental disabilities.
In 1995, the legislature established property, tax relief in the form of state monies provided to counties for
expenditures in the Mental Health/Developmental Disabilities Fund. The gro~vth innds were established to address
service cost inflation, new consumers and investments for economy and efficiency.
It is our understanding that the legislature has akeady taken $6t,415 from Dubuque County's incentive funds; the
new proposal wall take another $~68,. 88 from Dubuque County s ~ow~% fund, for a total of $429,90~.
On February 20, 2001, we were notified by the Depamnent of Human Serv'ices that Dubuque County would not
receive $5,035.75 in block ga'~t funding for fiscal year 200 t and that the monies we could expect from that fund in
fiscal year 2002 was ia doubt because of Cungressionat action.
While we realize that State revenues have decreased unexpectedly, we also know that you are contemplating
limiting property tax. How can the State contemplate reduction of property taxes at a time when the State is also
cuLCmg momes ongmalty meant to accomplish th,~t =oM.
The arFamenrs for taking this money from counties are that the proposed new rehabilitation services will be
available and w/ii save proper~y tax mort/es; that program is nor yet under way. The ending balance argument will
not wofr with the ~LH~T)D frond, pdm~.riiy because billings from Stare Institutions and for ser¢ices b/lied by the
State are frequently late. Ending balances also enable counties m pay for first quarter providers.
These actions are placing counties in an untenable simatiun. Please restore the Mti/DD innds and allow local
officials to make decisions about taxation. That is what we are elected to do.
Sincerely.
DUBLiQL]~ COL~TY BOARD OF SUPERVISORS
J~aller. Chairperson
jh
PHONE: 563-589-4441
FAX: 563-589-7884
EMAIL: brdofsup@dbqco.org
COURTHOUSE
DUBUQUI~, IOWA 52001-7053
DONNA L. SMITH
JIM WALLER
ERIC MANTERNACH
Mr. Dennis Janssen,
Managed Care & Clinical Services
Iowa Deparnment of Human Services
Hoover State Office Building
Des Moines LA 50319
September 8, 2003
Dear 1VLr. Janssen:
Please enter this letter into the Public Comment~ 0~I0~ Plan for Behavioral Health and the
experience that Dubuque County has had with th~ ~ ~ ~b past. We are asking that the plan be
modified at this time to be more accessible a and more fair to Iowa counties.
The [owa Plan reimbursement rate has
"negotiated" by the vendor administering th~ P!an
providers. Counties are forced to pa5
administrator. :
are unable to accept the low rates
have little to no choice of
,r rationed by the Plan
Dubuque o'f consumers ~ho~have. been :kTenied through the
pre-certificafion process for inpatient services echo are sbmetimes h'eite~ at)the:~Xt~nse Of the County.
We ask that the Department b~:k?rna/~ Ser~be~ and the Depar~nn~t'~of PabHC Erealth revisit these issues
and work to design and implement a system that will accomplish, the goals that you have established,
rather than the present system whictt has been a frustration for consun~ers, prowders and counties.
Sincerely,
jh
DUBUQUE COUNTYBOARD OF SUPERVISORS
cc: Senators Cormolly, I-iosch. Stewart
Representatives Jochum. Murphy, Osterhaus. Lukan. Mmnternach
PHONE: 563-589-4441
FAX: 563-589-7884
EMAIL: brdofsup@dbqco.org
COURTHOUSE
DUBUQUE, IOWA 52001-7053
DONNA L. SMITH
JIM WALLER
ERIC MANTERNACH
September 8, 2003
Ms. Janet Zwick
Division of Health Promotion, Prevention & Addictive ~ehaviors
Iowa Department of]Public Health
Lucas State Office Building ~:'
Des Moines IA 50319
Dear Ms. Zw/ck:
Please enter this letter into the Publ
experience that Dubuque Count5
modified at this time to be
: Behavioral Health and the
past. We are askthg that the plan be
and more fair to Iowa counties.
The Iowa Plan reimbursement rate has
ne~otmted by the vendor admnmstenng
prov/ders. Counties are forced to pay
administrator.
are unable to accept the Iow rates
> no choice of
by the Plan
Dubuque Coun¢
pre-certification
Others have ended
tgh the
County.
We ask that
and work to design and implement a system that will iccomplish the goals that you,have
rather than th~ present system whi~h has b&e~ a frusrrat/on fo~ ~ons~ers, providers and cotmti~s.
Sincerely,
DI~qBJdQUE GOUt'IT BO_ARD OF SrdI°ERVISORS
Jim Wallen Chairperson
cc: Senators Connolly. Hosch. Stewart
Representati~-es Jochum. Murphy, Osterhaus. Lukan. Mantemach
Solicitation for Public Comment
The State of Iowa is seeking your cormments on the Iowa Plan for Behavioral Health (the Iowa
Plan). The Iowa Plan, which integrates treatment for mental health and substance abuse, is
a&mhnistered by a single statewide organization that has contracted jointly with the Iowa
Department of Haman Services (DHS) and the Iowa Department of Public Health (DPH)
Division of Health Promotion, Prevention, and Addictive Behaviors. The Iowa Plan contractor is
at full risk for all Medicald-fimded mental health and substance abuse treatment services and
provides specified administrative services for the DPH-funded delivery system. The Contractor
also is required to manage services to persons with mental health diagnoses who are enrolled in
the State Payment Program (SPP).
The contract for the administration of the Iowa Plan has been held by the managed behavioral
health organization, Magellan Behavioral Care, since 1999. State and federal laws require that at
this time the state must seek to competitively re-procure contracts with vendors to administer the
Iowa Plan. The anticipated release date for the Request for Proposals is on or about October 15,
2003.
While the State is not intending to make significant changes to the program, it is in the process of
reviewing the current structure of the program and contemplating opportunities for program
improvement that it can incorporate into the program that is put out to bid.
As previously, the State has found it valuable to have the input of interested parties familiar with
and/or affected by the program. To that end, the state is once again seeking public comment.
The Iowa Plan was designed to offer:
· prompt and convenient access to appropriate mental health and substance abuse treatment
services and supports;
· improved outcomes for consumers which span today's boundaries of programs and funding
streams;
· integrated and seamless service delivery across different service systems (including health,
mental health, substance abuse, child welfare and juvenile justice, education and special
education);
· strong community involvement and investment, with the local delivery system contoured to
commtmity strengths and needs;
· coordination ofplarming and implementation between agencies;
· prevention and early intervention with those at risk, and
· minimal duplication between systems.
It has aimed to:
· serve people in the context of their families or natural support system;
· provide services in the home or in the community whenever possible;
· include consumers and family members in plarming and evaluating their services;
· build on the strengths of the family or individual and be responsive to their culture;
· focus on the problems or concerns which are most important to individuals and families;
strive to communicate in the first/primary language used by the individual/family;
· allow freedom to purchase individual service elements tailored to the needs of the individual,
child or family;
· promote the stabilization and recovery of persons with chronic illness, and
· permit a smooth transition between funding streams and services.
Please provide your thoughts on suggestions for the Iowa Plan program improvements or
changes at the mail or email address below no later than 5:00 PM central time, Sel~tember 10,
2003. Please attach a cover sheet to your comments that states your name, organization,
address, telephone number and email address so that the State may contact you should there be
any questions about your submitted corr2ments.
The State is particularly interested in hearing specific views on whether and how the
aforementioned program design objectives have been accomplished and any specific suggestions
you have for changes or improvements in the Ioxva Plan. Members of the public may present
their comments in person to DHS and DPH staff members between the hours of 1:00 PM and
3:30 PM on Wednesday September 10, 2003 at the Hoover State Office Building, First Floor
Conference Rooms 1 & 2. Oral presentations should be limited to 5 minutes. Please cai1 515-
281-4689 to schedule a time to make this presentation.
Please be advised that while the State will consider all comments, it will not respond to
commenters in writing.
If you have any questions about this solicitation, please contact Dennis Janssen at the number
listed below or Janet Zwick at 515-281-4417.
Please send written comments by 5:00 PM Central Time, September 10th to:
D epmis Janssen
Department of Human Services
Hoover State Office Building
Des Moines, IA 50319
Email: Di ansse(&,,dhs, st ate.ia.us
Facsimile: 515-281-8512
Phone: 515-281-8747
PHONE: 563-589-4441
FAX: 563-589-7884
EMAIL: brdofsup@dbqco,org
COURTHOUSE
OUBUQUE, IOWA 5200%7053
DONNA L. SMITH
JIM WALLER
ERIC MANTERNACH
March _4, 2000
Representative Danny Carroll
Iowa House of Representatives
Des Moines, Iowa 50319
FAX: 1-515-281-5868
Dear Danny:
The Dubuque County Board of Supervisors strongly supports the passage of House File 387 which would
allow up to 40 residential care facilities licensed to derve Up t05 Ceople with mental retardation to be
converted to residential programs operating under the current HCBS waiver.
In addition, we also strongly support Senate File 413 addresses the addition of day services re
Iowa's HCBS waiver program. We are requesdgg the addition of both "pre-vocational" and "day
habilitatiun" services to the current MR waiver menu~ The disabled people who receive these services are
not necessary- elderly. It therefore would_make sense to ensure that these services fall under a habilitation
definition rather than under an elde~hy sermces de£mition.
We understand that the current proposal for boq pre-vocational and day habilitatiun tadult day
care) ser~,ices from the Depm-tment of F!uman Services inciixdes rate caps for~these thvo seruices that are
below what it costs most organizations to prov/de the services. Obviously, this is something that would
inter£ere w~th the success£uI operation of these waivers, so we would sup¢ort reasonable compromise
rates as proposed by ISAC and IACP.
tt has been brought re our a~ention that the Department of Human Services ts currently
proposing to exclude those whc Iive in licensed RCF/MR facilities form being eli~ble for these
services. TNs prohibition severely limits who could benefit from these services with no legitimate reason
to exclude people from these services s~mply based on where they live.
The Dubuque County Board of Supervisors urges your assmtance and support of the passage of
le~slatiun that wilt add thes~ ~vo HCBS waiver servrees. The State of Iowa. Dubuque Connty, and
peo[ ie with disabilities will benefit if these services are added in a manner that allows their full
utilization.
SD,-CERELY.
DhgBUQUqE COL.~TY BO,~RD OF SUTERVISORS
.~m Waller, Chaircerson
Fields of Opportunities
STATE OF IOWA
THOMAS J. VILSACK, GOVERNOR
SALLY J. PEDERSON, LT. GOVERNOR
DEPARTMENT OF HUMAN SERVICES
KEVIN W. CONCANNON, DIRECTOR
September 5, 2003
Linda Hinton
Iowa State Association of Counties
501 ?tl~ Street
Des Moines, IA 50309
Dear Ms. Hinton:
This is in reference to our discussion regarding Home and Community Based Services for individuals who live in
Residential Care Facilities. The Department of Human Services has looked at the Federal Regulations, the Code of Iowa
and the Iowa Administrative Code and determined the following:
RCFs are licensed as health care facilities in Iowa. Iowa Code chapter 135C, titled ~Hea[tl~ Care Facilities"
defines "health care facilities" as "a residential care facility, a nursing facility, an intermediate care facility for
persons with mental illness, or m~ intermediate care ~acility for persons with mental retardation." lowa Code §
I35C.1(6). With some exceptions, a license is required to "establish or operate a health care facility in this state."
iowa Code ~ 135C.6(i). Thus, DIA rules address licensure of RCFs and RCF/MRs as health care facilities. See
Iowa Admin. Code r. 481-- 50.3(3) '~d", "g"; Iowa Admin. Code ch. 481--57; Io~va Admin. Code ch. 481--63.
This does not appear to be a problem under federal requirements for HCBS waivers, which require only that
waiver services may not be provided to ¢'inpatients of a hospital, NF, or ICF/MR." 42 C.F.R. § 441.301 (b)(I)(ii).
The federal waiver requirements appear to contemplate that waiver services may be provided in state-regulated
';board and care facilities," "institutions," or "group living arrangements" where State Supplementary recipients
reside. See 42 C.F.R. § 441.302(a)(3), citing 42 U.S.C. § 1382e(e). But the Depart~nent has previously taken the
position that at least some waiver services may not be provided to residents of any "health care facility," ~vhich
would include RCFs. As part of the controversy last year over the repeal of the RCF licensnre exception fbr five-
person supported community living homes (House File 2416), tile Department adopted rnles providing that for
supported community living services under the MR and BI waivers, ~;consumers may not live in licensed medical
or health care facilities or in settings required to be licensed as medical or health care facilities." iowa Admin.
Code r. 441--78.41(1)"c"(3), 78.43(2)"c"(3).
Therefore, tile Depmgment of Human Services wit[ be workiug with the Department of Inspection and Appeals to change
the Code of Iowa to allow individuals who live ill a IR, CF to receive HCBS services. Also, rule changes in the Iowa
Administrative Code are being developed to add a medical institution definition for HCBS. It is our intent to work
cooperatively with the Iowa State Association of Counties and the Iowa Association of Community Providers to
hnplement these changes. If you have further questions, please feel fi-ee to contact ~ne at (515) 281-9369 or
djohnso6~dhs.state.ia.us.
Sincerely,
Debbie Johnson
B tirean of Long Term Care
1305 E WALNUT STREET-DES MOINES, IA 50319-0114
STATE
OF IOWA
THOMASJ. VILSACK, GOVERNOR
SALLYJ, PEDERSON, L%GOVERNOR
DEPARTMENT OF HUMAN SERVICES
KEVIN W. CONCANNON. DIRECTOR
September 29, 200_3
The Honorable Steve Lukan
Iowa State Representative
State Capitol Building
LOCAL
Attn:
Dear Representative Lukan:
I am responding to your question in regards to billing for the medication Clozaril at the Independence
Mental Health ~[nstitute.
The method for billing counties for services provided at Mental Health Enstimtes is described in the Code
of Iowa. Section 230.20 removes direct medical services from the computation of the per diem and
provides that direct medical services be billed directly. Iowa Administrative Code, IAC~441.29.2(230)
defines dirpct medical services as including pharmaceuticaI services. Thus any medication used by a
patient would be billed to the County separately from the per diem charge.
The Food and Drug Administration requires pharmacies to be reg/stered to dispense Clozaril. The
amount of Clozarii that can be dispensed at one time is only a week's usage. Pharmacies must review lab
values ora patient's blood work to determine the appropriateness of continuing Ciozar/i before dispensing
the next week's dosage, thus the management fee charged.
The pharmacy at tMHt is currently not certified to dispense Clozaril therefore LM~I! utilizes Caremark to
provide the medication and a portion of the monitoring required to dispense. Caremark bills the County
directly for the medication and monitoring. In that these charaes do not 2o through the MHI billing, the
MHI does not bill or collect third par~y insurance. In these ca'es, the patient or tI~e County or~ behalf of
the patient could pursue third party pa?~ents where applicable. Since the medication does not go through
the 12vIHI phamracy there is no additional charge for IMHt pharmacy services.
Prior to the development and release of genetic substitutes, this arrangement was considerably less
expensive rbr the Counties. ~V[HI is currently irt the process of appI~ng for cexiication for the pha..'-macy
ro dispense Clozapine / Clozaril and the recommendation to do in-facility monitorin< and disoensin< is
expected to be brought before the ~aciliry's physician review commiuee for discussion and a_~prova{at the
end of this month.
...... ~_,~r~tac~ ~,_~e if volt haxe additional questions.
Cd:
~iclds of* Opportunities
STATE OF IOWA
THOMAS J. VILSACK, GOVERNOR
SALLY J. PEDERSON, LT. GOVERNOR
A[JG 2,2 ~Ou3
DEPARTMENT OF HUMAN SERVICES
KEVIN W. CONCANNON, DIRECTOR
Jim Waller, Chair
Board of Supervisors
Dubuque County Courthouse
720 Central Avenue
Dubuque, IA 52001-7053
Dear Mr. Waller:
I am responding to your letter of August 11, 2003, to Senator Mike Connoliy in regard to billing for the medication Clozar/I at
the Independence Mental Health Institute (IMHI).
The method for billing counties for services prey/deal at Mental Health Institutes is described in the Code of Iowa. Section
230.20 removes direct medical services from the computation of the per them and provides that direct medical services be
billed dkectly. Io~va Administrative Code, IAC~41.29.2(230) defines direct medical services as including pharmaceutical
services. Thus any medication used by a patient would be billed to the County sepamtely from the per diem charge. '
The Food and Drag Administration requires pharmacies to be registered to dispense ClozariL The amount of Clozaril that can
be dispensed at one time is only a week's usage. Pharmacies must review iab values ora patient's blood work to determine the
appropriateness of continuing ClozariI before dispensing the next week's dosage, thus the management fee charged.
The pharmacy at IMHI is not registered to dispense Clozaril. Therefore, IMHI utilizes Caremark to provide the medication and
the monitoring required to dispense the medication, Caremark bills the County directly for the medication and monitoring.
Since the medication does not go through the IMHI pharmacy there is no additional charge for IMHI pharmacy services.
Clozaril is ut/l/zed infrequently at IMHI.
If IMHI were registered for dispensing Clozaril, the cost of the medication would be increased to cover the costs associated
with stocking and dispensing through the IMHI pharmacy. Under this scenario, IMHI believes the county would actually pay a
higher cost due to the purchasing volume difference between Caremark and IMHI.
Independence Mental Health Institute does bill thkd party payers when a patient has additional coverage; and credits the
county bilI accordingly. Part A Medicare coverage is limited to 190 days lifetime and 90 days per episode. Most IMHI
patients who are Medicare eligible have exhausted their benefits under Part A prior to their hospitalization. In addition, part B
of Medicare does not cover any pharmacy services.
I understand your desire to contain costs for care and medications. EViHI believes this method of purchasing is the most cost
effective but wilt be happy to review its purchasing methods. Please contact me if you have additional questions.
Sincerely,
Kevin W. Concarmon
Director
KWC,'kk
CC:
Senator Mike CormolIy
Gary Lippe, Dubuque Service .,M-ea Administrator
Representative Robert Osterhaus
Dr. Bhasker Dave, Independence Mental Health Institute Superintendent
1305 E WALNUT STREET- DES MOINES, IA 50319-0114
PHONE: 563-589-4441
PAX; 563-S89-7884
EMAIL: brdofsup@dbqco.org
COURTHOUSE
DUBUQUE, IOWA 52001-7053
DONNA L,
,JIM WALLER
ERIC MANTERNACH
August t 1, 2003
Senator Jutie Hosch
22852 Butterfield Rd.
Cascade, Iowa 52033
Dear Suite.
Dubuque County is currently paying for a mentally ili individual who was involuntarily
committed to the Mental Heahh Institute in Independence, Iowa on December 17, 9002 In
addition ro the rare akeady being paid to the Skate t~0~ fi:fig service, we have just recently been
asked to fund the medication Clozaril separately; ThetM~ Pharmacy does nor stock Clorzaril; it
utilizes an independent supplier who bills the Ce ,tmty o~gaJ[ settlement directly for the
medication along with a case management fee. ~1,7'-"" "'
The Board of Supervisors believes that the MH~'g should ~tSdk all medications including
Clorzaril so that those consumers, who have[k third party insurance such as Medicare, could
uUhze that ftmdmg stream rather than County_ f:anamg. The Case Manage, m~,n~ fee. rs a
duplication of services as th~ MT-II:~ are'considered teaching and' ertucalffon' facilities, by the
Department of Human Ser~£ces w/ih Psychianic. Social ServiCes; Pt/armacolo~b~l and Nrtrsing
Deparrmen[s.
Thank you for ]'our consideration in this matter. We are ar~xious ro hear frorm you.
Sincerely,
DUBUQUIE COL~TY BOARD OF SU?ERVISORS
Iim W a!ier. Cn,,~raerson
Gary L/ope Dubuque .~rea OtUce
COURTHOUSE
PHONE: 583-589-4441
FAX: 563-589-7884
EMAIL: brdofsup@dbqco.org
DUBUQUE, IOWA 5200%7053
DONNA L. SM[TH
JIM WALLER
ERIC MA NTE.ClNACN
March I0, 2003
Senator Mike Comzolly
Iowa State Senate
S tale Ca?itaI
Des z¥loines I_A. 50319
De~- Mike:
f,, T,,w* ~'l, ar,~¢* for the c~¢ o¢ hnda,id,,al~ ,,mo ha,*e been found to be ..... mu~.e..~ to st*,~d tz.a!
and are committed to the custody of the Iowa Dep~ent ofHamm~ Se~ices or the iowa
MedicaI and Classification Center at O~dale under Iowa Code Chapter 812 ~e sent ro the
County o f legal settlement.
Our County Management Plan does not include payment for setw[ces tbr defendants in the
~'°~°" -'tied
criminal justice system, inc[udh2g the o~= comn'u individuals.
Dubuque County has ~%mded mi [ndixddnai al: the MeutaI Health Institute tbr many years, and is
currently ~vorking to find a communi~-b~ed sernnm Because the "8t2~' connnmnenr slams has
aot been dismissed, the consumer is ineligible for Social Sect~b~ D~sabllity Benefits_ and
there[bre Medicaid insurance. The Count- is therefore responsible ~br fading the endre daily
rare ~br a residential care facility, o~ppatienr m_enrat health and medical treatment, and
medicatioas~
t',eau,~ tzra~t teg~.sIanon to eliminate the ffnanciaI harden for counties for md~vmuals placed u', a
commtmity based sctuhYz, or ar an MHI or Oaf<dale unde': m2 "8!2" commktnent, ll:m~k you.
Sincareh'.
DUBUQL~ COUNTYBO:~R-D OF ~r~c -r ~; -
Revised on ~0~14~03 Fiscal Year 2004 Budget Cuts
El[eels of 10-10~03 2.5% ATB cut to local governments (excludes city