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DBQ County Legislative Priorit DUBUQUE COUNTY LEGISLATIVE PRIORITIES 2005 SESSION Presented November 10,2004 The Dubuque County Board of Supervisors begins this presentation by thanking you for your assistance in the past. We know that we can continue to work together during the upcoming session for the well-being of Dubuque County and the State ofIowa. 1. Southwest Arterial This is request for your continued leadership and support to keep the IA-32 Southwest Arterial Project moving forward. As part of the fiscal year 2003 federal budget Congress appropriated $2 million, the \DOT has an additional $21 million identified in their program and DMATS has pledged $7 million. The cost of the initial two-lane project is approximately $71 million. Requests for proposal for preliminary highway design were initiated in May 2004 and is expected to take 15 to 18 months. 2. U.S. 20 Corridor The completion of the u.S. 20 corridor project is increasingly important as Dubuque County plans for the tourists that will visit the America's River project at the Ice Harbor. Interim improvements began in the spring of 2004 from Devon Dr. to Old Highway Rd. and are almost complete. This phase will alleviate traffic congestion which included partial reconstruction of selected US 20 side street approaches and upgraded traffic signals. We look forward to continuing this project westward to Peosta, including North Cascade and Swiss Valley roads as priority areas. 3. Julien Dubuque Bridge Final bridge design work is continuing on the companion bridge for the Julien Dubuque Bridge making the crossing a four-lane facility. The Iowa DOT continues with property and land acquisition needed for the right of way which will be completed by 2005. The construction schedule for the new bridge crossing is dependent upon securing further funding. We urge our legislators to prioritize this project and we thank you for your continuing help with all three of these transportation projects. We strongly fee] that the u.S. 20 Corridor, Southwest Arterial and 4-Lane Julien Dubuque Bridge improvements comprise vitallirdcs to our continued economic growth and development. 4. Iowa Department of Transportation Illumination Specifications and Standards In the past the Iowa Department of Transportation has increased the illumination specifications and standards for lighting on Iowa highways and highway intersections. We would encourage the legislature to earmark special funding to the Iowa Department of Transportation to provide more lighting on Iowa's intersections and interchanges making the roads safe for our citizens. 5. Road Use Tax Fund Current studies show that aU road entities lack sufficient resources to maintain their existing road and street system. However, neither the Department of Transportation, cities nor counties should be aUocated less than their current share of revenue sources making up the Road Use Tax Fund. Additional dollars are needed by aU to make needed safety improvements and to respond to economic opportunities. We oppose any diversion of income to other uses and away from aU of the entities. 6. Agricultural Land Value Reduction The productivity value of agricultural land decreased by an average of more than nineteen percent statewide between 2001 and 2003, while the values ofresidential and commercial property each increased by more than five percent. Residential and agricultural property tax values remained coupled, the taxable value of residential cannot be increased, which win cause the residential roUback to fan below fifty per cent, shifting the tax burden fi"om agricultural property to commercial property only. We are asking that the legislature act this session to stabilize tax burdens between classes of property so that counties can budget accordingly. 7. Budget Schedule & Unfunded Mandates Counties in Iowa are required by law to certify budgets by March 15th. When the legislature adopts new legislation after that date, local goverrunents 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 goverrunent, 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. 8. Tax Credits and Exemptions During the legislature's special session in 2003, decreases to the Homestead Property Tax Credit and other credits resulted in hardship for senior citizens and others on fixed incomes, who had to pay more in property tax to make up the difference. Weare asking you to fully fund the Homestead Credit, Veterans' Exemption, Family Farm Tax Credit and Elderly and Disabled Credit. We as a County have tried to deal with the problems of elderly and disabled people who are receiving only a portion of the Elderly and Disabled Credit because oflegislative 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. 9. 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 definitions that would disqualify these confinement facilities from the agricultural exemption, counties could gain some control over the siting of these facilities. 10. Franchise Tax Recodification We are asking for the recodification of2003 Code Sections 405A.10 and 422.65, which would allow some of the franchise tax to be returned to state and local goverrunents. We are asking 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. 11. Juvenile Detention, Shelter Care and Foster Care The state-mandated cap on foster care for juveniles and the inequitable fornmla 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 al1ocated 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. Weare asking that the legislature carefully consider proposals about child welfare to look for shifts from state to property tax funding prior to enacting them. 12. Mental Health Parity Iowa needs to require that health insurance policies cover treatment of inpatient and outpatient mental il1ness 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 carriers and self-funded insurance to use the equal co-pays, deductibles and annual and lifetime limits for these il1nesses. This discrepancy is discriminatory and needs to be corrected. 13. Mental Health Funding The section of the MHIMRIDD formula enacted in 2002 requiring percentage fund balances for Counties to be eligible for State funds needs to be repealed. Counties cannot budget to the exact penny while insuring mental health access to its citizens. If Counties spend down all resources and new consumers present with mental health needs; their needs may not be funded or may be funded inadequately. Proactive and timely access to rapidly changing ARO and Waiver funded services using federal dollars generally give counties a higher fund balance that was originally budgeted in a given year. 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 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 cutTent tax levies to match federal dollars. Ultimately that amount would decrease 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 permanentlv. 14. Mental Health Institutes and beds for "state cases" One issue in particular is commitment costs for mental1y ill and substance abusers who come to Dubuque hospitals from Wisconsin and Illinois and other states. As you know, the costs of commitment for these "state cases" are paid 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 MHI. Dubuque County therefore continues to pay for commitments for "state cases". 15. Managed Mental Health Provider Dubuque County has experienced 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 low rates negotiated by the Managed Care Provider administering the plan, resulting in no choice at all for those consumers. 16. 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 Services are too low. Particularly in the area of dental care, poor and needy people cannot find 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. 17. Medicaid Eligibility During Jail and Detention Loss of Medicaid coverage when adults and children are injail or detention during the pre-trail phase results in the loss of needed services. Dubuque County supports the state funded continuation of Medicaid eligibility for those being held in jail or detention. 18. Mental Health Funding to MH/DD Providers 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 ofIowa 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-Bail1y accounting firm to gather necessary information on actual costs of service. The counties have assumed yet another cost shift from the state and therefore the state should not engage in rate setting or limiting rates (see section on Waiver Services) for those providers whose services are paid in whole or in part by the county. 19. Mental Health Restructuring It is our understanding that ISAC wi1l again support the restructuring of the Mental Health-Developmental Disabilities Fund this session of the legislature. The seven interdependent components contained in the Commission Report is dependent upon the state to provide adequate funding and be adopted as a complete packet. This plan wil1 abolish "legal settlement" and counties wil1 pay for services based on residency. As a county rich in providers, we oppose this concept until al1 services are paid for by the State ofIowa. Providers in Dubuque County furnish services to consnmers from many other counties, and currently the other counties pay for those servIces. In the event that the entire proposal is not adopted, legal settlement must remain in place. 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. 20. Waiver Services Al1owed rate for Enclaves under the Mental1y Retarded Waiver (MR W) has not had an increase since 1996; providers 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. Weare requesting eligibility for waiver funded pre-voc no longer be dependent upon pre- voc earnings. Currently, those who earn above 50% of minimum wage do not qualify for federal Medical dol1ars. Although the county supports this training to attain ajob in the community, additional training often takes years before the goal is accomplished leaving property tax payers to fund the service at 100%. Increasing the nnmber of state and federal funded Brain Injury Waiver (BI W) slots to eliminate the waiting list for the BI W. Currently there is a waiting list of 373 on the DHS HCBS W Internet site. 21. Adult Rehabilitative Option (ARO) 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 partnership 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 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. In addition, there appears to be a lack of consistent direction from DHS in providing technical assistance and oversight of the Medicaid Adult Rehabilitation Option (ARO) to ensure compliance with federal Medicaid regulations. This is also true for providers of HCBS programs to ensure the services and that the docnmentation for the service meets state and federal requirements. For example, Residential Care Facilities are in need of guidance when developing rates for their services. Specifical1y, should the cost of those services be a daily or hourly rate and what criteria should be utilized. Further, if criteria indicate that an hourly rate is appropriate, should the ARO revenue be deducted from the established RCF rate. 22. Case Management Targeted Case Management services are 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, consnmers are referred to the Iowa Foundation for Medical Care often because of a complicated pre-authorization process with the Managed Health Care Provider. This creates a cumbersome system and lengthy process (costing additional county funds while the referrals are in process) for deserving Medicaid recipients and those who have not yet qualified for Medicaid 23. Judicial Advocate Position The Judicial Advocate position continues to be a problem for counties. These individuals are appointed and supervised by judges. Counties were mandated to pay IPERS for advocates appointed under Iowa Code Section 229.19 in December of2000. Advocates appointed under 229.19 are not county employees, nor are they state employees. We object to paying for the advocates; it is philosophical1y a bad idea because advocates are paid to represent consumers, while the County pays for Targeted Case Management to make those determinations. We also object to paying rates over which we have no control as they are set by the ChiefJudge of the Judicial District, who also supervises their work. The state should complete the transition of funding and supervision of court-appointed mental health advocates from counties to the state. 24. Clerk of Court Aithough ¡his àoes not currently effect the Dubuque County commitment process, the Court should continue to find placements for persons committed under Iowa Code Chapters 125 and 229 rather than shifting this function and cost to counties. Counties wil1 continue to work with the courts to make this process function smoothly for those individuals who are funded by a county, but not all persons committed under these two Chapters are the funding responsibility of the individual counties. Dubuque County also supports ISAC's stand on the completion of the transition of funding court-appointed attorneys, advocates, sheriffs fees and court ordered diagnostic evaluations from the counties to the state. This should include both chemical dependency under Iowa Code Chapter 125 and mental health under Iowa Code Chapter 229. The state orders the services, sets al1owable fees and then sends the bills to the county often without the coordination to fulfill the county MHIDD plan requirements. 25. Unmet needs in Substance Abuse (SA) We continue to hear fÌom our constituents about unmet needs for Substance Abuse (SA) 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 housing services to Substance Abusers at the Julien Care FaciJity. These consumers are often awaiting a bed to a state funded SA Residential Treatment Center. Dubuque County has a halfway house for those who have completed residential SA treatment elsewhere in Iowa and are in need of ongoing recovery support services in a transitional living environment in the community. This service is being funded by federal and state funds and United Way funds in Dubuque. The original thinking about the transfer of substance abuse services was that the State of Iowa would fully fund SA services under Iowa Code including commitment costs, which counties continue to pay. Detoxification services should be included in the definition of substance abuse services funded by the state. (There is currently no mandate for counties to pay for detoxification services). The state should also follow the code section mandate requiring the Department of Inspection and Appeals to pay attorney fees for substance abuse and committals. There needs to be more SA dollars allocated to residential treatment in Dubuque County similar to what is being provided in other metro areas in Iowa. These areas include Fort Dodge, Mason City Iowa City, Cedar Rapids, Waterloo, Davenport, Sioux City and CounciJ Bluffs. The travel distance to surrounding treatment facilities is a barrier that does not allow the client and famiJy and other natural supports ready access to the treatment milieu. The money is managed by Magel1an and can't be relocated to different needs in a community. For example in Dubuque County, outpatient, halfway house services and assessment services are funded. The State is aware of the needs and new money should be allocated to under served areas so that all large metro areas have access to SA residential treatment. Approximately 70% of persons with chronic mental il1ness experience a co-occurring problem with substance abuse/chemical dependency. It is critical that the State ofIowa and the managed care contractor also approach and fund the treatment needs of this dual1y diagnosed population in an integrated community based residential treatment facility. 26. "812" Commitments Defendants requiring an evaluation to determine competency to stand trial, or restoration of competence, general1y receive services at a state institution. Those institutions, in turn, look to counties to cover these costs, even though they are a legitimate cost of the defense. The cost of the evaluation and restoration of competence to stand trial pursuant to Code Chapter 812 is a state funding responsibility. The Dubuque County Management Plan for Mental Health and Mental Retardation does not include payment for services for defendants in the criminal justice system that remain committed under Chapter 812 of the Code after they are discharged ITom the MHI. Consumers are ineligible for Social Security Disability Benefits and therefore Medicaid Insurance pending restoration of competence. Other states include eligibility for Medicaid for these individuals and we encourage you to do so in the State's plan, which would al1eviate the financial burdens when these individuals are placed in a community- based setting. 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.