Kankakee County Board, IL Finance Committee Meetings, 24 Aug 2022

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Finance Committee Meeting 08/24/2022 9:00am

A

It's all part of the finance committee meeting for august 24th 2022. We have a roll call. Please.

B

Can't hear you, let's start over.

A

All right, let me start over uh call together the finance committee for wednesday august 24 2022., uh a roll call, please.

C

Mr lear, president.

A

C

Sponson mr hess miss polk president, mrs webber, miss parker mr fairfield, mr eckoff, mr featherling, mr dental present.

D

C

Miller, mr long, mr hunter, mr raymond, mr wheeler, mr c ray, we have a quorum.

A

I have no request for public comment. Is there any public comment desired? Is there any public comment desired if there is no public comment desired, we'll move to presentations on mr lynch for the medical insurance yearly review? If you could come forward, mr lynch, we'll look at that presentation.

A

Good morning how.

E

A

A

We have two parts of the presentation. The first one is the near pacific. The second one has been distributed in paper form.

E

The cover page of the first report should say blue insight, monthly financial report, and there should be seven pages to that.

E

This report starts on january, the 1st 2022 and is through july 31st of 2022. um This is data that has sorry about that data that has come in and we have a lag in about 30 some days. So this report is the most up-to-date report we have on the experience and the claimed uses of the plans.

E

First page I have copied and given out here, is a enrollment overview. Just to give you perspective.

E

You'll see that on a month-to-month basis, through july in july we had 403 medical subscribers.

E

And then, secondly, in that line is a 872 medical members, and that includes the families who children, spouses and things of that nature.

E

To give you perspective last july, in july 2001 we had 415 members and so we're down about 12 members at that point in time, um in terms of medical members, we had 8.91 last year, so we're down uh 19.

E

At this point, the pharmacy subscribers and members are equal to the medical subscribers and members. So uh that's why I didn't go over those two columns. There's just uh you know a small negative in terms of the numbers of bodies that we had last year versus this year on page five, you can see over in the right-hand corner. Overall membership decreased by 1.1 percent.

E

Average age was 33.9, which in increased by 0.9 uh between the reporting periods last year versus this year, the contract size just basically an analysis of who's on as a dependent, increased 4.8 females between the ages, 20 and 44 increased from 19.3 to 20 percent and you'll. See uh at another point that I think male versus female in this group is pretty well balanced.

E

You can go over on the left hand, side and see proportions of males about 48 to last year, 48.2 proportion of females, 51 versus 51, 1 versus 51 8, uh and then a repetition of the 20 to 44 category uh numbers uh page six. uh It gets to what I uh would call the meat of the matter.

E

You'll see this is a financial summary and at the top there provides a breakdown of medical order of reduction from the build to the paid for the current month period prior period and a percent change uh over. On the left hand, column you'll, see the number of uh or the dollars that were built uh july. 2022 there individually was a 900 903 857 build, however, on the right side of the page.

E

If you look at january 21st to july 21st last year it was billed nine uh 9 and eighteen thousand eight hundred and fifty three this year. At this point, seven million two thirteen so blue cross is telling you there's a twenty seven percent reduction in the bottom line.

E

That's been billed to the plan, so that's that's, obviously very good uh not covered uh covered claims, which I would uh pay more attention to than the not covered uh eight million nine versus six million three, which is about a twenty nine percent uh reduction and if you'll skip down to the paid uh to provider.

E

You'll see that uh last year in 2021, uh the provider balances were uh two two million seven hundred fifty eight thousand versus current one, eight five one million eight hundred fifty six. So that's a 32.7 reduction in again medical paid down, 32.7 percent and then there's a group liability breakdown.

E

And here I'll give you some additional information. That's not on the page, but you've got 20 21 versus 22, but you'll. Remember back in 2020 we had a really good year. The uh medical paid up to this point was a million fifty five thousand three hundred and seventeen um in 2021. We see that it was two million seven sixty and right now we're at about uh 1 million 858..

E

So that gives you perspective on how the claims have come in and what the deviations are can be. Some huge changes, depending upon the medical conditions and the amount of high uh cost claimants that we see and that's another thing we'll see in a minute that that's down as well pharmacy paid there was uh in 2020 uh 360 000 in 2021, 632, 000 and right now, we're sitting on 552 000., so between medical paid and pharmacy paid between 22 and 21 medical is down. 32.7 pharmacies down 12.7.

E

Dropping down to the overall group liability, uh it is down 28 percent between 21 and 22.. Again. Perspective is uh in in 2020 we're at a million 422 000., so all in all we're sitting on top of a fairly decent year, but we're between.

E

If you look at those three numbers, we're between uh uh you know, 20, uh 20 and uh 2022 are the closest best numbers of the bunches on to page seven um financial overview, and this is what is called the medical and farmers pharmacy loss rating ratio, which is a kind of a key term it. This report provides the medical and pharmacy loss ratios and claims for the most recent reported 12 months, and so as you'll see over on the left column.

E

We've got the months that are being compared here back to august, 2021 through july 2022 and of those loss ratio months and if you go all the way over to the right side, you'll see more medical and pharmacy loss ratios and there's double digits in every one of those, except for three months in 2021 october november and december, which are kind of typical because you come to the last quarter of the year and people are getting stuff in and but those are three digit numbers they're above 100 percent without those three months.

E

This would look a lot better, but we're sitting on top of 87.5.

E

And again, if I give you the perspective of 2021, we were sitting at the same time at about 108.6.

E

So again we are a lot lower. That's a deviation of about 21 and uh while I can see the renewals being a lot better, this is kind of a key number right there.

E

Their desired loss ratio is somewhere um and I'll I'll I'll tell you that in specific, when I get a chance to refer to in another report that is in the uh right under the 80 percent mark, so we're getting close to where they want us to be and and last year was just a really. You know bad year for claims which covid was involved in there.

A

Steve I'm sorry, mr harris thank.

D

You chairman, mike, do you think the first six months of last year is still going back to the covid when there was no selective surgeries done in 20.

E

There's some of that there there's those surgeries that could be put off cataract thing. You know some and didn't necessarily have to be not important, but some things could be pushed forward. Yes and 21's got some of that in it without question, but uh you would have expected to see more in the early years of 2022 of that as well. In my opinion, from what I've seen in other places.

E

So um I I think you know the first in part of the second quarter showed up about things like that. I know cataract surgeries were just way off the mark. You know it doesn't hit just people over 65 either. You know there's a lot of that, but some of the elective surgeries were put off and I think they blended into 20 21 in in a great part, but 22s had some of that in the first part of it.

E

Let's see here, moving from seven, the next page I would refer to is page number ten, and here uh there is a uh an a layout of medical claims, expense, and this is kind of an interesting and important scenario, because you'll see in claims less than less than five thousand dollars there's.

E

uh You know the bulk of the annualized claims in those three areas in the five thousand ten thousand and thirty thousand there's less than ten percent of those claims. um If you look over at the the left or excuse me, the right side of the column, the paid percentages and the dollar amounts.

E

At this point, a million 697 000, totally paid in this portion of that represents 91 of the total claims versus last year, which was a million 643 000, so not a gigantic difference, but you can see.

E

Down at the bottom, you'll see key findings. The proportion of claimants who receive less than 200 in services for the current period was 27 percent. Those claimants spent about point. Nine percent of the total paid expenses and the average paid expense per claimant was seventy nine dollars point three percent of the claimants had expenses over fifty thousand dollars for the current uh uh period. Those claimants were about eight percent um and average paid expense per claim was eighty thousand last year, that number was 233 000..

E

So there's a big deviation in not only, I think, there's three now there's there's difference of three bodies uh one year versus the next, but the the the average claim for those bodies is huge.

E

So uh if you want to jump to the next page, which talks about uh the uh high cost, claimants uh you'll see that this report at the top there it says the report provides a detailed listing of the top 20 high claimants, with paid expenses of 50 000 or more for the current period, and then it lists not by name but by subscriber age, gender and the leading diagnostic category, the subscriber.

E

In all cases, that means the employee and blue cross lingo transferred to employee, and then it lists the age and gender first person was up against circulatory diseases, endocrine diseases for the second and the third one. It was not available, which is not unusual in many con. In many cases they don't have a specific diagnosis.

E

There's there could be multiple diagnosis, so uh that's not listed there, but next to the diagnostic category. If you will there's inpatient, paid, outpatient, paid, professional paid, that's you know physician and pharmacy paid, and then we get a paid column, but I'll drop down to the high cost claim it total you'll see there's 81 184 for your reference last year. At this time it was 141, 622.

E

outpatient- and this maybe goes back to his question about the the covid, and you know where some of this light outpatient paid uh was 55 000 last year. At this time it was 519 000. So you know there there's an in liar professional, paid, 39, 000 right now we're sitting on four or excuse me. La uh last year forty five thousand pharmacy paid sixty thousand one ten uh versus last year at 117 354., so the last year's tote yeah, I'm sorry. uh Last year's was 800 million yeah.

F

I'm sorry, I didn't see it yeah. I just got a question in terms of the uh two thousand dollar cap that was just passed uh uh recently. What overall impact uh has there been any prognostications as to what kind of impact would I have on on these numbers in.

E

Terms of I don't know that I can answer that question without maybe asking and taking it to a level at blue cross like in the reporting section to see if they've got any of that information.

E

I I know what you're referring to, but I I haven't seen anything like in writing from them and usually when they have a report that they want to notify brokers and consultants and agents out in the field to watch out for so to speak. They'll. Let us know that, but I'll mark that down and see if I can find.

F

It because I would think that they would know what the legislation was and and the the impact it would have on on the industry. So if you can get that to us, yes appreciate it too,.

E

um So, between this year at 236 268, you know last year's was sitting on top of 824 448 and then um that last column currently enrolled.

E

um I don't mean to demean anybody by this comment, but you're always happy when, when you see not enrolled and enrolled and all three of these people are still enrolled, so it's just telling you they're still on the plan and that you may have some claims that you have to watch out for going forward so financially, and so I think that was the last page um hang on here.

E

No excuse me, I had uh page 14 and 15 marked porch fake 14 is the overall medical paid per member per month by leading diagnostic categories and you'll see over there that health status wasn't even on the list last year, and this is just an evaluation. So the leading diagnostic category is for physicians. Reviewing the status of individuals.

E

Number two is perinatal. Last year that was at 10th. Circulatory uh is the third leading spot. Last year it was at fifth mental health, which we've seen an increase in in the last two years because of covid.

E

It sits there at fourth last year it was at eighth, injuring poisoning which it covers. A vast spectrum of injuries and uh justin's was at, uh let's see that's at five, and last year was at seven and last year's number. One was musculos, skeletal uh and, and this year it's sitting down at fifth, uh so just to give you an idea what what kind of things are going on? um If you want to skip over to page 15, we can see the financial, financial res or pharmacy financial summary.

E

um The uh comparisons between the two years are as important as anything, and you can see between 21 and um 22. In the build area it's gone down in both uh billed and covered about five and a half percent.

E

um The out-of-pocket cost is down that. That means out-of-pocket cost for the individuals down 15 and a half percent and paid to the uh providers down about 12.7.

E

I'm not quite sure that 2020 perspective is of much value at this point, but they were significantly less in the 2020 year.

E

At the bottom, you'll see total pharmacy paid versus specialty paid and you'll see. In the prior column, the total paid was six hundred and thirty, two dollar thousand six hundred and fifty five versus uh uh specialty paid 231 736 the current period were much reduced and I believe uh the 552 was a number that was 12.7 below uh last year and the specialty is 147 000., so in both of those categories, it's down, which is good news, but we'd like to see that stay the same over the next.

E

You know several months because that's where the true numbers really start kicking in, even though I'll talk about the renewal here, we've got it uh if it stays better. We've got a chance to work. That number is where I'm going with it so um and I'll stop here for any questions.

A

Andy, mr wheeler.

G

Knock the top off the mic, the um where's uh worst trend at right now for the industry.

E

You know they've said dinan 8.7 to nine and a half.

A

E

And uh that's the blue cross folks. When you talk to other carriers, they speak sometimes of different numbers, but I haven't heard a number: that's vastly different.

G

Okay, and so have you heard of an inflationary number in the health care sector. um We all know what it is and and the food and the gas and everything else. But what and you know you know other types of products perch that you can buy, but what's that number in health care.

E

You know the numbers we've focused on are the numbers that the underwriters have told us they're focusing on and that's the nine and a half to nine point. Seven. I can't tell you that I've heard anyone say of this 9.5 or 9.7.

E

This is what inflation is, because that number we're talking about andy is a medical inflation number right. That's what trend is so I I haven't heard them say anything uh different than that, so to speak.

G

I just say I just see lots of good things happening with the utilization of our health plan right we're down in almost at every category. I believe and.

E

We haven't announced.

G

What our renewal is, but I would like to have that discussion, yep.

E

um The first thing I'd like to do is go to the executive summary page and what was handed out. It's page number four at the bottom right hand, column at the top left hand corner. It says: executive summary this. This tells you what the utilization report really is um starting at the top uh kankakee county's overall enrollment uh decreased- and another thing I want to say is this: report is for two time periods and that is june of 21 through may of 22, and that's on an incurred basis.

E

Claims that have yet possibly to be versus a paid basis of six uh june 21 through july 22nd. So these numbers won't match up, because that's not the intent of this report. It's to the monthly report, which is you know, data, that's you know coming in as we speak. So it's it's very active data and this is looking backwards.

E

uh Enrollment decreased uh 1.3 between those two periods, um the average age among uh the membership increased from 33 6 to 33 7.. So, mr hunter, I think you asked a question earlier about average age, so it's gone up slightly, but nothing of measurable, interestingly uh female, again versus male 51 female versus 48.6 male.

E

The overall paid expense per member per month decreased by three and a half percent between those two reporting periods, the service categories that impacted the paid pmpm per member per month trend. The most was inpatient facilities which decreased by 19.7 percent and um was lower uh by 9.7 percent than the blue cross blue shield benchmark inpatient pm pm decreased by 19.7.

E

As I said, uh the surgical portion of that decreased by 36 medical uh application decreased by 42. So again, it's just applying uh to what andy said that it it's gotten much better outpatient, pmpm decreased by 11 between reporting periods. The two outpatient facility visit types that were paid were surgical and pharmacy and iv therapy, mostly chemo or yeah. Chemotherapies, that surgical decreased by 13 pharmacy and iv therapies decreased by 38 professional paid, was uh increased by 9.4 percent top two service units. There were uh evaluation uh management and it increased by 19.7.

E

The medical evaluations and management increased by 24.4 medical pm pm decreased by 6.7 between the periods 6.4 lower than the benchmark. I think, generally, when we look at those benchmarks, you can probably say that's chicago kind of to the downstate mark. If you will we're not necessarily centered in the uh chicago market land, so you can kind of interpret it that way.

E

Pharmacy paid pmpm increased by nine percent between the two periods, um as we kind of look before the diagnostic four diagnostic categories, uh by paid expense pm per pm were musculoskeletal health status, cancers circulatories. Those four diagnostic care categories accounted for. Fifty percent of the overall paid expenses for high uh cost claimants and those are uh defined as claimants over fifty thousand dollars.

E

This depe decreased by 17.9, almost 18 percent. Between the two time periods, a number of hccs also increased by 25 from 12 to 15. During those same time frames the proportion of paid expenses due to high cost claimants decreased from 31.8 to 27.4. So even those are those there is an increase in bodies.

E

uh The cost of treating those bodies have gone down.

E

uh The pmpm for emergency root usage increased by 27.4 between the periods er, it visits per thousand increased by 38 percent, and I could go through this utilization period, but I believe I looked at this and the much of the reason was centered mental health treatment, which is not a criticism. It's just a fact. There was a lot of people coming out of covid that had a lot of mental health issues. You know with staying home, possibly or what have you.

E

This was about 13.9 percent higher than the benchmark in the current reporting period. Pcp usage accounted for 38.6.

E

Of professional office visits compared to 34 in the benchmark, pcps accounted for 48.8 of the professional office expenses.

E

So uh moving on to page five, this this dashboard gives you a key metric uh scenario up there. In the top left hand, I won't go through all of this, but right now in this uh report, it's telling you that all of these categories- the overall paid per member per month, is going down about three and a half percent.

E

E

You'll see that that three and a half percent the current paid per member per month is 462 dollars and 27 cents, and what that means is, if you take everything and throw in a basket divide by the number of bodies and so on. That's what the cost is per member per month, uh annualize that out and that's where you you come into an average cost annually.

E

The change over last year is about three and a half percent, which is about 9.7 percent lower than the benchmarks. And then, if you want to dig down into all of those things into the uh individual utilizations, you can see that inpatient, outpatient, professional and pharmacy, and what's it what it has done in each category.

E

E

That's why I have these. I don't know why. I can't remember that.

E

Skipping on to page eight key indicator report, starting on the left side, you'll see again, if you really want to dig down and see, what's going on, you'll see inpatient facilities, outpatient facilities, professional, the medical summary, the pharmacy, individual and then the overall summaries, but you can see over there in in the benchmark variances versus the percentage changes.

E

We've got a lot of negatives in there in in the inpatient and outpatient areas at the top, but uh the benchmark variances are uh negatives in inpatient facilities, but increasing when we start looking at uh benchmark versus where we're at uh an outpatient professionals are are at a negative. Medical summaries are at a negative.

E

The pharmacy utilization per member is down and you'll see in the overall summaries. It's under 10 percent.

E

Over off to the right there you'll see, total medical paid per member per month decreased 6.4 in the current reporting period, um and that was 6.4 below the benchmark. Excluding high cost claimants, the total paid trend was 2.8.

E

Let's see, let's skip to page 11.

E

uh You'll see I picked this out because there are others in the reports, but on neoplasms cancers, you'll see that pmpm across between 20 and 21 ones, at 396 and 2020 through 2021 5.35 and 21 22.. That's a 35 change. The benchmark is 8.09, so we're under that benchmark about 33 percent.

E

uh So if you want to know yet, although we think this is a high cost claim area for cancers- and this group in the past has kind of shown that we're still under where most of those benchmarks are so to say that we're you know, have some sort of an outlier. I don't think we can say that um outpatient we've got some increases in the paid member per month, um professional there's negatives and that first column paid per month is down about 55 percent.

E

So this is is an example of how we can dig down if you want to get into the nitty-gritty of this stuff. It's not always appropriate for a meeting like this with the finance can committee, but we can do that. um Let's see here.

A

F

Yeah, just one other question sure, and and and this kind of macro you may not be able to provide specificity. um What impact would you think eap has on on service delivery, especially maybe mental health or something.

E

Well, I think that's where the real proof would be to be honest, uh mental health, and I would have to go back to our eap provider to garner one of those reports and include it like something or included as something we could make a comparison to. So I'm not pawning off your question, but I.

B

E

I haven't seen one of those reports to be honest with you and I'll make a note on my note pages here to to ask that question.

F

Because I think it would have some impact, I would think thank you.

E

On 12 page 12 on circulatory.

E

I do know that this group has a uh abundance of uh diabetic and uh hypertensions, and so I I wondered looking into that common. uh You know we have a current uh basis of about 29.6 and the benchmark is about 28.2, so those align up pretty well uh with you know what we're being told in the marketplace is that diabetics are part of every uh crowd um on the right side of the page.

E

The hypertension uh analysis shows that you know the current mark for this group is about 121 percent and the benchmark is about 103.. So those two areas you know can be looked at and say you know without proper medication and proper treatment. Those were the big causes of some. You know circulatory diseases come about.

E

I know a little bit about it. I is one and um you can you can take care of yourself and leave out a lot of things that will come at you get guaranteed and if you don't, uh you know it's a certainty, but if you don't there's a lot more things, I'm sorry did you have a question.

E

So, in any regard, um let's see here on to page 15.

E

uh Here what I wanted to to just read you is: you can see between the two time periods, there's 12 now we're at 15 25 change, but over on the right side. It gives you the uh verbal analysis. 1.71 percent were high cost claimants uh current period 1.35 going backwards.

E

They accounted for 27.4 of total expenses in the current period compared to 31 percent uh in the prior period and 42.4 is the benchmark. Pmpm for high cost. Claimants decreased by 16 between nine percent between the two reporting periods and was forty, two percent below the benchmark um paid pm pm. Excluding high cost claimants increased by 2.8 to between the two reporting periods. It was 14.3 higher than the benchmark uh 16.

E

um I just gave you that there's additional details there for the purpose of reading through it uh and seeing how much more analysis is there.

E

Page 17., I marked because of the here we've got top five high cost claimant diagnostic neoplasms, musculoskeletal circulatory blood skin, and you can see the difference between the two paid.

E

There's one claimant with the neoplasm four muscular skeleton circulatory was one uh one skin disease and you can see between the two uh uh periods that uh the cancer number is uh is down. uh Musculoskeletan and uh all the others are in some cases down, but again just to have you. uh You know review that page 18 is interesting.

E

uh High cost claims listing of the top 15.

E

and you can see it starts out as subscriber spouse or dependent, and you can see the total paid and where those numbers are they're all over 50 000, but again one of the ones. I I tend to pay a lot of attention to, and uh this got my attention real quick, because I don't think I've ever remembered this many they're, two four six, eight ten there's eleven of these claimants that are no longer on the plan.

E

So uh I you know they've gone off to either medicare or individual plans or they've reached the age of 26 and beyond so they're. No longer part of the liability here and just fyi.

E

19 outpatient facility overview: um you can look at both of those and read the that context of the or the uh indexes on the right hand, upper page um I'm gonna skip to page 22., uh outpatient provider. Summary.

E

I always look at this and kind of say that you know: are your people staying home and are we getting good value of the services that are available here and, as you can see, riverside and the outpatient areas had 25 admissions, st mary's 12 uh rush university, which is an upstream affiliate of riversides four and you you can go up and down there and see where people are going uh on the right hand, column, there's, there's the uh the text outlining what percentages there there are for that services.

E

Let's see the same thing exists for inpatient and I'll skip over to that right now, and that was on page.

E

E

uh riverside is also the top number one there um 1200 and some odd visits, uh 760 000 of the plans money was spent there, a total of 42 percent of the total, and you can see there what the dollar paid is per member per month. uh President saint mary's had 462 the paid number and the percentage of that total and then down from that central dupage renal treatment, centers of illinois, it's a pretty big name center for digestive health, and so you can see who your people are using. In that context I think page 28.

E

and that that that's really the end of the reporting overview, uh and so I mean questions on that in particular,.

E

uh The renewal mr swan yeah, I'm sorry.

H

um I don't have a question on that. Just curious on the medical pharmacy loss ratio uh end of 2021. We were three digits and it looks like current.

A

Page number you're on: can you tell the patient over here on.

H

A

That's on the first report right.

H

I'm just curious, it says we're currently sitting at 87 percent. You said the insurance company would like to see us under 80 right is that eighty percent, based on the total collections of premiums for the county only or is there something else.

E

Based on the medical and pharmacy usage uh in general, which are pretty much the same thing as for our 412 correct.

H

E

Yeah- and you know that would mean.

E

They would look at it as necessarily not a necessity to give you a zero, but you know it's what's still out there that they see um you'll, see in those claimants that, if they're still on the claim and it's something that has been there for a year or for a two-year period, it's likely that it's going to move forward. So that's something that they'll prepare for, and that does have something to do with it. That's a good question.

E

Excuse me, the key county renewal came in late last night and I asked it for I had asked for it for as early in august, and you see they got it to me on the you know the last part of august, but um they think the projected roman. If you look at it, it says at the top total projected cost by product is going to be about 403. So that's a net number.

E

I mean that's a number that they're just guessing that, based on you know what they've seen they're projecting the total net claims for next year will amount to about five million. Fifty nine thousand dollars illinois facility access fees which are blue, cross's, discount factors and then their discount percentages they charge and we share those dollars amount. Those dollar amounts with them now in in fully funded plans like we have, there is a pooling point and then this pooling point it's 110 000.

E

So what that means is up to a hundred and ten thousand dollars the claim counts. Against the group's experience over a hundred and ten thousand dollars, it ceases to count so you're not being penalized by that. um So the total uh charge, in addition to net claims, is six million. Eighty thousand now here I have to discuss this desired loss ratio.

E

They say is 96.72 now I know that they had suggested last year. It was under 80 because I saw the calculations, so I'm going to have to beg off on this and ask why they think that the 96 percent applies as opposed to the under 80 percent.

E

um I and I've got a note here to discuss this with him. I've got a call into it, because it's confusing to me, I would understand if it was a little higher than it was last year, but I'd like to know what their calculations tell me about that.

E

So I'm going to have to leave that at that right now. So the preliminary premium right now is 6 million to the required premium is the same thing. The premium at current rates is five million six, so the required premium at current rates is they're asking for a ten percent ten point: three percent increase.

E

However, anita showed me last night that you'll remember after we got through everything last year, blue cross came back and gave us what they called a communications fee, which is a discount amount of dollars that they sent to us to stay with blue cross in essence, and it was a hundred and some odd thousand dollars.

E

So if you back that dollar amount into it, it comes out at percent, I believe was the calculation I saw. So all we're saying there is that blue cross is asking us for 10.3, but where we're starting from in terms of rates is 11.1, because we got that cash uh in from blue cross. Now, mr.

A

G

Just so we're clear we're starting with that, because we passed that savings on to the employee side of things we just didn't, take it ourselves. The employees got that off of their premium. So when we we just want to announce that that that wasn't gobbled up by us. So accordingly, when we see 10.3 or 4 percent, you've got to add that back on that gets us over to the 11th one. Well,.

E

You don't want to be foolish about it, because that's that's the number right.

D

E

And- and uh I think that you know the easiest thing for me to tell you right now is from what I see there's a lot of work here uh to do and the work happens when we get the um rfps out to other carriers which they went out yesterday when we got the um the renewal, which is the final cog in the piece for other carriers, they want to know what uh how blue cross is analyzing this, and so they went out last night at about five o'clock and the two I hope to see uh come back with some something that we can utilize in.

E

Our discussion with blue cross is aetna, um possibly cigna and united health care. um uh Well, I I see some shakes in the heads and- and I know people like blue cross, but honestly, what all of us want in this business is to have a number. You can go back to your carrier with and say what about this, and so that's I I get that some people don't like what they've had.

E

I guess the hoops you have to jump through with united health care and I've always said you know you'll only like united healthcare, if you I shouldn't, say that publicly, you know only you'll like them. If you understand the hoops and what they're meant to be um they're there to contain costs- um and I know the look I'm getting from this- this young man up here means I don't like those hoops. So I I can only tell you.

E

I hope we get some good numbers out of this, so we can come back utilize them with blue cross and move forward with a discounted plan. From what we've been told at this point, I can't guarantee you that I I never can guarantee you that, but the last couple of years we've been able to make it work. So there are other questions, I'm happy to answer them. Anything.

A

Else, yes, jim, I.

G

I think it would. uh The committee would probably agree: please only entertain offers from uh carriers who have both hospitals locally. uh It's immediately disqualified, if there's only one, you know.

E

G

It's kind of a starting point.

E

Right, none of those uh that I remember have network they have. Multiple networks can be used which both are in dodge. It.

G

That way, hey I'm sorry in the research hospitals in chicago. That's a big part of this too you'll.

E

Remember last year- and I don't know how many people were here for that discussion- aetna had a a network that was almost identical to blue crosses and uh united healthcare has a variance of plans. They have a variance of networks, and so we can put that on the table, which may mean that we get a competitive or non-competitive number based on those, so um that that's another qualifying attribute. So we'll work hard on that.

A

Are there any other questions comments? Well, that was an excellent presentation. Well, thank you.

E

Thanks for taking detailed work stay in the uh stand in the moment, because I know their numbers.

D

A

All right, we're ready to uh excuse me for a minute.

E

Of what the timelines are, what we needed to do.

A

Miss twitter: do you want to speak the timelines.

G

This is the major cog in the budget, major cog budget, um so as quickly as possible. Obviously, but it takes time to go to market. um So, if I would say a month from now, if we're able to have something back at this meeting next month, that'd be the the best thing, because we're going to be doing a lot of planning on budget next month and uh we we've got to have it passed. Obviously for the steve. What is that october?

G

We're shooting for the october meeting so yeah if.

E

If you don't mind, what we'll do is call back to all these carriers this afternoon and say we have a revision and that revision is, it must be in the office by you, know three and a half weeks from now or three weeks, and if they don't get it in, we won't put them on you'll, we'll note it and we'll go from there and.

G

We'll use the 11.1 on draft budgets to start with now, because it won't get higher, but better I've not seen it yeah. You never know I've never seen coven before and by the way we asked mike for this, and we said we gotta have it in august. Thank you for delivering on that.

G

It's a big deal because then you're not scrambling around budget time to have special meetings, because your insurance renewal just got in and then anita can do open enrollment when it needs to happen and not have it be in three days where everybody's head's on fire. So thank you.

A

All right, we moved to uh approval of the minutes for july. 27Th is our motion to approve the minutes? That's parker, mr swanson. That's a voice vote. If there's no discussion, all in favor, say aye.

F

A

We moved to the finance department, mr mccarty good morning.

I

I

Tax collection, if you will um from sales tax and such um to continue um positive trend as far as overall, um I think I'm text um use text, so um I don't have a lot of uh specific things to say um on any one particular. So um I don't there's any questions uh individually or not. I don't spend any.

A

Any questions on financial reports or discussion.

A

If not, I will move right along uh cash flow update cash flow.

I

Yeah um no issues there, um we received our first tax distribution actually in august as far as the cash, so that's been the latest uh for a while. Not that that's a problem, but um I bring it up because um on our own, not only did we make it through july. There was a three payroll month in july um and we did it without any assistance of anything. So just another um explanation of you know positive trend and positive uh cash on hand uh from what we have experienced in the past.

I

So um so not not a criticism of nick or his staff, but just uh just the way things worked out um and just looking back at it. You know I would have been in tears uh if we didn't have that distribution with a three payroll month in the past. So um so good news, um I don't have much else we're working on.

I

I have this model out through 20 2025, um working on a number of um different scenarios um going forward and trying to save taxpayer money, um and so, as chairman wheeler said, the the health insurance renewal is a critical piece amongst many things, but uh that is that is a critical piece going forward um and see what trend is um so a lot of a lot of work behind the scenes going on right now that we'll be discussing.

A

Soon, questions on cash flow- that's very good news move to uh claims recommended not recommended for approval.

I

Yeah, the first one um is for the public building commission. um The flow of this one um went up uh happened. I had to be up front when it came back. It was manually brought back and was asked to put a note on there. um So I added the note. um The other purple markings were not uh there. After came back the first time, so I identified that because of the iga the new iga, which the board just passed.

I

um We made the first three payments. uh First, three months of payments uh under the previous one, there was no maintenance in 2022, so we didn't have any maintenance connected. So uh the reason we're in march april and may is because this iga has been going back and forth for three or four months, so I just waited to make payments until the new iga was passed, and so that this is the first one. So there is a manual calculation on both the health department and the county's portion to catch up the first three months.

I

um For that, so the claim wasn't even looked at um the first time it was in the auditor's office brought back and then the second time it comes back with the markings with timing of everything there's more vacation time there so nobody's going to be around in the office and all the other things going and trying to get these paid into october. um I decided to bring it here and to try to keep things moving, and I have to wait another month um depending so.

I

um The information is uh the there's two manual calculations on on in in built in here. So the the new ten thousand dollar um admin fee, uh there's so the the so the previous uh stopped at seven thousand uh and in 2022 and on there were zeros after that, so I plugged in the new uh admin fee for the new iga and then just had to make up the difference. So it's really the the 10 percent, the the health department pays 88 of the 10 000. The county pays 12 of the 10 000.

I

So three months of that difference is the calculation that got plugged in for both so um checked it twice. It's managed calculation to just move on. This is a one-time thing in this. This particular payment, um the rest go to the normal schedule, because then it will be on. We've already talked to the health department. They paid us, I believe, eight months um under the the previous. um You know agreement that did not include any um administrative fees and so we've we've identified with them.

I

What they owe us you know because of the new iga, so we've discussed that with them. So um that's the story with this one um just ask the committee to keep it moving, um so we can keep these bond payments going because they're due on december first, you know and the ho the public billing commission makes uh the 2007 payment on our behalf. You know because of that intergovernment agreement. So that's the story behind this first claim.

A

Is there a motion to approve this claim, mr wrong? uh Dr polk seconds any discussion, mr wheeler.

G

Thank you. Thank you, mr chairman. um I'm sorry what was the the when the auditor's office called you about this or you guys communicated did? Was there any explanations that went back and forth and any tabulations that were provided or was it.

I

I explained well when it came back um because there was no markings. She just said. Can you add a? um Can you add a a note? You know that what's going on so I did and I sent it back up and I had mentioned in person. I said well, there's manual calculations because we're catching up the first three months that were missed because the new iga.

I

No other questions, no other requests, so I sent it back up and this is how it came back monday, um just the other day, so I had to make a decision on. Do we keep going- or you know just just move it through at this point, so um this is so this.

G

Is the only thing.

I

I have at this point from.

G

There came back deny to get not denied just they wouldn't sign off. Exactly so and they're aware there was an iga that changed, those amounts and you provided those changes and the amounts and the reasoning.

I

Yeah and I didn't provide them the new iga, then nordward did they request it. I mean it's available um to them if they want it. um So I did I I did what they requested the first time they had this claim. Okay- and this is the note- and then this is the only other communication, the the purple or two guys. The bottom note um is the only other communication I received on this, so literally no effort on their end.

A

Any other question to discussion: if not, we have a motion to pay a roll call vote. Please. Mr.

C

A

C

Swanson aye mr hess, miss pope hi, miss weber, miss parker mr brookfield, mr featherling, mr dunno aye, mr miller aye, mr long aye, mr hunter, mr raymond, mr wheeler motion carries and.

A

G

Is this breakdown this pbc refunding revenue bond series 2007? Is that all in myth is this schedule in myth? This is a.

I

Separate spreadsheet yeah so.

G

There is no representation of this schedule in mip whatsoever. Okay, thank you.

A

All right so the second.

I

Yeah, the second one is a credit card as credit card activity. um There were originally two missing receipts. um One of the receipts um has been found, so I communicated out to um jim rowe and um his staff, and so there was a receipt for jot form was found. um I didn't receive any other communications on the pizza receipt, um and so this is here to uh just uh get the blessing to move forward. I'm assuming that it's lost since there's no other communications.

A

Is there a motion to approve the claim.

A

No, mr fairfield, mr swanson sevens any further discussion.

G

Miss tweeter. Thank you, mr chairman. I just want to draw attention to the note on the bottom. It said johnny's is a usual expense. It seems there's different sets of rules. Apparently the judges and the county board can't have sandwiches when they're interviewing uh vendors that we're gonna spend millions of dollars with, but the state's attorney it's okay for him to have pizza. So I just want to draw the dichotomy out there. It seems that somebody's picking and choosing thank you.

A

Any other discussion, uh roll call vote. Please.

C

Mr lear hi mr swanson aye, mr hess, miss polk hi, miss weber, hi miss parker hi, mr fairfield, mr featherling hi, mr donnell hi, mr miller aye, mr long aye, mr hunter. Mr raymond, mr wheeler motion carries.

A

The total any uh other questions there, if not, the total monthly claims report is in your packet. Is there a motion to approve on monthly claims? Ms parker, mr featherlin seconds any discussion, any items you wish to discuss?

A

If not uh roll call vote please. Mr.

C

A

C

Swanson aye, mr a mr hess aye, ms paul aye, ms weber, aye ms parker aye, mr fairfield, mr featherling aye, mr denno aye,.

I

C

Miller aye, mr long all right, mr hunter, mr raymond, mr wheeler.

C

Motion carries.

A

All right, we moved to uh harper funding, requests, there's nothing under lost revenue. I see under the arpa section, if I might for a moment, I'm going to suggest to the committee the following procedure and if there's unanimous consent, while we can use this we'll ask mr mccarty to discuss each item, take a quick voice, vote on the individual items and then, at the end, after we've gone through all the items, we'll have a motion to combine and take a roll call vote.

A

If there's unanimous consent on that, we'll follow that and then we won't have to do a roll call on each individual item.

A

Seeing no objection, let's move forward and go with each of the individual items, review right.

I

All right enterprises um doing business as well as sticks, infrared sauna studios. This is uh the second time um for this business. So this is the 2020 2021.

I

um We did review um other tax documents, um it's under the 10 000 small business, small business assistance cap, so fifty percent reduction within the municipality, so they are eligible for five thousand dollars.

A

It's a motion to approve because we're going to take a motion on each one, a quick voice vote, so we don't have to uh so we're clear that the individual items were approved.

A

Mr mr long, if there's no discussion, all in favor say hi all right, we'll move to the next study.

I

Yankee county health department: uh this is a request um for um parking lot um repair assistance. uh The request was 450 000. I believe chairman wheeler would expand on that. The code that we're using is 1.14 for capital investments and facilities that respond to public health emergencies, direct coveted on a reimbursement only uh basis uh chairman wheeler. Did you want to say anything on this one.

G

Just briefly, thank you, uh mr chairman. I've had conversations with, uh obviously uh mr carrico and as the uh the president of the board board, president of the health department, and then also mr beavis uh they've, got uh roughly uh more than double this amount in total parking lot work and they ask for a little bit of help doing that it fits into the arpa proper category, the kind of the hard to spend money it has to be based on something that is exactly what this is.

G

People accessing health care, whether it's shots for covid but also other types of healthcare. So it fits into that category of the hard to use dollars. If you will so, I thought it was uh well within our purview to to help out this. While it's not the county board managed it's a connection of the county. So that's why I thought that yeah I'll bring it forward under 150, and then we can talk about it in committee.

A

A motion to approve mr ass who's. Second, mr swanson, all in favor, say aye.

A

I

All right, sumner township um requested uh 25 000.. They are under the cap of 20 for non-covered government. um The request was for uh since it they also use the building as a polling place for looking at a standby generator. um That's what the what they're looking to do so they're eligible under reimbursement only uh for 20 000.

A

Motion to approve mrs parker and mr donald um no discussion all in favor, say aye aye,.

A

All right next.

I

Roman township uh requested 20 000 that are eligible for 20 000. Under the non-covered government cap fund reimbursement, um their request is to make a bathroom ada compliant uh and shower build up uh floor for wheelchair access.

A

Ms parker, it moves to approve mr hunter seconds, all in favor, say: hi hi hi.

A

I

And then saint anne fire protection district requested 45 000. They are eligible for 20 000 under the non-covered government cap fund, reimbursement for the letter and information and the application they had a fire, and apparently one of the fire trucks was not covered by insurance, um so they're trying to replace things um along that line. So that's what the basis of the request is for.

A

Motion to approve mr long is there a seven.

A

And that's all right, that's all I have could we have a motion then to combine all of those for approval by rojo vote. Mr furthering mr swanson any discussion, ms park weber,.

B

Thank you. I my question was: what are they all in the same year? Were they all 20, 21 or 30 20.

I

um Well, we're using up the 1920 first.

B

That's what yeah.

I

So the business is the only one at this point, um that is the 20 20 20 20 21, the.

B

First, one, the first one is the one. So that's why it's an additional amount, because they already used the last one, so we're going into the new year for them.

I

Well um because they're second time through and and we're looking at different years of comparison from the first time through. So thank.

B

You, what you just said is the four four bottom ones are from the 1920 and then the first one is 2021 and they did receive money. The 1920.

I

Yes, that that is a good question and the the non-covered governments actually could cross with once all of them come, um and I did not actually look and calculate that. So that's a good question I'll I'll follow up on that. Thank.

B

You very much yeah. We.

I

Might be crossing over with because they're all at 20 000, I think we're at like 76 000. If I remember right, um those could actually cross when, by the time they all are paid out um into the 20, the new, the new segment of.

B

The motion's still okay, isn't it.

I

Yeah yeah since they're both eligible, you know, since it's all there were the businesses, especially the second time through you know, if somebody's coming for a second time, we're definitely looking at that sure separately.

G

Yeah, it was just to mention that if you know that we had the first round of coping and that was allocated there, the second round will be allocated to the second round, we're just not going to use up the first we're going to keep track, of which buckets are where they're at uh we remember, as as a committee we had said, these will all end. You know at the end of 11 30., so you know that's.

G

We want to keep an accounting, because then that funds will shift back over into lost revenue, so just as a kind of a an awareness thing, the that that really doesn't matter for the health department, sumner, roma and saint anne, because it's not based on their tax returns, they don't have them. This is that's project based. I hope that makes sense. You know so we're not. We we we're going to put them in the appropriate bucket uh and I think we're dealing right now in this year.

G

I don't think there'll be anything that goes backwards for those. Would you agree steve um because the work is going on now, that's reimbursement. That would happen now. It's not based on last year's financials.

I

Yeah no well yeah the non-government requirement by the department of treasury um isn't necessarily that it has to be a financial impact, um there's a percentage of their budget. So it's it's it's more wide open for non-covered governments. If we, you know just say if the county board decides to, you know work with them. So um as far as the buckets um yeah we we have been using whether um our understanding might be different.

I

What the chairman just said was you know, no matter what um purpose we've we've been keeping track of non-cover government um and what we've paid out to them.

I

You know in that I just forgot to look to be able to answer that question for you, where we're at you know on the two buckets that have been approved so but yeah we we're definitely keeping track of it um and and the the different businesses we're a little bit behind right now, because um we're I'm a third down and help uh uh devlin's out on um paternity leave um here.

I

So we're we're desperately needing him back whenever you know, which I believe is at the end of the week here so um but uh but we are definitely keeping track and and all this flows into our reporting, you know with the treasury so.

A

Other questions discussion.

A

We have a motion right.

A

C

Lehrer aye.

A

C

Swanson aye mr hess aye, ms polk.

C

Miss weber aye ms parker, mr fairfield, mr featherling aye, mr dental aye, mr miller aye. Mr long all right, mr hunter, mr raymond, mr wheeler motion case.

A

Is there anything wrong for your department all right now we moved from the finance department then to the treasurer's office. You have the treasurer's report on monthly resolutions. Is there a motion to combine and approve mr hunter, mr miller, any discussion on the reports uh voice vote all in favor, say: aye aye aye approve those opposed, nay motion carries.

A

Nothing from the auditor he's not present no representative from his office does any other business come before the committee, any old business, any new business. Mr hess, a motion to adjourn mr long. I saw his hand first uh seconds all in favor, say: aye aye opposed, nay,.