Category: Cook County Health (CCH)

Cook County Board Business Conducted At Lightening Speed After 2 Hour Retirement Ceremony

12/20/2019

Cook County Board of Commissioners Meeting
December 19, 2019

The Board devoted the first 2 hours of their meeting to the honoring of retiring employee Martha Martinez, former Commissioner Jerry Butler, and the late Reverend Clay Evans. Testimonials lauded Martinez for thirty-four years of exemplary service. Former Commissioner Jerry Butler received a touching tribute from the Board. HIs career as a popular vocal artist and member of the Rock and Roll Hall of Fame was noted. Commissioner Butler sang one of his hits, “Let It Be Me” to the delight of all present. The late Reverend Clay Evans was honored as an icon of the black community and for his work on civil rights with Dr. Martin Luther King.

Action Items:

Agenda Item 20-0016- The proposed amendment to the Inspector General ordinance regarding reports and public statements was referred to the legislative committee. It requires that the IG share a statement with the head of the affected department and not issue a public statement for ten days. If the department has a response, this must be attached to the public statement. The Civic Federation supported this amendment during the public comment period.
Agenda Item 20-0735- The Board unanimously passed a resolution supporting federal universal background checks for firearms. It is hoped that this will add pressure for passage of gun control legislation in Washington.
Agenda Item 20-0721- The Board unanimously passed a resolution to support refugee resettlement efforts in Cook County. Several agencies testified to the challenge of working under current punitive federal policy.
Agenda Item 20-0437- Approved an intergovernmental agreement between the pension fund and Cook County. In 2016 the pension was 54% funded. $306.2 million will be contributed for 2020. This infusion of funds has now raised the percentage funded to 68%, one of the highest in the state.
Agenda Item 20-0732 - Changes in committee chairmanships were approved. These new assignments will give greater responsibility to the newer members of the Board.
Agenda Item 20-0658 - Proposed tax on cannabis was referred to the finance committee.
Agenda Item 20-1831- Board approved a commission chaired by Britton to create a new design for the county flag. The deadline is 2021 when the county celebrates its 190th anniversary. High school students will be asked to submit designs in a competition.
Agenda Item 20-0726 - Board approved a resolution to support Cook County Health’s construction of a new Provident Hospital. It also provides for the Cook County Board Health & Hospital Committee to hold a hearing to receive an update on the project.
Agenda Item 20-0712 - Board approved a resolution to discuss the Cook County Health Formulary Program. The resolution describes how insurance companies use “step therapy” in an effort to control drug costs. Step therapy is when patients first try the less costly drugs to see if they work. This can delay patients getting the treatment they need.
Agenda Item 20-0011 - Proposed ordinance regarding zoning for recreational cannabis was referred to committee.
Agenda Item 20-0579- Board approved authority for Public Defender to accept $500,000 grant to aid data analytics.

Commissioners Daley, Deer, Suffredin, Arroyo, Sylvestri, Gainer and Moore thanked Dr. Shannon (CCH) for his service to Cook County Health. Dr. Shannon was present and acknowledged their kind words.

Observer - Georgia Gebhardt Meeting Length: 3 hours, 20 minutes (includes 40 minute lunch break)

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Good Food Purchasing Program Pursued by Cook County Health

12/20/2019

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Cook County Board of Commissioners - Committee Meetings
December 18, 2019

Dr. Terry Mason, CEO Cook County Department of Public Health, reported on an initiative to address food purchases made throughout the offices and departments of Cook County government. This includes Stroger Hospital, County Jail, Juvenile Temporary Detention Center and others. After assessing costs, vendors, quality of food for healthy eating, etc., the program will promote sustainability, economic development, using local food growers, good quality food and other healthy eating goals. The power point presentation of this program is available on cook-county.legistar.com

Other topics discussed and/or passed by the various committees:

Rules and Administration—Several changes have been made to the previously approved list of standing committee and subcommittee chairs and vice-chairs mainly to give new Board members more experience and responsibility and also to replace Commissioner Tobolski’s committee positions. This Rules committee will have Commissioner Britton as the new Chair and Commissioner Degnan as Vice-chair. Commissioner Suffredin is stepping down from the committee completely.
Human Relations—Agenda Item 19-6895 an amendment to the Just Housing ordinance was passed which will give a one-month grace period before penalties and fines could be assessed for not following the ordinance. This ordinance was passed recently but has needed several hearings and changes to be acceptable to most stakeholders. It sets forth parameters to make it easier for former convicted felons to rent housing.
Finance--An amendment to the Master Bond Ordinance was passed which allowed the issuance of General Obligation Refunding Bonds. This will bring about $230 million in bonds to be refinanced at a lower interest rate. Cook County earns a lower interest rate than several other Illinois governments due to its higher rating. $138,000 will be paid to the outside organizers of this deal.

Observed by Karin Hribar

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Charity Care Is The Challenge in FY2020 Budget for Cook County Health

11/16/2019

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Cook County Board of Commissioners- Finance Committee
Departmental Budget Hearing
Oct 29, 2019

Cook County Health (CCH)

CCH proposes an austere FY2020 balanced budget of $2.8 billion, of which approx $1.8 billion is related to County Care (CCH's Medicaid Managed Care plan).
In Cook County FY2020 budget, the Cook County Tax Allocation given to CCH represents less than 5% of CCH's operating revenue.
The CCH FY 2020 budget anticipates $590 million in uncompensated care (charity care, unpaid patient bills, insurance companies not reimbursing claims) of which $409 million will be for charity care.
The budget includes 6601 FTEs and no layoffs (750 vacant positions were taken out of the budget), expenses for expected increases for drugs, medical equipment, and for employees' wages/benefits.
The Cook County Budget allocation of $83 million to cover CCH health services provided to Cook County Jail, the Juvenile Temporary Detention Center and Public Health functions falls short of CCH's anticipated expenses.
$513 million patient fee revenue is projected for health care services from insured individuals (not County Care members) through their Medicare or other commercial insurance.
The FY2020 budget for Stroger Hospital is decreased by 8% and Provident Hospital budget increased by 5.4% due to planned increase in services
County Care receives approx $1.8 billion payments for its members from Medicaid administrator. Of this amount CCH anticipates earning $173 million for providing health care services to County Care's members. Other healthcare providers outside of/not associated with Cook County Health system receive $1.5 billion from County Care for providing health care services to its members.
Charity Care is the largest and most important/challenging expense/issue in CCH's FY2020 Budget. Charity care at CCH is anticipated to grow at 4% for a total of $409 million. CCH in 2019 provides over 50% of charity care in Cook County. DSH (Disproportionate Share) and BIPA (Benefits Improvement and Protection Act) are federal funds paid to CCH to offset charity care. In the FY2020 these payments are approximately $289 million. In the current year, CCH will spend more than $377 million for charity care, a budget gap. CCH spends $1 million/day for charity care and this means that in FY2020, CCH will run out of money before the end of the year to pay charity expenses. The ever increasing burden for CCH stems from more individuals being uninsured and underinsured. Also another major reason for this charity burden on CCH is that other Cook County hospitals will treat uninsured patients for emergency conditions but discharge these patients with referral/instructions to seek follow-up care at CCH (these institutions decline to treat these patients for follow-up care).
Plans are in place to improve the growth of CCH health system and revenue with new/expanded services such as chronic ambulatory dialysis at Provident campus, expansion of surgical services at Provident and Stroger hospitals. CCH anticipates continued growth in extramural funding which brought in more than $25 million over the past three years. CCH FY2020 budget anticipates County Care membership of 326,000 (as of today membership slightly over 320,000). CCH will continue to seek additional Federal, State, and Cook County money and continue improvements to revenue cycle capture of money (clinical documentation, billing, coding, collections).
The budget gap between DSH and BIPA federal funding and CCH's growing charity expense outlay is CCH's greatest FY2020 Budget challenge. CCH will always provide health care regardless of the ability of the patient to pay, but this budget challenge will force CCH to make necessary difficult choices in restricting/cutting back services/delay getting equipment.

Observed by: Michele Niccolai

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Cook County Board Holds Hearing on Cook County Health Finances

9/30/2019

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Cook County Board of Commissioners Health and Hospitals Committee
Public Hearing
September 26, 2019

This hearing was requested by the Cook County Board of Commissioners to note and understand discrepancies between the Inspector General (IG) Report and the rebuttal of Cook County Health (CCH) and the firm—Deloitte—hired by CCH to analyze the Inspector General's Report. The IG Report generally stated that CCH’s insurance program, County Care, was unsustainable and was being subsidized by Cook County taxpayers. The IG report looked at ALL of the CCH finances, not just County Care. CCH disputed this and hired Deloitte to analyze the IG report —mainly the viability of County Care—and report to the Cook County Board. Deloitte did NOT do an audit as this was done previously by another division at the firm. It also only looked at County Care and not all of CCH.

There was a lot of confusion by the Board on what was being stated by both the IG Office and Deloitte. Mainly this was because of the Accounting Systems used by CCH and the various ways accounts receivable, payable, assets, etc. can be interpreted. All parties are looking at the financials and cash flow differently. The main question of the Cook County Board was “Do we have any concerns about the stability and viability of CCH?”

Here are the basic findings as this Observer understood them:

Inspector General Report

CCH is using other assets to pay claims in County Care, so the “hospital system is subsidizing the County Care Insurance program.”
There is between $501-$700 million in outstanding bills -—not paid or paid late.
Vendors are not supplying some necessary hospital, medical items because they are not being paid.
Transparency of revenues and losses is an issue.

Deloitte Analysis--

Revenues from County Care (provided from governments state and county) have covered its expenses.
CCH needs to make more timely payments to providers (90% of claims are processed but not nearly that number are paid) and this is a concern
County Care is profitable and can run the program
Assets and Liabilities in County Care are sustainable
At any point in time, County Care will have a $500 million or so liability because as old bills are paid, new ones come in that need to be paid -a backlog.
Funds from the State and County are sometimes not timely, which puts payments behind.

Dr. Shannon (CEO of CCH) Statements:

The premiums that County Care receives are more than enough to pay its expenses in County Care and in fact subsidizes some of the charity care and other programs that CCH undertakes.
CCH has suffered reputitional damage due to the IG report. People will not be willing to use CCH if they don't feel confident in its sustainability and viability.
The State of Illinois needs to speed up its application process for Medicaid enrollees.
CCH is in deficit due to increased charity care and non-payment by individuals who have insurance—NOT because of County Care.

Cook County Budget Office:

CCH will be working with the Cook County Budget Office to use best practices and increased transparency in reporting between CCH and Cook County Board.
There is room for improvement on the cash/payments flow system and they are working on it.

Observer : Karin Hribar Length of Committee Hearing: 2 hours and 20 minutes

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Several Contracts Questioned by Commissioners at Cook County Board Meeting Especially for Clerk Of Court Brown

9/30/2019

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Cook County Board of Commissioners - Meeting - September 26, 2019
Absent: Commissioner Tobolski

Board Actions:

The Board unanimously voted to DISAPPROVE a contract request (Agenda Item 19-5564) from the Clerk of the Court for $20,000.00 to print 10,000 calendars used in courtrooms and by some attorneys. Objections raised included that paper calendars are an outdated, ineffective method not used by many in the Court system and that they are a political advertisement for the elected official (Clerk Dorothy Brown). An ordinance had previously been passed that disallows the name of elected officials on these types of materials.
Commissioner S. Morrison questioned contract extensions (even beyond the original extension expiration dates) without RFP bids. Procurement should have put out this furniture contract (Agenda Item 19-5580) for re-bid. He asked why this was occurring again and stated that “this sounds like procurement rules aren't being followed.” Asset Management countered that there wasn't time to get a new RFP out but it will be ready for the next round.
Commissioners S. Morrison and D. Miller both voted NO on a contract for the acquisition of property for $15,000,000.00 for a new health clinic (Agenda Item 19-5233). This was discussed in closed session at the Asset Management Committee yesterday (9/25/19). Today the vote for approval by the Board was bundled with several other items with no description.

Items referred to Committees for future discussion and consideration:

(Agenda Item 19-5620) Voting Opportunity and Translation Equity Ordinance was referred to Legislation Committee. This ordinance would have more voting materials translated into more languages for voters who do not speak English. This would encompass 13,000 voters and would be ready for the March elections.
(Agenda Item 19-5629) which would give leniency to municipality-owned parking lots from the new increased Cook County taxes on these lots, was referred to the Finance Committee.

Committee Recommendations Approved:
Very quickly and without much explanation the following committee items were approved by the Board of Commissioners (I may have missed some that were bundled with other items and approved):

(Agenda Item 19-3776) Proposed Cook County Health Preliminary Budget
(Agenda Item 19-5556) a new State’s Attorney program to reduce violence—“a new approach”
(Agenda Item 19-0768) an approved substitute ordinance for the Charitable Rotating Bond Funds which prevents fees, court charges and attorney fees from being taken out of this posted bond. Also it would not prevent a Public Defender from being appointed to the bonded defendant.
(Agenda Item 19-5845) sets up a new Special Purpose Fund in the Assessor’s Office in order to receive their share of GIS distributed funds.

Observed by: Karin Hribar Length of meeting: 1 hour 50 minutes (includes 45 minutes of public speakers)

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No Expected New Taxes or Fees Projected for 2020 Cook County Budget

7/26/2019

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Mid-Year Budget Hearings of the Finance Committee of the Cook County Board
July 17 and 24, 2019

Over these 2 days, the Finance Committee (composed of all 17 members of the Board and chaired by John Daley) met with each elected official, bureau chief and major department head to go over the expected revenues and expenses at the end of the 2019 budget year (Nov. 30, 2019), and what was expected for 2020.

Highlights from these meetings:

Overall: It is expected that the County will end this fiscal year in the black, and no new taxes or fees will be needed to balance the budget for the upcoming 2020 fiscal year.

Projections are that the General Fund will have a $14.9 million net favorable. Currently, there is a projected deficit of $103 million in the Health Fund; however, Cook County Health has a plan to eliminate that deficit by the end of this fiscal year.
Looking to the 2020 fiscal year, the current projections of revenues and expenses would result in a gap of $11.9 million for the General Fund and $6.8 million for the Health Fund, or a $18.7 million deficit. Very small compared to past years.
Over the next several months, the Budget Department will be working with all areas to eliminate that deficit and produce a balanced budget from the President, as required by law.

Cook County Health (CCH):

Commissioners had many questions for CCH representatives. Message was that CCH needs to do a much better job of providing information to Commissioners, who stated that they want to help CCH, but cannot do so without accurate information. A separate hearing is being held on July 25 with CCH representatives, and they were told to provide clear and accurate information.
Plan to eliminate 2019 projected deficit of $103 million involves receiving funds from Medicaid to provide graduate training ($77.3 million in revenues) and not filling some positions ($26 million in reduced expenses).
CCH providing health services for more uninsured patients than in past several years; about 45% of the patients; Medicaid enrollment down across Cook County; State has been slow to process applications, but seeing an uptick.
Long-standing issue of CCH not getting full reimbursements from insurance companies for those patients who are insured continues; continuing issue of not coding properly. More and better information wanted by Commissioners.
Commissioner Moore had questions about providers of County Care (the Medicaid HMO run by CCH) not being paid because those providers not coding properly according to CCH.

Chief Judge: Asked to respond to Chicago Supt. of Police’s claim that too many people are being arrested for violent crimes and being released on electronic monitoring, Chief Judge Timothy Evans provided these statistics:

In the 15 months since judges began using the new assessment tool:
37,233 people have come before the court
30,466 have been released
only 70 have been subsequently accused of violating the order of release (less than .2%)

Sheriff: Questions raised as to why, with significant reduction in daily jail population (from 11,000/d a few years ago to 5,600 to 5,900/d now) there hasn’t been more cost reductions in Sheriff’s budget for the jail.

State’s Attorney:

SA Kimberly Fox stressed that office using data to make decisions on staffing and prioritizing work. Top priority are cases involving violent crimes, which are up 1% this year. Convictions for crimes involving guns up 9% this year.
Now available on www.cookcountystatesattorney.org/dashboard is information regarding number of felony cases initiated, disposed of, and sentencing results, which you can get by year and by Commissioner district, along with other information. This is updated every day.
Highest number of potential felony crimes by far is retail theft. Largely because threshold for felony is $300 in Illinois, much lower than surrounding states. To keep focus and resources on violent crimes, most of these lower value retail theft cases are instead being dealt with as misdemeanors.
SA Fox said that 770,000 prior convictions in Illinois for cannabis usage may be eligible for expungement under new law; 72% of these in Cook County. Not sure how to staff to take care of this.

Public Defender: While will not exceed budget for 2019, PD Amy Campanelli said that will be pushing for more money than President’s Office wants for 2020, in part to start an immigration unit with 4 new staff members. These would represent those charged with crimes (whom they are representing anyway in State courts in Cook County) at Federal immigration detention hearings. Cites statistic that have a 90% chance of no detention if have a lawyer and 90% chance of detention if do not. Would not work past detention hearing, but leave to pro bono immigration attorneys to handle the rest of Federal cases.

County Clerk (elections):

More registered voters in Cook County than ever before.
New voting equipment tried in 3 townships in April local elections was very well received. Will be used throughout suburban Cook County in 2020 primary and general elections.
Assured Commissioners that confident that election security in place.
In change from past practice, Clerk’s office will not allow people on ballot who do not have the requisite number of petition signatures. Previously, allowed people on ballot unless someone successfully challenged.

County Clerk and Recorder merger in December 2020:

Working groups formed to deal with various issues that have to be addressed.
After merger, Clerk expects to be able to provide recorder services at 2 satellite locations closed by utilizing existing Clerk’s personnel through cross-training.
Both Clerk and Recorder said they understood the need for Recorder’s office to come into substantial compliance under Shakman cases prior to merger.

Observer: Priscilla Mims

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Cook County Board Business Conducted At Lightening Speed After 2 Hour Retirement Ceremony

Good Food Purchasing Program Pursued by Cook County Health

Charity Care Is The Challenge in FY2020 Budget for Cook County Health

Cook County Board Holds Hearing on Cook County Health Finances

Several Contracts Questioned by Commissioners at Cook County Board Meeting Especially for Clerk Of Court Brown

No Expected New Taxes or Fees Projected for 2020 Cook County Budget

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