Category: Cook County Health (CCH)

Cook County Board Holds Hearing on Cook County Health Finances

9/30/2019

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 Health (CCH) Focus of Cook County Board Mid-year Budget Review

7/26/2019

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Cook County Board of Commissioners - Finance Committee Meeting
Mid-year Budget Review - July 17, 2019

What did the Board decide?
Several commissioners requested follow up numbers from Cook County Health (CCH) on a number of issues.

Other Discussion:
Debra Carey (in the absence of Dr. Shannon, CCH CEO) presented the review of the budget and stated there is a projected shortage of $103M this year. She said they expect to be able to eliminate the deficit. They just received a payment of $77M from Medicaid for County Care and the rest they hope to cover by budget tightening and not filling open positions. Charity care is up for the first time since the implementation of the Affordable Care Act (ACA). This was blamed on a problem in Springfield because there is a backlog of eligibility determination and Medicaid is down 7%. The state is addressing this but it will take time.
It seems that coding and documentation is a big issue both for collecting revenue and the outside coding agencies are the delayed accounts payable cited by OIG. There was a lot of discussion on how this is being addressed.

Additional observations:
Commissioner Tobolski asked if there is a structural deficit for the hospital and wants CCH to pay more attention to the business aspect.

Observer - Lisa Slankard Observed for 1 hour

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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

Cook County Health (CCH) Focus of Cook County Board Mid-year Budget Review

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