Item P3BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: March 21, 2012 (Marathon)
Bulk Item: Yes No X
Division: Colm Attorne
Staff Contact Person/Phone #: Suzanne Hutton X3473
AGENDA ITEM WORDING: Discussion & direction re Human Services Advisory Board policies
and procedures, including whether the State match required by F.S. §§ 394.75 & 394.76 for Substance
Abuse and Mental Health services should be treated in the same manner as the Baker Act funding
match, as a separate line item in the County budget.
ITEM BACKGROUND: On March 5, 2012, the Director of Internal Audit released the Audit Report
of Monroe County Human Services Advisory Board Grants and Grant Policies, with Audit Conclusions
on page 4 thereof, summarizing the recommendations found in each segment of the Report. In addition
Attorney general Opinion 2011-23 was issued on December 5, 2011, clarifying each county's
mandatory responsibilities for providing match funding for substance abuse and mental health
(SAMH). Pages 2-4 of the Audit report and AGO 2011-23 are back-up for this item. Assuming that
the BOCC determines that the Audit recommendation for written policies and procedures and adoption
by the BOCC, development of such policies and procedures will probably take longer than the time
frame for the current HSAB allocation recommendation process, with the applications due about the
same time as the BOCC April meeting. It should be determined if the mandatory match of SAMH
funding should be removed from the HSAB process (in the same manner as Baker Act funding) since
there is no discretion allowed with respect to mandatory match. The statutory mandate has been in
place since October 1, 1974, with some appropriation categories being removed from match
requirements since then. If it is removed from the HSAB process, the BOCC should determine if there
should be a possible discretionary component allowed, and if so, the process either discretion on a
program by program basis, or a straight percentage.
PREVIOUS RELEVANT BOCC ACTION: See page 2 from the Audit Report for historical
background.
CONTRACT/AGREEMENT CHANGES: N/A
STAFF RECOMMENDATIONS:
Direction re HSAB policies and procedures. Change minimum state funded match (25%) for SAMH
funding to be line item in budget in lieu of going through HSAB process.
TOTAL COST: INDIRECT COST: BUDGETED: Yes No
DIFFERENTIAL OF LOCAL PREFERENCE:
COST TO COUNTY: SOURCE OF FUNDS:
REVENUE PRODUCING: Yes No AMOUNT PER MONTH Year
APPROVED BY: County Atty 4f OMB/Purchasing Risk Management
DOCUMENTATION: Included Not Required
DISPOSITION: AGENDA ITEM #
Revised 7/09
E. Internal Audit Department compared reimbursement request made to other agencies with
HSAB payment records for duplicity.
III. BACKGROUND INFORMATION
The Human Services Advisory Board was created by BOCC Resolution 077-1991. The Human
Services Advisory Board purpose is "to evaluate County needs and agency performances using
established guidelines so as to determine where the community will derive the greatest benefit from
the tax dollars expended..." The HSAB "shall establish eligibility guidelines and application
procedures which shall become effective upon approval by the BOCC. The HSAB shall (1)
carefully evaluate the County's human services needs, (2) recommend the most cost effective way of
obtaining needed services, (3) develop measures of the services provided, and (4) determine which
of those services are appropriate for public funding." See Exhibit A — Monroe County Board of
County Commissioners Resolution 077-1991, dated March 13, 1991.
BOCC Resolution No. 056-1992 states that the HSAB shall consist of five (5) members, each of
who shall be appointed by each individual County Commissioner and limited to a term of two years
or the termination of the respective appointing Commissioner's term. The original Resolution set
the HSAB board at seven (7) members. ." See Exhibit B — Monroe Counts Board of Counts,
Commissioners Resolution 056-1992, dated January 8, 1992.
On June 16, 2010, the BOCC approved the creation of a committee "to examine and possibly
modify the HSAB funding process and policies including funding categories, weighting of
categories, etc." The committee will consist of 9 voting members including the 5 current HSAB
members and 4 additional members to be appointed by each of the 4 commissioners, not including
the Mayor. The committee will meet approxitmtely 5 times and complete and forward a series of
funding policy recommendations to the BOCC by Novmember 2010, to be incorporated into the
FY 2012 budget process. See Exhibit C - BOCC Agenda Item and Excerpt from BOCC Minutes
from June 16, 2010. On November 17, 2010, the BOCC reviewed the recommendations of the
committee and made several changes to the HSAB procedures. See Exhibit D - BOCC Agenda
Item and Excerpt from BOCC Minutes from November 10, 2010. The following changes were
made: "modify/streamline the application; elicit additional information about how prior year's
funding was utilized; offer an opportunity for organization to change their funding category;
eliminate the weighted percentages attached to each of the funding categories for two years; move
several organzitions that are not statutorily or otherwise required to be funded from BOCC line
items to HSAB with the funding (these are: Big Pine Athletic Assoc., Heart of the Keys Youth, Kids
Come First; Rural Health Network, Upper Keys YMCA and Keys to Recovery); and to make an
explicit policy that the vast majority of HSAB funding granted to any agency must be spent in and
directly benefit Monroe County.
According to the "Recommendations for County Funding for Health and Human Services
providers for FY 2012", the three categories of human services are: medical, core social services and
quality of life services. The fiscal year 2012 HSAB budget is $ $2,221,777 (this total represents
2
$1,768,200 in previous HSAB organizations budgets plus $453,577 for the budgets of six
organizations previously funded from BOCC line items to HSAB). This amount has remained the
same since fiscal year 2010. The overall budget has decreased since its amount of $2,326,581 in
fiscal year 2006. See Exhibit I? - Recommendations for County Funding for Health and Human
Services Provider~ for 1-Y 2012.
The HSAB reviews funding requests from nonprofit, human service organizations. Each year, the
HSAB meets in February and May to discuss and review the applications and finalize its
recommendations for funding to the BOCC. According to the "Recommendations for County
Funding for Health and Human Services Providers for FY 2012", The HSAB prioritizes funding for
organizations that; use HSAB funds to leverage ouside funding, do not duplicate existing services,
demonstrate need for services and demonstrate sound financial management. The HSAB uses
categories and weighted percentages assgned to each category as a guidline to assist in making its
funding recommendations. Medical Services category is weighted 65% and means the organization
provides medical, mental and/or dental care for economically disadvantaged. Core Social Services
category is weighted 30% and means the organization provides essential services such as food,
clothing or housing; emergency diasaster relief; family violence issues; adult and child daycare; end -
of -life support for the disadvantaged. Quality of Life Improvement Services is weighted 5% and
means the organization provides services created to improve the quality of life for individuals or
community; educational, preventative, training, recreational and cutural services, etc. See Exhibit E
- Recommendations for County hunding for I lealth and Human Services Providers for FY 2012.
7
IV. AUDIT CONCLUSIONS
A. BOCC Agreements for HSAB grant funding should contain specific information on which
expenses qualify, for funding and reimubursement by the County.
B. The HSAB needs written policies and procedures codified and formally approved by the Board
of County Commissioners.
C. Monitoring and performance measures need to be established and utilized.
D. The HSAB needs to establish or adhere to existing term limits for board members to promote
independence, accountability and transparency.
E. All organizations applying for HSAB grant funding should submit an IRS form 990 or a
Statement of Functional Expenses, if they are only required to file IRS Form 990-EZ.
F. The organization's IRS Letter of Determination Indicating 501 c3 status should be checked for
current status.
G. Three individual HSAB grantees were chosen for audit: Big Pine Athletic Association,
Independency Cay, Inc. and Womankind, Inc.
G1. The Big Pine Athletic Association, Inc. should be aware of reimbursements received and HSAB
funding amounts available.
G2. The Big Pine Athletic Association, Inc. did not receive United Way funding in 2011.
G3. The Big Pine Athletic Association, Inc. operated a concession stand without entering it into
their bookkeeping records or reporting it as project income on their application.
G4. Independence Cay, Inc. did not file the 2009 and 2010 IRS Return of Organization Exempt
from Income Tax (Form 990) that was submitted with their HSAB applications.
G5. Independence Cay, Inc. submitted that same bill for reimbursement to the HSAB and the
Southernmost Homeless Assistance League (SHAL) for reimbursement.
El
7
Florida Attorney General
Advisory Legal Opinion
Number: AGO 2011-23
Date: December 5, 2011
Subject: Substance abuse/mental health services, county funding
Mr. George G. Angeliadis
Sumter County Attorney
11031 Spring Hill Drive
Spring Hill, Florida 34608
RE: COUNTIES - SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES - CHILDREN
AND FAMILY SERVICES, DEPARTMENT OF - AUDITS - APPROPRIATIONS -
county's role in implementation of substance abuse and mental health
services requirements in the county's district. ss. 394.75 and
394.76, Fla. Stat.
Dear Mr. Angeliadis:
On behalf of the Board of County Commissioners of Sumter County, you
request a legal opinion on substantially the following questions:
1. What is the formula, and source of data represented therein,
utilized to calculate the county's portion of "local matching funds"
required by section 394.76, Florida Statutes?
2. Are "in -kind" contributions by the county considered in
determining the county's contribution pursuant to section 394.76,
Florida Statutes?
3. May the county require disclosure of financial reports and sources
of other funding to validate data used in the formula to determine
"local matching funds?"
4. Does the county possess oversight of an entity requesting "local
matching funds," such as participation in the operational or budget
review or approval process of such entity?
5. May "in -kind" contributions be used to offset the county's
matching funds obligation?
6. Who is required to establish the level, source, or availability of
other local matching funds when there is a dispute as to the level of
funding to be provided by the county?
In sum:
1. Section 394.76(3)(b), Florida Statutes, requires local
participation on a 75-to-25 percent state -to -local ratio of funding
for all contracted community alcohol and mental health services,
except those programs specifically identified in the statute and
those specified in section 394.457(3), Florida Statutes.
2. & 5. "In -kind" contributions are recognized by administrative rule
as satisfying requirements for matching funds.
3. & 4. A local governing body is statutorily required to have an
annual audit performed on the expenditure of public funds it has
provided to carry out the provisions of the act to ensure that such
funds are expended only for substance abuse or mental health
purposes. No other statutory provision appears to grant local
governing bodies oversight of the operation or other financial
activities of a substance abuse or mental health services provider.
6. While the act contemplates that a county will have input into the
development of a district plan for the provision of substance abuse
and mental health services and is one of the enumerated parties that
must approve the plan, ultimately, the legislative appropriation to
the Department of Children and Family Services will determine the
level of local match participation by a county. The district
administrator is authorized to require changes to bring the district
plan into compliance with the statutory requirements and any dispute
between the district administrator and the district board, including
the projected budget, is to be resolved by the department's
secretary.
You state that Sumter County has received a request for funding from
a non-profit provider of mental health, crisis stabilization, and
Baker Act services to citizens of Sumter County and Lake County.
Currently, such providers submit requests to the county, then await
approval through the budget hearing process. Sumter County, however,
is unable to determine whether its share of the funding amount to the
provider is affected by other sources of funding such as its "in -
kind" contribution of physical space to the provider, or by the fact
that the provider's services are provided to residents of two
counties. The county further believes that other forms of available
local matching funds must be identified, accounted for, and
considered prior to its committing any funds. Additionally, the
county wishes to participate in the planning, evaluation, auditing,
and implementation of the programs for which it provides funding.
Questions One and Six
Part IV of Chapter 394, Florida Statutes, is "The Community Substance
Abuse and Mental Health Services Act" (act).[1] Section 394.76,
Florida Statutes, addresses the financing of district programs and
services under the act and specifies the means to determine the local
match funding level, if such level is not provided in the General
Appropriations Act or the substantive bill implementing the General
Appropriations Act. Section 394.76(9)(a), Florida Statutes, states:
"State funds for community alcohol and mental health services shall
be matched by local matching funds as provided in paragraph (3)(b).
The governing bodies within a district or subdistrict shall be
required to participate in the funding of alcohol and mental health
services under the jurisdiction of such governing bodies. The amount
of the participation shall be at least that amount which, when added
to other available local matching funds, is necessary to match state
funds." (e.s.)
The term 11[1]ocal matching funds" is defined as "funds received from
governing bodies of local government, including city commissions,
county commissions, district school boards, special tax districts,
private hospital funds, private gifts, both individual and corporate,
and bequests and funds received from community drives or any other
sources."[2] Generally, with enumerated exceptions that do not
require local match funds, [3] " [a] ll other contracted community
alcohol and mental health services and programs, except as identified
in s. 394.457(3),[4] shall require local participation on a 75-to-25
state -to -local ratio."[5]
Thus, the plain language of the statute mandates that state funds
appropriated for community alcohol and mental health services shall
be matched by local governing bodies and directs that the formula for
determining the local match funds is based upon the state providing
75% of the funding for programs subject to local matching funds, with
the remaining 25% match provided by the local sources available for
matching funds.
As referenced above, the governing bodies within a district or a
subdistrict must participate in the funding of alcohol and mental
health services under the jurisdiction of such governing bodies and
the amount of their participation must be at least that amount which,
when added to other available local matching funds, is necessary to
match state funds. The statute, therefore, clearly acknowledges that
there may be multiple sources for contributing to the local match
amount and, in defining local matching funds, gives an open-ended
range of sources that may be included.
Further, as in this instance where two counties within a service
district are to be served by a provider, section 394.73(3), Florida
Statutes, states:
"When a service district comprises two or more counties or portions
thereof, it is the obligation of the planning council to submit to
the governing bodies, prior to the budget submission date of each
governing body, an estimate of the proportionate share of costs of
alcohol, drug abuse, and mental health services proposed to be borne
by each such governing body."
The act, therefore, directs how the proportionate share of costs of a
substance abuse or mental health program will be assessed when two or
more counties receive services from such program, but does not appear
to contemplate that an individual county has the authority to
determine the amount it must pay. This is not to say that the county
is without a voice in the overall process. Section 394.75, Florida
Statutes, sets forth the procedure for establishing state and
district substance abuse and mental health plans. Subsection (3) of
the section directs the district "health and human services board"[6]
to prepare an integrated district substance abuse and mental health
plan. The statute specifically provides that the plan shall include:
"(a) A record of the total amount of money available in the district
for mental health and substance abuse services.
(b) A description of each service that will be purchased with state
funds.
(c) A record of the amount of money allocated for each service
identified in the plan as being purchased with state funds.
(d) A record of the total funds allocated to each provider.
(e) A record of the total funds allocated to each provider by type of
service to be purchased with state funds.
(f) Input from community -based persons, organizations, and agencies
interested in substance abuse and mental health treatment services;
local government entities that contribute funds to the public
substance abuse and mental health treatment systems; and consumers of
publicly funded substance abuse and mental health services, and their
family members. The plan must describe the means by which this local
input occurred.
The plan shall be submitted by the district board to the district
administrator and to the governing bodies for review, comment, and
approval. [ 71 11 (e . s . )
The district plan must also include:
"a procedure for securing local matching funds. Such a procedure
shall be developed in consultation with governing bodies and service
providers . " [ 8 ]
In developing the district plan, the statute requires that "optimum
use shall be made of any federal, state, and local funds that may be
available for substance abuse and mental health service planning.
However, the department must provide these services within
legislative appropriations."[9]
Thus, while a county has input in the development of a district plan
for substance abuse and mental health services, it would appear that
the county's level of participation by local matching funds is
ultimately determined by the Legislature's appropriation for the
Department of Children and Family Services (DCF) to provide such
services. As reflected above, the county is involved in formulating
the district plan for delivery of services. The district
administrator, however, is required to make modifications to the
district plan he or she deems necessary to bring it into compliance
with the provisions of the act.[10] If the district board and the
district administrator are unable to agree on the plan, including the
projected budget, the disputed issues are to be submitted directly to
the department's secretary for immediate resolution.[11]
Questions Two and Five
While section 394.76, Florida Statutes, does not specifically address
"in -kind" contributions in relation to local match funds, Chapter
65E, Florida Administrative Code, administrative rules promulgated to
implement operation of the statute, provide assistance in determining
what constitutes a matching fund and how "in -kind" contributions are
counted. Among those items recognized as satisfying matching
requirements is "[t]he value of third -party funds and in -kind
contributions applicable to the matching period[.]"[12] (e.s.)
Moreover, the rules allow the donated use of space to an
organization, with the value of the space as an allowable cost, and
specifically recognize that "[t]he value of the donations may be used
to meet matching requirements."[13] In determining the value of a
donation of equipment, building, and land, Rule 65E-14.006(4),
Florida Administrative Code, states: "The fair market value at the
time of donation of the equipment, building or land may be counted as
matching."
This office has been advised by DCF that "in -kind" contributions may
be considered in calculating a local government's contribution of
matching funds. Thus, in light of the fact that "in -kind"
contributions are recognized by the controlling administrative rules
as a means to satisfy requirements for matching funds and DCF's
acknowledgment that "in -kind" contributions may be used to meet
matching funds requirements, it would appear that the county may use
its "in -kind" contributions in meeting its share of local matching
funds.
Questions Three and Four
Section 394.76(10), Florida Statutes, authorizes a local governing
body to appropriate moneys, in lump sum or otherwise, from public
funds for the purpose of carrying out the provisions of "The
Community Substance Abuse and Mental Health Services Act."[14] The
paragraph further provides:
"In addition to the payment of claims upon submission of proper
vouchers, such moneys may also at the option of the governing body,
be disbursed in the form of a lump -sum or advance payment for
services for expenditure, in turn, by the recipient of the
disbursement without prior audit by the auditor of the governing
body. Such funds shall be expended only for substance abuse or mental
health purposes as provided in the approved district plan. Each
governing body appropriating and disbursing moneys pursuant to this
subsection shall require the expenditure of such moneys by the
recipient of the disbursement to be audited annually either in
conjunction with an audit of other expenditures or by a separate
audit. Such annual audits shall be furnished to the governing bodies
of each participating county and municipality for their
examination. " [15] (e. s. )
Thus, the plain language of the controlling statute requires local
governing bodies to have audits performed of the expenditure of
public funds they have provided to carry out the provisions of the
act to ensure that such funds are expended only for substance abuse
or mental health purposes. Such audits may be in conjunction with
audits of other expenditures or by a separate audit and must be
furnished to the governing bodies of each county or municipality for
their examination. I have not found, nor been referred to, any other
provision in the act which expresses any further authority of local
governing bodies in regard to audits of the operations of substance
abuse and mental health providers.
Section 394.78, Florida Statutes, places administration of the act
under DCF. The department is directed to adopt rules necessary for
the act's administration and may adopt, among others, rules relating
to "full disclosure of revenue funds and expenses." Thus, it may be
advisable to work with DCF in further evaluating the performance and
financial sources of mental health and substance abuse providers
within your county. [16]
Sincerely,
Pam Bondi
Attorney General
PB/tals
[11 Section 394.65, Fla. Stat.
[21 Section 394.67(13), Fla. Stat.
[31 Section 394.76(3)(b), Fla. Stat., states:
"Residential and case management services which are funded as part of
a deinstitutionalization project shall not require local matching
funds and shall not be used as local matching funds. The state and
federal financial participation portions of Medicaid earnings
pursuant to Title XIX of the Social Security Act, except for the
amount of general revenue equal to the amount appropriated in 1985-
1986 plus all other general revenue that is shifted from any other
alcohol, drug abuse, and mental health appropriation category after
fiscal year 1986-1987 or substance abuse and mental health
appropriation category after fiscal year 2000-2001, shall not require
local matching funds and shall not be used as local matching funds.
Local matching funds are not required for general revenue transferred
by the department into substance abuse and mental health
appropriations categories during a fiscal year to match federal funds
earned from Medicaid services provided for mental health clients in
excess of the amounts initially appropriated. Funds for children's
services which were provided through the Children, Youth, and
Families Services budget which did not require local match prior to
being transferred to the Substance Abuse and Mental Health Services
budget shall be exempt from local matching requirements. . . . "
[41 Section 394.457(3), Fla. Stat., authorizes the Department of
Children and Family Services to contract to provide, and be provided
with, services and facilities in order to carry out its
responsibilities under the "Florida Mental Health Act," with, among
other entities, "counties, municipalities, and any other governmental
unit, including facilities of the United States Government."
[51 Section 394.76(3)(b), Fla. Stat.
[6] A footnote relates that health and human services boards were
abolished by s. 2, Ch. 2000-139, Laws
of Fla., which substantially reworded s. 20.19, Fla. Stat. Section
20.19(6), Fla. Stat., requires the establishment of a community
alliance in each county composed of stakeholders, community leaders,
client representatives, and funders of human services "to provide a
focal point for community participation and governance of community -
based services."
[7] Section 394.75(3), Fla. Stat. And see s. 394.75(12), Fla. Stat,
providing that "[e]ach governing body that provides local funds has
the authority to require necessary modification to only that portion
of the district plan which affects substance abuse and mental health
programs and services within the jurisdiction of that governing
body."
[8] Section 394.75 (4) (h) , Fla. Stat.
[9] Section 394.75 (7) , Fla. Stat.
[10] Section 394.75(11), Fla. Stat.
[11] Id.
[12] Rule 65E-14.005(1)(b), Fla. Admin. C. Cf. Rule 65E-14.005(2)(b),
Fla. Admin. C., making "[c]osts or third -party funds and in -kind
contributions that are used to satisfy a matching requirement of
another State contract or Federal grant" unallowable for matching.
[13] Rule 65E-14.017(4)(j)2., Fla. Admin. C.
[14] Section 394.65, Fla. Stat., providing the title to Part IV of
Ch. 394.
[15] Cf. s. 394.76(5), Fla. Stat., stating: "The department [of
Children and Family Services] is authorized to make investigations
and to require audits of expenditures. The department may authorize
the use of private certified public accountants for such audits.
Audits shall follow department guidelines." See also Rule 65E-14.003,
Fla. Admin. C., relating to audits of contractors participating in
substance abuse and mental health programs.
[16] While not posed in a question, your memorandum of law refers to
Ch. 119, Fla. Stat., Florida's Public Records Law. I would note that
the right of access to public records extends to records of private
entities acting on behalf of a public agency. See s. 119.011(2), Fla.
Stat. Where a private entity has contracted to provide services in
place of a public agency, the records generated by the private
entity's performance of that duty are public records, subject to
disclosure (absent any applicable exemption or provision of
confidentiality). See News and Sun -Sentinel Company v. Schwab, Twitty
& Hanser Architectural Group, Inc., 596 So. 2d 1029 (Fla. 1992). A
copy of a standard contract used by DCF in securing services (CF
Standard Contract 06/2011) requires a provider "[t]o allow public
access to all documents, papers, letters, or other public records as
defined in subsection 119.011(12), F.S. and as prescribed by
subsection 119.07(1), F.S., made or received by the Provider in
conjunction with this contract except that public records which are
made confidential by law must be protected from disclosure."
C
UNIFYSMONROE
KEY WEST FLORIDA 33040
(305)294-4641
District 4 Office:
9400 Overseas Highway
Florida Keys Marathon Airport
Suite 210
Marathon, FL 33050
Ph: 305 289-6000
Fx: 305 289-4610
Ern: boccdis4L�monroecounty-fl.gov
BOARD OF COUNTY COMMISSIONERS
Mayor David Rice, District 4
Mayor Pro Tern Kim Wigington, District 1
Heather Carruthers, District 3
Sylvia 1. Murphy, DistriW5
George Neugent, District
O
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r`s
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o
Interoffice Memorandum
Date: March 21, 2012
To: Danny Kolhage, Clerk of the Court q
From: Mayor David Rice, District 4 /�✓ `� _ ` ��
Re: Notice of Voting Conflict �l z
Per Florida Statute 112.3143, I hereby disclose by written memorandum that I will
abstain from the vote on certain issues that are brought before the Monroe County Board of
Commissioners with entities that I am involved with.
I will abstain from the vote on issues concerning the Guidance Care Center, Inc., a
private, not -for -profit entity, which receives some of its operational funding from the County,
as I currently serve as a member of the Board of Directors of the Guidance Care Center.
At the March 21, 2012 BOCC meeting, I abstained from the vote on two item(s)
concerning the Humans Services Advisory Board and the county funding provided through that
advisory committee process.
#G1: Discussion of FY2012 Human Services Advisory Board funding
cycle, including approval of amount of $2,221.777. (This amount reflects
no net increase over last year. Funding has been flat since FY2009.)
#P3: Discussion and direction re Human Services Advisory Board
policies and procedures, including whether the State match required by
F.S. 394.75 & 394.76 for substance abuse and mental health services
should be treated in the same manner as the Baker Act funding match, as
a separate line item in the County budget.