Board of Commissioners - Regular Meeting

You get the honors.

August 18th, work session of the Cherokee County Board of Commissioners. As noted, Commissioner Cagle is not with us at the moment. He is expected shortly. Other members are present. We have some important stuff to go over today, including first presentation of the proposed 2027 health benefits plan changes. This is from Spencer Allen and Associates. So thank you for being here. We turn it over to you. We are anxious to hear what you've got.

Not quite. You do well.

We'll let the microphone.

Yeah.

How about that?

Better? Doesn't sound like it's working.

Oh, yes, that helps.

Much better. So since that time, we've been working with the HR team and the finance teams, really the leadership team, to develop strategies and solutions to control the cost of healthcare, and we've implemented a lot of things over the last decade, and as you'll see in the executive summary, 14 of those have been huge. We've saved the county $84 million, over the last decade. So we have been trying to mitigate claims spend and add value to the plan for your employees and their dependents. Now, what does that really mean? That means the county hasn't really had to make plan design changes or really make significant increases to employee premiums because we've been keeping the cost for the county below national trends. And I think right now you guys are running 5.7%. per employee per year trend since 2017. National trends today are running 10%. So the arbitrage between those two numbers gets to be really big, right? To date, our fully insured equivalent rates to your spend, and remember, we track everything on a calendar year. Chuck wanted me to make sure I said that. So this is not the fiscal year. So we're looking at calendar year 26, calendar year 25, et cetera. And so for this year, we're running about 97% to the fully insured equivalent premiums. Now, everybody knows your health plan is partially self-funded, but we create rates that look like you're fully insured, and that's what The leadership team decides how much of a percentage of that rate the employees pay for single and family, et cetera. So we've got about a $506,000 surplus to those rates year to date. We are up 1.26% year over year. So really good there, right? We're not running 10%. We're about 3% higher than the industry benchmarks, almost 17% higher than the size for your organization, and about 28% higher from a regional basis. And the region would be the southeast. We are projecting, without any plan changes, using a rolling 12 months of claims plus 10% trend on those claims, we're projecting a 14.7% increase to the fully insured equivalent rates. Now, that doesn't mean the county is going to spend that. But in order to set the rates based on your experience and the fixed costs that are associated with the plan, we would need to raise the rates by 14.7%. And of course, then employees would pay their share of that, depending on what that looks like. Now, we got the message from HR and from finance and Jeff saying, we got to come up with some savings, and we need a lot of savings. And so we've presented to HR and finance and your leadership team seven new opportunities that can effectively generate about a $5 million savings. Now, some of these are new programs. Some of these are replacing existing plans with better vendors. Some of these are going to involve plan design decisions. And so once we look at that, we're going to move. And when we reprojected claims, we're looking now at not a 14.7% increase to the fully insured equivalent rates. We're looking at a 4.4% decrease to the fully insured equivalent rates. So that's a $6.8 million swing for the county.

Let me get to the next page here. Yeah, here we go.

I wanted to present to you guys what's happening in the industry. So when you look at this chart, the purple line is CPI. The orange line is the average wage increase. The blue line is the medical trend. And we used 10% trend for the 2026 plan year. And we used 10% trend for the 2027 plan year. And then the green line, you see what RX trends look like. you guys have about a 0%, slightly a negative RX trend, because we put in a fiduciary PBM back on 1-1-17. So here are all the solutions that we architect them, and all the work gets put down to the HR teams. So they've been very busy, and you can see Everything that we've done since 2017, we changed TPAs, we changed PBMs to USRX Care. They're a fiduciary PBM, and everybody knows what that means. If you're a fiduciary, you have to act in the best interest of your client. We implemented script sourcing for international sourcing, so members can actually buy drugs from Canada and the UK and New Zealand and get them for free. But the county saves 40% to 50% every time they do that. And that's been a big help. And if you look over there to the right, you'll see just our USRX care savings And this is through 2025. We didn't go 2026 here, but all of these savings are through 2025. You can see USRX has saved, you know, $56.5 million since they were implemented January 1 of 17. You can see script sourcing for international business is running almost 5.8 million. Just those two alone have been huge. when the members can get free drugs. And we also expanded the preventive list. So there are a lot of other drugs. Your blood pressure, your cholesterol, they're at no cost to your members. We also implemented an imaging solution here in 17 called Know the Costs. That saved almost $4 million. And members got free imaging services. No deductible, no copay, no coinsurance. We also brought in Teladoc in 2017. Teladoc has saved us almost $3.7 million. We think a lot of Teladoc virtual medicine really came about during COVID when everybody couldn't go to their doctor and they had to do it online. And so we see virtual medicine expanding. Then we brought in SurgeryPlus, which is now called Lantern. They're an imaging network. Excuse me. They're a surgical network for bundled surgeries. So think the facility fee, the surgeon's fee, and the anesthesiologist fee all rolled into one. We save about 40% every time we do that. The members get the surgery for free. You guys save 40% versus having it done in the Cigna network. So you might see a little bit of a theme here where we are carving services out of, we call them the BUCAs, Blue Cross United Cigna Aetna. I also call them the cartel because they pretty much are. So the more we can move away from those guys, the better the county does and the better your membership does. Let's see. We Care Connect is a new, well, it wasn't new in 2019, but We Care Connect is a program where we compliantly move membership from the self-insured health plan to the ACA. And we have done that since 2019. And it's been a huge savings. You can see up here, $6.7 million a county has saved by moving high-cost claimants voluntarily, they have to agree to do it, to the ACA. And that's been big for the members because they have no premiums and they have no out-of-pocket costs, yet the county saves a ton of money. So it's been a really good program. We negotiated, and y'all were the first employer to have a direct contract with Northside Health System. That was quite an undertaking. I'm going to talk a little bit more about that in the presentation. But that has been a really good thing, where we have better discounts than Cigna. Through 25, we had about an 8% difference in discounts, meaning for every dollar that came in the Northside network, we saved 8% versus being in the Cigna network. For 2027, that spread has been increased to 23%. So every dollar going into the Northside network, we're saving 23 cents versus the Cigna network. And that's direct contracting. And I think that program has developed over the years. And I think membership is going to take a hard look at it this year based on the plan designs that we've set up and, with your approval, the contributions. Let's see. Where am I? We moved from Anthem to Cigna. We did that for a number of reasons. But when I calculated up, we're looking at about $240,000 a year in savings, or since we did that, about $80,000 a year just on the difference in the fee to access the network. Anthem was really expensive, and they were giving us trouble in terms of getting data that we needed to manage the plan. So that was an easy decision. We added out-of-network benefits to the Northside health plan. We made a few changes last year to help reduce some of the cost. And then we implemented a program, a co-pay assist program to the pharmacy program where members can get their meds for free and the county still saves money. This is what we've been doing, right? This is not where we're headed. But these programs are going to continue except for Know the Cost. Know the Cost is that imaging vendor. Without notification, they just stopped doing breast imaging. And that has been a real noise maker and a real pain to deal with. So we're going to be bringing in a new vendor called Green Imaging, which is fantastic, and we have on all our other clients. Now, Kathy wanted me to make sure that everybody understood how deductibles and out-of-pocket maximums work. So in this example, we're talking about Jill, who goes to see the doctor. She's got a primary visit. She's got a specialist visit and a prescription. But none of that goes to her deductible. It's all co-payments. Those charges do go to her out-of-pocket cost. And then another example here, John is sick. He's got a three-day hospital stay. He has a $500 hospital copay plus $1,000 deductible. All of those charges go to his out-of-pocket. And then after the deductible, it's 20% coinsurance until he spends $2,000. But once he's spent $2,000, any other charges, medical or RX, are at 100%. Yeah. And since y'all's plan has been very rich over the last years, you've got a lot of people at that 100% category. And that's just money coming right out of the health plan. Now, this example. We're looking at $1,000 deductible for Sam. He's got a $2,000 out-of-pocket. And of course, once he meets his out-of-pocket, it's going to be covered at 100%. Tom is just covering his spouse, Allison. So once each of them hit their $2,000 out-of-pocket, the plan pays 100%. Now, this one's a little more tricky because we've got a full family here, right? So this program is $1,000 deductible with a $2,000 out-of-pocket max. When one of the folks in this family hits that out-of-pocket for that individual, it's 100%, period, end of conversation. Now, for the family, because the out-of-pocket maximum is $6,000, it would take two other members in the family to hit their $2,000 out-of-pocket. And then it would be 100% for any other charges the family has. Are we good here? I want to make sure everybody understands as we move into the current plan designs. So these are the current plan designs today. What you see highlighted were small changes that we made for 1-1-26 to help lower the cost of the renewal. Minor changes, I don't think it was a huge issue for the membership. And based on that plan design and our underwriting, remember I talked about a 14.7% total increase? So this is how that would shake out. Over here on the left, you've got current contributions. You see the fully insured equivalent rates that we've calculated for both the Cigna plan and the Northside plan. You see the employer cost by tier for both plans, what the employees are then paying per paycheck. Now, this is a monthly number here, not a biweekly number, just for the record. And then you can see from a percentage perspective how much the county is paying for each tier. In case the Northside plan, it's 89%, and the employees are paying 11%, or $111. Down here for the Cigna plan, the employees are paying 139, or 13%. So we don't have a lot of arbitrage between these two numbers. And when you looked back here, there wasn't a whole lot of difference in the plan designs. So membership was not really incented to go into the Northside plan. And so given the fact that the Northside plan is going to have a 23% differential in terms of discounts, We wanted to try and improve that plan and bring the Cigna plan up to market, because it is not at market right now. Before we get into that, I wanted to spend a little bit of time talking about the solutions that we've come up with for Cherokee County effective 1-1-27. The Northside Health Network discounts are based on your current enrollment. But these are the additional discounts. If no one else joins the Northside Health Network plan based on a 23% new differential, it'll gin up $156,000 in savings. Green imaging. And you notice, we asked the vendors to give us a low, mid-range, and a high. So green imaging on the low end based on utilization. And remember, we're not requiring people to use green imaging. It's a voluntary program. So we're not forcing anybody's hand to use these solutions. If they want to use the solutions, they get free imaging. And imaging can run in the hospital anywhere from $1,200 on an MRI to $7,000 on an MRI. And we can get them through green imaging in the $600 to $800 range. So that may not sound like a lot of money, but multiply it times your membership, and it gets to be a pretty good number. We made some changes to the Northside plan, and we're looking at about $111,000 based on the current enrollment. We made some changes to the Cigna plan. So as I said previously, from a benchmarking perspective, this plan is way below the benchmarks, and it still is going to be below the benchmarks even after we raise the deductible and the out-of-pocket a little bit. But based on your current participation in that Cigna plan, those plan design changes are worth almost $3.3 million. Opioid Free America is a new program that is designed to help members with opioid management. Now, this would not affect the members directly, because this third party would be speaking to the member's physician. About half of the doctors out there do not take any training in pain management, which is what opioids are used for. And they all know when to prescribe the first prescription for opioids, but nobody teaches them what the last prescription for opioids should be. So there is no per employee per month cost for this program. It's a $500 per doctor engagement. And net of costs, we think it can save on the low end a million, upwards of three million. We gave Opioid Free America a claims run on the pharmacy side. And they looked at it and used their algorithms and their software to come up with these savings based on utilization. And we think not only is this going to save the county money, but we're talking about employee lives here, membership lives. Their algorithms can tell by the drug usage when someone is becoming addicted or going through withdrawals. And their goal is to teach the doctors and to give the doctors the tools to recognize this and to start to titrate the members. Because the waterfall effect of opioid abuse, and of course, the doctors, they don't mean to do this. They just keep refilling the prescription. the waterfall effect is huge. And what Opioid Free America has found that they can save in total spend between 4% and 8% of the medical and Rx claims bucket. Now, that's a lot. And I didn't know this, but if you're kind of hooked on opioids, you can't sleep at night. So now you get a prescription to help you sleep at night. You also are constipated, so now you get a prescription for that. Then you run into the urgent care, you run into the ER, and then you have an overdose, or you have bad withdrawal symptoms. So it really opened up our eyes as to how we could help manage clients and manage their membership indirectly. And all we have to do is send them a claims file on the quarter from pharmacy. And it's de-identified. And then they take it from there. So we're really excited about this program. We just found it about 90 days ago. We've had them run reports on all of our clients for the January 1 effective date. And it's really amazing some of the things that we're seeing. So I'm a big proponent of that. Yes, sir.

I got a question. Not too long ago, they came up with a new drug. It's a non-opioid pain medication. And I forgot the name of it. It's on my phone. But the insurance will not pay for it. Insurance will not cover it. And it's non-addictive. I'll be glad to give that to you later. But it's going to hit the big pharma in the pocketbook.

Commissioner, I'd be happy to look at that for you and kick it up to our PBM, our USRX care, to see if it's on their formulary list. The beautiful thing about the program you have is that we can add drugs and take drugs off, because you own it, and USRX Care is a fiduciary, and they work for you.

Well, this would be great if you guys can work out something, because it's non-addictive, it's non-opioid, and they say it's just as effective as oxycodone, hydrocodone, any of that stuff.

Well, we'll talk to USRX Care, but I'll also talk to Opioid Free America and find out, hey, are you guys prescribing this drug? And if so, I want to make sure it's on our formulary.

OK.

Thank you for that.

Question on this, Cedric, while we're here. Yes, sir. The million dollar low end range savings, is that just in prescribed opioids, or is that kind of this complete package that you described, including the downstream effects of?

Yeah, that's the complete package. OK. That would be the complete package.

And it depends on you getting to the doctors.

It depends on how quickly the doctors change their prescribing habits. What we've found with Opioid Free America is that after three years, they've converted 98% of their doctors. So it's not going to happen immediately. But you never know, right? Once a doctor understands the tools and the best practices of titrating people off of opioids, you know. But we wanted to give a range. And that was, Mr. Chairman, that was the range.

Who had opioid-free Americans making this call? I mean, are these?

I'm sorry, sir.

Who at Opioid Free America is making these calls that now we have these? Registered pharmacists. Registered pharmacists, not actual pain specialists.

Well, I am sure they have pain specialists in their organization. But the pharmacists that they have have been trained on recognizing stages of opioid use. I'm happy to take that back to them and follow back up with you, Mr. Commissioner.

I would. I mean, just simply because that's, if you've got somebody who's been prescribed something by a legitimate doctor who specializes in clean management, and then all of a sudden you've got a pharmacist who's just looking for certain prescriptions that have been filled, they don't need to be the one making that kind of health call on the employee itself.

Well, they're informing the doctor about best practices, and they're giving the doctor tools to utilize in their practice on opioid management. The doctor doesn't have to do it. They're just making them aware of the fact that Spencer might need to come off of this opioid. You may have just been refilling it for the last six months, and he doesn't really need to be on it.

Well, I guess that's my point with any kind of medication, that as long as we have I'm not OK with a pharmacist saying like, OK, well, we don't want to pay for this. Or we think that he can be on something else when the doctor has actually written him something.

Yes, the pharmacist is not saying to the doctor, we're not going to cover this anymore. They're saying to the doctor, We think you could improve the management of this patient because it looks like Spencer's hooked on opioids, or Spencer's going through withdrawal on opioids. So there's no hard line. The doctor doesn't have to do what Opioid Free America suggests. So it's not like there's a hard line.

But how does the statements come in if he doesn't? So I mean, how do we come up with this number where I mean, what are opioids costing us now where we get this million dollar savings on the low range and $3 million savings on the high range? What are those numbers based on?

It's based on the proposal we got after they took a look at a year's worth of claims data from USRX Care. So I'm happy to forward the proposal over to you, sir, if you'd like to see it. Yeah, please do. OK.

But it assumes. assumes the representatives of Opioid-Free America reaching these doctors and getting some level of agreement from these doctors to reduce some opioid prescriptions and gaining some savings downstream, fewer ER calls due to people in late stages of opioid addiction.

Let's stop it before the waterfall effect happens.

So I mentioned... Well, again, just my concern is, you know, I mean, opioids do have a valuable place in... Sure they do. I've got a lot of friends who serve that, you know, they're injured. They need them. So I want to make sure that we're not going in and saying, okay, well, just because they've gotten it filled for... 12 months in a row that all of a sudden we're going to interject ourselves into their health care.

Yeah, no, that's a good point. And I would tell you that the co-founder of this organization is ex-military. And he started this business to help his buddies who had overdosed and who were having trouble. That's how this whole thing got started.

Do we have a lot of employees overdosing now? I'm sorry? Do we have a lot of employees overdosing now?

I don't believe you do.

I mean, I kind of...

But based on the data that we turned in, there apparently are people that need to come off of opioids in your membership.

OK.

If you would send me that. Sure. Appreciate it. You bet. Can I interrupt one more time?

Yes, sir.

If you've got something to write this down, I'll give you the name of that drug. I do not, Commissioner.

Kathy, do you have anything?

You got it. OK. It's J-O-U-R-N-A-V-X.

Z or V?

V. V as in Victor. Genavix. Genavix. Thank you, Chrissy.

Thank you. Dr. Weatherby.

Yeah. Thank you. The reason insurance usually doesn't pay for these drugs is they're super expensive. I'm just, I'm wondering if that's the case here. We'll see.

But maybe it'll come down. Often they do. So I'd mentioned Lantern earlier. Lantern is your surgical network that we have. And they can do mandatory surgeries for certain surgeries. If Cherokee County wanted to mandate that orthopedics and spinal surgeries ran through Lantern versus the Northside plan or versus the Cigna plan, we could do that. And that looks, depending on utilization, anywhere from $120,000 up to $555,000. Now, we have that program in place now. And just to let you guys know, Northside Health Systems happens to be Lantern's favorite place for surgeries.

So that's where they do all their orthopedic surgeries.

it would come under the Lantern label, not the Northside Health Network label. And then a new vendor that we recently found, these guys are based right here in Atlanta. I know the C-suite. Select Doctors is a network that has credentialed every physician in the United States based on their specialty. And they have recognized the top 20%. The top 5% are elite in the United States. The next 10% are excellently rated, excellent. And the next 5% are good physicians. Now, these are the same guys that built WebMD and Medscapes. So they know this space very, very well. What this does is it would allow your members to go online, put in their doctor, and look up their doctor. And if their doctor didn't float to the 20%, ask for the top 20% and get doctors close to their homes or their businesses. And we like it because, in my opinion, it also relieves some fiduciary duties that Cherokee County may have when you direct somebody into a Cigna network and you give them better benefits than if they go out of network. and something bad happens with that member in the Cigna network, what's going to happen? Well, maybe that member sues the doctor. Maybe they sue the hospital. Maybe they sue the county because, hey, we told them to go in network. We pay better benefits if you go in network. From a fiduciary perspective, this also, I think, helps relieve any potential liability that you guys may have relative to a bad experience in one of the networks. And they've also agreed to overlay on top of the Northside network too, which is great. So they would be over both the networks. We're looking at net of fees between $190,000 and $381,000. They will put fees at risk. So if they don't hit their numbers, then the county can get back some of that $4 PEPM. But anyway, you know.

And how does it save money? I mean, getting a better doctor?

Getting a much better doctor. Because when you see the best doctor the first time around, you don't have, you know, sponges left in. There's no second surgical opinions. There's no readmissions. There's no sepsis. and the right procedure was done at the right time by the right doc. But this is also for primary care doctors. It's also for gastros. Any doctor they've credentialed. So that is that. Now, one of the big savings vehicles that we talked about were plan design changes. On the left here, you see what you have... currently. So the 2026 plan designs are pretty much the same when you go down the page. What we are suggesting and what HR and finance and the leadership team have approved, subject to you guys, is improving the Northside network plan. So going from $1,000 deductible, $3,000 per family, to zero. no deductible for members that now take the Northside Health Network plan. There is an out-of-pocket of $2,000 and $6,000, which is, you know, the same as it is today. Coinsurance stays the same. We are tweaking the prescription drugs for both plans to encourage members to utilize the script sourcing program. and to really think about the medications that they're picking up from the pharmacy. We're also changing the specialty Rx. These are your most expensive drugs and taking that from a $300 max to $500. But most of these specialty meds can be purchased through script sourcing on an international basis, and the members get it for free. You guys save 50% on those drugs when they go through script sourcing. And we have a lot of drugs going through script sourcing now, but we've got some members that just don't want to do it. So we're trying to give them a little bit more of a reason to do that. We also took away the primary care physician, the PCP co-pay for the Northside Health Plan. It is now zero, so it's free. If you follow on down here, green imaging, as I said, is going to replace know the costs. And any time someone uses that, whether they're in the Northside plan or whether they're in the Cigna plan, it's 100%. If you don't use green imaging, now you've got in the Northside plan, you have a $500 copay in 20%. just like inpatient hospitalization and outpatient surgical care. Again, if you use Lantern for surgeries, colonoscopies, endoscopies, it's covered at 100%, no deductible. Now, the Cigna plan, we definitely made some changes here. at a $2,500, $5,000 family deductible and $4,000, $6,000 out-of-pocket on the family. That is still below the national benchmarks for plan design. We also increased the out-of-pocket from $2,600 to $4,800. But remember, once an individual hits their own out-of-pocket max, it's 100%. Prescription drugs bumped up a little bit, just like it did in the Northside plan. Specialty, the same thing. We also increased the primary physician co-pay. from 40 to 50. Come here. And we increased the specialists from 50 to 60 and the urgent care from 50 to 60, really trying to separate and have some disparity between the Northside plan and the Cigna plan. Obviously, the 23% discount we're going to get for claims coming into the Northside plan is a big deal. And yes, we did increase the deductible and the out-of-pockets under the Cigna plan, but these have not been increased in a long time. Like, I mean, before I got here. So, you know, we haven't had to do that because we've been able to keep costs relatively stable for the county. And you can see the rest of this, so no big deal here. Now let me take you over to how this looks from a deductible and out-of-pocket expense again. So under the Cigna plan, you've got a $2,500 deductible and $4,000 out-of-pocket. So if you have charges that go to your deductible and then 20%, the maximum you'll spend is $4,000. Out-of-pocket max right now, from a benchmarking perspective, in PPO plans are running between $5,000 and $6,000. So we are still less on an individual. And on a family, we've got an $8,000 out-of-pocket, and that's right in the benchmark standard. Sometimes you'd see $10,000 out-of-pocket. Now, this is how this breaks down when we assume about a 25% migration from Cigna over to the Northside plan. So that's what this migration represents. We underwrote each plan individually this year because In effect, the Northside health plan members were kind of subsidizing the Cigna plan. So we wanted to underwrite this based on what maybe more transparent costs are. When we do that, you see pretty big differences in the fully insured equivalent rate Not a lot of increase here on the Cigna plan. And then you see what the county is picking up. And then from an employee perspective, we left the Northside Health Network rates the same. So if you joined the Northside Health Network and you were in the Cigna plan, you're going to go from 139 to 111. If you are in the Northside health plan today, you're going to get much better benefits, and your price is going to stay the same. That's an easier sell for HR for retention and recruiting. So hey, we've improved our plan for Northside, and we left the rates the same. And you can see how much money inures to the county when we do that. On the Cigna plan, we did what we were told, and we increased the employee cost 10%. So from 139 to 153, from 486 to 535. And then these were the percentages. And it changed because we increased it 10%. So these are a little different than where we were, but they're still close. So you're looking at a biweekly difference over here of $6.42. Or on a monthly basis, that's $14 or so on an individual basis. What that does is that shows the county saving about 6.4% over current costs. employees and membership in the Cigna plan picking up about 6.7%. Now, remember, these aren't static rates. Your plan is partially self-funded. So we underwrite and we project claims and we take discounts where appropriate. Are we going to hit these numbers? I hope we're less than these numbers, right? We're 97% today. We're 97% today. But we follow standard underwriting, standard actuarial methodology to do these things. So the message for membership and the employees is that, you know, come on down to the north side plan. We got better coverage. We got your pricing the same. If you don't want to do that, you've got to pay a little bit more, and your plan designs have decreased somewhat. We have not done this in the past 10 years. I have made recommendations, but they didn't want to do it. So I think now is the time, given what we all know we're facing here. And then I've got some slides in here that I won't take the time today to go through. But we put them in here for you guys to see the savings potential for green imaging. I mean, look at this. If we got 90% of the screens going through green imaging, we can pick up a million bucks. Opioid-free America. We've got three employees in a catastrophic risk, 12 in a severe risk stage, 50 in a high risk stage, and 12 in moderate. And we actually have 48 that are going through withdrawal right now.

According to the algorithm by people who aren't doctors, I just looked them up. So I think we do need to discuss this further. We've also got a couple of texts from employees since I've been sitting up here with HIPAA concerns about that. I think this needs some consideration.

So I would tell you, no offense to doctors, they can't keep up with the changes in the pharmacy. They just can't.

Well, you know, there's already steps in place now to make sure that we don't have employees going around doctor shopping. You know, you can't get one prescription for opioids from one doctor and then go get it filled from another one. Georgia's had that for 10, 15 years now. And this is apparently some kind of nonprofit. It's definitely not a nonprofit. I didn't read anything about doctors.

It is definitely not a nonprofit.

Well, I didn't read anything about doctors being involved on it, where basically they're saying that they run this algorithm. They find these people who they feel, not doctors, that they feel are at risk. And then they call and pressure the doctors to change them to something else. That may work with everybody, but I think we need to leave the decision. They educate the doctors.

They don't pressure them. The doctor doesn't have to do it.

Well, we've got people who aren't doctors educating doctors. So I think we need to leave people's. Let the doctor make the decision.

The doctor does make the decision.

Now, why are these people texting them or calling them?

Because they see.

They see patterns, but I mean, that's it. I mean, they're not.

Well, I think what you've explained is it's a recommendation only. You can't force the doctor to change someone's prescription, right? That's correct. It's a recommendation that we feel this person should be on something different. Doctor doesn't have to do it.

Well, that's true, but you've got somebody who's not a doctor reaching out to a doctor saying that they don't feel that they should do it. And apparently this organization has some really big HIPAA concerns, so I think that's something we need to be mindful of.

Well, the file that we sent is de-identified, so we don't have to worry about any HIPAA situations.

So then these three employees, like so, if we signed up for this and it's saying that we have three employees at catastrophic risk, what is this company going to do at that point? They are going to have access to the employees' medical information, and they're going to reach out to these people's doctors and say, hey, this is your medicine.

They don't know who the patient is. They know who the physician is. It's de-identified.

So how does that benefit the Cherokee County employee anyway? Are they trying to get them to change their whole practice?

I'm sorry?

Are they trying to get them to change their whole practice?

So half the doctors out there have never been trained in pain management. Half.

I fail to believe those numbers. I'm pretty sure they all have. I mean, they all have classes in pharmacology. And the opioid crisis in America is not nothing new. I've got serious concerns about this. But let's clarify your question.

I think the answer is yes. So what you're saying is the call by these folks to the doctor's office is generic to their entire practice, not to how they're treating one specific patient, because they don't even know who the patient is. Is that right or not?

If they're de-identified. I'll need to get back to you, Commissioner Cagle.

What they're calling saying, like I'll just use myself as an example as an employee or something, say I do have county insurance and, you know, I'm prescribed that. And they call and say, hey, you know, we're looking at Will Cagle's algorithm and we think Will Cagle is at a catastrophic risk.

That's a HIPAA. They don't talk to the employees. They talk opioid-free America.

But are they talking about the employees themselves? Are they naming them? Correct. It's saying, hey, you know, we think you've got this guy, this guy, and this guy, giving them names.

I'll need to get back to you on that, Commissioner.

Okay. That's my concern.

Yeah. I understand. I think you'd find it very interesting when you look at the USRX care savings analysis that we have and how many millions of dollars of drugs have been prescribed by physicians that were not following protocol or compliant or the wrong drug for the wrong disease state. It's millions of dollars. Well, I get that.

But in particular opioid-free America, I just looked them up and they're also advocating for opioid-free surgery, which I mean, again, that's up to the doctor to make that determination. If they think that the pain generated during the procedure is enough to warrant some kind of pain relief, then I don't think that this company should be dictating that. It needs to be up to the doctors.

It is always up to the doctor. The doctor knows the patient.

OK. All right.

What's our current north side participation percentage? It's about 25%, I think, about 280-ish.

Yeah, let me go back.

Yeah, 272 versus 1310.

And that's what you were hoping for was 25%, wasn't it? Did I hear that? Yes, sir. So this is current.

It's more like 18% right now.

And we were trying to get it moved over to where we had about 25% of the total. 25%? Yes, sir.

That's not a huge difference, if I understand that right. You said we're currently at 18? Yeah, 280 to 572 to 600.

This slide reflects the Lantern savings that we've had since. Well, sorry.

Hold on a second.

Sure.

We're going to 40%. I'm just looking at these again. So today it's 18%. It's 272 out of 1582. Right.

We're trying to move 25% from, not a total of 25%.

Greater, so increasing by 25%. Oh. OK. Increasing by 25% of the total employee count, not adding 25% people of the Northside number today. Yeah, so going from, what was it, 272 to 600. OK. Right. That's a big jump.

This is a slide from Lantern over the years where members have utilized Lantern and You can see what it would have cost under Cigna and what it cost Under Lantern and then we got a proposal recently for them to do mandatory Orthopedics and spinal surgeries if you guys wanted to do that This was the select doctor number

Let's back up to the mandatory. So is that, I mean.

This is not reflective of the mandatory. This is what has happened since we put them in 1.1 of 2019. Right.

But it's in the proposal to go to mandatory, right?

It is a proposal, yes, sir. And it's in the assumed $5 million of savings that we're estimating.

And I'm not necessarily against that. I just want to understand. So it would mean that for these types of procedures, you really have to use the lantern doctor.

That is correct. And is the juice worth the squeeze, right? We can hear a lot of noise from the membership. On the low end, we're looking at $120,000. On the high end, $555,000, assuming the same utilization year over year, because we can't predict utilization. But this is based on the 2025 plan year utilization.

And where in this list is the shift to north side? Where does that... in the estimated savings that you just showed us?

Yeah, so it's basically built in. All of these things that we talked about are built in to the projected rates here. I did not bring an underwriting example, but leadership team here has seen it. And so that's something that we can absolutely give to you. Underwriting is a little bit of a science, a little bit of art. And we've been doing this, well, I go back a little bit, so 35 plus years.

What I'm trying to get at is, are we assuming some savings to the plan based on a shift of some 25% of participants from Cigna to Northside? Right. And we took the... Where does that add in? How does that fit into the $5 million of savings that we're trying to get to?

So the plan design decrements were built into the underwriting modeling. And so... It's all wrapped up in here. All of those $5 million worth of savings are wrapped up into these numbers right here. And we took the low end, right? We were very conservative on the savings number.

I get that. Can you go back to the list of the $5 million?

Right. Yeah, the deductible changes.

Mr. Chairman, I'm sorry. Where do you want me to go again? Slide 10. One that adds up to a low end $5 million of savings.

Yeah, I think, Mr. Chairman, what you're looking for, and if I understand you correctly, keep going right there, is to see a line item here that says shift to north side. Shift 25% of the employees to north side. There's a number.

Yeah, we didn't break that out. We could have. And what we did when we did that analysis is that, We didn't base it on a 25% increase or 25% additional headcount in the Northside plan because the Northside plan is running so well. We took 25% of the Cigna claims which are not running real well and put them into the Northside plan and then we took the 23% discount on those claims. So we were really trying to be as conservative as possible.

So are you saying that that expected savings is embedded in the Cigna plan revisions number here? Or is it not embedded in the $5 million at all?

The Cigna plan revision number reflects plan designs for the Cigna plan only. OK. We got a little bit of savings on the Northside plan. Right.

But you're leaving it more as is. So I'm still curious. I mean, if we move this 25% or some number from Cigna to Northside, would that be additional savings on top of the $5 million?

No, sir, because we've got all of these savings built into the fully insured equivalent rates that we presented. So I would say no. So all of the savings, plan designs, lantern, green imaging, all of it is wrapped up into these numbers. Now, you might say, well, why aren't we seeing a $5 million savings here? So the issue is that the fully insured equivalent rates for 2026 were not sufficient to cover trend going forward. And so to adjust these rates appropriately, that's why you're not seeing a $5 million savings here. But these are just the rates. This is what we anticipate the spend to be. It doesn't mean it will be. And that's kind of the hard part to get your head wrapped around. Yeah. If these rates over here had been sufficient to where it could support more of the cost going forward, you would see a much bigger number over here. But if we're running 97% in trends or 10%, and over an 18-month period, that's going to be 15%, you add that to the 97%, and we're underwater. And so that's why these rates don't look as good as you would hope they would. But again, this doesn't necessarily reflect what the spend is going to be. It's our best guess on a conservative basis.

I'm still confused then about if we're saying it's $1.9 million savings here and the other page adds up to $5, Which is it? You may have just answered that, and I didn't follow.

Let me get the underwriting exhibit for you, and I can show you how the sausage is made. It's fairly complicated, quite frankly, but I'm happy to share it and walk through it with everybody here so you can actually see how the projection went forward and how it affected the fully insured equivalent rates. If these rates for 2026 we're running at 80% and not 97%, we would have seen a much bigger delta here. But remember, we're running 97% to the premium equivalents, the fully insured rates. While we have a surplus from our perspective, it's not where we would hope that you would be. We'd hope you'd be running about 80%. And had you been running 80%, this delta would have been a lot better. But suffice it to say, these rates were not, well, we projected them a year ago. So these rates were not sufficient to keep up with the spend that occurred on the plan. And quite frankly, 2025 was a terrible year for all employers. Our book of business saw a 6.8% increase year over year. And we've got a very progressive book of business, as you can tell, based on Cherokee County's solution and all the things that we've done over the years. But again, I'm happy to take anybody through the underwriting exhibit. We spent a lot of time on it.

I'm not sure how helpful that would be. My concern is just that we're banking on a $5 million savings as part of our proposed budget. Is that a reasonable expectation?

I think so. From a rate perspective, though, it's different. These rates include fixed costs. They include margin. They include trend. So you've got your conservative, basically, your COBRA rates over here. And then you've got actual planned spend over here.

So you're saying the $28,155,420 Right? Under Cherokee County, 2027 proposed renewal contribution, Cherokee County, down at the bottom, $28 million. That's variable.

All of this is variable.

Right. I mean, the employee cost is not.

Correct.

The $28 million, you're saying, if everything goes to plan, $1.9 million. But if we implement these other cost savings measures, that's where the additional cost savings can come from.

So again, these fully insured equivalent rates here represent the savings that we have put into the plan, that table you saw, the $5 million, plus expenses, plus margin, plus trend. We don't know what your trend's going to be. We've got 3% margin in here. And we do know that these programs are going to save money and lower spend for the county. Where that's going to come out, we think it's going to be around $5 million by the end of 2027.

Another thing that I may have missed, and it may be embarrassingly obvious and I should have seen it, but we're really comparing now 2026 to 2027, the $5 million is really comparing 2027 to what 2027 would be without those changes. That is correct. So there's the big difference. In other words, it would have been up several million dollars. Yes, sir. It would have been up $7 million or so.

Yeah, remember too, let me go back here. So without any changes, Well, we're looking at a 14.7% increase.

I see. Yeah, OK.

So we're going from, you know.

Would have been up $5 million. Now it's actually down, or I don't know.

$35 to $28.

Yeah, actually, assuming all this happens, it's a year-over-year decrease in cost to the county.

Yes, sir. Based on these programs, based on the participation shift, I should have realized that. I'm sorry, I didn't explain that very well.

And the $5 million is an estimate of what we're saving compared to not making any of these changes. That is correct. Okay. Which is driving 1.9 savings and offsetting increases as well. Yes, sir. Okay.

So on the first slide, you mentioned the 97% with a surplus of $500,000 right now. So I'm trying to understand this and how it relates to the next bullet point. So we're running under what we budgeted. Ideally, we'd be at 80%.

Yes, sir.

But even though we're still under what we budgeted, we're 16.8% and 28.4% higher than the benchmarks.

So two things. Yeah, two things. Why not? One, this is our representation of the health plan budget. Chuck has probably a different number, right? So that's the first thing. So yeah, 97%, we would want to see you guys running 80%. Now, we're not at 100%, so that's good. But it just means that by the time you add trend and margin, that's how you go from zero to a 14.7% increase. And is that driven by?

Is our plan too rich? Have we had too many large claims? I mean, what's driving that? Because again, I'm trying to relate between we're under budget, let's say, but we're still way above the benchmark. Where we ought to be, correct.

Yeah. So 2025 was a terrible year. Just some stats so you guys have some context around it. There were 200% more $2 million claimants than they were the prior year. 50% of all employers have had a million dollar claimant over the last two years. Cancer accounts for 36% of all the big claims. Dependent children account for a significant amount. They're the number one factor right now. You've got cancer drugs that you see on TV, Keytruda. Wholesale acquisition cost for that is $20,000. The health systems are charging $75. Why? Because they can. So we've got a client right now that's taking, one of their members is taking Keytruda and another drug. It's going to be $1.2 million next year. So we're doing everything we can to try to figure out how to impact that spend. Can we move them off of their self-funded plan to the ACA? But we've got to make sure their doctors are in that program, their hospitals in that program, the drugs are covered in that program. So it gets to be a little tough. But the trend rate is the highest it's been in 20 years. Medical trend is running 9% to 10% in the partially self-funded world. It's running 13% to 14% in fully insured plans. So if you're a fully insured employer in Cherokee County and you've got 75 employees, if you run well, you're getting a 15% increase guaranteed, probably closer to 30. But you guys are partially self-funded, and you can control, vis-a-vis the programs and the point solutions that you put in, you can help control what your spend is. The county's been very benevolent. There's no question about it. Y'all have one of the richest programs in my portfolio. And we've got...

I kind of think we have to, you know, because we've got people...

Lower wage, maybe.

Well, no, I'm saying we've got people who, just by the nature of their job, they're putting their lives on the line. Oh, yeah. Firefighters exposing themselves to smoke and cancer. And that's why I want to make sure that we're not saying, hey, you can't get this, but you can get this. Or you don't need to take that.

And Commissioner Cagle, we're not telling them they can't have it. We're talking to their doctor, saying, hey, look at this person. What can we do to make this person's life better? That's the end game. The fact that we can save some money, that's extra.

It's very enlightening. We certainly need the savings. We're counting on the $5 million versus the point at which we started this process, not necessarily from last year. Right. Any other questions at this point?

Please, I'm happy to answer any questions if Kathy can get me on the cell phone 24-7. Thank you, Chairman. Thank you, Commissioners. I think, based on what you guys are trying to do, this is pretty much what we can do at this point.

Thank you. Thank you, Mr. Allen. OK, there was a lot there. That brings us to a walkthrough of our evening's agenda. We had already three agenda amendments listed. I'm going to propose two more. So we're going to have five altogether, the three you see on the printed agenda here. And then there's one I've talked to Lewis Klein, somebody we had discussed perhaps appointing to our Audit Committee. He has agreed to be appointed to the Audit Committee. If we're willing to make that appointment, I would like to move on that tonight. But that would be an additional item to be added. We would put that as item 6.2 under Commission Business. And then another item that Commissioner Weatherby has brought forward is a discussion and potential moratorium on apartment development. So Commissioner Weatherby, tell us what you have in mind there and just so we'll know what we are considering.

COMMISSIONER WEATHERBY I'm going to propose a 30-day moratorium on any application or construction of multifamily high density like the RM-10 and up. I think we need to do a little bit of a study to find out How much of county resources are being used and utilized by those types of developments as opposed to high density residential owner owned development? So I'm going to do a little cost comparison.

All right. And then you and I had a discussion. I'm not exactly sure what we can do legally without a public hearing. Mr. Day, can you advise us on that? I draw from this because in the case of the data center, we decided we could do 30 days without a public hearing, but we needed a hearing to go longer than that. I'm not sure where that came from. Maybe that was just your intuition. But if so, is this a similar situation?

from his vast experience.

We've got legal counsel in the room. But what we've done before is we've rolled out kind of a 30-day moratorium, typically because they're supposed to be short in nature anyway. And I think there's always been a school of thought, you know, that you want to have a public hearing not too long after that to extend it so that you don't get accused of not, you know, you don't get accused of making a zoning decision without a public hearing.

Yeah.

So we did do, I mentioned to Commissioner Weatherby, we did complete a process multifamily moratorium in Woodstock probably about 10 years ago. And it's a little bit different there. But ultimately, same result. I think it went six or nine months. It got extended a couple of times. And then the council wanted to modify the code. And so that allowed us that opportunity to do that. So in this case, if you were to adopt this tonight, We would do very similarly to what we've done with the data center moratorium. We would turn around and do a legal ad, have a public hearing. And in fact, I guess you would need to call for a public hearing tonight on September 15 to then extend it 180 days. And if you did that, then we could work to complete a study, make sure that we understand the full scope and service delivery and everything that we're looking for. And then if there's any regulations that you feel that we need to update during the moratorium, we'd be able to bring those back to you before the expiration. you could conduct another public hearing later on and extend it, or you could end it early.

So that's my- Yeah.

So there's not a hard legal line necessarily, but best practice, let's call it.

In your opinion, best practice would be to only, without a public hearing, only go about 30 days for a moratorium like this, and then hold the public hearing if we want to go farther.

Well, that's how we've been advised before by legal counsel, but I'd certainly defer to them. Okay.

That is consistent with what our legal advice has been. And we often call it an emergency moratorium without notice. In 30 days, I think it's about the max there to allow for advertisement. What's useful in that is you haven't provided notice. Because if you provide notice, someone can come in with a flood of applications and it defeats your purpose. So that is the point of doing it in that way for a short period of time. But what the case law says is that you can only have a moratorium for a reasonable period. There is no black letter law on what that is, but I think about 180 days is where we start getting a little antsy. But we want to have a public hearing before we start extending past 30 days, because by not allowing someone to apply, that can be construed as a zoning decision. So ultimately, we want to follow the ZPL, have a public hearing. And if nobody comes and complains about it, that gives you a little more confidence that you can take the time to do what you need to do in your study.

OK, so as I understand it, we would consider a 30-day moratorium with a call for a public hearing to consider extending it. Right, at the end of the 30 days. So that's going to be a requested addition to the agenda as well.

And we'll just want to be clear on what the moratorium is for the acceptance of applications, I think is what I heard, but for what zoning districts, if we can just state all that clearly.

Yeah, RM-10, RM-16, I think are the ones we're talking about. Those are the two we have in that category. Okay, good point. Okay, so those are the additions. So let's see. We have a discussion of vacancy on the Board of Ethics. I talked to Mr. Klein about possibly either or, the Audit Committee or the Board of Ethics. And he asked me which we needed him more for. I said the Audit Committee. But that does leave us with a vacancy on the Board of Ethics due to the resignation of Ken Ball. So we need to be thinking of somebody there. It's a similar kind of person, somebody who's trusted and respected in the community. That's really what we're looking for there. Of course, we'll have our minutes. We have several public hearings. Is it seven? I think it is. Five. Oh, yes. Two have been eliminated. Okay. So skipping the ones that we have the public hearing on the extension of the data center moratorium. Do we need to talk about that one now?

Mr. Chairman, my plan there is just to briefly reiterate the reason for the extension, obviously, to continue to research and receive public comment. Then I'm going to end the presentation. I don't think it'll go. It'll be extremely short, because I'm sure you're going to have a lot of speakers tonight. But that's really all there is to it.

OK. Thank you. So then we've got modification of zoning condition. Wait a minute. I'm skipping one. Public hearing. Yeah, this is TJDJ Enterprise LLC. This one is a case that's recommended for denial, and we're going to hold that hearing to consider something other than denial.

Yes. This is a piece of property they want to split zone. It's already GC. They want to rezone almost four acres in the back for light industrial. But, you know, considering the time, I didn't want to bring up the presentation and go through it very much. Right. Unless you have any questions.

Yeah. Okay. Maybe we just, we know enough about that one to go into it this evening without talking about it now. Okay. So then we've got... The modification of zoning conditions, that's 8.3 on our agenda. Kyle Lyon for Fox Lane Homes.

This is a 2006 rezoning case at the northern end of Collette Drive near East Cherokee. Commissioner Cagle and I met with them again. I think we have a way forward to modify the condition. This is some of the same problems we've had before. There's very specific design requirements from 20 years ago on the homes. You know, styles, tastes have changed. So there's one condition that we're going to take a page out of Commissioner West's book and kind of modify it to allow a water table that's masonry instead of focusing the masonry on the front elevation.

We probably said it had to have all brick or all stone.

70% brick or stone on the front facade. So we're going to kind of change that to allow more of that farmhouse style that is currently popular. So I've got a presentation on that. It's only a few slides.

And then we'll have item 8.4, street side company modification or zoning condition regarding the minimum square footage in some town homes, I think. Yeah.

Yeah, these are the townhomes that were approved in 2024. They're just south of the main entrance of Bridge Mill, just south of Sixes Road and Bells Ferry. And they're really just asking to reduce the heated square, the minimum heated square footage that was required as a zoning condition.

OK, and then we got 8.5 removed, 8.6. Oh, yeah, we have our, this is the one, yes. AG 5.

Yes, sir. Public hearing. And we, just to kind of briefly tell you, we, or to mention to you, met with Commissioner Cagle earlier today. And we have Kimley Horne in the room and some of our staff. But in looking at this, it's progressed extremely well. But I think that it's easy to see that we've got some loose ends that we need to tighten up and got some things that we need to run down. at a minimum and we don't have to do it now and tonight may or may not be the right time. Because ultimately what I think we'd like to do is go ahead and ask you to please conduct a public hearing and get that comment and then table the decision to September 15th. But I do think that ultimately we will need some direction on some things because the ordinance has kind of evolved over time based on input we've received. We want to make sure, ultimately, that whatever y'all are looking for, whatever you're looking for, we're able to deliver that and bring back to you ready to go, signed, sealed, and delivered on September 15 for that meeting. So just kind of quickly to look, this chart is probably the main feature, kind of details the main features of where we stand today. It started off as its own zoning district. We actually have now really made it more of a permitted use. It's like a subdivision type, but it's a permitted use in AG and R80. And the reason for that is there was some concern about zoning to it. Do we zone to it? Do we not zone to it? If you don't want to zone to it, then it needs to kind of be in an existing zone. So it made sense to do that because we had already tied it largely to those two zoning districts. An additional feature, and I don't know that we really talked to you about this specifically, Commissioner Cagle, is there was also the thought of tying it to District 1. Because initially, as we were looking at the fire regs and things like that, it was said, well, the rural part of the county, these rural regulations, may be easier to navigate in the rural part of the county. We can revisit that, but that is something that was added. There was also a five acre. We had the five acre minimum for all the lots. That actually went to an average of five acres. So based on the number of lots that you would have served by an easement, you would be looking for an average of five. And so that would mean, of course, some could be smaller, down to two acres. Some could be larger. But you would average it out to five. And the input we got on that was you might have a tough piece of property where you would develop on the front of the property fairly easily. But on the back, it could be difficult to develop because of topography. So you would do maybe some smaller lots on the front, larger lots on the back. But then you would average out to five.

And a concern I had about that was, so what happens if it's, well, we're talking about 25. What if it's 24 at two acres and one at 100 acres? I mean, we'd want to have some protection against future development of the 100 acres because, let's face it, I would believe going into that that they're just saving the 100 acres to be divided later. But I mean, I'm not against the concept. We just need some kind of got to go into a conservation trust or maybe just a restriction against subdividing that lot for some period of time. Just something to think about there.

Yes, sir. And in perpetuity, to the chairman's point, I'd like to see it where once you elect into this, that's it. If you do decide to do a 100-acre lot, you can't come back five years later and say, OK, I want to do another 20 on top of that.

Yes, sir. And I think to answer y'all's question, I think that we have that. We'll have to show you the section that we had the no-chain subdivision requirement already in the code. That's kind of been brought forward. And in addition to that, there's discussion about the parent parcel not being able to further subdivide. So let me share that language with y'all. I don't know that y'all saw that in the last version, but I think you'll like what you see when you see it. But to your point, we are going to have some deed restrictions, I think, that we're going to recommend for these projects. Because since they're not going through zoning, they're going to be a permitted use. The deed restrictions can really, in some ways, take the place of that underlying zoning. Not that we want to be like Houston, Texas, but they're famous for using those zoning restrictions instead of zoning. And that is another tool that we can look to for something like this. So we can share that with you and see what you think. And that would certainly help, I think, expedite approvals and reviews and construction, because then there would be no zoning action that would have to be taken. Also, the lot width, again, the 150 to 120, the max lot coverage. On that one, I think we had concerns about the enforceability of that and how we would track that. The open space disturbed max. Initially, it was looked at as, we talked about 25%, no more than 25% disturbed. That kind of got flipped into, well, 75% would be protected or open space. But really, I think at the end of the day, what you were looking for is no more than 25% disturbed. So that's kind of what we have in that right column there. The 50-foot... Front setback, we still have that with any lots that would front like a county road, but interior One comment we got was it would be ideal to have some flexibility on that front setback To be able to bring some of those homes a little bit closer to the road again These are all going to be private roads private easement so if you're 20 feet from the edge of easement or say 45 feet from that center line You can always be much further back. But if you, for whatever reason, had a desire to have the unit closer to the road, that would provide that flexibility. The side and rear setbacks are the same at 30. Everybody's on board with that. The access easement. You know has been 60 feet. I think in the past in the county many years ago was was 50 possibly You know it was it was kind of suggested 50 might be more desirable the road width at 20 That's been a standard that that we've actually worked with the fire department on over the years 20 feet clear access I think we are, the request was 18. I think we are gonna further research that and see what our options are with that to see if that in fact does need to be the payment width or are we just talking about clear access to access the site. So we need to just get a little bit more clarity on that 20 versus 18. 20's kind of been, everybody's gone with 20 for a long time, not saying that that's the final word. We just need to do a little bit more research on that. You mentioned pavement, but we're really not going to require pavement anyway, right? Oh, I'm sorry. Whatever the driving surface would be, that's right. And speaking of that, I have that here. So to kind of wrap up, You know, we, not unlike the rural subdivision code the county adopted five years ago, this one's also exempt from the tree ordinance requirement. We've also got the private infrastructure, as you said, Mr. Chairman. Of course, asphalt's always possible if someone would like to pave, but gravel, chip and tar, you know, at the end of the day, we're just looking to make sure the surface can support the 75,000 pound requirement. The stormwater requirements, working with the topography and looking at the low impact development stormwater standards. The fire protection, again, that's been a critical path for us, working with the fire department. determining and Jenny to determine what our options might be on that. So we're going to continue to work through that. Back to the covenants conditions and restrictions, the CC&Rs and the deed restrictions, with those and the final plat, we can memorialize quite a bit of the requirements on everything. We've also included in the draft several ways that people can receive relief. with a project that, for whatever reason, might not exactly fit the process. We have what we call a design review, which would be potentially if there's a project, an illustrative plan, if you will, that is close but is not something that the staff is comfortable maybe signing off on. Maybe there's something odd about it or some difficult characteristic of it. We have the ability for the applicant to come to the commission, get a reading from you, say, is this acceptable? Does this meet the intent? And be able to get approval of the plan. We've also got administrative variance, which we've assigned to Margaret. Margaret will get to approve all the administrative variances, so that'll be exciting. And we're trying to keep that fairly broad, because inevitably we can't think of everything and there'll be some pinch point or some weird property that'll have an issue and just a little variance would make it work. And we probably need to work on that portion a little bit more to define some things on that. And then there's the appeals, which is kinda like what you're used to seeing, but in this case, what I'm recommending is they come directly to you with an appeal because again, this is gonna be more about design, more about intent. with the project. And if there's something a little bit different but you feel like is acceptable under the scope of what's been adopted, then you would be able to approve it. And I think that's really more of a policy decision than a traditional variance. And I think that will greatly help expedite some projects that might be stuck. And then, of course, we have the administrative process and the planning requirements. We're trying to streamline all of that to the extent we can. The goal from the beginning has been kind of backing up a second, that tiny text there. But to be able to provide the subdivision type in these rural areas, very low density with larger lots, minimal private infrastructure and access, and to streamline and expedite project delivery and reduce costs. So that is what we're working to try to achieve. I think we're really, really close. But as I mentioned to Commissioner Cagle earlier, it's that last 10% that's the hardest part to get to. So we appreciate a little grace and have the public hearing tonight to get a little, some more input. That would be very valuable. And then if we could get it tabled, we'll definitely get it buttoned up.

All right. Any questions for Brantley at this point? All right. Thank you. Thank you. So then we're going to have one more public hearing about mailboxes.

Rhett, all right. Let me just say that this is coming out of my area. Our mailbox ordinance was from the 1990s. You were involved in that. I look back to history on it, Chairman, so don't.

I didn't take office till 2000.

Well, your name was in there. But anyway, it was sort of a blanket ordinance. And I think Brett's done a good job of writing an ordinance that will bring us back and give us some exemptions and options for the diversity that we have in our county. So thank you for that, Brett.

Yeah, the original ordinance he's referenced was 1999. And it basically prohibited any type of masonry structure, fixed object type structure inside the right of way. Fortress mailboxes.

I do remember fortress mailboxes.

A lot of those. So Commissioner Carter kind of came out or reached out to Brantley. And I started researching around different areas in Georgia that had ordinances made available. Off the top of my head, I want to say it was Henry County and Walton County had specific ordinances to this. And it kind of married up a lot of what they had. Our old section was only about three bullet points long. Obviously, it's expanded to try to include that. What it does is it actually gives us a little more teeth in terms of enforcement on those mailboxes. But it also provides an exemption for those to be utilized inside of platted subdivisions where what I would call internal roadways to a neighborhood. It also gives an option for roads not inside of a neighborhood that are 25 miles per hour subject to the approval of the Transportation Department. I know a specific case I've talked to Commissioner Carter about. It's kind of a dead end road way towards the back that they're looking at. The reason we put that in there with approval from the Transportation Department, we do have some 25 mile an hour roadways out there now that are connector roadways in between East Cherokee and Arbor Hill, maybe. Arbor Hill. The one that pops to mind is like Beavers Road. Realistically, that's posted at 25 miles an hour. The likelihood of people actually traveling that is not that good. So those are the ones where we wanted to be able to say it may not be appropriate on a three road where volume or speeds are typically higher versus low volume type roadways that really aren't connecting to major roadways within the county.

So as it stands now, you can't do these big mailboxes? Anywhere? On any road?

Correct. I mean, we have the enforcement power to do them. We did add a section that gives us kind of a penalty section. If people put them up and don't want to take them down right now, it goes through code compliance. And people usually don't receive it very well when they get the notice. Because, I mean, some people spend a lot of money on these mailboxes to go in. I think when it happened back in 99 or early 2000s, we kind of went around. more or less paying people, gave them a check, and gave them a Wood Post mailbox to put in place of the masonry structure.

That really, I mean, the intent was to put it on areas where you've got relatively high-speed traffic and risk of a fatal accident, somebody running into one of these masonry mailboxes.

And both of these exemptions to that are the internal subdivision streets, which are always designed to 25 miles per hour, and then also non-subdivision streets that are 25 miles per hour. But we would have to look at each of those instances individually to try to determine. And I think we've got it in there. Jenny, you can help me with this. If we make a decision as a transportation department, that appeal would come, was it ZBA or was it coming to the board? It would go through ZBA to appeal a decision we have if somebody doesn't agree with it.

Real quick, why did you decide on 25 miles an hour instead of 35 miles an hour?

Because that's the most of what our residential roadways are posted at, like internal subdivision streets. There's statistics out there. If a vehicle hits a fixed object, what is the likelihood of injury, death, and that sort of thing? Just to give you a little bit of stats somebody gave me a heads up. You're gonna ask that question. So I researched it Nelson's a 35 mile an hour road.

Yeah on a masonry company.

So yes, sir at 20 at 20 miles per hour I Mean this some of these numbers actually surprised me There's about a 90 percent survival rate for seat belted drivers that strike a fixed object at 20 miles per hour minors are killed

Yeah. That's kind of surprising.

Wearing a seatbelt at 20 miles an hour.

Yep. Is that from the impact of the structure coming apart and flying through the windshield, or is that just blunt force?

It did not specify that. But what I looked up is a fixed object. Some of these will potentially crumble and go over. But it's going to significantly have an impact and jar the driver. It does increase. 30 miles per hour is a more severe risk. And you're looking at drivers sustaining broken bones and internal injuries at 30 miles per hour. And obviously, if you get up 40 and 50 miles per hour, the chances of death increase and things like that.

Well, and I think we know 25 means 35. 35 means 45. I mean, that's the reality of life.

Especially in District 1.

Yeah. And a lot of times, when you're talking about internal roadways and less volume roadways, that's the key. The risk goes down if you have lower volumes on that roadway.

And is there still a setback from the pavement?

It does specify, well, not curb and gutter streets. The post office is going to want it close enough to where they're not hopping the curb to be able to deliver the mail. There are guidelines on non-curb and gutter streets. The recommendation, I believe, is eight foot off the edge of pavement. You'll see a lot of times they'll have a little pull out there. I think it allows it to go down to four feet in cases where there's not adequate shoulder.

All right. Anything else on this one?

No, I am going to abstain from this vote, just because we do do mailboxes from time to time.

OK. All right. So then we've got three items under planning and zoning. Holly Springs annexation.

The city of Holly Springs has proposed the annexation of four parcels along Holly Springs Parkway. This is to be rezoned to GC and for commercial development consisting of retail, medical office building, professional office, and a coffee establishment. So one of the things you'll see in the presentation this evening, their contiguity is to several parcels that were annexed back in 2020. However, with House Bill 1029 going through, those parcels will be coming back to us in unincorporated Cherokee County. Therefore, there'll be some evaluation that we need to do related to the contiguity of that. And then the next annexation is for ball ground. Well, wait a minute.

Can we have a little discussion on that? If you didn't hear what she said was there's the continuity for this annexation is based on two parcels That will be coming back into the county January 1 and so my question is Do we consider this a valid? annexation knowing that in four months It's not going to be Now, there could be one possibility. Holly Springs Parkway is a city road, so can they annex along the road is the question we might have to ask.

Well, they can't do a spoke annexation just along the road. They can jump across the road. But we're talking about the two dotted parcels, Kathy? Yes.

These are the ones from 2020. There is no city property across the street.

Yeah, yeah. So I think it's problematic. And I think we're in this quagmire of, intermediate period with that legislation. But we know that that's going to create an island. And so that's illegal to create an unincorporated island. And so that could be the position we take is that it's illegal because we know that as of January 1 in the 2020 legislation that these two parcels are going to come to the county and then these will not have sufficient contiguity.

What's interesting, though, is they are contiguous to Woodstock. Oh, gosh.

Is that Woodstock?

Yes. To the left there.

So what is the red strip on the front there by the road?

That's commercial.

These are general commercial, not city, though.

Well, I think that's going to be the first question we need to wrestle with. So thank you for your input on that. Maybe we'll have some more even by 6 o'clock. OK. All right.

Good point. Thank you. Go ahead. We've also got a ball ground proposed for the next session.

This one is actually good news. So as you recall, there was an annexation proposed for 1583 Ball Ground Highway. The applicant was John Boyd for a rezoning to LI for a flex warehouse. And we discussed the parcel to the Northeast that belonged to Georgia Power. And Georgia Power has since come back, and they're going to annex that parcel. So it will address the island issue that we had communicated to ball ground staff.

Good deal.

So that's some good news for us.

All right. And then an appeal of a ZBA decision.

So this is a request that we received concerning a decision by the Zoning Board of Appeals. This is an appeal of that decision. And we put it on your agenda to decide if you want to hear that appeal. It just relates to a tree ordinance variance request. I don't have a formal presentation for this this evening.

This involves some tree recompense level.

Yes. Yeah, the applicant wanted elimination of the tree recompense. The ZBA recommended a 75% reduction. They're asking again for the full reduction.

Yep.

Okay. Okay. Very good. Thank you. So, Mr. Martin.

I'll go through the consent pretty quickly. I've got six items there. First will be to consider a request from Information Technology to surplus and dispose of several computers, monitors, and miscellaneous equipment that have reached their useful life. Second item will be to consider a request from the district attorney to accept a total of $3,500 from the US Secret Service For cost reimbursement of an assigned joint operations task force, these funds must be kept separate from the district attorney general fund budget and can be used to reimburse costs, overtime costs, training, certification, or supplies and equipment costs. That budget amendment would be needed to allocate those costs to the 2026 district attorney's budget. Third item would be consider requesting staff senior counsel for approval of a countywide administrative policy establishing a process and guidelines for accepting event sponsorships for county hosted events. This policy would establish a consistent process for evaluating and accepting event sponsorships But at the same time, ensuring those sponsors support the event's stated mission and are treated fairly and consistently. It will also provide standardized procedures for sponsorship applications, review and approval of those applications, and record keeping, and then some staff training to make that all standardized. The fourth item is being removed. That was a call for a public hearing. Fifth item is to consider a request to hold a public hearing on September 15 of 2026 to consider and update Zoning Ordinance Article 7 regarding livestock and mobile sawmills and associated definitions in Article 4. This would align the county zoning ordinance to recent updates in state law pertaining to livestock and to mobile portable sawmill regulations. It would consolidate those provisions and provide more specific details for those uses. And the proposed amendment definitions would just align what is being revised with the definitions in Article 7. Sixth item to request to hold a public hearing September 15 to consider and update zoning ordinance article 14 regarding administration. This proposed amendment would provide for enforcement of zoning ordinance by citation and to establish authority to issue citations for noncompliance of the zoning ordinance. And then item 7 is to consider a request for hold a public hearing also on September 15th to consider an update to article 2 of the Coda ordinances regarding consumer fireworks This proposed amendment that annoys ordinance consolidates the regulation of consumer fireworks Into a new subsection to align with state law and prefer to define terms and requirements some of this has to do with The new equine requirements that came out, reinforcing some of the definitions and all that, and clarifying for enforcement by the marshal's office. More details will be explained during the public hearings on the 15th.

All right. Any other questions for Mr. Morton now?

All right, moving on to county managers. Under my portion, I've got 12 items. First one will be to consider a request from the Information Technology Department for the purchase of a solution and licenses for a county-wide network access control in the amount of $75,490.80 for a three-year term. To maximize cost efficiency, the IT department has recommended to secure a three-year agreement for this network access control. It acts as a gatekeeper for the entire network and continuously inspects and verifies that every device connecting To the network it will actually it'll check for both wired and wireless devices connecting to the network Extension of this agreement will keep non County devices and non compliant devices from connecting into the county's network IT department requested quotes from three vendors and they're proposing to go with the lowest price quote and this is a budget item in the IT department's fiscal year 2026 budget Second item will be to consider requesting the Marshal's Office for a five-year agreement with Axon Enterprises for a purchase of replacement tasers in the amount of $8,879.39 for fiscal year 2026, and then in the amount of $25,528.24 for the subsequent years, totaling $110,992.35 over the entire term of the agreement. Marshall's office is requesting to replace its aging taser units. They've reached their useful life, and this axon agreement will cover 16 tasers, accessories, and training for a five-year period. This is budgeted for in the Marshall's office FY26 budget and will also be included in subsequent annual budgets.

Kind of hate to think our marshals need tasers, but I guess you do get into those conflicts, and you'd rather tase somebody than shoot them. So better to have them.

Correct. Item three is a consider request from the Sposs Roadway Department for task order CD-20 under the professional services agreement with Kimley Horn LLC to perform traffic engineering and constant development work. for the Ball Ground Highway and Fate Con Road intersection improvement project in the amount of $38,170. This is a project that is included in the 2025 TSPLOS referendum project list. The intersection geometry and site distance do not meet current design standards, which contribute to traffic curing during peak periods and also numerous crashes occurring near that intersection. This task order will include complete traffic analysis and completion of a concept study to evaluate potential alternatives to improve the intersection. And once we have those alternatives, it will help to inform subsequent engineering and design services, which will be handled under a separate task order. This project is TSPLOST funded. It's one of the first ones off the ground of a new project in the TSPLOST.

What would be the timeline on completing this study, you think?

I'd say they'd probably be finished by the end of this calendar year, pretty quickly. Item four is to consider requesting a SPLOST Rotary Department for task order CD-21 under the professional service agreement with Atlas Technical Consultants to perform right-of-way appraisal services for the State Route 92 at Churkin Road intersection improvement project in a total amount of $71,200. This project improves the intersection of Trickham Road and State Route 92 in a left turn lane, right turn lane, and through lane capacity. It is 80% federally funded. This task order will update appraisals for six parcels that are still undergoing the condemnation process. Once again, this project is 80% GDOT funded, with the remaining coming from SPLOST 24 funds. Item 5 is to consider a request of the SPLOST Roadway Department for an agreement with Georgia Power Company to allow encroachments into an existing utility easement for construction of Technology Bridge Parkway Phase 4 in the Airport Road Spur Project. This project will relocate Airport Road and make it possible to extend the runway at the Cherokee County Regional Airport. Georgia Power Company maintains power transmission lines in the area with a 200-foot wide easement. In order to secure access for the eventual construction, the contractor will need to access that easement for grading and utility relocations. This easement agreement gives the county and its contractors right to encroach upon that easement area that is under the jurisdiction of Georgia Power Company. Six is to consider requests from Katz Transit for purchase of office furniture for the new Katz Administration Building from Office Creations Incorporated under state of Georgia contract in a total amount of $149,763.70. The new Katz Administration Building is scheduled to be completed by mid-November. The existing furniture is old and probably will not survive the move to the new space. They are proposing to purchase new furniture from Office Creations, who is authorized distributor under the State of Georgia contract. Just want to remind you that this project is 80% FTA funded and then 20% funded by Georgia Transit Trust funds. The Georgia Transit Trust Funds serve as the county's required local match. We were successful in gaining $1 million in Georgia Transit Trust Funds to go towards the construction of that project. Item seven is to consider requests from Recreation and Parks for a facility use agreement with 112 Events LLC for a drive-through Christmas light show at Cherokee Veterans Park for a term of two years with an option for three consecutive one-year terms subject to agreement by both parties. For several years, 112 Events has had their Christmas drive-thru light show at Veterans Park. The previous contract expired, and staff has renegotiated the terms of agreement to include some more restrictive move-in and move-out dates and increased fees paid to the county. Basically, the move-in, move-out times will be 30 days less than the previous agreement. And the fees paid will be in line with current recreation parks' updated rental policies. Estimated revenues for FY27 are approximately $15,000.

So I know it seems like we do one of these every year. Maybe they're all running together.

I don't know. Well, last year we came to you where we canceled the agreement with 112 Events for their event at Hobgood Park and their event at Veterans Park. This is a new agreement based upon new terms, our terms, and based upon them using the park for 45 less days for move in, move out, and then increasing the fee to meet current fee structure.

Which actually doubles it from past years.

Correct. Right. But I think what we talked about before was, for years, it was our impression they were a nonprofit. And a lot of this money was getting donated back. Correct. Turns out that's not necessarily the case.

That's not necessarily. This is a for-profit, so that's why they're going.

Good question. Even if it's $15,000 double what it was before, is that sufficient? If this is a for-profit business and we're charging $450 a day to use a massive park, is that enough? I guess that's my question.

Jason didn't think it was. When we got Jason to think it was, he seemed to think that it was, I think they were charging $225 for both parks last year. So they were having it hard. I asked the same thing. And he thinks that's more than enough to cover the cost of the power bill.

actually generate a little bit of money for us. And it is the winter months, too, when the park isn't being used as much. It's November, December, half of November, December, and January when the park use is a lot less. OK.

So I had the same question, but he seemed to feel like it

Yeah, when we thought it was non-profit, there was some goodwill there, right? And of course, there's still some of that. But if it's for-profit business, then I just want to make sure we're getting an appropriate amount. So thank you for looking into that.

All right, item eight is to consider a request from Community Development Agency for renewal of the CityView software maintenance agreement in the amount of $97,683.14 for an additional one-year term. CityView is the enterprise software that the Community Development Agency and Fire Marshal's Office use for plan review, permits, inspections, and business licenses has been in use by the county Since 2003, annual renewal is 6% higher than the 25-26 rate. However, Development Service Center had included that in their upcoming 2027 budget request. Item 9 is to consider a request from Recreation Parks for purchase of a towable boom lift from Aerial Titans in the amount of $65,300. They are requesting this purchase to support their maintenance operation activities that require elevated access. They have located a used unit with 424 operating hours for this price of $65,300. It is located in Cartersville. They did some shopping around, and they found a 2023 unit, 550 hours in Pennsylvania. It was listed for $67,000, while a newer unit in Michigan was listed for $83,810. Whereas buying a brand new one would be just under $100,000 at $99,850. They are requesting to buy this used unit in the amount of $65,300 to realize some savings. They are proposing to purchase this with SPLOST funds. Change light bulbs mostly? Is that what? Yes, change light bulbs and any kind of? Yes, field lights.

And correct me if I'm wrong about this. Like in the past, we've been renting, but you have to reserve them. And sometimes it takes, what, two months to get them? Yeah. So these lights are sitting there. Not working. Yeah.

Does a used one come with any kind of warranty? Are we missing out on something about buying used?

Item 1210 is to consider a request from property management for a service agreement with Woods Brothers Roofing and Construction LLC for a roof replacement at the tax commissioner's office at 195 Town Lake Parkway. Total amount of $49,375. The roof at the tax commissioner's office is in need of a replacement at the Town Lake location. Property management solicited a competitive quote from four vendors for the project. Woods Brothers submitted the lowest quote and has successfully completed two previous roof replacement projects for the county at Union Hill Community Center and the Historic Courthouse. There was a Cherokee County local vendor that was Infinity Roofing. Their quote was 5.114% higher than the lowest quote. It exceeds our procurement local vendor threshold. Our procurement department did ask Infinity if they could identify their Local subcontractors, and they did not do that. They only provided their Canton business address. Our property maintenance department has got SPLOST funds budgeted for this roof replacement. Item 1211 is to consider a request from the Sposs Roadway Department for Amendment 2 to the construction agreement for the 2026 resurfacing project phase 1 with Summit Construction and Development for incorporating an additional roadway for resurfacing. Total amount of $214,161. Phase one of that resurfacing project consists of resurfacing approximately 29.271 miles of roadways. We partnered with the cities of Canton and Woodstock for a joint resurfacing project, and that project was awarded the summit in April of this year. This amendment adds resurfacing a bowling park road from area to highway to the second wastewater plant entrance and parking lot. At the request of the city of Canton, staff analysis by both the city and the county find the proposal to be reasonable. Cost for this amendment will be funded by the city of Canton through a forthcoming IGA revision. And then item 12, the last item, is to consider Amendment 2 to the intergovernmental agreement with the city of Canton to provide resurfacing and road repairs for various roads. Per this IGA amendment, the city and county agree that the city will pay costs associated with the Bowling Park Road from area to highway to second waste road plant entrance parking lot paving project and shall reimburse the county for all costs the city of canton is scheduled to consider this amendment at their meeting of august 20th and that is all that i have on my agenda all right thank you mr morton and we have executive session is there a motion to adjourn executive session i'll make a motion to adjourn the executive session to discuss property acquisition personnel matters and pending threat litigation

Motion by Commissioner Cagle to adjourn to executive session. Is there a second? Second. Second by Commissioner Carter. Any discussion? All in favor of such adjournment, please say aye. Aye. Any opposed, nay. Motion carries unanimously. We will adjourn to executive session, and we'll be back at 6 o'clock. Thank you.