Health & Human Services - Regular Meeting

Good morning.

Good morning. Welcome back, Charlie. Good to see you.

Charlie, there you are. Hello there.

Accept the motion to accept the minutes. Sam. All in favor. We're going to go with eyes today.

Okay.

Who does it against?

Wayne, looks like you're up first. I'm up first?

You are. All right.

Okay. Well, I think we can make this kind of short and sweet. There's going back to the other way with the back bills. My understanding, right? You come here first. We've got three of the caseworkers, senior social service diameter and community service lender. So it's Not any different than our existing staffing pattern. It's not an additional ask. It's replacing folks in our existing staffing pattern. All positions are needed and critical at this point. And I really want to highlight one particular position, the senior social service examiner. That person who has recently left, as I believe her husband also worked for the county. locations. But it was a very critical position because it helped with a lot of our homeless stuff and particularly our COVID-19. So if there's any questions you have on that. Questions on these bagpipes?

I wonder if any services workers are actually housed in Yes.

Nobody has any questions or comments. Is there a motion to move them on to personnel? If not, then it's from me. Is there a second? Second. All in favor, aye.

Aye. Opposed? Okay. I'll show you some statistics that we provide for you every month. Homeless numbers continue to drop. I do believe, I think I sent out an email that I received from the state. A year ago, we were third worst in the state. I think the rate we had was 41 individuals per 10,000 in Washington County were homeless. By the last time they did the data, which was a couple months ago, we were down to 12 individuals per 10,000, which puts us in a a better third in the state. And we just did some numbers checking this morning, and I believe that number is now below 10. It's in the same digits. So significant cost savings there. And that is due to some of these positions that you see that I'm asking for back bills. Those folks downstairs have worked really, really hard trying to get a bunch of numbers under control to monitor spending in our department. and the amendment of our community and the county and department as a whole. On to the last, if there's any questions, John, can you do that? Could you just briefly explain some of the techniques and things that you use to raise that number down? Sure. Well, we've got a team of folks that specifically work on, for example, landlord relationships, creating relationships with landlords, we're trying to focus more on aftercare. So we don't want recidivism coming back into the system, making sure that there's supports aligned. So there's a specific homeless team that we kind of revamped a little bit. And some of that is funded to the FCCM, which is Family Centered Case Management Program, a grant through the state, some of this. And I think we, as part of the position where I asked for funding and we maneuvered some grant money that was going to a nonprofit, and we brought it back in to get a 20-hour person at no cost to the county. So it's really working on meeting people where they're at, getting out there, building relationships with landlords, getting people off that hotel list that's been on for one, two, three years, and getting them housed. It costs a lot less to have permanently house somebody that they keep doing in hotels, as you all know. So again, we still have, I think this is the first time in I don't know how many years, we have nobody in hotel placement for more than one year. Previously, it was two in three years. I think we had one individual that was in a hotel for over 12 months. What's that make you?

Please. The fire alarm system at the municipal center

maintenance for the next five minutes. If there is an alarm activation, please stay in place. It will be a maintenance activation only. Thank you.

I think the easy answer, Supervisor, is that we're front-loaded. We're doing the hard work now to make sure that we're building a good relationship, not only with the clientele, but the landlords, making sure that people are supported so they're not coming back into the systems.

So I guess the follow-up to that would be that, so in result, you're saying that those things are all driven by the person that you currently have now. Yes. And that's why you need the back fence.

100%. Okay.

I just wanted to make that clear before I came to the personnel committee. Yeah. You know, we felt something everybody else doesn't reason with. To do the work, we need the people. Yep.

Great job. First of all. Thank you. Second of all, are you finding enough landlords to be able to reach out to to provide jobs and get seated?

I'm sorry, can you?

As you're reaching out to landlords, are you finding enough landlords to be able to do the supply and demand of housing, the homeless that we had for a certain period of time? Are you coming up with really more rentals?

I don't think the landlord is the issue. It's the affordable housing more of the issue. There's a lack of affordable, safe housing. That's a bigger issue. There's housing out there for it.

So what's the amount ?

It depends on the household makeup, the eligibility of the individual that has applied. There's a lot of factors.

But there is a range. There's a low and a high. There is.

And I don't know what those are. That would be a program question. Yeah.

I could kick that number out to you, too. Sure. I just want to comment that I downloaded this last night to try to read it later on last night. Thank you for you, Becky, your people for the numbers. You put a lot of numbers together. You're showing us where the costs are. You're showing us the savings that we're getting. We've never had hard numbers before coming out of this, especially in this part. Also, a little further on in there, some of the other programs that they also run and the eligibilities and whatnot on them. And I went back to my cheat sheet we gave us at the beginning of the year, and some of those we pay 50%, and some we pay 100%. So my question is, are people down there trying to help people that come in with the 50% cost ones kind of push them that way rather than the 100% cost to us? Just Well, we may not have a choice. That's what I was wondering. If there were ways we could steer them.

I do think that once they get further involved into our programs, that there are some opportunities to change what their eligibility might look like based on the standards that are set by the state and federal government. But when neighbors come in, take them as they are.

Thank you. Are there any other questions before we move on?

And on the last sheet is the kind of letting you know where we're sitting budget-wise. It's the only one. We've talked about the code blue and the heat bill before that that balances out in the fall here. But we see the buyouts is a little bit high. Resignations and retirements. And there was an explanation on the backside of that. based on transit prior budget years, wage increases. We do that understanding who we believe is going to be leaving the agency every time from the county. This is one of the main reasons why we really have to focus on taking care of our staff and making sure that they want to be here and we don't get that turnover and how critical staff is to doing this work so we can continue to manage that number. So that's, I think it's about 7% above, which doesn't take much to move that number. So, you know, I mean, there's certain things we can control and things that we can't. We don't have a ton of control over that number. And if you have any other questions on that document, best person to ask is in the room. That's not me.

Nice way to socialize.

A lot nicer than was tried yesterday.

Any questions? Again, thank you for all the information. Sure. Thanks.

Good morning, everyone. Good morning. Good morning.

The first thing on my agenda, the Rural Health Transformation Program. This is just more of just for your information. The state received $212 million from the Centers for Medicare and Medicaid Services. That was for the first budget period of a five-year period. It's to support rural communities to improve healthcare access quality and outcomes. So our county obviously was deemed as rural. So we cannot be the lead on this funding as far as the local health department. It has to be with a hospital partner or a healthcare provider. So for our county, I know of two applications that were submitted. The two applications, they were due, the applications were due July 14th. So each county is gonna receive $500,000 to develop collaborative plans that are supposed to increase and enhance healthcare delivery within rural areas. So in our county, for our county, I know that Glens Falls Hospital and Hudson Headwaters collaborated together to submit an application. And also Healthy Alliance, who also holds the 1115 waiver for our area. Those are the two applications that I know of that were submitted for our county. In addition, that's considered a planning program. In addition to that, there was opportunities to submit implementation project. And that can be for multiple counties within one application. That's $3 million that would be awarded to submit an implementation project. So how are you going to implement whatever you're planning? So I did sign a letter of support for the Hudson-Cadwaters and the Glens Falls Hospital application. Theirs was really focusing on OB and maternity services to expand those services within our rural communities. Healthy Alliance, like I said, also applied for the funding. Theirs was focusing more on the social care networks and the social determinants of health and tying those in to health care. So it was more of an FYI. We will not receive the funding directly, but we will be collaborating with the partners depending on who the state The grant period starts September 1st. It's very quick for the first year. It's September 1st through June 30th that they have to spend this money, the $500,000 and the 3 million they submitted for multiple counties. So it's more just letting you know that it's out there. You'll probably hear more about it, and I could definitely keep you updated. I have not seen their detailed applications. that they submitted, it's probably something that would be released after the state decides who they're gonna award the money to. The state did say that if multiple entities submit applications, they would encourage them to collaborate and work together. So I don't know what the outcome will be of the applications, but we should hear soon because the contract period is supposed to start September 1st. So I will keep you updated on that. But again, we hopefully will be involved and have a table for that, for the planning and the implementation. Any questions on that?

Great question. Lens Falls Hospital slash Albany Med.

Yes, I'm sure that they were part of it. But the Lens Falls Hospital slash Albany Med, yes, and Hudson Headwaters, they did a joint application together. Okay. The second thing, again, this is more for your information. We do have a significant wait list for our early intervention services, which is our zero to three-year-olds within the county. This is not unique to our county. This is across the state. It's been an ongoing issue, but I just wanted to make sure that you were aware. We do currently have 34 children that are on the wait list for services. And when I say services, I mean it could be speech therapy, occupational therapy, physical therapy, or special instruction. And kids could be waiting for multiple services. They could need speech at the same time they need occupational therapy. So that is an unduplicated count. There's 34 children that are waiting. The wait times, we have 19 that have been waiting zero to three months. We have 11 that have been waiting three to six months. We have 12 that are over six months waiting. And we have one that's been waiting for over a year. And again, the state is aware of this. The early intervention providers, they actually contract with New York State. They are not directly contracted with the county. We do pay for those services after Medicaid and insurance. It comes out of our escrow account. And then we do get 50% back on those. But we're being told that it's a lack of providers as well as because of low reimbursement rates. And those reimbursement rates are set by New York State. They did receive a 5% increase last year. But again, it did not get them up to where they could be if they were working for the hospital or not providing some other than early intervention services. So again, just an FYI, in case you hear that in the community, that my child's been waiting months for services. We are aware and we've worked very hard to try to get more providers to work in our county. But again, it's not something fiscally they can do right now until those rates are increased.

So just- Doesn't that have a cascading impact though? I mean, eventually it's going to lead into CPSC. Exactly. These kids are going to be. Behind. Way behind, which is going to go further into school. I'm thinking back to my, my own son had all four of these services. He was getting nine a week. He was getting nine appointments a week and just given the expectation of what's expected as a child is supposed to develop, even with those nine appointments, he was falling at least initially further and further behind. Does the state have any plan of either raising the rates or is there partnerships with some of the private entities that can be done? I mean, I realize I'm on soapbox here, but this is quite frankly, I know we have nothing to do with it. That's unacceptable.

It is. And there has been a lot of advocacy at the state to get these rates increased. The other piece here is the state did transition to a new program Documenting system a new software system for the early intervention providers, and it did not roll out well It was very frustrating for providers to get their information in there to get paid timely Even the 5% reimbursement that are the 5% increase that passed Last budget state fiscal year. Yeah, and they just received it like a month or two months ago. Yeah, they just received it so Even that, there was huge delay at the state, even though it was approved last state fiscal year.

We wouldn't expect any less from our state.

It's frustrating. It's frustrating to be a provider and be providing these services and not getting the reimbursement that you should get.

So if things were all right, is there enough providers to actually provide the services that are required on a large basis?

No, not right now.

But that's also a problem. It's not just the providers.

do it right give you more money but you can't get them in your clinics no matter what it is right so some more money so i guess the point i'm trying to make is money's not just correct problem right it will help it'll help you it will help maybe more people go into that field right and there also has been a push at like the the university level the college level to you know for to serve these this age group the zero to three um You know, and it is a more difficult age group to serve for the, you know, for these types of services. So that's another thing that they're advocating for, you know, at the college level.

Why is the one out so long? Special means that the one kid that's over a year?

We don't have the OOP flyer.

Is there any way, like the zero to three months, three to six months, that would be wrapped into the Lens Floss Hospital when we run HHNS aftercare? Could they wrap that into that and serve that group of infants? It's a possibility.

I know Lens Floss Hospital does have providers. And again, some of these children, this is children that are waiting for services in the home. Is that correct, Fran?

Right.

So they could possibly be able to go to a center-based, but it's a matter of transporting, and they're little, zero to three years old, and to get them into a center might not be the best setting for the child when they could be getting the services at home if those providers were available.

It's going to increase in centers. Right, because they can provide group therapy, so they can provide therapy for multiple kids at one time, so we have to need to increase in that, but there's only so many agencies that can provide that service, so they're also doing PTSD as well.

Right, right. And as Dan mentioned, it does have that cascading effect to get these kids ready where they need to be.

How many are we able to service at 34 on the wait list. We are serving.

We are. So right now, we have 138 in early intervention. Yeah. And that includes these 34 that are waiting.

And we have 35 individual providers that serve Washington United.

Across the disciplines. Across the different, yeah. And we have several service coordinators on staff, and they do an amazing job. Every Friday, they send the waitlist out to all the providers that are contracted with the state to provide services in our county and say, is there any way you can pick up another child or see this child? So we are actively working to try to get the waitlist down, but just not picking them up to provide services.

Are some of these children also participating in Head Start too? Early Head Start, yes.

Is that an opportunity to get into an area?

Yeah. You could grab people from the wait list.

As a discussion, you'd have to have that type of provider on the, on the van, you know what I mean? You're not a boss. Speech therapists are an occupation we invest.

Yeah.

Any more questions or comments on this?

The next thing I have is a resolution request for WIPs. We'd like to request a WIC budget modification to move 2,500 from the equipment line to the office supply line. We had some equipment come in under the equipment threshold that we had originally budgeted in the equipment line. So we just purchased, we had to purchase those out of the office supply other line. So we just want to move that money down into the correct line.

Move to finance for a second. Second by Mr. Erd. Any questions, discussion? All in favor, aye. Aye.

Opposed? And I do have a couple of program updates. One is actually a request that came in after the agenda was due. So right now, we contract Durand Transportation to provide transportation. They could provide transportation to an early-adventure kiddo or preschool, which is the three to five. Back in May, I came to you requesting an increase in their transportation rates by 2%, which is contractually what we're obligated to increase their rates by based on the CPI index. So the CPI index was actually over the 2%. So we have our contract limits at 2% each year. So they were granted the 2% increase, which would have started September 1st of this year. So since then, we've received a request from Durham to increase their rates by 3.5% versus the 2% that's the maximum within our contract. Increasing the rates by 3.5% would increase the net expense to the county by about $13,000 as compared to the $9,600 that would have been the increase of the 2%. We do have sufficient funding within the 2026 budget to cover a 3.5% increase if it's approved here. So I wanted to bring it here for discussion and to see if we would approve the 3.5% increase versus the 2%, which is what's in our contract. Durham has been our vendor for many years for transportation, and they are really the only game in town. for transportation, for transporting our kids to center-based programs. So I know other counties, and I know we might want to compare ourselves to other counties, but other counties did increase them by the 3.5%. So that's why they were reaching out to us to see if we would, I don't know, if we would need a contract amendment or how we would do that based on the contract, or if it would just have to be here. But we do get 59.5% back on transportation expenses. So when I say $13,000, that is net of that revenue. That does include the revenue offset for the increase. That's the net then? Yes, the $13,000.

So this original contract expires when?

So we are in our September 1st. We'll start our last contract year during. So next year, probably March or April, we'll be going out to bid for transportation.

Is this something they've done in the past, coming for an increase in the contract?

So every spring, we look at the CPI increase. And if it's above 2%, we limit them at the 2% increase. If it's less than 2%, they don't get, no. If it goes down, the CPI increase, we have had years that they've had no increase because the CPI had gone down. But their max has always been 2%. I believe we're in a five-year contract period. going into our last year.

I think you need a resolution here proving the increase, and you'd also need a contract. But one minute to this year, this coming year.

In the past, they have requested increases for individual cases. So if they're transporting a child far out of the area to a certain center-based facility, then they have come back and said, this one is a unique case. We're transporting you a further distance. It's taking a lot of time. The driver's waiting. We have done off individual cases where we've increased. During COVID, we did give them an increase during COVID that was based on what was going on during COVID.

So I just want to clarify. So you said we did the 2%. It would have been approximately $9,000. is $13,000. So really, it's only a $4,000 increase, and we're going to be reimbursed 59% of that, so it's... Oh, she's already done that. That's already there?

That's about $3,500. $3,400.

I just wanted to get that, because we're out on a bigger number, so it's $3,500. It would be an additional increase. Yes.

What is our mileage rate that we're increasing to reduce? What is the charge?

So we pay grandparents that. We pay them extra.

Yeah, so we pay currently right now, we pay them $71.60 round trip for our kiddo. And then if there's a situation where our child needs an aid, that really increases the rates, and that has to be in their IEP. That's $223 round trip. So there's different rates, yeah, depending on the wheelchair that also, there's another right to that as well.

So their whole contract was about a million dollars. Just to make them, move them back beyond.

Well, they have 38 kiddos that we transport.

I was using the numbers up.

They get a million dollars.

So they come in under a million dollars.

usually around $700,000.

That's our cost.

That's our cost.

So it says $1.5 million. Or $1.2 million. We're getting 56%.

No, I'm sorry. $700,000 is our question line. That's our net cost.

Gross.

Gross.

That's okay. And this is based on

a few numbers come September. We have kiddos that phase into kindergarten. So those numbers may change. And luckily, we have had a lot of parent transfers. So we do pay them the 16 cents, not 3%. It really helped our cost.

Yeah, really brought it down.

And we do encourage our service coordinators you know, we do let them know, you know, if you're transferred, you will get reimbursed. So they are, you know, they're aware of that. They know that that's an option that they could transfer.

And the other thing is we're going to come to negotiate with a new contract. So it's hard to select the person you're going to negotiate with.

Yeah, that's what I was going to say, that, you know, just even though you'd have to honor the contract they have now, for the new one, it may be more difficult to get a contract if they're the only provider.

They are the only provider.

You don't even have to sign it.

But right now, who knows what will come spring. But right now, we're not aware of any of that.

Probably that $3,500 doesn't even come close to their cost of fuel jumps. But what is the flavor of the committee here? What do you want to do?

I'll move to the Finance Committee.

And we have a motion to finance. I have a second. Mr. Giles?

Do we need two motions, Dan, or do we just need... No, I think you can just move this to resolution. The contract's kind of a separate thing.

A motion to go into the 3.5%, moving it to finance. Any more discussion, questions, opinions? Mr. Treasurer.

Chairman, just a procedural thing. If Mr. Hoda can jump in and Would there be no budget impact? It may be able to come right out of this committee to the floor. I don't know. Do you have to go through finance on this? If you needed a budget amendment to make it happen, you would go to finance. But this one might be able to go right to the floor. I'm just moving the funds back to the floor.

I'm withdrawing my motion to move it to the finance committee. Do you like the motion to move it here?

Does the second agree with that? Yes. He agrees with that. Okay. Again, any more questions or discussion on it? All in favor, aye. Aye. Opposed?

Aye.

Chair. What? As much as I hate to ask this question out loud, because we're trying to downsize and right-size the county, but when you look at the cost of an outside provider like there, have we ever looked at what it would look like to internally provide the services? Would the county, can the county provide the service cheaper I know a lot of times we're all about get the outside vendor and not get, you know, not get the personnel and the frames and the retirement, all that. But with $700,000 at safety, have we ever looked at what it would look like if we transported those 35 kiddos? Have we ever, like, at least looked at what that model would look like?

No, not that I'm aware of. We have not looked at that. I mean, you'd be looking at purchasing buses.

How many buses would we need? That type of stuff, yeah.

But again, with the dollars involved, it might just, I mean, it might not, it might be twice the cost to us. I don't know. I was just curious if we'd ever even looked at it.

Are you moving a group of kids all to the same place or do you got one kid going here and one kid there? You'd have to figure out the logistics on that one.

To move those 35 kiddos, they may only be using one or two buses. Alright, so That looks very different than, you know, Yeah.

And I don't want to open up a panel here, but there has been a push from the counties that have to pay for this transportation like us to have the schools be responsible for transporting. CBSE kids are technically part of the school district. They are part of that district. And sometimes you have the school might already be there picking up a sibling. So you have one kiddo going on one bus and another one going on a... So that's been up for discussion for a while. There's been analysis done that it would be a huge cost savings. We would still be responsible...

Cost savings to us.

Right.

would the schools be able to do it cheap enough still heading the taxpayers to the county? Right.

So we partner with them. We can partner with them if they're going to sit on it at the same time.

So we would still be fiscally responsible. Yeah. I mean, that's in regulation, but we wouldn't probably. And now since it's been done, it would be a cost savings to the county.

But even if it wasn't a cost savings to the county, you'd much rather give it to your old school districts that are within the county than give it to an outside one, to be honest.

So there has been a big push for that.

Does that take getting school administrators together and sitting down with you guys? Is that a big ask?

Well, it could be because at the end of the day, a CPSC program is parents' choice and where they best may be, as it turned out. When my son was in the program, the best program for him was at Ballard Road. We drove him down every day, and I think Durham brought him up to daycare afterwards. So you've got to make sure that there's not going to be limitations on choice for a parent to choose the best program for their child.

So where would we start to investigate that? What would be your recommendations to how to

I think that you would kind of have to dive into what kind of fleet are you talking? Is it one buses, three buses? The amount of buses obviously is a huge factor. And then what that personnel would look like, not only while they're here, but even legacy, right? We have to remember some of us are lucky enough to be retiring soon. And there are legacy costs there. As you start this program, eventually there will be legacy costs as well. So again, I hate to ask because we're trying to right-size the government now, but sometimes we can do it better. We've always had the mindset that to let somebody else do it, that's not always the best way.

We were partnered with the schools.

No, that's a game changer. You might not have invested so much in the bus. Well, even if the partnership was the asset, the bus is a heavy lift. So even if the partnership was the asset and we provided the personnel, that might be a game changer.

Well, we have to pay anyway. So they provide their own area, bus drivers and buses.

Even if we had to provide the personnel, the asset is a really huge cost. The person where I need the help.

And it's been running for a few years now. And for the veterans, disabled access.

Yeah, they have to be utilized.

But I think we've got it for like 79 grand, though. They weren't.

Right. We don't cost them. We know what it is. We buy on all that. We

We have that. It's not like a quarter million dollars. It's reasonable. We're not talking the big yellow school buses, right? That's not showing the bus. Right.

It's smiley.

Yeah, the transport vans I have, they max out at about 13,000 a piece.

And you'd probably never be able to be fully modified. I'm sure you've seen them.

They use the old school buses that get turned up.

Is there a point that we ever fill that small bus? No. So again, it would be an acceptable replacement.

Because if you're $79,000 a bus, even if you needed three buses, and I don't know what the personnel would look like, you'd probably get a three or four hour staff. What would those numbers look like versus the $700,000 with no end in sight. I mean, let's face it, Barron is a for-profit business. They're not going to come to you in 27 with reduced rates. In 28, they're not going to come to you with reduced rates. So where's that tipping point that maybe we should be looking at? At least what the dollars are. It might not make any sense at all. Yeah, I got to think first.

How many school districts in the county have these kids?

I was going to say, going to schools as of now where they're not mandated to have the electric bus, it may be cheaper, but it may jump up much more if they have to run the electric buses where we don't have that restriction as we speak.

Sam, how can some of these rural districts ever run an electric bus when the electrical system isn't where the grid is?

I agree with you. We've seen the states do crazier things than they did stuff they put down there. So we're trying to fight without it.

There's a time where you draw the line.

That's right. Well, I understand that. We tried. We weren't too successful with that yet.

No, no, it's good discussion. We're looking to think out of the box all the time here.

Yeah, it's definitely something we have to take a look at.

Especially if we were tied with the schools and you see them Well, I see him because I'm not sitting in an office, but I see the buses, school, and they're moving all the time.

All hours of the day. Yep.

So, did we end it? Does it have to go to the full board? No, it just approved it.

You just got to get a contract. You probably need a resolution for the chairman to sign the contract amendment.

Yes. Second. Second for Chairman to sign a contract amendment. All in favor aye. Aye. Opposed?

So the last thing I wanted to just discuss, I'm sure you've seen in the media. And we did do a press release on it. We have seen an increase in the number of animals that have been testing positive for rabies. We have three specimens test positive in a week, which is high for us. We had two raccoons and one bat. So, so far this year, we've sent 37 specimens to be tested in early in July. And just as a note of reference, last year, we sent a total of 42 for the whole year. So out of those 37, we've had four that have come back positive for the whole year for this year so far. We've had two raccoons and two bats. So I just wanted to, if you had any questions or want to discuss that, I'm sure you saw the press release that went out. We did that in conjunction with Public Safety. And it's more of an FYI that it's out there. So we have been getting an increase in calls in our department with people with questions, things like that, which is great. We love to educate people and let them know how to handle certain situations. So our next rabies clinic is scheduled for September 12th in Fordham. And again, that's a free clinic. So we encourage people to get signed up for those if they need it. Any other questions for me?

Okay.

Thank you.

Hey, is there any other business? I don't... I don't know if the committee would like to, but I see Robert's sitting here. We have an update on our ongoing with the state. Where are we at?

I think to date, our charters are running for the 730 competency restoration expenses. I think we're running at $393,000 for June. $393,000. And we have budgeted $500,000. I did hold that meeting, the other meeting with the chairman, district attorney, public defender, several of the supervisors there, also there, and basically the outcome was the chairman wants to send a letter, and I think he's going to ask them to come through the audit committee. The audit committee sends correspondence to the Office of Mental Health requesting more detail on the expenses.

Are we still in arrears on last year? Yeah, the total arrears between last year and this year are around 70. Were we going to try to ask just because of our frustration level that we would that they would refigure that at the lower rates of some of the other facilities since it seemed like our people were going to the highest rate facility all the time. Was that, I thought that was some of the discussion.

I think that was part of the discussion. I'm not sure if that's the ultimate, what's going to go into the correspondence.

That's part of the discussion. Basically, we're looking at an itemized bill to see what was actually restoration expenses and what was stuff outside of restoration. For those I recall, I don't think the The state was sounding too keen on going with the lower rate, saying that the higher rate was the one in place at the time of service. We'll see.

Okay. Rob, didn't you say that you thought the rates for the upcoming year had changed?

The rates change every year. They send out a rate sheet. Sometimes they go up a little bit, sometimes they go down a little bit. So I haven't anticipated it yet. raise, we'll keep changing, but it's hard to protect us.

We just, I asked us, we just hadn't heard as a committee where we were at, and I knew that you guys had meetings. At some point in time, we're going to have to figure something out. At $300,000 some thousand, we're probably going to blow through what our budget is. That's usually the case.

Did they discuss at the meeting whether they considered going to the mental health court?

I don't think that was discussed.

It would seem like that would be part of the conversation. I didn't hear what you asked, Sue. I asked if they talked about looking at the mental health court.

I think it's really two different issues because A mental health court is somebody who's competent and makes a decision that agrees to go through a specialized court. Somebody who's questioned about the competency, everything stops in terms of the legal process until that issue of are they competent to even enter into an agreement for a plea to allow. So the competency question is answered separate issue. It came in or into any agreements. You're actually in charges between DAL and separate court.

Chair Hunt. Yeah. Rob, who would the advocacy have to be to for us to start asking for things like caps? So it's, and again, I'm not a health professional. We just say that on the record. but it seems to me like within 90 or 120 days, you kind of know, right? I mean, it seems to me like there should be a point where these restorative charges become more mental health programmatical and more in your vein, right? The services that we're already paying your contractors for, right? It seems at some point during this restorative process, You know that it's not restorative, but it's more treatmental put in a restorative center.

It's sort of built in, at least in the penal law. Rob can correct me if I'm wrong. If it's a misdemeanor level offense, that's pretty much what happens. They're sent to a facility for up to 90 days and the charges are dismissed. Sure. Where it's when we have the more serious charges, the felonies, that it could go on at infinitum.

But it seems like there still could be a legitimate cap.

Because they committed a more serious crime doesn't mean they have any less sake. I think, unfortunately, they may have to construct a system somewhat similar to civil confinements for sex offenders. That's really the one system where you have to go through a jury trial and say, this person has a condition that they aren't safe in the community and they are hereby still confined until such time as their status may change. There's not per se, pure mental health, similar system. And you could, and I'm just thinking a lot of that could Send some people down a slippery slope, perhaps.

It just seems like for the 57 counties, there's got to be a way to stop the blank check. It literally is a blank check.

I don't disagree with you. I just don't know that there is a structure in place similar to that at this point. That may be incumbent upon the state in some way, shape, or form.

There are two bills that have passed both houses of the legislature awaiting governor's signature. One is form a work group to focus on reform, but the other one is a little more focused and does have specific, I believe there is a timeline in there where they, one of the first things they ask is for the examiners to state an opinion about whether the person is restable. And then there is a cap We were advocating for 90 days, but I think it got moved out to 120 or something, but I think there is a cap in proposed legislation. That would be a great start, right? I mean, my statewide association has been very focused on this and then worked with NYSAC on it. I know companies all across New York state are dealing with this. So there has been a lot of advocacy in terms of that. Point of advocacy was your question. She signs those legislation.

One of the frustrating things is this is all state-run facilities. And you would think that Warren, Washington, Essex, Saratoga, everybody could get together and we could utilize MSTAC there and set up a facility and run it at a lot lower cost and provide the same services. But the state will probably shoot that down no matter what. Sue, you agree?

Yeah. I think that Dan brought up a good point about sexual offenders. It's the story that nobody wants to talk about. Whether it's through developmental delays, and people don't understand the outcome from a sexual offense, or it's their own age, they don't understand the outcome for a sexual offense. Even the people within those two different organizations, they want to put blinders on regarding how this works. The ultimate person is the New York State DOC system that's filled with people from both of those systems at the higher level. And it's usually sexual offenders. And then they come back, because they might be given a sentence of four years or five years. They come out. They are looked at for New York State parole. So they're usually around three months. And then they go back in. They serve their time for a year. They come back out. and they do their three months again, and then they go back in, and really that original sentence, it's really a lifetime sentence, which is what you're talking about at the end, is putting away for life, basically.

That would be not the hope in that situation.

That's exactly what you just said.

I know, I said it potentially could be.

So whether we deal with a problem through OMH or developmental delayed, and think about these people that don't have the capabilities And our expectation is that they should be able to maintain themselves. They're getting disability checks. And they've been told by everybody that the expectation is they can't do this until we start recognizing that. We're faced with a system of people just going in and out. They're at the door. They're at Emden House. They're in there . That's causing chaos. It's a crazy system right now. That's one of the good effects. But that's my personal opinion.

We have the attitude that everybody's fixable. I'm not sure everybody is fixable.

That word drives me crazy. Reformative drives me crazy. Who's going to put the criteria for reformative?

Anything? I'll thank you, Rob, for you.

Just one more comment would be the other thing that we're advocating for is a tiered system where there's consideration of outpatient restoration for some people who are still felony level, but the district attorney would have to agree that they're not at risk to the community, then they could be restored and that curriculum could be provided on a patient basis. And there are some, even within the felony category, some level of crimes that are not necessarily a danger to other people.

And then they would be possibly, some of our free trials are right in that vein? we would be able to work partner with that model, right?

There's several pretrial services and we had one or two cases where we ended up filing AOTs.

Yeah, there are other ways to try to manage that population. Again, this is where the attorney comes in and their association was opposed to some of the reforms for that reason. You know, when somebody's at a felony level and they're not competent, can be a risk to the community, public safety. So the district attorneys, you know, we're just as happy to see them, you know, in a facility somewhere, at least they're, you know, the community's safe. But we think that within that population, you could tease out some people that are a risk to them.

Sure.

Thank you.

Anybody have anything else for today? Thank you very much. Really?