Audit and Finance Committee (AFC) Transcript – 12/13/2022 Title: ATXN-1 (24hr) Channel: 1 - ATXN-1 Recorded On: 12/13/2022 6:00:00 AM Original Air Date: 12/13/2022 Transcript Generated by SnapStream ================================== Please note that the following transcript is for reference purposes and does not constitute the official record of actions taken during the meeting. For the official record of actions of the meeting, please refer to the Approved Minutes. [9:36:04 AM] ready for us to get started. Okay great. Well, good morning, everyone. I'm Alison alter and I am chair of the audit and finance committee. It is 9 36. And when I call this meeting to order on December 13th. We are going to have a council member tovo, Kelly and Fuentes, virtual with us this morning, and council member pool will not be in attendance. Council member harper-madison had wanted to attend for, the cold weather shelters, but is under the weather herself this morning, so will not be joining us even virtually, we are going to start with public communications. We have one speaker, Ms. Greenberg if you would like to come up here you'll have three minutes. Chair alter and members of the committee. My name is Betsy [9:37:04 AM] Greenberg, and I'm, a member of the ethics review commission. In July, the commission passed two resolutions. I attended your meeting in November and asked you to consider the resolutions and I am here today to ask again. The resolutions recommend changes to section 2-7 of the city code in particular the parts of the code that described what is required to be listed on the statement of financial interest as council members, one of your important responsibilities is making decisions about land use, and members of the public need to be assured that the mayor and council members do not have conflicts of interest. When making these decisions, so the purpose of the first resolution is to require that interests and real property be identified even when property is held by a corporation partnership or other entity in which the official owns a substantial interest as defined in the code. Currently the mayor and the council members have interests in limited partnerships. But [9:38:05 AM] there's no disclosure about what these entities own. So this code change would improve transparency. The second resolution would further improve transparency by requiring the city clerk to post to the city's website. The financial disclosure forms filed by elected officials as well as candidates for elected office. Currently the forms are available, but only with a public information request, which means it can take weeks to obtain information. I emailed this committee asking for the ethics review commission resolutions to be considered. I was ignored, so I came in person in November and again today. If you are in favor of transparency , please talk about putting these code changes on a future agenda when you talk about future agenda items today, I look forward to seeing you at your next meeting. Thank you. And especially thanks to, council member tovo for her many, many, many years of [9:39:05 AM] service. Thank you, Mr Greenberg. Okay, are. Next item is item number one the minutes. Do I have a motion to approve the minutes? Council member. Kelly makes that motion that's seconded by council member tovo all those in favor of approving the minutes that is unanimous on the diocesan, virtual dais. Thank you. We will now move to item number two, which is presentation and discussion of the cold weather shelters and hot weather cooling centers audit. Is the manager of this project, and he is actually online with us today because he's not feeling great. But Henry katima was the lead on this project and will be making the presentation this morning. Thank you. Good morning. My name [9:40:06 AM] is Henry katima and I was the lady auditor. For this audit. The objective of the audit was. Does the city effectively provide emergency shelters and sure its residents receive necessary services during cold weather and hit emergencies? This audit focused specifically in cold with a shelters and heat emergency cooling centers. We did not look at shelters for declared disasters like floods while the fire's winter storm or E hurricane evacuations, etcetera. We also did not look at homeless shelters and more shelters. The city established temperature thresholds and with us situations that trigger the need to activate cold weather shelters and heat emergency cooling centers. When the temperature is expected to be at or below 35 degrees, with the rain or high winds. Or any time [9:41:09 AM] the temperature is expected to be at or below 32 degrees, regardless. City staff are required to activate called weather shelters. This year over the cold weather shelters have been opened in pad recreation centers. When the national weather. When the national weather services issues and excessive heat warning advisory for Travis county city staff was supposed to activate cooling centers. The city mainly uses recreation centers, senior centers and libraries as cooling centers. First finding is that the city did not consistently opened cold weather shelters when the forecasted and observed temperatures made the established hold with sheltering. Thresholds. As a result. Vulnerable residents may have faced increased risks. From freezing and sub freezing temperatures. From January [9:42:10 AM] through March, 2022. The city opened called with shelters on 17 nights. However. We found that there were at least four additional nights that has shown on this slide. In which the city should have opened shelters but did not. On two of these nights, January 3rd and for about 27. The forecasted observed temperatures were in the twenties. This was well below the city's established cold weather triggers. We did not identify similar issues with the city's heat emergency cooling centers. I was second finding real released oversight provided by the city. The city is called whether shelters and extreme heat cooling centers. Activities include multiple departments. Like homeland security and emergency management. Pard. A P H a. P D on the Austin public [9:43:11 AM] library. We found that there were there was not sufficient oversight. Over the cold weather shelters and extreme hit calling center activities. We saw this in different ways that I will talk about in the next few slides. The first one. The city's plans are outdated and do not reflect current shelter operations and responsibilities. Both the cold weather, shelter operations plan and a special operations plan for heat emergencies are supposed to be reviewed and updated annually. But this has not been done consistently. The code with a plan was last updated in 2019, and the special operations planned for heat emergencies was last updated in 2020. Since that time, many changes to the operations were made in response [9:44:12 AM] to the pandemic. For example. Before the pandemic, the city relied on multiple external partners like American red cross , local nonprofit organizations and faith based groups run registration sites and provide shoulder space stuffing and supplies. Due to the pandemic. Many of these entities have reassessed their commitment to the city. As a result. City departments and staff have changed their operations to feel these gaps. All these changes are not reflected in the current plans. Second one. There is no process to ensure shelters are adequately stuffed. While the plans indicate that external partners will provide staff for the shelters these shelters have primarily been staffed by part employees and volunteers from other city departments. Staff [9:45:14 AM] stated that it has been difficult to get enough volunteers and shelters often lack security and mental health professionals. There is no clear process to request for volunteers from the departments. Also the cold weather shelter plan does not assign the responsibility for staffing of these shelters. There is no process to ensure shelter staff appropriate train. We found that there is no person or department responsible for training staff to work at the city's shelters. Without proper training employees may not always be equipped to handle the complexities of working with shows a guests, including people experiencing homelessness. This may pose a safety risk for shelter, guests and stuff. We surveyed staff who worked during a recent cold with a shelter event and founded that 57 of the [9:46:17 AM] respondents said they did not receive relevant training in adolescence. While some pads stuff indicated they received the training. They noted that the training was high level and did not cover the specifics of how to operate with a shelters. For example, they did not receive training on how to work with people experiencing mental health issues or how to perform various tasks like administering covid tests. 46 of the respondents indicated that they did not receive information about shelter procedures and how to perform their roles. Expenditures for cold weather, shelter operations and now consistently attract I will try to determine how much the city spends on cold way that shelters but could not because expenditures are not consistently tracked. Powered and a ph have their own [9:47:17 AM] dedicated budget holds the weather shelters. Municipal court would only provide some expenses. Police tracked the expenditures but did not appreciate between types or shelter activities. Hurricane evacuation competitive all with the shelters. Without career tracking. The city can't determine the costs for operating called with the shelters and may find it hard to budget for future expenses. Current shelters are not equipped for extenuating circumstances. As noted before the city relies on part facilities provide hold with a sheltering. However. These five facilities may not be appropriate shelters for extenuating and circumstances. For example, not all party facilities have backup generators show us. In the event [9:48:18 AM] of a power outage or prolong the need for sheltering like the weather tans and stays all following expected longer times than expected. The plants don't say what should be done. What this issue does not affect polling centers. The plan says there could be a need for an overnight pulling shelter. In the event of an overnight pulling shelter. The lack of resilience. Could be an issue as well. The fiscal year 2023 budget included $1.2 million for Austin public health contract out the cold shelter with the operation. If a contractor is hired the city plans will still need to need to be updated. Management indicated that until the operations that contracted out the city still plans to respond as needed. The potential [9:49:19 AM] this potential change operation of the city's old with a shelters does not applied applied emergency cooling centers. We issued through recommendations to address the issues noted in this audit. The first one addresses issues relating to oversight and monitoring roles and responsibilities. Stopping the show social, the shelters. Training staff and consistency in opening the shelters. Management concurred with this recommendation. Implementation timeline is December 2022 through February, 2023. The second recommendation relates to ensuring that all plans out updated. Again management concurred with this recommendation. Implementation timeline is October 2023. The third one relates to services that should be provided at the [9:50:20 AM] shelters and ensuring that city has provisions for extenuating circumstances. Once again management concurred with this recommendation and implementation timeline is October. 2023 for always, sort of plans. This act. Concludes my presentation and we will be happy to answer any questions. That you may have. Thank you. I believe we have a presentation from staff in response to the audit before we take questions. Good morning. Good morning. My protein and committee members. Veronica bresciano, assistant city manager. We have a multiple departments here to respond, but we're going to have one or these are director of his, walk through the presentation, and then we'll be available to answer questions as their wise. Thank you one. Good morning [9:51:23 AM] council member. Are these? The director for his, and I'll be walking us through the, the response to the emergency shelter. Dangerous temperatures audit. Before we specifically covered the, our response to the recommendations of one of the things that we wanted to point out specifically is that there are two different types of shelters, one that we call the cold weather shelter would just primarily serving individuals are there are on house and it's intended to be an overnight of, situation where the temperatures are that meets specific criteria, and we want to make sure that people have a warm place to stay overnight safe place. And then, in the morning generally open ah, for the folks [9:52:25 AM] who, you know if, if necessary be able to access other city facilities like public libraries or parks and recreation department facilities. The other is the emergency disaster shelters. This is a disaster shelter that is open when we actually have a disaster. This impact in the community and it serves to take care of the population when that is displaced from their homes. And we where we have widespread emergency, and that is really more something happened at the event of a disaster where we may have very little to no warning in advance or as part of the response process after we have a disaster and the duration and the locations are determined. Based on what the disaster. Assessment is that is determined [9:53:25 AM] and where we identify the need and determine what the need is for the population, so the main difference is that cold weather shelters we can we can look at the temperatures we can. We can predict them and we know exactly which must be going to open. The emergency disaster shelters. It's really more of a response to an emergency situation. The recommendation to ensure that the city's cold weather shelters operations are affected effectively managed. The first one was assigned the overall ownership of the of the city's cold, whether shelter activities are often public health has has been, has the ownership of the co brother shelters because these are have the primary purpose to protect the unsheltered homeless and I primarily used by people experiencing homelessness doing extreme cold weather conditions . This is something that we are , proposal lamentation. Exactly December of 22 with this is in [9:54:27 AM] conjunction with the other efforts that are already underway. To look at how we can improve our response. And this, in this area of need to our community. Letter B, clarify and communicate the roles and responsibilities of each group and entity involved in the city's cold weather shelter activities. Ah these roles and responsibilities will be establishing, define and assign , with clear triggers and activation information because weather shelter plan will include city staff required to activate and run the these facilities as well as and an option for community partners and contractors to supplement called weather shelter turned shoe it clear and transparent process. As you all know, council authorized public health to negotiate and execute an agreement for $1.2 million with the contracted to operate cold weather shelters. Ah the city will rely on part facilities [9:55:28 AM] with hybrid city staff and contract vendor support to operate cold weather shelters doing the early part of this season. 2023 once the contractor began, us and vaginal evaluation will be needed to determine if the funding and the contract scope are properly aligned with proper programmatic goals to include fully outsourcing services to a turnkey vendor are proposed. Ah implementation of the of the entire process is February of 23. This will allow us to have the vendor in place and for them to shadow our efforts. If we have activations this year and be able to better determine what that gap analysis would be to make sure that the plans are set up accordingly. Let her see ensure cities. City operators shelters are adequately staff and that staff are properly trained. Several key departments and employees [9:56:29 AM] staff cold weather shelters, while other departments employees volunteered to work at cold weather shelters just needed staff at cold weather shelters should be individuals who have training or experience working with vulnerable populations, including people experiencing homelessness staff will continue to identify staff that meet minimal requirements as well as staff who are interested in supporting cold weather shelters went the need arises, city volunteers and contractors staff will receive training prior to step in cold weather shelters. Our implementation date is February 23 as well. Letter D ensure the city shelter related expenses are tracked. Response is a actually a reporting code has been established to help track staff, time and other expenses when co brother shelters are activated, and this task has been completed. Let her eat, [9:57:31 AM] implement a monitoring and accountability process to ensure that cold weather shelters are consistently open, according to establish whether conditions and events and that each group entity fulfills their assigned roles and responsibilities. Staff response for the upcoming cold weather season. Cold weather activation shall be determined primarily by us in public health, relying on data convened by he, some from the national weather service. The national weather service shall be the official weather's resource and the camp Mayberry. What weather station will be the official location? Used to determine cold weather shelter activations for people experiencing homelessness in future years. The cold weather shelter vendor may be charged with tracking the weather forecast and activating cobra shelters. Public health in conjunction with his, and other partner departments have already updated the cold weather. [9:58:32 AM] Shelter activation criteria to include consideration for windshield factors. All weather shelters serving people experiencing homelessness are activated when the following overnight temperatures thresholds thresholds are met. 32 degrees or below and dry or we have 35 degrees and below and wet. The key factor. There is whether we have precipitation in the forecast or not. In addition , 35 degrees with a wind chill factor that drops the temperature to 32 degrees or lower Austin public health in collaboration with his, will maintain a record of when cold weather shelters are open. Upper proximamente Shen is a date is January of 23. The next commendation is in order to recommendation number two in order to ensure that the city is cold weather, shelter operations plan and special operations plan for emergencies reflect current [9:59:32 AM] implementations operational resources and roles and responsibilities. The director of the office of homeland security and emergency management show work too. With applicable stakeholders to update the plant at the minimum . At the minimum, the plan should reflect the various entities currently involved in the city's cold weather, emergency shelter and heat emergencies operations and define their respective roles and responsibilities. Reflect the potential shelter facilities include their activation hierarchy. We can current this recommendation. He's some while he's conducts annual reviews of the cold weather shelter plans by November and special operations plan for heat emergencies in may, the reviews the reviews are annually and he's some recognizes that we need to improve the manner in which this has been documented that that the review has been conducted. The cold weather shelter operations plan will be [10:00:33 AM] updated by October, 23 with clear roles and responsibilities for partner departments and supporting agencies and factoring and the new vendor selected to provide cold weather services. The cold weather shelter plan will be updated with locations for potential shelter facilities to include an activation Harkey. That explains how the how and when each facility is activated, he said, will maintain the plan and will collaborate with public health, awesome public health and other involved departments to conduct annual reviews. He's and will update procedures to incorporate proper documentation of plan reviews and update once the third vendor contractor is on board. Are proposed implementation day. This will be October 23 in order to ensure that this also includes not only the cold weather shelters, but the special operations for heat emergencies as well. To ensure [10:01:33 AM] that the city effectively recommendation number three to ensure that the city effectively provides necessary services in the cold weather shelters. The city manager should determine which services will be provided. To shelter ease and have provisions for extenuating circumstances like power failures and extended length of stay. We concur. The cold weather shelter plan will identify the services provided in cold weather shelters. And include provisions for circumstances that might extend the extended length of states. Currently, cold weather shelters are designed to provide basic services overnight, a place to sleep access to toilets sinks. Not showers. Ltd meals and access to, charged electronic devices, including certain medical equipment. These services could expand overnight based on the vendors feature capabilities. The city will convene a group to establish [10:02:34 AM] protocols between stakeholder departments and community partners for scenarios involving extended length of stay and overflow contingencies. The city will assess the additional resources needed for such and, event including using emergency contract and on city resources to supplement what the city can provide. All city facilities have continually plans in the event of an emergency power failure at their facilities or city facilities that may serve as a cold weather shelter. A gap analysis will be perform staff will identify potential mitigation projects that will further hardened city facilities to include incorporating the city's climate resiliency and adaptation plan for city assets and operations and the city's resiliency strategy currently in development to increase resiliency in city owned facilities. And improve our ability to respond in an [10:03:35 AM] emergency. Are proposed implement implementation date is set out October 23rd. Excuse me, October of 2023. That's the end of the recommendations and staff is here in in to answer any questions. Thank you, Mr tease colleagues who have questions council member tovo and then cancel number of points. I have quite a few, so I'll ask a few and then maybe you can come back around. Okay on the second tier . Thank you, director artist for the response. I'm not sure. That I'm understanding how we got to this position, though, where one of our very trusted partners doesn't appear to be involved in the in the staffing. And you know, I see page 12. That you conduct reviews every year to plan for the cold weather, but it would seem like at that point it became clear. That you weren't going to get the [10:04:35 AM] volunteers that you needed from that external organization, so I have a have a variety of questions related to that, let's start with I guess whatever did you interview the American red cross for this audit? Yes, council members we did. And so. You know, I had back when we were doing the audit of the winter storm response. Someone who has been a volunteer for a long time. Emergency operations mentioned that some of the meetings that typically take place with the city to plan for these kinds of events hadn't been happening as regularly as they had in the past. Did you? Did you talk with the American red cross about whether those planning efforts were going on as scheduled? No. We did not discuss that. Did they? Did they [10:05:36 AM] indicate what their communication had been like with the city? As far as. I mean, did they did they let the city know clearly that they were not going? I'm sorry. I can't remember. Tovo if you're coming in and out was that question addressed to Henry or to myself. I think we might have lost her. Council. Manitoba, are you there? I'm going to suggest that we go on to council member point will come back to that. Thank you and director Ortiz. Can you afford us? Your power point that you just presented? I don't see it on the on the online web page. I didn't see it in the email in the backup. I want to make sure I have that to cross reference. You colleagues. I want to draw your attention to the fact that during the budget this year's budget process, we [10:06:37 AM] passed an amendment a budget writer. Excuse me, a budget writer that I brought forward that was centered around our cold weather shelter plan and specifically asked for an update from the city manager to provide to counsel with the initial status report of the emergency shelter plan. In that direction , what we asked, and it was built upon another item resolution. That council passed back in July. 28 July 28 2022. The budget writer that we passed , asked for a plan to include community input that should be informed by frontline volunteers with the experience and outreach and response efforts and also asked the manager to increase the availability of shelters outside of city owned facilities by exploring community partnerships. And also, you know, I'm not gonna read it verbatim. But it also asked for the training piece to also be incorporated. So that budget writer asked for an update to the emergency shelter response [10:07:38 AM] plan by November 1st of this year. We obviously didn't get it. And in this audit report, we're finding that we still don't have an update that's ready to go. In fact, the implementation date of and I'm happy to see some progress at least knowing that Austin public health will be in charge of activating the shelters, but it's still says implementation. January 2023. I'm concerned that in January February will have some extreme weather events. As history has shown thank you for providing the dates of the of last year's extreme weather events when we did not have shelters. Do you want to punctuate that those dates were in January February of earlier this year? And so I'm just a little concerned as to how we got here with this report, and it seems like there's been not significant progress made. So director or these? Can you talk us through? And I don't know if this question is for you, or for, director stir up but based on the previous council [10:08:38 AM] resolution that was adopted in July, the budget rider that council also adopted that I asked for an emergency shelter response plan to be updated and provided ahead of this year's winter season. What? What were the contributing factors that that led to this delay? Well let me all start over the response and I'll ask my partners to, cover at any additional information that I meant. I mean, I have in front of me. I want to make sure that the council is aware that we are, we do have a cold weather shelter programming plex staff actually is meeting? And working in this effort and the record what the record what the audit found and recommendation number two is that we have inconsistent how we determine that how that review is conducted and documented. While the plan is reviewed. [10:09:39 AM] Sometimes it is not updated because staff feels that there really is no need to update it, but we are going to be making some changes in that procedure and to ensure that we document not only the plan update but also the review process. Oh, we also know that in the fy 23 budget process, there was funding that was made available for public health to go out and pursue a vendor. That process is still ongoing. And I can tell you that we met throughout the year leading up to this point to ensure that not only was there going to be a vendor in place, but also that we have a contingency in the event that the vendor was not ready to activate and staff is ready to activate all weather shelters at the locations that have been, identified. And we're ready to do that. In addition to that. [10:10:42 AM] Well as part of the winter storm Yuri audit and winter stirrup with some jury after action report staff has identified and pre stage shelter supplies and nine separate shelter locations to ensure not only do we have shelter supplies for hot weather's but also shelter supplies in the event that there was there was another disaster in any time of the year, and we can activate those facilities. And we're working to meet our goal of having a shelter location in every district, and expanding on that we are working with our, volunteer agencies that work in this, in this area like the American red cross and the awesome disaster relief that work just to mention two of several, but some of these agencies have, limitations as [10:11:44 AM] well. And some, and years past the American work, woz has has been a great partner in providing a supplies but not necessarily the staff for cold weather shelter activations, but they have been a partner and we're very grateful. For what they're doing, and other organizations are stepping up and we're adapting to the changes that the pandemic has required us to make. Director Adrian. Anything else that I might have missed. Good morning. Thank you. Director Ortiz. No I think you covered it quite well, Boston public health works on their standing standard operating procedures annually, and, admittedly, we need to do a better job of updating the written plan for the team does meet with community partners to make sure that we are ready for cold weather sheltering. That's [10:12:44 AM] why you see the updated recommendations to include wind chill factor. For the threshold , so we are constantly looking at the conditions and better ways to improve sheltering. We've met as a team internally to prepare for the solicitation that director Ortiz mentioned it was a group effort. We successfully rey able to have a vendor in place, and now it is a process with stakeholders to make sure that we're taking information that we heard from the community but also from our internal subject matter, experts to make sure that the scope of work reflects the level of services that our community has come to expect. And then also the plan that director Ortiz spoke about because with that solicitation, there's a cap on the number of individuals that the vendor will be able to serve , and we're working collectively to be able to when we get to person 201 that needs a place to [10:13:45 AM] stay during a cold weather shelter activation the city is planning to be able to stand up those additional resources. Thank you. I appreciate that feedback. I just have 11 further question. Based on this solicitation, the solicitation in the vendor well, that and I may have missed this, I guess in the presentation is that already in place or should there be a cold weather extreme weather event, let's say in two weeks from now that vendor is going to have people in place that are trained and ready to respond at our emergency shelters. We have a target date of contract execution for the end of this week. We have been in conversations with the vendor and, provided that these this last phase of negotiations go well. They are confident that they will be able to have the staffing in place. For any activations that take place. And also we, we do realize that [10:14:45 AM] there's going to be a little bit of a learning curve as we bring the new vendor on board and why we're giving a proposed implementation plan date is to allow us to capture those lessons learned and allow us the opportunity to modify the plan that we have in place today. To be able to adapt. What what the impacts are going to be from the , the vendor that was identified through this association. Also we have here on available is then a gray that may have some additional information to provide. Thank you, Juan. Council member Fuentes. I wanted to, to respond to one of the questions you asked, particularly about the direction that was given in late July regarding shelter planning, as you likely recall, that direction came accompanied, with. The approval of the emergency shelter contracts for the arch [10:15:46 AM] and southbridge shelters and so the direction. To the city manager was that we engage in an assessment of our overall sheltering system, not just cold for weather events. And come up with at least a vision for future activities in our system , so the direction and that sort of intent of this audit and that planning are certainly related, but they are separate efforts. We have already started the community engagement effort on that track, and we are working with technical assistance consultants provided by hud very closely with echo on that it will be a several month process because we do want to do it right and really think comprehensively about our system. The specific timeline that was communicated to us with the direction was that that [10:16:48 AM] assessment was to be complete before the emergency contracts for the art or south bridge where we competed, and so that is what we are targeting, and we'll continue to update council along the way. Thank you. Thank you, councilor Kelly and we'll go back to council member tovo and the night because I'm conscious thank you, man. Thank you so much for presenting this report to us today. I have a couple questions about ensuring that the expenses are properly tracked. I was just wondering, director Ortiz. What what? What did you all identify as the barrier? To ensuring that that was happening in the first place. Was it simply a coding issue because it sounded like during the presentation that you created a code specifically for tracking the expenses. I didn't know if there was anything else that was involved in that. Basically, that was it. It was a coding issue in, while individually, we might have been tracking some costs. We did not [10:17:49 AM] really have this ability as to what overall departments were tracking as far as cause. But this change, while it's a simple change. And honestly, I don't know why it didn't occur to us earlier, you know it will allow us to better track those costs of what departments actually spending in support of this of this of this mission that previously prior to this fiscal year was not was not budgeted in departments anywhere, so departments were basically taking it. Out of operating funds. But now, I think it's a lesson learned and I think the audit really shine the light the way it should, and, we're going to make that change, and I think it's gonna help us so we can better reported council. What we're spending in support of this mission. And I appreciate that explanation very much so because with the accurate [10:18:49 AM] tracking of the expenses it'll help counsel, especially during future budget sessions, really be able to go back and look and see where we want to put resources in the form of funding so that we can help support this. I think it's a really important goal to have counsel and involved in that. And then also just being good stewards of the taxpayer's money and making sure that we're spending as effectively and efficiently as possible. So that's all I had. Thank you. Before I go to council member tovo. So you've changed how you code it? Has there been any change to what happens? Safer part is getting next to no money. For this. But has to put a lot of resources into this. In this process. They they can. They can code it, but that doesn't really help them. I I think my coding it will allow us to identify what the costs are and be able to better, make recommendations for future [10:19:49 AM] budget. Years and be able to have a better idea. So what? What is necessary to budget for, and supported this this effort in future years? Okay I'm gonna ask that and prison you maybe you can help make this happen. That it says in your response that you're gonna allow for mitigation. Requests to happen during the budget. I would like us, you know, as part of our Q and a or information that we re received that we are very clearly told what requests for mitigation where made and which ones are granted in the budget. I'm not weather to being council budget Q and a but in some format so that it's very transparent to us in the budget. Process where there may be gaps in addressing their requests now that we will have the data of following this change. Absolutely we can certainly provide that. And to, to support what Juan is saying to be very [10:20:50 AM] clear. We are communicating with the departments that we will fund them and make sure they have the funding they need to provide the services. We're just trying to get a better idea of what that amount is two budget, but in the meantime absolutely any mitigation costs. We can certainly be transparent and share those with council. But will they be retro? So? So I just want to be clear what I was asking was, you know they're gonna track this and then they're going to say we need to cover these. Costs. We have had a history with respect to hasten, for instance, where they've been requests for things to be funded and they weren't funded and then we never knew those requests were there so we didn't know. About a particular need. And so what I'm saying is , I want to make sure that that need is very transparent better is if you fund it all and I don't have to know that there are any gaps. But I just want to be clear on that. But it still doesn't address what happens this year. If we have a lot of cold days again, as we've had in multiple years. Where you know part is using its facilities. It's using its staff. I mean, the clear lesson from this. You assigned it a ph. But the work is being done by part. In a lot [10:21:52 AM] of these cases, and they have limited resources that it is and now they're being asked to do all the sheltering with no accommodations for that, so they can continue with the rest of their so, yes, we will be transparent in those requests and I take a step further are discussing in a different way. And one mentioned this in his presentation, but early on in this year, we started meeting as across the city team. I guess we started those meetings and February of last year, maybe March and assistant city manager hidden. Howard has led that the effort that team of directors so that we can have these conversations this group meets regularly, believe they're meeting monthly. Is that correct? And having bringing those requests to the table, bringing those needs to the table so that we're very well aware and that we're not putting any of our departments in a position of not being able to staff or resource the needs that are that they're that they're seeing. We also in trying to look at our our strategy and [10:22:52 AM] updating our plans. We want to make sure that we are transparent and forthcoming on with those needs are absolutely thank you. Council member tovo if you're there. I am sorry about that. I wasn't able to hear the response. I don't want to take us backwards. So if this question got answered just let me know and I'll catch up on the tape. But I'm I'm super. I appreciate hearing about what's going to happen in the future, but it's not clear to me what's happened. You know what happened to create the situation that the audit discovered and it seems to me as others have mentioned the burden on the audit mentions. Really clearly, the burden on has fallen to the parks department to staff. These I'm really struck by the comments that individual parks department staff made about you know about the impact that that has had on them. I also I also understand that that means that those staff Ben needed to take time and. And hours away from their other key [10:23:55 AM] responsibilities because this is not been described as one of their key responsibilities as one of the employees who was quoted in the audit made really clear. I'm also concerned because we've had a multi decade relationship with the American red cross and I'm not clear. On on what the communication has been here, did they? And I was starting to say, and I'm not sure if you were able to hear me on this, but in the in the days after the winter storm when we were talking about the winter storm audit one individual who had been a volunteer for a long, long time indicated that their communication had really broken down. Prior to, the storm and that there were not the kind of regular meetings that had been happening in the past. So my question was to the auditor, and I'll catch up on that response on I do want to ask. Director Ortiz at what point did you realize in your pre planting in the fall? Did you realize that [10:24:55 AM] you are not going to have participation from the American red cross? In helping staff. These winter weather shelters. And what did you do next to make sure that they would be adequately staffed? Because I don't. I don't remember seeing any calls that went out to city staff generally to ask them, you know if they would be interested in signing up to be volunteers and receive that training. I don't remember seeing any any calls in the community, soliciting volunteers and you know, part of part of what? What I have observed in the last few years is you know, just, as potential I mean, we were looking at the gaps after they're occurring. But these are these are part of the work that that your department does stay in and day out to make sure that we're prepared for or emergencies, and I understand the pandemic was going on. But to what extent did you did you know that our traditional partner of multiple decades would not be able to staff and did you? Did you try to [10:25:56 AM] community? Recruit other community partners. Did you try to recruit other city staff? Council member tovo, just want to make sure that we're speaking about the same type of shelter. The audit was on cold weather shelters. And these are like I mentioned primarily persons that, on house population in our community, so they have a place to stay overnight. Traditionally the American red cross in this type of shelter. Has provided supplies. But has not provided. Staff. That is, what's that's that is my understanding. I heard you say that earlier director Ortiz. It was the audit . The audit was saying that some of the external partners that had in the past years were not able to provide volunteers. And so perhaps it's not. The [10:26:56 AM] American red cross at the audit was referring to. Perhaps they were referring to churches and things, and so if somebody apologize, but what would the plan says on page five and looking at that chart? The plan requirements were that nonprofit and faith based organizations are the primary shelter providers. And that went city facilities are used for cold weather shelters their staff by local nonprofits in the American red cross. So that's what I was referring to. It sounds like the plan in the past has been to stop them through the American red cross volunteers. And through nonprofits. I hear what you're saying that that's it sounds like maybe that hasn't been the practice, but. Could you could you help me understand that discrepancy? I hear what you're saying that they typically that the American red cross typically provides just materials, but the plan says clearly that they're staffed by the red cross and the local member nonprofits. If I may, council member tovo. Pre covid. [10:28:01 AM] The city had a good relationship with shelter providers, churches and faith based organizations who were really the frontline and helping us provide overnight shelter during the cold weather. Once the pandemic hit that changed everything, our shelter providers front steps you know, was one of the biggest players at the art because of the reduced capacity in the impacts on staffing. That's really what changed the dynamic the same with the houses of worship. People being afraid to put their congregants at risk in 2019 year old there wasn't a lot that we knew about covid. And then in subsequent years, you know people getting back to noted in the risks of being in, congregate. Shelter operations became very clear to folks and so now that we're past covid, we're at a stage where we are re engaging those partners. It's kind of like church attendance. [10:29:01 AM] Wright during covid. Everybody went online. Churches are open back now. And, you know, pastors are working hard to refill those seats because people are used to a different process in the dynamic, and so now it's really about re establishing those relationships with community partners. A ph. With help from H S D is going to work with the vendor to help. Create those relationships in communities so that we can have other facilities aside from part as well as, other volunteers who feel safe and comfortable. Training to once again support those efforts. So it really was that shift that happened with covid. That caused us to have a disruption in our volunteer base and access to community facilities. I think that makes a lot of sense to me. Thank you, director Stuart and I can understand that completely. What what is maybe relevant for [10:30:02 AM] future? For future preparedness is understanding. But the communication was like because clearly some of those you know that gap? It was something we could anticipate and so director rts, can you can you help us share how often your meeting with external partners or what? Your what? Your meeting and communication. With those external partners in the community to help to help understand what their capacity could be. In the future, because it seems like that, you know again, it seems like that is something certainly in the fall. That could have been anticipated since most of the churches were closed and another things power power, I guess. To look forward . How are you going to improve your communication with those external partners? To be sure that that you fully understand what their capacity could be and how that may be changing based on you know a myriad of factors. Kathryn merteuil a that that's really yes, and that's a really [10:31:03 AM] good question. And what we're doing is we're reengaging like director stirrup indicated with all of our partners, we are specifically directly meet with some of them in person. But my staff my team is meeting with them. Very much on a monthly basis in different facets. That too. Main agencies and the area of sheltering outside of cold weather. Sheltering as the American red cross and the awesome disaster relief network. And I specifically meet with them, on a 3 to 4 times a year in person to ensure that we are continuing on those efforts. That's in addition to additional , monthly meetings that are taking place in different subject areas. Just like ah! The volunteer agencies that [10:32:03 AM] supported whether sheltering we also saw that in the other disaster, remember agency disaster related tough to sheltering that some of these volunteer agencies, they're volunteers where high risk and they and so went to a, if you recall, we went to a non congregate show sheltering strategy that during hurricane Laura, we primarily, put those evacuees, from the coals in hotels. And that was not just Austin. It was a process state and really across the country, so now that we're coming out of the pandemic, we are re engaging and will be meeting with them. Had several meetings with them have even taken some of them and to tour some of our the new sheltering facilities that we have to ensure that we re establish those connections. But they are also going to need to build their volunteer force [10:33:04 AM] because they're suffering from that as well. And and we're here to help them to do just that. As one of the things that we had to do. We have to think outside of the box and we created the disaster reservist program to help alleviate some of those efforts. And thank you the council and fy 23 provided some funding that allows us some more flexibility in the city to be able to respond. To urgent situations, whether it's a sheltering or an apartment complex without water to be able to lessen the impact of those disasters. But I will tell you it's not the final solution. We really need those volunteer agencies to build their volunteer numbers up again so that we are as prepared as we possibly can be. That is going to be the challenge that just for Austin, but too many other cities across the country. Appreciate that response. Thank you, and you mentioned some [10:34:05 AM] subject areas. I hope that, meeting with integral care and others who are providing mental health support as part of that, because that will but that also runs through the audit as a as a primary need in all of these shelters. And my guess is that volunteers. Would be more likely to assist if they feel like they'll have somebody providing that level of care. Are you done with your questions? Yeah. I mean, if anybody on that call, and I don't know if that's director, stripper director rts or Diana, Greg and can let me know whether integral care is a and others are primary. Part of these conversations so that so that that support exists in the winter weather shelters. Council member. I would say that you know, and I think it is important and one of the complexities here is that we are [10:35:05 AM] for this. Looking back at the audience audit. We're looking at historical operations, and this year we are anticipating something of a hybrid model, right because we're just getting our vendor in place. But the rfp for the turnkey services for the vendor. Did include a request to have some behavioral health supports or an and or well trained frontline staff on site at the shelter, so that's certainly part of the conversation. And I will also say that, and I think as director stirrup referenced around the cold weather shelter we are prepared. We've been focused on on on, you know, getting to the point of executing the contract with this vendor, but we and other you know, parts of a ph. Excuse me participate regularly. There's a crisis committee and shelter committee within the homeless response system leadership [10:36:05 AM] council that were involved in and do anticipate stepping up to work arm in arm with the vendor to help kind of expand that network of community based support in the in the coming months and years. That's terrific. Thank you. So much for that response. So I want to go ahead really good. Kimberly Mcneely. I just wanted to add when we were talking about the funding issue that the parks and recreation department does receive $16,000 in funding and the primary expenses because we're house site. The primary expenses are the staffing in the utilities that are associated with that. But I do want everyone to know that our sister departments that are online here are also supporting those efforts. So what they're paying for caught. They're paying for blanket, and he sort of meals that might be served any sort of snacks. Security is paid for outside of the parks and recreation department, so I just wanted to give you assurances that while we're tracking our costs, there are other [10:37:06 AM] individuals, other individual departments that are absolutely supporting the effort just so that you had a clearer picture of expenses. Related to the proximal creation. Do you think that's $16,000 comes anywhere close to the costs? Of stopping. I mean, it's I don't know how many nights it was 21 days that were under cold. Yeah. So. I believe that those 21 days that we're talking about. We're also part of a emergency, a local emergency response. And when we have a local emergency response were able to recover our cross through feet, expenses in those such such things, so when we're talking about an emergency response, there's another funding source. On a typical for a typical year. Responses. I will run the numbers, but I believe that 16,000 is fairly sufficient, but I'll need to run the numbers just to make sure that I can confirm that when we have a longer elongated event, [10:38:07 AM] then there's another funding source that we're able to, to utilize after he's okay. I think it would be really helpful to get clarity. On those numbers because just running math of having the numbers of people overnight if they were not doing part of it just doesn't it doesn't ring. Like the right amount to me, so I would love to see those numbers. Mr up. You mentioned earlier. You spoke about the contract, that you're negotiating. I believe it's with the urban league to carry out. The cold weather shelter support . Can you clarify? No it's not signed yet. But when you anticipate that going into effect. The target date for execution is the 15th of this month. But acknowledging that the team internally is still refining the statement of work. And the vendor urban league hasn't had the opportunity to review yet. So we may need to [10:39:08 AM] build in some days where their review process but the goal is to have it executed by December, 15th. Okay, but we often have a contract executed and they don't start work until much later. I'm just trying to understand because we have the cold weather is coming in January and February. And what I'm not having a clear sense of given this contract is not totally in effect. Is, you know, will we be covered if there's cold weather in January and February and who's doing it? And what are the plans? So my understanding that at the moment of execution that they have been preparing and they will be in a position to provide staffing, support and security for three sites. And because we're working this hybrid model that my colleagues talked about earlier there still will be some city support with registration and the embarkation site and coordinating transportation. For guests in [10:40:09 AM] need, but as far as the staffing for the three locations and to provide security for the three locations they have indicated to me that they will be ready to go. Upon execution. If tonight we have to open up cold weather shelters. We are going to be implementing our plan that we have in place. So so either way, where wow, we. Moved on to ensure that we have a contract in place and plays, but we also have a back up. We continued our our planning efforts to make sure that we're ready in the event that there were any delays. Okay and under normal circumstances is three. The number of shelters that we've been having in place for the cold weather. Rights or is that ? Yes traditionally, the number had been less than 200 a guess. At these facilities are the three facilities actually have a [10:41:11 AM] capacity of 280. But the contract is talking about being able to serve 200. So there is built in capacity, it would end the three facilities, but it depends on what we what do we get right? A lot of males. A lot of females, a lot of, partners. So it's there's a combination, so we have a capacity of 280. But the contract is going to be serving primarily 2 200, then we have some continuous sense of place if we need to go beyond that. Okay I mean, part of what I'm struggling with is you know the audit says, you know, implementation of February 2023. A lot of the cold weather happens in January, and a lot of it happens in February, and we often get recommendations that say a month and then it's like the end of the month. So is this , you know, implementation by February 1st for rec one, I [10:42:13 AM] think was bnc or is it well, what would that specifically is talking about is we have an opportunity to have the vendor in place work with the vendor. And do a gap analysis and determine what additional modifications or changes to the plan needs to be made. And that's why we have that date there. Where that's not going to prevent us from activating. That's not going to prevent us from providing this service, but we wanna make sure that we have time to captured the changes and update the plans and then move forward as we go from there. Okay and speaking of updating the plans, I'm again. I'm still a little confused on that on the timing of what's happened the way the audit is written. It seems to suggest we have not updated the written plans since before covid, but it sounds like you've made all sorts of other changes. And so I'm I'm what [10:43:15 AM] we're making. It's not going to be updated until October of 23. I'm trying to understand what that means in practice because that recommendation also talks about the extreme heat. And that's going to happen until this next summer. And so we are going to look at what we need to do. To get ready for the summer months. And then right after that, there will be some changes on what we learn. And so we'll make those changes so the complete recommendation will be done by by the by October of 23 , but we're going to have different faces of completion as we as we had breath bowl as we address both cold weather sheltering, which is occurring now and, extreme heat conditions . Okay, so how's the plan been updated for the cold weather shelter? Yes it's being updated now and in fact, I'm expected sign in when I get back to the to the office and staff has been [10:44:15 AM] working to incorporate what we know. But we also recognize that when the vendor comes in place, that plan is going to require some changes. As we move forward. We do an annual review. What we failed to do is to have a way of notated that that review was taking place. But we have the meetings that that we held, and the work that staff did, but we just they we did. We didn't have a way of capturing that that review was actually taking place. Okay, so I think those are really important distinctions for us to understand, and I think that's confusing. Within the responses, to be able to. You know, I think what we're all trying to make sure that we have confidence going into this cold weather season that we're prepared and that we're ready. Knowing that your contract is not fully on board. Knowing that we've had problems in the past how we learned from that. And are we moving forward? Am I correct in your saying you feel like you you're ready and that you've [10:45:16 AM] learned from stuff and you've documented what you've learned. You're anticipating some revisions further as you implement with the vendor is that that is correct. And I think the fact that council but approved the budget to have a vendor that's gonna be a game changer and how we are able to meet this need in our community. And if I could just point out thank you, director Ortiz. I believe it was a Saturday, November 12. Where there was some cold weather that was being predicted. I know you're right to who's on the line and the team from H S D. He's him in Austin public health met that morning. To get the update from the national weather service and make a determination of whether or not we needed to stand up for cold weather shelter operation, so we have had some close calls already in in this season. Those snaps or south were already we're analyzing data. We are reading resources, and luckily [10:46:17 AM] we didn't have to make the call that day. To stand up resources so that active monitoring watching and planning is happening regardless of the status of the contract that we're hoping to have in place to kind of help, streamline and support services, so I don't want the impression to be that we're all standing still, until that contract is in place, or until these dates are realized. You're right. Cold weather is here and we are responding accordingly. Thank you, Mr Ortiz. If when you have signed that update, if you can share that with members of this committee, I think we'd all like to see what that with that plan is, last question before we move on, at least for me unless others have other questions. The memo that you responded with references, the council initiated and council funded resilience hub pilot program. Can you please confirm when the six locations will be announced if they've not been announced [10:47:17 AM] already, and by what date the locations will be ready. To be functional emergency disaster shelters is my understanding that they've only been selected. So if you could speak to that council members, are we talking about the resilience to help locations? Yes. I don't have I know that. Laura is working on the timeline to release Alan have a specific specific information do you have to get that will be operational. Well there's expected to be operational. This year, the in the next month as far as information centers and that and there'll be work that's going to be done to, to look at how that can be expanded as part of the pilot process. Apollo project process. What is an information center? Be able to provide information. Average really, I think Laura will be the better person that can answer that specific question. But I don't think we can get her here. And [10:48:19 AM] we are trying to save Laura can join us virtually. But if not, we can certainly follow up with your office with an update on the resiliency. I just think there's been some confusion and you know the end of your from the city manager and what's been communicated versus what's been communicated to us. In the joint subcommittee, where it seems like they've been identified, but they're not operational, and there's been no clarity about when they will. Be operational. Understand? You have the material that's been deposited and in several districts, but not yet in my district. For readiness, but, but the resilience hubs are separate from that that they're not, you know that they have simply been identified and not fully operational. That is correct. The, the emergency disaster shelter locations we have identified. Nine there have been prestaged with supplies and we are working to identify additional ones. To ensure that [10:49:21 AM] we have locations in every district. And I provide you some information on where those are located and what districts were so working to identify additional ones, but that is separate. From what the resiliency hubs are. Okay. Thank you. Colleagues. Are there any other questions before we wrap up? Thank you all accounts Mok mayor pro tem. I'm sorry. I do have a question. Go ahead. Did we all receive that information about where those council members. I can make that information available. Thank you. And I do think you know some of our districts are pretty pretty long. Geographically and so I continue to urge and I know our resilience officer is definitely working on this but really making sure that we're using that resilience tool kit to help help communities identify other places within their within their areas that can also serve as resilience, hubs during times of disaster. [10:50:23 AM] And also, you know, blue sky days because we're certainly gonna need more than just the winds that the that the city is standing up, and I'm excited about that work and thank you for your role in that. And council member tovo. I would also add, it would be great if we can also find additional shelter locations throughout the city. So, that would be very helpful. So now only resilience , it helps, but it also shelter locations. Well, I know we've we've had multiple organizations indicate that they are interested in participating in that process, which is one of the reasons that we followed up with the resilience hub toolkit. I mean, whether so I would I would I would suggest that I think there are good possibilities in that if we can really get that coordination going, I think we have nonprofit partners and others in the community who would like to would like to make sure that their facility can serve in just that way in times of emergency. It's prison. You I'm gonna give you the last word. And then we're gonna need to. We are [10:51:23 AM] moving Laura over but I don't see her quite moved over just yet, so we can provide a overall update on resilience council. Wonders of. So if you're watching the meeting, we're waiting to pull over a staff member so we can get an answer to a question. Laura, you are unneeded. Can you hear us? Yes. Okay. Can you hear me now? Yes, we can go ahead [10:52:26 AM] morning. Ah good morning committee members. I have you please repeat the questions that you'd like for me to answer at this moment. I have not been able to support in, directly, so please have to step out and I apologize for that. No problem. So I was trying to understand the status of the resilience hubs. Whether they have merely been identified or whether they are operational, and if they are not aberrational when we expect them to be operational. For the pilot. For six pilot and whether they have been formally identified. To the public. Yes so we have identified six locations within the eastern crescent, which are the, specific locations that were identified through vulnerability analysis. Over the summer and then concluding in September, we had extensive community [10:53:27 AM] engagement to identify specific locations. Six locations of pilots right now we're evaluating, and working with staff at each of the locations which are particularities. To understand what services are being provided. From a resiliency standpoint, meaning the programs that are ongoing and that already existed facilities to understand which ones can be amplified and uplifted. In the meantime, we're also working with our partners in, he's to ah! Understand what resources information resources can be provided at these locations. During the winter weather and what what we should expect in next month coming moving forward. Is more engagement at each of these six sites and now has been located identified. And within that start really developing the [10:54:27 AM] programming of workshops for preparedness. Understanding, specific community needs and developing and specific partnerships that are more locations specific. In the long term. We're also working with our internal partners, like often energy and often water to identify the specific structural improvements to the facilities. These will take, that longer as they will have to go through design and planning, planning and design for each of those structures to understand what what are the energy requirements for the building to the big hand. Have that redundancy. So at this moment, facilities are not going to be operating during an emergency. Because they don't have the capacity to structurally, but they will continue operating based on their normal day to day activities that are provided by [10:55:28 AM] the department themselves, and we will be working with them and other departments to integrate preparedness. Response and recovery workshop, so work with communities, many of them as we work through and get the level that we need to with Brazilians have the first level being information hubs and what they can do for information. And ultimately being able to provide additional services like food and water distribution. After an event and even serving as warming centers or cooling centers during hot days or cold days. So that's that's a bit of an update. So that answer your question. Yes thank you. Appreciate it. Sounds like we have work underway but are not not fully operational at this point. Thank you. Thank you all for your work on this. This requires cooperation along a lot of, departments. But this is critically important for our our [10:56:30 AM] community and given, you know. The past and the PTSD from storm . Yuri. These are gonna be continue to be questions that we ask and get asked from her from our constituents, so appreciate your work on this. Thank you. We're now going to move to item number three on our agenda. Briefing on efforts to improve the emergency medical services revenue cycle. Good morning, chief. Having me here this morning. I'm excited to have the opportunity to share with you. Some of the work that we've been working on on our billing and revenue cycle services at E. M S. I never start off by briefly going over some of the updates on our billing processes that we've been working on. As I mentioned the last update. We did have a consultant. The joined us, several months ago, back at the beginning of my tenure here in March and the second consultant that came later in the year that helped us develop some key performance indicators to provide us with methodology to judge the [10:57:32 AM] performance of our revenue cycle to judge the performance of our building staff and really review where we're at, so we did get those recommendations. We have implemented those kpi S and have begun an internal dashboard that is distributed both on a daily and monthly basis to identify where we at with our building processes. In fiscal year 2023. We did have approval to add additional building staff to our department in order to bring us to the national standard from a staffing perspective, and we're adding nine additional staff. We did post those positions in October. And at this point, we have completed our interview process and we do anticipate to be beginning to onboard the majority of those staff in the coming weeks. And that does represent a 50% increase of our building staff from where we were out in the past. There's been a number of questions about the backlog that has been plaguing the department for several years. Now as you can see here, we did begin back since they began. But if we go back to early August, we had close to 19,000 transports that were in backlog or were waiting to be billed. We reduced that [10:58:33 AM] number to just over 15,000. So we are seeing an improvement. We do still have some work to do work to do. It was about $4.3 million. Still, in an outstanding claims that we are working to, to identify and to submit for payment. We do anticipate with with those additional staff that we're going to be adding in the coming weeks that we will see that number continue to drop and hopefully more precipitously dropped, with an anticipation that will clear that black backlog by middle of next year. From a revenue perspective, so the actual outcomes of our building processes. We did see in fiscal year 2023 that we did exceed our transport revenue estimate by $2.3 million that does include the $1.2 million from the charity care that we received in October. 2021 that number will be, more significant as we move into the next slide next explain why I shared that year. We are anticipating a $20.2 million revenue in fiscal year 2023. If you look at this graph, you can see the consistently since may of 2022. [10:59:34 AM] We have collected additional revenue. In in the months of 2022 than we did in the months in the calendar of 2021 in every month since may. If you look in the month of June, you'll see a significant increase. I believe I mentioned this last time that does represent realignment of our priorities to focus on those claims in the backlog that will have a timeliness component to them. So specifically, those claims in medicare were required to submit them within a period of time. And so we're focusing our efforts to ensure that those claims are released more timely , and those claims that don't have a timeliness requirement. We're delaying because we know we have more time to collect that revenue. The charity care update. That was the question that came up in the last. The last presentation we did receive our charity care payment for this fiscal year was $4.6 million. That's an increase as they said from the $1.2 million that we received last year. It was less than we anticipated. We did project $5 million in claims , but it's important for the context here is you take a look. You can see that the overall [11:00:35 AM] statewide charity care funding for ams was reduced from $167 million to $84 million. And so that's the reimbursement for our charity care claims decreased from 65.6% of cost to 21.7% of costs. Although it was not where we anticipated being we are. As I mentioned we are seeing an improvement on the general revenue collection, so to offset the less collections that we anticipated from charity care. What I will note, however, is that our share of the charity claim a charity care claims in the state increased from 4.5% to 8. Couple of things I would just like to highlight in the graph here. You can see that Austin Travis county msr agency, the city of Austin received 8% of the total claims within the state. Comparably, you can see that there are some cities that did receive significantly more. But there are other cities that received significantly less. I highlight medstar, which is the organization that serves the city of Fort Worth that received less than 3% of the claims. So we are very happy with the share [11:01:37 AM] of the claims that we receive. We do believe that it is reflective of where we should be. Some of the other items that we've been working on to improve . Our overall revenue cycle includes documentation and compliance, so we have been working diligently to improve the education of our providers. Over the past few months. We've increased our audits internally from our compliance officer to identify how we're doing. In terms of that compliance. We did see a decrease. Of our claims that had missing or incomplete information from 50% to 38. And those claims that were inaccurate that required some but post transport edits, reduced from 28% to 20% so we are seeing an improvement in the quality of the documentation that we're receiving from our front line providers. We do still have some outstanding items that I think are going to really help us in the coming year or in this fiscal year. The timelines that I put here are the same time lens that identified during my presentation in. I believe it was October or September. So we [11:02:37 AM] are going to be implementing additional training. We continue to do that we have begun those processes. Particularly as we bring in new academy classes. That's the easiest way for us to get focuses when they first enter the process. So, given the work that we're doing on staffing and the number of academies that were increasing, we are ensuring we completely revamped the process that we have in the train that we do for incoming, T S and paramedics. And we are continuing to focus our continued education around documentation in compliance. The early alerting system we have from for data validation, so this is a system that will in real time alert our district commanders and our division chiefs that are on duty of any issues from a compliance or from a documentation perspective. That process is ongoing. We do anticipate, most likely ahead of schedule. So when very early Q two of fiscal year 2023 so most likely within January, sometime that system will be going alive. We've been having regular discussions, so that will, send text messages and alerts to the command staff. While the [11:03:38 AM] individuals are still working to identify those claims that are still outstanding that, may not meet our standards of documentation so that we can work with the team members work with the frontline providers to, identify what barriers they might be encountering two completed that documentation and give them the tools that they need to be successful. We continue our work with oh, cmo to revamp our performance improvement process includes documentation review. And from that perspective, that a lot of our work around performance improvement with gmo was focused on the clinical pieces, ensuring that the medicine is accurate, and we had somewhat of a disconnected process for us to review our documentation piece, more from an administrative perspective and so by by pairing those processes together, it ensures that we're able to identify the needs for reeducation and needs for performance improvement, both from the clinical perspective and the documentation perspective at the same time. And not have that disjointed process. One of the concerns that we was expressed to us by [11:04:39 AM] our front line providers was some of the challenges are electronic health record system. Like many pieces of technology, trying to ensure that it is user friendly, and that, there are no barriers to them being able to complete the their their trips and other things. It's very important and so, what we've done is we've implemented and like trying to health records advisory committee that includes representation, both internally from the department from front line team members as well as from our data analyst as well as from our performance improvement team from mostly amount and others. To really focus in on making sure that we have the most user friendly system in place that can be possible so that it is easier for our frontline providers to be able to complete their charts in a timely fashion without any additional challenges, in addition to the hard work that they're doing every day. On the revenue cycle side, so that piece of the documentation in compliance when I look at the internal operations of the revenue cycle department, as I mentioned, we are on track to hire the nine additional [11:05:40 AM] employees and the coming weeks, very excited that, a piece around, somewhat complicated piece around, dispatch and building that when you are able to better align this piece is, it makes it much easier for our revenue cycle department to properly build some of these claims and ensure that they're being built at the appropriate level. That process has been ongoing. Pretty much for about nine months or so. It's been an integrated process with our with the E. M S department as well as with CML. To ensure that our dispatch processes are truly linked to the medical necessity of the patient. And so we are very excited that that process will be going live by the end of this month. We have a meeting in the coming week actually to finalize that process so that it can be live before we enter the new calendar year. And we continue to look at our overall performance and determine whether or not we need to engage additional revenue cycle consultants and particularly around rcm operations to, evaluate whether we can internally implement some of [11:06:41 AM] these best practices or if we do need some assistance externally to help us get some of these processes online. And with that I will open up to questions. Thank you, chief. I have some questions. But do my colleagues have questions? Well appreciate the thoroughness and the clarity of your presentation. At least I've been following it, so I know it but some of the some of the some of the terms mean here . I wanted to ask for the E. M S, charity care. Obviously it looks like there was a reduction almost in half from the state funding that's available, which is where you're getting that from what what was it that, led to that sharp decline? And what are we doing to advocate for additional funding during this legislative session? So I can't speak as to why the state made the decision in terms of shifting some of those charity care funding to other healthcare entities. It is a large pot of money that comes that is both for E. M S as well for hospitals [11:07:43 AM] and other healthcare providers. The dollars that are distributed from charity care originate from the federal government through a disproportionate share funding. What I can say is that in conversations with. The healthy human services commission and looking, nationally but also very specifically to Texas in terms of how it is that we distribute dollars that are coming down from the federal government specifically to target the underserved communities. It is anticipated that in the coming years coming very short years that there is going to be a complete, look at how it is that those dollars are distributed to make them more equitable from the state's perspective. As you can see, as you saw in that graph in that pie chart that I had their, when you look at comparable cities for example, San Antonio Austin and Fort Worth, you see a very disparate way that those dollars [11:08:45 AM] were distributed, and the state has acknowledged and recognized that we need to look at that and see if we can make it more equitable. There are also additional funding opportunities from the federal government that the state could engage in in order to pull down additional federal dollars. I can't speak specifically here today, as to how that process would work out here in Texas and through the legislative session, but it is something that we're advocating for, and I believe that there that they there is a movement in place for us to be able to, engage additional dollars for the state. Specific to E. M S. And all of the conversations that I've had are very optimistic about in the coming years, seeing some changes there, and I'm happy to spend some time because the, federal dollars that are distributed to the states that get distributed programs like charity care and other ways that we address healthcare equity. Are some of the most complex and convoluted [11:09:45 AM] processes and formulas and whatnot. And it's extraordinarily challenging to understand them, even as they come back, but to predict them is even more challenging, but I am happy to spend some time. In a separate discussion to really break that down, because it would take a lot of explaining to pull that up artist exactly how it's calculated, but I am optimistic. That the way that this is going to be recalculated in the coming years will be favorable to the city of Boston. Great and, maybe we can continue that conversation online and see about how we can accelerate engagement with our delegation, for instance. On that, since it sounds like it could be potentially, promising, and we could have some good allies elsewhere. You mentioned the electronic health records advisory committee being set up and you spoke. Briefly about what they're talking about. Can you speak a little bit more about what their focus it is. Sure absolutely. So, when we the [11:10:48 AM] electronic health record system, is the computer system that we use? I think it's pretty straightforward, but it's the computer system that the frontline staff used to enter the information on the patient's both clinically as well as billing and other pieces, and it's what we use as a database to do analytics and other things again, both from clinical perspective operations perspective and also from the documentation of compliance perspective. So the committee is really tasked to get all of those stakeholders together to say, what do we need to do in order to be effective for everyone so what happens sometimes, is the needs of one of those stakeholders may overshadow the needs of another . For example, if we need certain documentation from a billing perspective, whether or not we add a mandatory field or a check box or something that would fire someone to enter that, may all of me ultimately downstream affects a frontline provider. So if you say I need this, this this field to be, [11:11:50 AM] completed and we prevent you from really moving to the next step, for example, we've all used computer systems that you know this is a mandatory field, but the frontline provider can't say collect that information at that point in their process, but they can't get to the next page to complete the next period of the documentation, then we hinder the frontline staff. And so we need to talk through that and work with the frontline providers and say, what are the challenges that you have? In collecting the information and why, for example, might you not be able to get a signature? Or might this piece not work for you? And then we need to have the billing revenue cycle department saying well, this is why this is important and we need to make sure that this gets in here at some point and same thing from cmo. Same thing from operations. There's certain information that we need and I think we could do a better job of really getting that full. Input. I think that, but. The electronic health records process was was very driven clinically to ensure we were [11:12:50 AM] absolutely collecting the best clinical information and that is absolutely important. But ensuring that we have the input of the revenue cycle department , which I would say was probably the second loudest voice prior to us developing this committee. But also very critically, is knowing how all of those changes that we make impact the frontline providers because ultimately they're the ones that need to collect the information . And if they have a barrier to collecting that information, and they don't then it adds to the workload on the revenue cycle department trying to collect it after the fact if they can even do that. And so this is an opportunity really, to give voice to the frontline providers as to how we can improve that record system. Thank you appreciate this sort of systems approach and understanding sort of how all of these pieces together. You didn't. I don't think mentioned the contract that we just approved for revenue collection to supplement the work that you're doing. So I want to note that but from your view, you know? We started this journey before you came on as chief, in response to dispatch [11:13:53 AM] equity study that highlighted that there was a lot of revenue that we were leaving on the table because our billing system was not functioning at the level that it could be. Obviously you've provided some data on progress with Brexit charity care and reducing the backlog, etcetera. How will we know when we are sort of done with this process or that we're at a good equilibrium? With this process. Well two fold one. I think we have identified those deficiencies that we need to work on some of which I highlighted in this presentation around how it is that we can have better processes and ensuring that we're collecting all the information we need in the manner that we need to. I think once we get all of those processes implemented, those are best practices. We've had multiple consultants that have come in and their recommendations that I concur with, and I think that will be one piece. And then of course, the second piece will be when we see the revenue increase and we [11:14:54 AM] have started to see that at this point I don't think I highlighted earlier some of the specific numbers but based on our budget of this year for fiscal year, we budget about $1.7 million per month in collections for fiscal year. 2023 already we are seeing approximately $2 million per. I'm sorry 1.7 million per month. And already we're seeing about two million per month that we've been collecting. Since the beginning of this this fiscal year, so we are seeing the actual dollars come in, and ultimately that's going to be when we know we're successful. Yes, when we when we see those numbers increasing, and I think , frankly, what we'll do is once we once that revenue stabilizes will then go back and reassess and perhaps re validate that all of those processes we thought we needed need were implemented and perhaps even bring in another assessment to see if we've met their mark. Thank you. We'll probably have you visit us again in the spring. There were two budget writers that I wanted to just, check in on one, was mine about coming back with the recommendations about transport [11:15:56 AM] the increases if you could provide the status of that, and then the other was with respect to council member. Fuentes is but a direction regarding the M S. Staffing plan for the airport . So if you could speak briefly to those before we conclude that be great, so we will come back with recommendations regarding the schedule. I can tell you preliminarily. I do believe that it is time for us to reevaluate that and as we go into the fiscal year, 2024 budgeting process. I will be making recommendations that we increase the fee. I do think that we need to ensure, as I'm sure you all agree that we bet that threw the equity office and we ensure that whatever fees we do increase don't have a disproportionate impact. But my conversations might evaluations my assessment with other cities of similar sizes that we are fees are below where they should be. And based on our costs cost of service study. We do have that that latitude to be able to increase our fees. That answer that question. It does just add that from my perspective, and I think from that budget writer that funding should be reinvested in [11:16:57 AM] E. M S and in rms professionals as we're going forward with our contract. Process, etcetera. So I believe that was our direction as well. And I understand that you may not control that. But I just want to reiterate that and then if you could speak to council member apprentices, budget writers her. Absolutely we continue to have ongoing conversation with with the airport. A B I a, and, we're we're making good progress. There continues to be challenges with space. I actually yesterday was at the airport touring the facility trying to identify space. I actually walked away yesterday afternoon, very optimistic that we may have located space. It will require a brief amount of construction of which the airport has righteously offered to help us are. They will conduct the construction. They will be doing that for us. Internally with their staff. Are from E. M S perspective. We have already begun the process of lining up [11:17:57 AM] the employees and we are completely prepared and ready to go. Next steps for us working with the airport to secure that space in which I believe in and in my conversations with the airport can happen within the next few weeks, getting the side of clearance. The security clearance for our staff, which I'm told should just take a few days once we get to that phase of the process, and I am very optimistic, particularly post my meeting yesterday that we will have this live in February. Great that's wonderful news, and we can talk about this because this is part of the revenue cycle because the airport is contributing to that, in terms of German this to this topic. So that's great news. Really hope that you'll keep us apprised. Of those developments, not just council member of qantas, because I think it's a really important step for the health of our community and those who are visiting, our cities, so thank you, colleagues or any other questions for chief Luckritz. [11:18:58 AM] Great thank you. I really appreciate the straightforwardness and the thoroughness of your report and look forward to further increases in the revenue that we can invest in R. M S. Thank you very much. Thank you. Great thank you. So our last item here is item to be discussed at future meetings, miss stokes. Yes so we are. We are planning at the January meeting. That's January. 18th we are planning to have the Austin water independent external review. So our consultants will be coming to present that item. At that meeting that report actually per the resolution earlier this year , actually request that that report posted publicly a week in advance of the public discussion. And so we'll be posting that January 11th. And then presenting it to the un in finance committee the following week. Thank you. So colleagues about Burt, Fuentes and Kelly council member pool as well will be returning. Since we have four [11:19:58 AM] continuing members of the committee. We're going to go ahead and meet in January so we can hear that report. So if you can make sure that that meeting is on your calendar and be prepared that it is quite a long report. And quite technical in all likelihood, but hopefully throw and I understand that Austin water is working. Closely, with the team on their management response and has been cooperative and welcoming. Of the learnings that are happening through through this process. I don't know if you're evil. I had asked you some questions about how this was interfacing with the water director search. I don't know if you were able to get any answers that you can share or comfortable sharing in this forum. I think that the I guess the main thing I would say is that we'll make sure at this point it is still a confidential report. And so it's. It's not out for public review, but certainly we will make sure that the candidates no that it's coming and kind of the timeline [11:20:59 AM] for when it when it will be released. Okay, counselor, Fuentes. Thank you and Corey if we can set up a meeting with my team and your team to discuss that report in advance of the committee meeting that would be helpful. And colleagues believe Austin water has sent this press release out, but they have identified the three finalists for the Austin water director position and there is a meet and greet scheduled. I believe for this week I want to say Thursday, but someone please correct me if I'm wrong, so just wanted no. Take that as well. Council member, Kelly I think you council member Fuentes for letting us all know that I appreciate it. And then I too would like a meeting in advance of our audit and finance meeting about the Austin water audit. Great. I think we already have those, in the works. So I think we all want want those, budget want to underscore the timing so that you guys can be prepared for that because I think it's [11:22:00 AM] going to be really important information that our that our community is gonna want. Want to be. Hearing. Are there other topics that are coming up that you wanted to flag? We have. I think there are several several items that we are looking to have in February. But I think talking about those at the January meeting makes the most sense. But we have, I think. Hmm one or two audits that will be available in February once related to the strategic direction 2023. And then and then I believe we also have slated the update the winter storm Yuri audit, update or disaster preparedness update for that meeting. But there may be others that come up between now and then. Great thank you. Colleagues. Are there any other topics that you want us to? Be looking up. Well with that on, I think council member tovo for her service on this committee and on council and you've been on this committee for 11 years or something. Like that, and [11:23:01 AM] chair probably multiple times, but we have all benefited, from your leadership and your mentorship on this. And I don't think this is your last too many meetings. I think you're sharing one tomorrow. So we won't. We won't. We will. We will save things for them and for Thursday night, but I did want to acknowledge, your service and your your leadership and particularly with respect to this committee, which is an extremely important, committee. We do sometimes get into weeds of things, but it's I think that's the nature of what we what we cover here. So thank you, miss stokes. And for all of us, those of you stop who work with us on this committee. Have a happy holiday. So thank you for your work. And with that I will adjourn this meeting at 11 23. Thank you. Thank you.