Community and Family Resources requested a rate increase for its substance abuse treatment services Tuesday from the Webster County Board of Supervisors.
Michelle DeLaRiva, CFR executive director, asked for $421 per day, up from the $299 rate in place for the last 10 years.
"Our board this past year has really been focusing on being fiscally responsible," DeLaRiva said. "In looking at our detox program for the last several years, our program has lost upwards of $200,000 each year. It's definitely one of our loss leaders."
In fiscal year 2012-13, the program served 85, with 32 clients paid for by Webster County. Of those, DeLaRiva said, 77 went on to further treatment.
"It's very difficult to detox off of substances," she said. "It can be a very dangerous situation, where people have seizures, heart attacks. They have to be monitored very carefully. It is a very popular program."
According to DeLaRiva, Webster County has never paid the full rate, receiving instead a discounted rate of $215 per day.
"It is a larger jump," she said. "There's other counties that were paying more than that for this service. Our goal, as an agency, is to have everyone pay the same rate all the time, and have it be a rate that we can actually break even."
Supervisor Keith Dencklau asked DeLaRiva how CFR came up with the requested rate.
"We looked at the cost," DeLaRiva said. "Our service is run and staffed 24/7, so you have the cost of a nursing staff and your cost of just the general food, shelter."
DeLaRiva said while CFR is asking for an increased rate, the county may be charged less often with the Affordable Care Act taking effect in January.
"I can't project for you how many of those clients that come in our door will have insurance, but I can tell you we ran the numbers at CFR. Seventy percent of the clients under our current Iowa Department of Public Health contract will be eligible for traditional Medicaid," she said. "And Medicaid does pay for this service."
Supervisor Mark Campbell asked if would be possible for CFR to wait until next year's budget comes out.
"We would not want to wait," DeLaRiva said.
Supervisor Clark Fletcher, who serves on the CFR board, said while the new rate is not out of line, he would like to know how it would affect the county's health services budget in the middle of the budget year.
"If we accept the rate increase, we have big problems with our budget," he said.
Board Chairman Bob Singer questioned the suddenness and approach of CFR's request.
"When you have those kinds of increases, whereas before you were functioning maybe in the red, don't you have some responsibility to bring your vendors up a little at a time, as opposed to all of it at one time?" he asked. "From our standpoint, it puts us in a bit of a bind. You're not bringing anything to the table other than a 90 percent increase for us, or 40 percent of your stated rate."
He added, "The message to us is 'deal with it.'"
DeLaRiva argued that the detox program benefits the county.
"We have continued to provide the detox services even though we have known it has lost money because it is successful," she said. "It is the starting point for people coming in. Once they're detoxed, its so much easier for them to go through treatment."
Ken Hays, Webster County Community Services director, advocated the nonprofit.
"This is a needed service," he said. "We need to support them. It's just an issue of the fact that we don't have it budgeted right now."
Fletcher motioned to table the agenda item until the board could be informed how the new rate would impact the county's budget.