Welcome back to this weekly meeting of the Health and Safety Committee with Denver City Council.

Coverage of the Health and Safety Committee starts now.

Good morning.

This is the uh 11-5 health and safety committee meeting.

My name is Daryl Watson.

I'm honored to serve all of the residents of the fine district nine, and I'm also honored to be the committee chair for this health and safety committee.

We have one action item uh this morning.

It's the Denver Health Operating Agreement with the City and County of Denver.

And before we roll into the presentation, uh why don't we do introductions around the table?

First, let's let me check to see if anyone's online.

No virtual participation.

So we'll start on all right.

Thank you.

Kevin Flame, Southwest Denver's district two.

Amanda Sawyer, District 5.

Good morning, Sadana Gonzalez, one of your council members at large.

Uh good morning, Paul Cashman.

Denver District 6.

Jamie Torres, West Denver District 3.

We look forward every year for Megan's and Donna's uh presentation on the operating agreement.

So we'll turn it over to Megan Parrizzo and Donna Lynn, CEO of Denver Health, for your introductions and to take charge of the presentation.

Great.

Thank you all.

Uh my name is Megan Prezzo.

I'm with the Department of Public Health and Environment.

We are the holder of the operating agreement contract with Denver Health, and very happy to be here.

Thank you all for having us back every year.

And I'm Donna Lynn, the CEO of Denver Health.

Happy to be working jointly with DDPHE and many of the other city agencies that provide services to Denver Health and back.

And I think we're also going to be talking a little bit about 2Q at your request to get into more specificity around how Denver Health is spending that money in calendar 2025.

And a little bit of a preview of next year.

All right.

Thank you so much.

I would be remiss if I didn't thank all the folks in this room, and beyond our partners at Denver Health, Donna and team, lots of uh hard work goes into this every year, and our other uh departments across the city and within DDPHE that work so hard to get this agreement in place.

It's a heavy lift every year, and so very much appreciate all the work that goes into it, including our partners in City Attorney's Office and Finance and otherwise.

So thank you all for having us.

This will look relatively familiar as similar years.

Um we've added a few details but generally the same presentation as you all are familiar with.

Uh we've already handled introductions, obviously.

Uh, we will do an overview of the operating agreement, uh, talk about a few high high-level kind of understanding of the structure of it, talk about the changes.

There are very few, but kind of the nuanced uh changes of the uh language this year, uh, talk about the budget for 2026, um, and answer any questions you all have.

So uh I believe you all received a copy of the agreement ahead of time this year.

We worked hard to make sure that happened.

I know that hasn't always happened in previous years, so I want to make sure, and I see some head nods, so that's great.

Okay, jumping in.

Um, this is a new slide this year because with the addition of 2Q and sort of the complexity of the Denver Health landscape across the city, we thought it would be helpful to sort of give a little bit of lay of the land about Denver Health Funds within DDPHE.

This isn't the entirety of the operating agreement or across the whole city, but for the 2025 uh DDPG budget, we thought it would just be helpful to let you all know the green slivers here are what DDPHE has in place with Denver Health.

The sort of light green towards the top up here is the operating agreement portion that is DDPHE specific.

So that's $38 million out of the entirety of the operating agreement.

This larger dark green sliver is the 2Q sales tax, which was originally estimated.

Well, not originally, it's been estimated at various numbers, but 64 is generally 64 million is generally where we're estimating today.

And then this thinner light green sliver, um, we have several other sometimes dozens, depending on the day, week, month, or year of contracts with Denver Health for various services, as you might imagine.

And uh there's a list of folks of uh other services here, and so that totals roughly five million on any given day that goes up or down depending on kind of the services, depending on our grant funding and and the work we're doing with Denver Health.

But just wanted to give a lay of the land because I think it's getting more complex over time, and wanted everyone to see that.

Uh, this is also in relation to DDPHE's operating agreement or operating funds.

So, this blue slice here is everything that DDPHE uses to operate our work.

Um, and then these peach color other kind of pass-through sales tax revenue caring for Denver and Healthy Foods.

So, thought that was uh helpful mostly in relation to 2Q and how that fits into DDPHE's budget.

Okay.

Specific to the operating agreement, you all have seen and heard this uh multiple times, but um way back in 1997, um the under uh state statute uh the hospital separated from the city and county of Denver, which was the original kind of intention uh behind developing an operating agreement with Denver Health and an agreement to talk about the services that the hospital provided to residents of the city and county of Denver.

In 1996, uh they adopted the Charter Amendment, and officially annually since then, we have had the operating agreement that outlines all those services.

Again, it feels like it's it's starts as soon as we finish.

As soon as we get across the finish line, we talk about what's coming.

But uh for January through April, we have sort of some off-cycle negotiations, some things to think about before we get into official negotiations.

Uh, we kick off the annual negotiations in April.

April through the July are the really heavy negotiation timelines.

This operates alongside the kind of budget timeline within the city to make sure our agreement is working alongside the budget timeline.

Budget meetings and legal drafting happen kind of July through October time frame, and uh we are here today in this October through December timeframe, presenting to council and getting it hopefully uh executed before the end of the year.

Uh this is a similar slide as well as previous years.

There are in 2026, there will be 36 services in the operating agreement.

In 2025, there are 37, as you can see in the pie chart.

The green um one section of the operating agreement will be removed in 2026, and this is specifically related to the Park Hill Clinic uh sort of capital funding that the city has paid, kind of a loan repayment fund for Denver Health.

Um, and we have reached the end of the fulfillment of that commitment to Denver Health, and so this is 2025 is the last year that that will be in the agreement.

So there'll be one less section of the operating agreement just as a result of that ending.

Uh 10 sections were updated for language and again very minor tweaks.

Uh, there's a lot going on this year all over in lots of ways, but I think because of the budget landscape, we didn't do a lot of changing of the language in the agreement.

So you'll see very minor tweaks, but nothing too major, other than the sections where budgets were affected.

Um, Denver Health was a partner with the city this year, as they always are, and they were asked to reduce their budget this year alongside city agencies and alongside our city budget process.

And so I'll get more into the nuances of the budget in a few slides.

But um, seven sections of the agreement have budget implications.

There's two quick slides here, sort of the details of the language changes.

Again, they're pretty small, but always want to highlight a few things to make sure we call out the most substantial, and these aren't super substantial, frankly.

Uh, but for our public health clinic services section, we better defined the scope of the immunization and travel clinic.

Uh, that was just refining the language a little bit to make sure that was clear.

Um, and often we look at the metrics in various sections of the agreement and update them as needed, and so that section had some updates for the metrics.

Um, Denver cares A4, we also added uh some metrics to the final reporting of that section and those services.

This is an appendix A, which is the core services, and in appendix B, as I already mentioned, the Park Hill Clinic Capital Funding kind of loan repayment portion will be removed from the agreement, and then the at-risk intervention and monitoring, the AIM program, moved technically moved from uh Department of Safety into OSEI with the move of the Office of Neighborhood Safety.

And so we needed to make that language change in the operating agreement as well.

All right.

Talking about the budget, the the hard conversations we've all been having for months now.

Um, like I said, Denver Health was a partner in helping the city reach our budget reduction goal.

For 2025, the operating agreement budget was $74 million or is currently $74 million.

In 2026, the operating agreement will be $69 million.

Denver Health was asked to cut $5 million of their budget.

Um they, as you all know and remember, and and saw at the budget hearing, Denver Health is flows through the budget cycle similar to a city agency.

And so they've presented to you all in budget hearings.

And so you've seen some of the nuances of that.

And we'll talk a little bit about those here.

But they uh just like city agencies have been through that process.

$30 million, $30 plus million for the patient patient cares or MI payment was left in place this year.

That portion of the budget was not part of the $5 million in reductions.

And then $38 million is the other core and non-core services in the operating agreement for 2026.

As a reminder, there are also some services that the city provides to Denver Health.

Some are related to career service employees that are still employed at Denver Health that have been with Denver Health since the separation.

And so we provide some career service support to those employees.

I said one clarification.

So even though you see a reduction in the total contract, none of the services associated with reduction are going to be curtailed.

So we will continue to provide those, but we will simply fund them ourselves.

I'm just teasing, you deserve it.

You deserve it.

We expected that there would be service cuts from Denver Health as a result of this request from the city.

And it's an incredibly generous thing that Denver Health has chosen to maintain all those services without that five million in funding for next year.

What that means is that in 2027, we'll need to continue to have the conversation around what does budget look for those services at Denver Health.

Going a little more in depth about the budget reductions, and one increase that is not general funded.

We did a lot of back and forth with Denver Health and the teams figuring out what was the kind of most appropriate places to cut funding.

The city couldn't from a budget reduction standpoint, couldn't reduce funds in a place where we would have to also pay for that service if Denver Health weren't providing it.

And at the time when we started negotiations, we weren't sure that those services would continue to be provided.

So we couldn't cut budget in a place where we'd have to turn around and pay another vendor or contractor or partner to do that same work.

So with a lot of back and forth and um lots of compromise, we ended up with the list here.

Um I'll walk through those relatively quickly, and we have experts at the table and in the room that can speak to some of this better than I.

So as we get to questions, happy to defer to those folks.

Our section A2, the emergency, the EMS section of the operating agreement.

Uh we reduced the emergency service patrol, which is the van, the vehicle that transports folks to Denver CARES.

Um the entirety of that portion of the budget is 900 plus thousand.

Um, and in talking with Denver Health, we agreed for a 558,000 reduction in that cost.

Again, no service reductions, the van will still operate, the transport will still happen.

Um Den Paramedics, the Den Enter Denver Airport Enterprise Fund is funding a slight increase for paramedics at the airport, and because that's not a general fund, we were they were able to make that increase.

Um A4, Denver CARES.

Um, I believe you all are familiar with Denver CARES and the service it provides to the city.

Um, this 3.2 million is the entirety of the city's contribution to the Denver CARES services.

Um, this is being cut all but one dollar, I think in the operating agreement.

We reagreed to leave a dollar in there as a signal that we want to ensure that this is funded in the future.

We know this is an incredibly important service to the city and the residents of Denver.

And so this is uh retained um in the operating agreement as one dollar in the city's budget.

And I will probably say it every time, but no reduction to services here.

Again, Denver CARES will still be operating.

Um A8, which is the Rocky Mountain Poison and Drug Center, the call center, and uh that responds to needs related to questions and concerns about uh poison and other kind of focus there.

Uh that's the entirety of the portion of the DDPHE city budget that goes to Denver Health for that.

I believe there's other funding sources outside of the city's funding source for that uh center, and that has been entirely cut from a budget perspective, but the section is still in the operating agreement, which is true for all of these.

Uh jail medical services.

This is not an actual cut to the budget.

This is sort of an administrative cleanup line.

We did not cut the amount of funding going to jail medical services in 2026.

That was crucial for us to retain the entirety of that budget.

Hands down, no one disagreed with that.

This is a line that was a one-time uh budget item, I believe, in 2024, and it accidentally lingered in the budget book in 2025, so we just need to remove it from the agreement in the budget book in 2026, but there's no actual funding cut related to it.

Uh, B7 is treatment on demand.

Um, the service uh that supports folks coming into the emergency room and needing support to connect to uh potential uh MAT treatment or other treatments related to addiction services that they may need out of the emergency room.

I believe the data, and of course, there's folks here that can clarify and correct, but I believe the data said 90% of those uh the treatment on demand connections out of the emergency room go to other Denver Health services, and 10% go outside of Denver Health to other kind of related services in the community.

Um that uh 680,000 is the entirety of that section's budget in the operating agreement.

So that has been fully removed.

The section remains in the agreement, and the services will still be maintained in 2026.

The Park Hill Clinic, we've already talked about twice, so I won't reiterate that, but that's being removed from the budget just because it's ending in 2025.

And uh B7 is the Southwestern Clinic, the Penny Clinic.

Um, this is uh similar to the Park Hill Clinic.

Some capital funds uh and sort of loan repayment support that the city provides to Denver Health.

It's a total of 1.2 million per year, and we agreed to cut 250,000 out of this for general fund savings.

Um that totals in on paper, uh, five million plus, but technically five million in actual budget reductions and an increase in the 213 out of the Den Enterprise Fund.

And I believe on that not so fun note, um, I will just reiterate uh the city's appreciation for Denver Health, maintaining these services.

We know they're critical, it was incredibly hard, similar to city agency budgets.

It was heartbreaking to talk through where crucial services need to be cut, and so it was a hard year all around, and Denver Health has been gracious in offering those services next year.

And that's it.

Happy to take questions.

Thank you so much, Megan.

Um CEO Lynn, did you want to add any additional thoughts on this?

I know you're gonna be speaking specifically to two Q afterwards, but um, I think a couple things.

First of all, um, we did this out of the spirit of the partnership with the city.

It was very hard.

Um, there are no layoffs or workforce reductions associated with these.

So I'll put that in one bucket.

The second bucket is that this is a one-time from our perspective.

This is a one-time reduction.

This is not a permanent reduction.

We could not sustain this.

Just so happens that we are able to sustain it this year, and as I said, keep all those services and employees going.

Um, the third is that we still have some issues with the city, not so much DDPHE, but with the sheriff, which you well know, around two issues that we think uh we've gotten a commitment from the city to try to address as soon as possible, including uh this month.

Um we didn't want to hold up the operating agreement um with respect to those services because there's so much more embedded in it, but we continue to be concerned about uh malpractice costs that are associated with providing health care in the jails and the lack of indirect support.

Um, based on what we know, particularly other city agencies, when they go out to contract, they provide indirect uh support to vendors, quote unquote.

I'm not gonna call us a vendor because I don't look at us that way, but we certainly don't have either the infrastructure that the city provides, nor the payment for things like IT, um finance, and certainly HR.

And given some of the challenges that we have in the jail, those are pretty um important.

But we are pleased that the mayor's office has agreed to continue those conversations, and we didn't think it was appropriate to hold up the operating agreement for those.

That's it.

Thank you so much.

CEO Lynn, please.

Can I make one clarifying question?

Um it's a really challenging topic, and I think uh part of the conversation around the budget in 2027, feels like that's gonna even be the harder part of the conversation because Denver Health is able to cover those services this year.

I think if we get to 2027, and that's not the case, and the city general fund hasn't and probably won't recover in the way we all would hope it would in the year.

I think there will be some really hard conversations about 2027, and I think from uh city perspective, we would love to be able to commit to these being only one time, and I think that's hard for the the city and the budget office to fully understand or to fully understand where we're gonna be from a budget perspective next year.

There are certain services we think are uh undeniably crucial, crucial, and we'll want to make sure that they're funded in 2027, and there are a few services here that we think we have more conversations and negotiations to have.

So we would like to be able to say they're all one-time cuts, and I think that's uh I just want to make that clarifying point so that we're clear that from a DDPHG and city perspective, we think there's really hard budget conversations still to come for 2027.

Thank you so much.

Uh Megan, thank you so much, CEO and then.

Before we go to the queue, I'd like to welcome Councilmember Parity and then online, Council President Pro Tem Romero Campbell.

Um, I would state before we go into the queue, um, both to uh CEO Lynn and to um to Megan that um we'll check with council president.

I'm not sure what the protocol would be.

But with these one-time um uh infusion of cash from Denver Health and the uncertainty of the 2027 budget, we may ask for some type of up uh um mini briefing.

I don't know what that wouldn't be on the operating agreement, but really uh so that there is not a surprise uh coming to our next um operating um uh agreement this time of the year because then really there's not much that we that can be done.

So we'll work with um through council president to see what the protocol of any uh interim update on uh the steps and discussions forecasts that your team uh may have.

And with that, we'll go to um Council President of Protema.

I always want to check in with folks who are online first to make sure I'm not skipping you over.

Um did you have any questions that you would like to be added to the queue first, and then I can go to the folks sitting around the table.

Uh am I on hi.

Thank you.

Um I don't have any questions at this time.

I didn't mean to put you on the spot.

I'll just feel so bad, like sometimes.

Uh if I don't have a calls first, it it mess them.

Council member Flynn, then Councilmember Perry.

Um, Sir Chair.

Hi, Da.

The operating agreement briefing is always my opportunity to raise the DERP question.

So I know that it's not in the operating agreement, but I was at an event uh last week where I ran into a retired uh uh Denver Health Pediatrician who had been a career service employee, and he's happily collecting his DERB.

So I just want to check in to ask are we on track with those catch-up payments?

So we negotiated.

I'm sorry, thank you.

Yes.

Uh DERP is the Denver employee retirement plan, and because of Denver Health used to be a city agency up until 97 or 8.

97.

You still have some career service employees and the contributions coming into the DERP plan, but fewer and fewer uh employees each year.

That's correct.

Um, thank you, Councilman Flynn.

I'm gonna uh open it up and then turn.

I've got two wonderful people here, both our CFO and our chief legal officer who can amplify.

Um, as you said, we have employees who already retired and are collecting benefits uh through DERP.

We have a handful of employees who, when the um uh separation occurred, exercise their rights to stay into DERP.

But any new employee who we hired after 1997 goes into a much skinnier defined benefit, defined contribution plan, excuse me.

Um so we have an agreement that we negotiated with the city around, as you said, increasing our share of the contributions uh to DERP.

And um we also have some unfounded liability, which both the city and Denver Health have.

Um so I'm gonna.

Who would like to start?

Enid or April?

Should I start?

April O'Dane is our CFO.

Hi, good morning, everybody.

Uh so to answer your question, yes, we are on track and we have paid what we need to.

Uh there's gonna be an extra payment this year based on where we are from a margin perspective.

So I think it's gonna be an additional uh three million dollars that we will pay in this year as well.

Thank you.

That's very good.

That's very good to hear because you had some high earners.

Yes, compared to our our solid waste workers, for example.

So it's that's very good news.

Thank you.

And then last question on uh the Penya Clinic.

What impact will that reduction this year have, if any, on the operating, not it won't have an impact on the operations at the clinic, but on your bottom line.

Yeah, thank you.

Um, the Penya Clinic, which is uh the most recent primary care clinic that we opened on uh federal, the city agreed to help us, as you heard from Megan, offset some of the capital.

You know, there's two ways they can do that.

We can do what we're doing now, for example, with Fibrant Denver, or they can just give us a flat payment.

Um we will just absorb the cost.

So again, that's something we would assume would be restarted in 2027 subject to negotiation.

So we just have to absorb that within our existing budget.

So we have fewer, we have fewer earnings, so to speak, in terms of what April just identified as our margin.

I mean, that's just a one year change.

Well, that's my view.

That's my view.

It would be mine too, and in the best of all worlds, it would be mine too.

Because that the Penny Clinic, the Southwest Clinic has just been a godsend to the folks on the west side of the river.

And you may know, it was built over capacity.

Yes, and it was filled up and we are now under, we we don't have enough space for all the and we're and we are open uh more than just five days a week at the Pennure Clinic to accommodate that.

I remember when it opened, and the thought was, well, see all those rooms down there.

Right, we're hoping that down the line they will be utilized and down the line came pretty quickly.

We're now past the line.

So thank you for no, thank you.

Thank you, Mr.

Chairman.

Thank you, Councilmember Flynn.

Councilmember Parity and Council Member Cash.

Thank you so much.

Um I appreciate this, and it's nice to do it for a few years now and have like some because it's just so complicated what you guys do every year.

Um I wanted to ask about um the three grant-funded uh Matt uh treatment providers in the jail whose grant funding has ended.

We all knew that was coming.

Um, and my understanding is that Denver Health is just sort of continuing to pay those people, even though the grant has expired, I think through the end of this year.

Um and I I don't want to misspeak because we had a lot of volume of stuff happening last week with the budget, but I think my understanding is that Denver Health isn't able to do that in 26, which is if so very understandable.

Um if that's the case, I um wanted to talk about whether there's a thought for towards applying for DOAC funds for those positions or another plan.

Um, but yeah, generally just what's happening with those three folks.

Thank you.

Uh Mark Grey, who is an assistant uh operating officer for Denver Health and oversees the jails, Denver Care's and all the other more difficult jobs.

Thank you very much.

Um the answer to your question is uh we are continuing to fund those positions going to 2026.

Um we absorb them in 2025 when the grant funding ended, and then moving forward, um, we have some additional grant funding that's supposed to be in related to MAP services specifically in September of 2026.

Okay.

Um, which is a larger portion that does not include those three employees, which will be ongoing negotiations that we'll have to figure out.

Okay, so so say that to me again in terms of those exact three positions.

We're still figuring it out, or sorry.

So those were absorbed in the 2025 budget, and um, they're part of the B3 section for 2026.

We are aware that um some of the map programming for 2026, in addition to those three positions, is scheduled to sunset in September of this upcoming year.

And that's in coordination with the Sheriff's Department.

We're trying to figure out what the liability would be in that in that regard.

And so those will be future conversations.

Um, and then relatedly, I know that the um some of the medications that are really successful for people like Savoxon art is incredibly expensive, so and I know that's been a barrier.

Or um, I mean there's always barriers when it comes to mat treatment, but that um that's certainly one challenge, and so also curious about the thoughts about um between the city side and the Denver Health side trying to fund um some of those medications and enable people to have the option of being on the more expensive ones if that's better for them and so on, um, and whether again, whether there's lots of funding sources for that and whether there's lots of a um opioid uh application for that.

Yeah, there's not currently uh a plan to apply to the DOAC for uh the the MAT program.

What I can't say is that um the medications that we're currently providing in the GLS, we have no plans to change anything on the formal year, as it released today.

Okay, and for uh listening public, could we uh explain what the acronym do act?

Oh, sorry, Denver opioid abatement commission.

Thank you very much, Mr.

Chair.

And those are the settlement funds, uh Denver's share of uh Colorado's open settlement funds from you know the settlers and others.

Yeah, and what I can't say in terms of um part of um our interactions with DOAC is um the biggest line item that we saw in terms of cuts this year and some of the changes coming to the Denver CARES program.

Um, not to be confused with obviously MAT services in the jails, um, that's risen as a priority um in terms of, I believe uh Denver Health's ask um 30 DPHE for feel like.

Right, in terms of Medicaid reimbursement for Denver Care.

Yeah, okay.

That's that was actually the next thing I was gonna ask about.

Um, is just is there any update about the planning to um get Denver cares to the level of treatment instead of social detox to that medical detox so that it can keep being eligible for Medicaid?

Absolutely.

So we're actively involved in um moving from uh the current level, which is being eliminated to uh the 3.5 ASAM level and hope to make those modifications primarily those changes are going to need to include some capital construction uh issues, which is part of why we are applying through the DOAC to hopefully draw down some co-ec money as well.

Got it okay.

Just as infrastructure uh co-equity infrastructure funding.

Yes, yes, yes.

The city's been really supportive in recognizing, you know, what that means for us in 2026 and 2027, including some financial support of having to make those changes.

So I would love if when it's time to have an update briefing on that, I would love that.

And I don't think anyone's surprised.

Stephanie's like, I know, I know.

So thank you.

Thank you so much.

I appreciate that all.

That was all I wanted to ask.

Thank you, Mr.

Chairman.

Thank you, Councilmember.

Um Councilmember McCashman and Council Member Sawyer.

Yeah, thank you.

Uh Mr.

Chair.

Thanks.

Good to see you folks.

Um, can we go back to slide 10, please?

That's 10.

Yep.

Is that the one you're looking for?

Uh it's not update there.

It is the one I'm looking for.

On its face, it's one of the most offensive slides I've looked at in 10 years.

Um, out of the 5.156 million dollars, basically most of it is taking away from addiction recovery.

And um, wondering with all the services that Denver Health has to offer, why such a broad based assault on such important services?

Yeah, it's a great question, and I think lots of perspectives on how we landed on these specific services.

I'll try to answer some, but happy to hear Donna's perspective and others in the room.

Um, uh I'll try to go line by line.

The the Denver CARES line um was is not something we've uh suggested permanently cutting.

Um we definitely think in 2027 the city is committed to figuring out how to pay for that.

We know that that's crucial.

And we uh when it when we were discussing the five million in cuts, Denver Health suggested that that may be a service we could cut from the operating agreement because they could absorb the costs in 2026.

So it wasn't a choice made flippantly, and it wasn't a choice made with the expectation that those services would be taken.

Sure.

I mean, and I'm sure you can justify all of them at one level.

I understand what you're saying.

The problem is a budget is a statement of values.

I understand.

And that's not a good statement to make.

So I understand.

Let me try it.

I'm gonna try it at a different way.

So these service the services, maybe could you go back to the 38 million?

I want to go back to ah, so of the 38 million that the city pays to Denver Health to provide services, almost 24 million of it is in the jails.

There is no way to cut that.

There just is no way to cut that.

In fact, we're arguing we need more.

So it would severely impact the services, the health services that we provide to the injuries.

So take take 24 out of that, and we were looking at a bucket of 14 million where we had to find areas where we would supplement.

Again, none of the services uh come down, but we literally I felt like there just was no way to, there's no way to cut in the jails.

Just like I think the sheriff would say, there's probably no, it's very hard for him to cut fixed post kinds of assignments in the jails.

So that's that's really how we started and trying to whittle down.

The second is from a philosophical point of view, um, I will tell you that my position was that that $30.8 million dollars that we get for the medically indigent, as you know, is severely lower than what we should have gotten.

And I think that's a statement that the city the city wanted to cut that.

That's a diminishment of their commitment to Denver Health and to the uninsured people that we have in this city.

So I honestly drew a hard line at that one.

So please understand that um no lack of commitment or message that we're giving.

Uh, we think Denver cares is critical to the services that we provide, and that's why we stood up and said we're gonna fund it ourselves.

I appreciate that.

I would just say that if you come, if you come to me in 27, um, or in 26, proposing uh those types of cuts.

I would hope there are plans not to plant a flower in a city park.

Um that better be the last available place to go because that can't be cut.

So thank you.

I very much appreciate Denver Health pick.

I don't know, I'm looking forward to hearing about two Q because I don't know where to come up with the document.

The other thing that happens, and I think we heard this from the police department, you know.

If Denver cares were not there, what would happen?

And in addition to many of those individuals not getting treatment, many of them would end up in our emergency room.

Oh, absolutely.

And that's a very expensive place for them to get care, and we don't need to have an overcrowded emergency room.

We don't need to have the social detox that has to happen at Denver Cares, get transferred to the emergency room.

And it would mean more work for the for the police department because they'd have to be figuring out do I take this person or not take this person, our EMS uh drivers, et cetera.

So this is a great stopping point uh on hopefully what isn't uh a road to the emergency room.

We talk a lot, my last comment, Mr.

Mr.

Chair, about that we don't shoot our wounded, but cutting programs like this as well as the programs that count Councilman Parity were asking about uh cutting those programs amounts to shooting our wounded.

So thank you very much.

I appreciate the explanation.

Sure.

Can I just provide just a quick comment?

Um I I think the entire city would agree that those are crucial kind of necessary services that are near and dear to DDPHE's heart.

I mean, we support those sorts of services, we funnel the DOAC funding through DDPHE, and it's a huge value of DDPHEs and hard to see it on the slide and hard to see it publicly.

And um to Donna's point, we tried to be as strategic as possible in places where the services would actually not be cut to those folks, and also not touch the the crucial services that Denver Health had kind of and the Sheriff's Department at a bare minimum could not lose.

And so I just want to I just want to state the value that DDPHE in the city has for those services as well.

It's a hard hard thing to see on the page.

I believe that to be true.

Thank you.

Yeah.

I would just say that this is just another section of a discussion that I know is beginning on giving council more time and ability to really look at the city budget.

Because this is just another part of all that, and to look at one piece and leave one piece out.

This doesn't work.

Thank you, Mr.

Chairman.

Great sir.

Thank you very much.

Thank you for the responses.

Councilmember Sawyer and Councilmember Torres.

Thank you, Mr.

Chair.

Thank you guys so much.

Donna, it's good to see you.

Sorry I missed Saturday night.

I was really looking forward to it.

Some of the council has then I got last-minute tickets to Eagles at the sphere.

So sorry, Denver Health, you lose out on that one.

Um thank you for everything.

Um during budget season, we had a conversation between three different budget presentations yours, the sheriff's office, and tech services, about the medical records issue and moving medical records over to um digital.

Is that the word?

Is that electronic?

Electronic, right?

I don't know, technology is not my thing.

First thing I tell anyone I hire, you're gonna have to manage up when it comes to technology.

So um, so where did we land on those?

I know it's not part of this operating agreement, but it is an incredibly important part of the work that Denver Health is doing in the jails.

Um, so there it dovetails.

So where did have we landed on that?

I think we have delayed.

Is that correct?

Wait, you gotta go to the thank you, Stephanie.

Stephanie Seiner, Denver Health.

We have um put in place.

Megan, um, was able to put in a contract for this year.

Okay, so we are actually in the point of invoicing for the services that we've already done.

So we did stop until we could figure out how to get paid.

Now we we are gonna get paid to 25.

So we restarted those processes.

So it's in cue to continue to be billed out in probably late second third quarter of 26 when we should be in full up and running.

I got a face.

Um, wait, nope, you gotta so uh just because of the microphones and people watching online, you have to come to the microphone and speak into it so that they can hear you.

I know it's not ideal.

It's using yourself as well.

Hi, Ronnie Brown, Dale Medical It's Render, Denver Sheriff Department.

Um, the last information I have is actually I don't have a big contribution, but spring of 2026 is when we're anticipating.

Oh, fantastic.

Yeah, yeah, yeah.

Great.

Okay, wonderful.

Really glad to hear that that has been short up.

Um I will just say I am also really concerned about this.

I'm so grateful to Denver Health for picking up that five million dollars um in 2026.

That is incredible and extraordinary, and we so appreciate it.

Um, I will also echo council member Cashman's concerns about 2027 and the services that are being provided and paid for in 2027.

Um, I also want the mayor's office to hear clearly, it is not okay to be putting pressure on our community partners and contractors, just like it is not okay to be putting pressure on independently elected officials to cut their budgets as a result of the Department of Finance and the mayor's office overspending our budget.

I want that to be clear.

It is not okay.

I apologize.

I want to do what I do most days, apologize for somebody else not doing their job.

I apologize.

It is not acceptable that we came to you and asked you to cut five billion dollars from an already short budget because of our overspending.

Thank you.

Thanks, Mr.

Chair.

Uh Councilmember Torres, thank you, Councilmember Story.

Thank you.

Um, just curious about Denver CARES.

One of the statistics that I had heard, oh, it's probably been about 10, 12 years ago, was that um some of the um highest utilization of Denver CARES beds were in instances when Denver hosted like the COCUCSU game or after St.

Patrick's.

Are you able to recover from those users of Denver cares when they utilize the Hub Bed?

You mean like CU itself or the individual idea?

Yeah.

So Mark, do you want to take a stab at it?

Thanks.

Yeah, uh answer that mark right again.

Um, so um funny you bring up the CUCSC of football game.

I'm happy to have an offline um fun story about that at some point.

But um, as it relates to that, we've been pretty intentional about the highly utilizers that you referenced through the Denver CARES program and uh providing additional treatment options to where we've brought in actual um rather than withdrawal management, which is the short-term treatment for people who are under the influence, bringing treatment programs within the four walls of the Denver CARES program that really is focused on reducing the higher recidivist in that program.

And so that's been very, very successful, and we continue to um try to expand those beds so people can have uh 30, 60, 90 day treatment option um after they um come out of the withdrawal management program.

Love that.

Curious though, because these for me um uh come across as a uh a population of users that could, users of those beds, um, that could pay, right?

That could recompensate Denver Health as opposed to um uh somebody who's unhoused or um so are you able to recover funding from those users?

So we're able to bill uh Medicaid for those uh treatment services in some of these.

Okay, or their insurer or something like that.

Okay.

Okay.

Absolutely.

Alright.

So and that's been a fundamental change where those services historically would have been fully funded to the city uh 10 to 12 years ago.

Thank you, Ingrid.

We also bill commercial payers, and um many of those we we work on our billing and coding so we can actually capitalize and maximize our ability to recover.

I mean, the truth is we don't recover as we don't get 100%, we don't get that in any area.

I also want to add as far as CARES is concerned, we do see an uptick.

I won't say CSU, but associated with different events, Red Rocks, for example.

And in addition to those folks coming to our ED, they also would go to the jail.

So we have a good partnership with the police department where they bring folks who don't necessarily need emergency care, bring them to care so they can decox.

So we see a lot of those folks as well.

Interesting.

Okay, I don't know that folks know that as much, right?

That of who actually ends up in this um uh basically bridge away from jail, just to kind of sleep it off and avoid some steeper issues, and that's how Denver CARES often takes care of a greater population.

So thank you so much.

Though that was my only question.

Uh thank you, Councilmember Torres.

Um, any final thoughts?

Um, and I guess I have one comment, but any final thoughts on Megan from you, CEO Lynn.

I'd like to um address 27 because it's really important, and I want to do that and close this and then we can talk about two Q.

Um, you may have seen last week the governor released his budget, and in his budget, remember the state's on a different fiscal year than we are, but he proposed no increase in Medicaid.

Forty-eight percent of our patients are on Medicaid.

We have to pay wage increases, we have to get prescription drugs.

I mean, the cost of health care goes up dramatically.

So in understanding 27, that's an important context because that would take effect uh July 1st of 2026, their fiscal year.

Um the second, as you watch the government shutdown, the main issue in the government shutdown is subsidies to people who buy their health insurance off of the exchange.

Not people like us that get it through our employer, but buy it through the exchange.

So we've already released the rates, all the health insurance plans, and the prediction, as you know, is that nationally 10 million people will lose their health care.

Well, some of them live in Denver.

Some of them live in the surrounding areas.

So we are anticipating that if those subsidies aren't extended, that we will see an increase in the uninsured patients that we take care of as soon as January 1st.

That's number two.

Number three, in 2027, as you know, the one big beautiful bill.

Oh, I don't say that out loud.

Takes effect.

And what that bill does is that it also makes significant cuts to Medicaid.

So we're not just talking about the city budget.

I want the council, and I know this we've had some conversations with the budget office as well.

That there's a little bit of a crisis looming for next year for us, but certainly a much bigger one in 2027.

Where the projections are for Colorado.

I've seen 200,000 people, 300,000 people lose their insurance just because of the HR what I call HR one.

So thank you for giving me the opportunity to set that context for the future conversations.

Thank you, CEO.

And we have uh council member parity.

This is a voting item, so we're gonna need to actually um have a vote on this as well.

And so, Councilmember Perry with a last um call.

Um thank you.

And I just wanted to kind of flag this because I think um there's gonna be a role for the city to play in um the eight the big ugly bill um outcomes when it comes to work requirements because we um have so much contact through all of our different providers um with people who are experiencing homelessness, likely on Medicaid, and highly likely to be within the population that um might be required to meet work requirements and have difficulty doing that.

Um, and so I'm just saying that in every space that I possibly can that I think that's gonna be an unusual.

I mean, we're not the city usually the free business, you know, but of course you all laugh because we kind of are.

Um, but we rely on that to fund the medical care at our shelters, the medical care in the jail and so on.

And so it's really in our interest to make sure that people are able to stay enrolled and meet the work requirements, do the paperwork.

Um, and I want to put out there um the idea that private hospitals have this hospital community benefit funding, and it would be highly in their interest to be spending that to help people meet work requirements on things like Denver Day Works programs within our shelters.

So I'm just saying that because of who's here in this room, and that's it.

That was my subbox.

Thank you, Mr.

Chair.

Thank you, Councilmember Parity.

One quick comment.

Um I think um C O L N and and Director Um uh Perezo.

I know that could I promote you to director?

So direct your subject.

Um I know these negotiations, these discussions are tough discussions.

I don't think any of anyone's taking it slightly.

I I know that this council um has um uh I would say across the board, unanimous support for making sure that um uh Denver Health is made whole.

Uh the difficulty of the 30 million flat every year is something that we may have we may um not lean in more to ask for additional dollars there, but for them to take on five million ongoing um would not be something that I I cannot imagine um in any budget coming to Denver City Council that we that would be supportive.

So we look forward to finding some way of some interim update on the status of that.

Um I'll leave it up to the legislative team and to council president to identify what that means and how, and we'll inform this larger group.

But um I think you have 13 council members that are saying we need to find uh those funds that cannot um Donna Lynn and her team can't be figuring out five million dollars next year.

That's a nice effort this year.

Wonderful when none of the counties are paying you for sending folks here, and I continue to push Metro County Commissioners and others um to, you know, we are the number one safety net hospital, but we don't have the number one amount of dollars uh to take care of the entire state, and so um strongly support you.

Action item uh before us.

Um there's a need for a vote.

Um, we'll need a motion.

I see councilwoman Sawyer, I see Councilmember Flynn.

I make sure everybody's on committee, you are.

Um is it movement second?

Um, is there a need for a uh fingers up, thumbs up?

Is Ramura Campbell on this committee also?

No, she's not.

So that's good.

Okay, um, so this will move to the floor.

Thank you both uh so much for your presentation.

Um thank you so much for providing this information on the good work um that you lead.

We have uh another briefing on two Q, so we'll take a few minutes just to have the transition over.

Thank you.

I'm running it for you.

Specialist.

Thank you, Council President Protect.

It looks like we are ready.

Stephanie, if you don't mind introducing yourself and um, and then we'll move into the presentation for auto briefing for Denver Health 2Q spending update.

Thank you, Council.

Stephanie Seiner, Denver Health Government Community Affairs.

Donna Lynn, CEO of Denver Health.

People all Dane, CFO of Denver Health.

Good to see you.

Okay.

Thanks for this opportunity.

I'm happy to entertain any questions.

My first slide might be a little redundant based on some of the conversations we have, but I think it nevertheless it's important.

How we look at the two Q sales tax is that we have an accountability to every person in the city and county of Denver, of course, to our elected officials as well.

And we have an accountability to spend the money in the way that it was intended to be spent.

And as you know, we had some very specified areas.

I'm gonna go through each of those five as we go through the presentation.

Thank you for teeing up the medically indigent or what is often called the patient care services.

It has been frozen, as you know.

It's a little less in the beginning than 30 million, but it wasn't two million.

I think it was ballpark, it was in the 20s, high 20s.

What led us to think about this was not just the flatness of the city's contribution to the MI payments, but you know, there were years where it was partly sufficient.

But since 2020, we have seen an explosion in uncompensated care.

Um, some of it's due to the changing service nature of our economy.

Um, just the quite frankly, the cost of living in Denver makes health care and other services somewhat unaffordable.

So I'll show you a slide in a minute that shows you just the increase in the number of uninsured patients who come from Denver.

Um so we have um we're gonna show you some of the things that we have spent the two Q money on.

Remember, it was also intended to help us get through the fact that we do have so many uncompensated uh care costs, and we have a need for infrastructure improvements.

Um again, thanks to the Vibrant Denver Bond for helping us with the West Side.

Long term, as you know, we have a 550 bed hospital that was built in 1970, and we have a long-term plan that we will have to present to the city to the city council to be able to replace that hospital.

It is old and it is not as uh technologically advanced as many other hospitals in the metropolitan and the state area, and long term we're gonna long term is not so long, midterm.

I'll still be here and breathing.

I hope when we bring that one to you.

All right, let's go to the next slide.

So this slide you are very familiar with.

This shows you, and just for a snapshot of uh uh recent year period, the flatness of the medically indigent payment from the city is at 30.7 million, and as I pointed out, that growing amount of uncompensated care uh beginning in 2020, uh both attributable to city residents, so a hundred and ten, almost a hundred and ten million coming from the city and uh 36 million coming from outside of the city.

You can go to the next slide.

So this is what I referenced in terms of, you know, something is happening.

Um, there was a little suppression of care, as you can imagine.

Um, COVID did a couple of things.

Certainly in 2020.

Um, a lot of people stayed away.

They maybe got sicker, as we all know in health care.

And so we had a little bit of an uptick in 2021.

But you can see, in other words, that was, I'm sorry, unmet needs.

People avoided doing things that they needed to have done that were non-related to COVID.

They didn't come to the hospital to have a knee replacement or to just deferred care.

So, you know, if you took 2021 out, you could see there's a pretty gradual, and then unfortunately in the last year from 23 to 24, a steep jump in the number of Denver patients who do not have uninsured, who do not have insurance.

This includes they don't have Medicaid, they don't have commercial insurance.

I'm not sure you're all aware.

Denver Health is an enrollment site for the state of Colorado, so we've gotten that designation.

We enroll patients in Medicaid or other hospital discount programs in all of our clinics.

On Bannock between 6th and 7th Avenue, you can see a lineup out of the old Robert Spear building.

Every single morning we are trying to enroll people in the appropriate insurance they qualify.

And even as much inside the hospital, we attempt to enroll people in whatever insurance they might be qualified for.

So this is not for lack of trying.

We actually have 79 employees that work in our enrollment functions to get people appropriately covered.

You can go to the next slide.

It's partly driven by the fact that health care costs go up every year, much greater than the cost of living.

One of the unfortunate conversations that we need to have with the governor, and as you know, we have TABER in our state, and TABER goes up at general inflation.

Healthcare does not go up at the rate of general inflation.

It's usually two to three percentage points higher.

So that's his one of his goals is to bring Medicaid in line with TABER, and that's just not possible without denying people services and denying, you know, people even qualifying in some cases.

So it's interesting this confluence of what the governor's trying to do, albeit in a thoughtful way, with HR1.

We are very labor-intensive at Denver Health, so 70% of our costs go into labor.

And you can see the other categories, as I said, pharmaceuticals, that other bucket includes things like rent, maintenance, insurance, and other things.

You can go to the next slide.

So what is this thing called uncompensated care?

It consists of two things people who don't have any insurance at all.

They can't qualify for Medicaid.

We also provide care if someone refuses to fill out those forms, for example, because they're afraid of putting things on paper these days, especially.

And then Medicaid and Medicare themselves do not cover the full cost of insurance.

Commercial insurance generally does.

In fact, it overk overcompensates.

So a hospital or health system that's able to attract a lot of commercial patients is often able to have a decent profit year after year.

You can go to the next slide, actually.

I think it's important.

One thing we did want the council to notice, we did step up last week and contributed over $35,000 to food banks.

We did that not because we have money to give away, but because the social determinants of health, you know, many of our patients come in and their lack of food, transportation and housing compounds their health care problems.

So we thought, given the current crisis that we have around SNAP benefits around WIC, that we would do that.

You may know that we provide WIC services in most of our ambulatory clinics as well.

Okay.

Now we're going to get a little dense here, so I apologize, but you have the slides, and I'm not going to read through every single thing.

But again, you wanted the accountability, and we believe in that.

There will be a formal, much like you get your annual report to the city on the things that the city buys from us.

There will be a companion that details where we're spending the money in 2Q.

So remember, five buckets: emergency and trauma care, primary care, pediatric care, mental health, and substance use.

So the first one is emergency medical services, and this is where a lot of the investment is going.

We've actually introduced some new technology.

Again, we want to take care of the core of patients that are part of our mission.

But we also want to take care of commercial patients.

I'm a commercial patient at Denver Health.

Our mayor is, our prior mayors are, and they're important to help us shore up some of our finances.

One of the things that we did not do is invest in technology.

We now have what is, first of all, we have two robots at Denver Health that allow our physicians to perform more accurate surgery, and it's also sort of state of the art when a trainee comes out.

They are often trained in medical school and residency on robots.

They're not like facsimiles of me that walk up to you.

These are arms that you stick your hand into, and they're able to do more.

That's that's my medical knowledge.

I've seen it, I don't know how to do it.

The other thing that we've done is we created a hybrid operating room.

Why is that important?

In the past, where we needed radiology for a patient in the midst of surgery or just prior to surgery, we were wheeling them, you know, down a corridor through an elevator.

And now the hybrid OR where you need that clinical capability is one big room, and so it's efficient, it's much more effective, it's less concerning to a patient who you've all seen TV shows, right?

And you see the patient going through the hallway, that's what we want to avoid.

Um we have also created some staffing capability and to create Denver Health as a stroke center.

It's a certification that gives somebody sort of in the old days you would think of it.

I'm gonna look at Councilman Flynn since he and I relate, the good housekeeping seal of approval.

Are you gonna object to that?

So when we get a stroke center certification or ambulances, the ambulances will bring patients to us.

Oftentimes they are commercial patients, and it's state-of-the-art care, whether somebody's insured or not.

We are launching a fellowship program that helps continue to train new people, new residents to come into Denver Health and so forth.

So you can see some of the things that we have started to do to improve in our emergency medical services.

You can go to the next slide.

A lot of money being spent also in primary care.

For those of you who are East, one of the great things is our Lowry Clinic.

When you think about Denver Care's Denver Health's footprint, we actually make everybody travel to Denver Health, this main campus to get X-ray, ultrasound, and mammography.

We do have a MAMO van that moves around the city, but as you can imagine with many of our patients, convenience is important and transportation can be a problem.

So we just opened up radiology in Lowry.

The new West Side Clinic, the Sam Sando's clinic, will also have radiology, and so it's an important thing to provide care more timely, more conveniently for our patients.

We've expanded some of our services as you can see, and we've added some dental hygienists both at Mombello and at Lowry, and you can see the increase in the number of visits that we're able to provide.

And we're really excited about some of the work that we do down here on the main campus to increase our hours.

So we paid people to work longer hours to take care of patient demand.

And that's true in Lowry as well, separate and apart from radiology.

We are now open on Saturday, both for our main clinic as well as pharmacy.

The OMs, I'm sorry, the OMC dental is also evening hours, just so you get a sense.

Evening hours, three days a week, as well as on Saturdays.

You can go to the next slide.

Oh, I'm sure I should have mentioned Warren Village because I know Warren Village is an important part of our fabric.

We now provide medical care at Warren Village for the families that go there.

It's a couple of days a week.

We don't have that much demand.

It's one standalone unit, but certainly providing medical services as well as behavioral health is important for the women and families that use Warren Village.

This is the new Alameda location.

You can go to the next slide.

So pediatrics, we are spending about $2 million dollars in pediatrics of our 2Q money to do a variety of things.

We have added a new nurse practitioner in our neurology and our pediatric neurology surgery areas.

We had some wait times.

We do have wait times at Denver Health because the demand is pretty extra excessive for a lot of our services, particularly in the specialty area.

So this allowed us to reduce wait times.

We added some services in our school-based clinics that resulted in over 3,000 visits, excuse me.

And then we will be adding, as you know, this is not a 2025 expenditure, but a 2026.

When the newest of our Denver Health School based clinics opens next year, hopefully, we will be providing services to one of Denver's largest high schools at the Sandoval campus.

One of the things that I love that I didn't know about Denver Health that's amazing is foster care kids who, as you can imagine, move across the system.

Previously, we had one clinic east where you know we could bring in, have a complete integrated electronic medical record for the parents who are bringing in their foster care kids.

Travel again became an issue.

And so this year we've added two new clinic locations and staff to support our foster care populations.

And go to the next slide.

I'm almost done.

We're spending close to 14 million of our 2Q money in the space of mental health.

We have invited you all next week, hopefully next Friday, to the opening of what we call IMAP.

So if you remember, Denver Health has 78 inpatient psychiatric mental health and substance use beds for those people that have to be inpatient for their services.

We kept them closed.

This was a question that we got from Councilman Cashman a lot, which was why can't we open them up?

And it was because the cost of hiring nurses was so high that we made a decision to keep 50-ish of those 78 beds open.

Recognizing how the world has evolved and the fact that many of our patients who come in with psychiatric problems also have medical.

We created 10 beds that are a combination of psychiatric and medical, so you get care for both.

So what you will see next Friday, the 14th, is the opening of our capacity to take care of patients in that space.

I'm sorry, 12 beds, I thought it was 10.

And that's really exciting.

We've been doing all the capital work, building up the staffing to be able to start seeing patients.

You can go to the next slide.

And then in the finally, in the alcohol and substance use areas, we have expanded our behavioral health team to coordinate people with substance use disorders, and we've created more of a walk-in and intake approach for those services.

You can see some of the volume that we have in those spaces.

You can go to the next slide.

So just summarize what we've done.

We have added, we've added staff, you know, and I do want to keep this separate from the conversation about next year and the budget, but we have been able through 2Q to add staff in the key areas where we've been, we've been focused on from the tax initiative.

I laid out some of our concerns for the next year in terms of how it will impact Denver Health's budget overall.

And then finally, I don't know if uh councilwoman Romero Campbell is still on.

We will begin to be able to see patients at the tail end of this year, but certainly a full opening for our Southeast Clinic, which is on Evans and Monaco, and serving uh patients there, not only for primary care, but for specialty care.

It really has we have a great model, but we make people travel a lot, whether it's for radiology services, it's for specialty care services.

And in that Southeast Clinic, we will have orthopedics, we will have dermatology, we will have rheumatology, we'll have a lot of specialty care services.

So I'm pleased that uh we will be able to expand that way using 2Q money.

Happy to take any questions.

Thank you so much.

Uh CEO Lynn for that presentation.

And I'm curious, Stephanie, I'm not seeing the IMAP.

I received an email.

I don't see the meeting on calendar.

So it's there's two events.

We um because of the doors not coming in on time, um, we are gonna do a VIP tour with Donna on the 14th, and there was an invite.

Bonnie already had moved off your schedule.

So it's I think it's December 12th.

Okay.

So I will get you guys an email today with and please choose one, but you will get it.

We're welcome to come and see it without the doors, but apparently we can't do it.

So you would get a VIP tour with Donna if you come on the 14th with no doors, and then December 12th, we'll also have another uh possibly the ribbon cutting when the doors are installed.

So it's it's been a little fun getting these doors.

I didn't mean to break the surprise of the VIP before, so I apologize.

I apologize.

Thank you so much, uh CEO Lynn for the presentation.

Um, and we have two members in a queue.

And um, I don't know once again, Councilmember Romero Campbell.

Not asking you to ask a question, but just letting you know if you'd like to be in a queue, please let me know.

And we'll start first with Councilmember Flynn, then Councilmember Torres.

Okay, Mr.

Chair.

Um, the two Q payments come in monthly.

They do.

And it's a fixed amount, 64 65 million dollars.

But as you know, we are not achieving our sales tax goals.

So what's going to happen for the true up at the end of the year?

Are you concerned about having to Lisa's here?

Perfect.

So I imagine if our sales tax calls are I'm actually not concerned.

So I'll explain why.

I'd love to hear.

Hi, folks.

Lise Matall, DDPHE, I'm the Denver Health Sales Tax Administrator.

Uh, similar to other sales tax projects, the reconciliation process happens, and I'm sure Department of Finance could say a much better explanation, but uh it'll all be finalized in the beginning of the next quarter of the 2026.

Uh right now it's still on track because of the sales tax items that are collected for the sales tax.

So we're not necessarily projecting being radically under, but through the reconciliation process, like the cities up to one percent will be reconciled as well.

So we'll be giving that money to Denver Health as well.

Okay, how does the reconciliation occur?

Is it it's not a lump sum, is it, or is it?

It's uh so with caring for Denver, we do a true up invoice.

So uh if we have overpaid caring for Denver, we'll send them an invoice and they will pay us back.

Uh so similarly, it'll be a true up invoice and per the contract, you all have a year to pay it back.

So there's a little bit of time.

So it's spread, that's what we are, so it's spread out.

It's not yeah, we won't require them to pay it immediately.

Yeah.

Thank you.

Thank you, Mr.

Chair.

That was my only question.

Thank you, Councilmember Flynn.

Uh, Councilmember Torres.

Thank you.

I'll pick up on that line of questioning.

You're budgeting for more than the projected amount, though, uh, by about 5.7 million.

Um the estimates of what you're uh projecting to spend is more than the estimated.

Oh, you mean the thing, but I've shown you.

Correct.

Yeah, it it it it's we are budgeting, so we're budgeting for exactly what the city told us to budget for.

If you add up the things that we're spending money, yes, it it is higher.

Um, you know, at one point we thought it was 70 million.

Yeah, um, we brought it back conservatively to sometimes some days it's 64, some days it's 65.

I think mostly it's 64.

Um, but we started going down the road of where we were spending the money because of demand.

So, you know, it might be a little over in this area or the other.

Um, we've we've had some good news from the state this year.

We know it's not gonna last, but um we knew we had to get we I didn't want to come to you at the end of the year and say, oops, we were only able to spend 30 million, and so we put in motion as soon as 2Q passed all the plans that we knew that we needed to meet some of the demand.

I guess my um question is like do you already know where some of that will shave off?

Um, you want to so the thing that we have to keep in mind for this is that each year is going to be a little different.

There are going to be some areas that might need a little bit more.

So we're looking at all of that, and we're in the process of finalizing our budget for 2026, but we will be within the budget that is determined by the city for us to spend for 2Q.

Okay, so and I mean, let's take um we hired the pediatric um neurologist, like we did that knowing we had the safety of 2Q, but we wouldn't just fire, we're not gonna fire that person because 2q is a little short because we know the demand is there, and in some cases that patient that excuse me, that employee is taking care of allowing us to bill.

So your billing question before, it's allowing us to bill commercial patients where we might have some offsetting revenue as well.

Okay, it is definitely a blending of sources that becomes a little hard when you true up to understand okay, what is 2Q paying for uh versus all your other sources?

Um is there gonna be like a uh a way that we're gonna be able to see that very clearly, or is it gonna be because the general categories of you know about 14 million pays for um uh extended hours, additional, you know, whatever um the pieces are in the five areas, but will will it be really discernible or is it gonna kind of still be a little gray?

I think it'll be discernible.

So I think we're we want to do it by category, which is what we presented to you today, and then we can also ascribe to it, you know, additional visits, you know, as you said, extended hours.

So we can do it.

I guess accounting would call it a functional analysis versus, yeah.

And I think if Dr.

Federico were here, um he would say that it's really tough too when you get into teams, because you know, Dr.

Hanratdy doesn't just see uncompensated care patients, right?

Dr.

Hanrady sees uncompensated and insured, and so I think breaking those down to the nickel and dime of each AU is gonna be really tough.

I think we really wanted to show that labor is a huge cost.

And so anytime you see an extended hour or anytime you see um any type of extended service, um, that means that we had to create a new team to provide that service.

So we we will be able to dive a little bit deeper in how that those funds are spent, but it is really gonna be hard to get all the way down to that nickel and dime.

Um, but we know that the service is there too.

And we can also show in those departments how many of those patients are uninsured.

We just won't be able to break down six patients were uncompensated for Dr.

Hanraddy and six were, you know, commercial.

Okay.

Um in terms of like what's publicly available information.

Um, are we looking at like an annual report or yeah, okay.

So remember, you get everybody gets that spiral bound report to the city.

I assume we probably should be thinking about it being electronic.

Uh, but yes, you will get a a report on the two Q expenditures.

And we're currently working with the lease on the Third Horizon consultant that they've hired to really look at the breadth of what are we missing from our lens to really make sure that it's readable for the general public on how those dollars are being spent.

Yeah, that's great.

I think that's what I'm getting at, okay.

Thank you, Stephanie.

Yeah, thank you, Councilmember Torres.

Um look around the room, so there are any other questions on 2 Q.

Um seeing none.

My comment.

Oh, please go ahead, Council President.

Thank you.

Thank you, Mr.

Chair.

Um, I just wanted to make a real um quick comment, and I think that um it's kind of been touched on already.

Um that Southeast uh Denver clinic that is opening um so needed and wanted.

Um is the location yet public?

Oh yes, I'm sorry.

Um I don't know the exact it is on the corner of Evans, on the southwest corner of Evans and Monaco.

It is a wall, it was a Walgreens, it has a big parking lot around it, and that's really helpful for us to be able to have a discrete parking lot for our patients.

And yes, so that's so drive by it today.

I think it's gonna be a great location.

It's right off of bus lines, it's on Monaco and Evans.

It's not only I think very accessible for um District 4, but also for um my fellow council members here with District 6 with uh Councilman Cashman.

Um I am also really excited about the model that you've been talking about for much-needed services in the area because you also take um private insurance and being open to those services with Denver Health and being able to also have private insurance income coming into that clinic as well.

I think is a nice combination for um long-term sustainability.

Great, thank you.

Yeah, no, thank you.

Very excited about it.

Thank you, Council President Pro Tem.

Um quick question.

For Clayton Early Learning Um CEO Lynn, uh that expansion is that included anywhere within two Q, or is that just separate?

The Monaco.

No, no, yeah, Clayton early learning.

Clayton learning, I'm sorry.

I didn't hear you.

Um, Clayton Learning.

Well, um, so Clayton Learning, uh no, we were at their event, uh, is has two pieces to it.

One is the physical conversion of the space to be able to have a clinic, which Clayton Learning is uh raising money for, and then the staffing um certainly can be a two Q.

Yes, we can certainly can.

I think we're in that's into a 2028 time frame, but we certainly could use view that as a two Q expansion.

The staffing definitely will be, right?

To the point about building teams.

The staffing at Clayton will be two Q supported because without that staffing, especially for a population that's highly Medicaid, right?

We have uncompensated care costs that we're gonna have to backfill in order to keep growing those teams.

I want to thank you and your team for that.

I think that is such a uh needed space and opportunity and for the families that are currently there, and then the possible expansion of that campus having you as a partner, it's gonna be essential.

So um one last look to see if there are any other questions.

Um, seeing none.

Thank you all for being here.

Thank you for the presentation.

Thank you to our friends from DDPHE as well for their initial uh presentation and action item.

We have nine consent items, and seeing that none are pulled off, uh this meeting's adjourned.