County Board Meeting - Administration Center — Agenda Packet

1 COUNTY BOARD REGULAR MEETING Wednesday, February 18, 2026, 9:00 AM ADMINISTRATION CENTER - ROOM A-204 121 W. MAIN STREET, PORT WASHINGTON WI The following business will be before the County Board for initiation, discussion, consideration, deliberation and possible formal action: The public can access the meeting by viewing the live stream on the County website, Agendas & Minutes page and select the meeting agenda date. The public can submit comments here: Public Comment Form Public Comment Policy & Instructions For Submitting Public Comments Online AGENDA 1. CALL TO ORDER 2. PLEDGE OF ALLEGIANCE TO THE FLAG 3. PUBLIC COMMENT Legislative Update Chairperson's Proclamation 4. COMMUNICATIONS 5. PRESENTATION a. Integrated Behavioral Health Day Treatment (Dual Diagnosis) Program Presentation Jason Dzwinel, County Administrator; Kim Falkner, Human Services Director and Emily Plahna, Behavioral Health Manager 6. COMMITTEE APPOINTMENTS/REAPPOINTMENTS 7. COMMITTEE REPORTS AND SUPERVISOR ANNOUNCEMENTS 8. ADJOURNMENT Persons with disabilities requiring accommodations for attendance at this meeting should contact the County Clerk’s Office at 262-284-8110, 24 hours in advance of the meeting. Page 1 of 8 Item: 5.a. Agenda Item Information Sheet To: COUNTY BOARD From: Jason Dzwinel, County Administrator Meeting Date: February 18, 2026 Department/Office: Dept of Administration Item Name: Integrated Behavioral Health Day Treatment (Dual Diagnosis) Program Presentation Jason Dzwinel, County Administrator; Kim Falkner, Human Services Director and Emily Plahna, Behavioral Health Manager Summary: Proposed One-Time Use of Opioid Settlement Funds Recommended Action: Attachments: 1. Dual Diagnosis Support Document_Payor Mix (002) Page 2 of 8 Executive Summary Proposed One-Time Use of Opioid Settlement Funds Integrated Behavioral Health Day Treatment (Dual Diagnosis) Program – Ozaukee County Funding Context Ozaukee County currently has $1.7 million in opioid settlement funds available, with a total allocation of $3.7 million through 2038. These funds are presently supporting the co- responder team and must be used for opioid harm reduction and treatment expansion. The anticipated annual expenditure of approximately $225,000 in 2026 for the co-repsonder team. In an effort to put these funds to their best use, the County Administrator, Human Services Director, Public Health Officer, Sheriff, and District Attorney met as ad hoc group to review potential uses of the funds to assist with opiate harm abatement per the requirements of the settlement. All parties agreed that the establishment of an Integrated Behavioral Health Day Treatment (Dual Diagnosis) Program emerged as the most strategic and system-impactful use of these funds. Program Need There is currently no comparable day treatment service in Ozaukee County. The lack of this service serves as a barrier to county citizens seeking this treatment. It is not offered by all of the health systems within Ozaukee County and no not-for-profit organization currently operating in the county holds the appropriate licensure. In the absence of this level of care, individuals with co-occurring mental health and substance use disorders often cycle through: • Emergency departments • Crisis detention • Jail and court involvement • Inpatient psychiatric hospitalization These systems are designed for short-term stabilization, not sustained recovery and are costly for the county. Moreover, the county is currently using contracted Psychiatric services to maintain our DHS 75 licensure that currently supports the ongoing treatment services in the Human Services Department. While this approach satisfies the state licensing requirements it is not optimal, expensive and can be a hinderance in mental health court hearings. The use of contractor examiners places the county in a position that is incongruent with the intended statutes and opens the door to liability, legal battles, and additional costs. Using one-time opiate settlement funds to establish a Dual Diagnosis Day Treatment Program fills these services gaps by providing structured, intensive outpatient treatment Page 3 of 8 while individuals remain in the community. Additionally, the funds that the treatment billing will generate will allow the county to hire a Medical Director replacing the contracted Psychiatric services to not only serve the program, but also other treatment programs in Human Services as well as satisfy the requirements of the Ozaukee County Courts. Program Overview The proposed program would: • Operate five days per week • Serve up to 16 clients per day at full implementation • Provide integrated treatment for serious mental illness and opioid/polysubstance use • Support administration of Chapters 51 and 55, including court hearings, re- commitments, and guardianship cases • Coordinate closely with the behavioral health team including crisis, the co- responder unit, courts, law enforcement, and jail services • Provide a ready treatment solution for individuals in crisis reducing the need to voluntary and involuntary commitments This creates a defined treatment destination beyond hospital emergency detention or incarceration. System Impact This program strengthens and complements the co-responder model by: • Providing an alternative to emergency detention • Reducing jail admissions related to behavioral health crisis • Reducing the number of individuals waiting in jail for higher level step down level treatment • Lowering emergency department utilization • Offering a more humane and clinically appropriate stabilization pathway Instead of cycling individuals through hospital and jail systems, the County would have a structured, recovery-focused option Pro Forma Summary (Based.on.Behavioral.Health.Cost.Model) 1. Annual Operating Cost (Staffing-Based) • Total Annual Cost: $661,168 (Represents.direct.staffing.cost·.does.not.include.supplies.or.equipment¡) Page 4 of 8 Staffing Plan NEW HIRE STAFF CURRENT STAFF 1. Psychiatrist (0.75 FTE): ~$306K • Needed for State license compliance • 0.25 FTE to support Behavioral Health Services 2. Case Manager (1.0 FTE): ~$105K 3. Occupational Therapist (0.50 FTE): ~$59K • Needed for client services and licensure from State • 0.50 FTE to support Behavioral Health CCS Program – full cost recovery 1. Behavioral Health Manager (0.35 FTE): ~$56K 2. Clinical Lead (0.75 FTE): ~$93K 3. QA (0.25 FTE): ~$26K 4. Support (0.25 FTE): ~$16K • Reallocation of responsibilities to clinic operations • Capacity created with enrollment of current clients in clinic CLINIC PRO FORMA ASSUMPTIONS Estimated Hourly Clinic Billing Rates Medicare Rate: $41.00 Medicaid Rate: $21.00 Insured Rate: $58.00 Self Pay: $16.00 Estimated Per Diem Rates Medicare Rate: $250-$350 Medicaid Rate: $170 Insured Rate: $350-$600 Self Pay: $128 Current Outpatient Payor Mix Ozaukee Medicare Rate: 37% Medicaid Rate: 45% Insured Rate: 12% Self Pay: 5% Page 5 of 8 PAYOR MIX BILLING ASSUMPTIONS - CURRENT PAYOR MIX Eight Clients Annual Biling Hours: 12,240 240 Weekly Hours 51 Weeks (Omitting Christmas) Hours Billed Revenues Medicare Payor: 4559 $186,935 Medicaid Payor: 5539 $116,311 Insured Payor: 1499 $86,965 Self Payor: 643 $10,282 TOTAL $400,493 Sixteen Clients Annual Biling Hours: 24,480 480 Weekly Hours 51 Weeks (Omitting Christmas) Hours Billed Revenues Medicare Payor: 9119 $373,871 Medicaid Payor: 11077 $232,621 Insured Payor: 2999 $173,930 Self Payor: 1285 $20,563 TOTAL $800,986 Clinic Operating Cost: $661,168 Reduced Outpatient Payor Mix Medicare Rate: 27% Medicaid Rate: 55% Insured Rate: 5% Self Pay: 12% Page 6 of 8 PAYOR MIX BILLING ASSUMPTIONS - REDUCED PAYOR MIX Eight Clients Annual Biling Hours: 12,240 240 Weekly Hours 51 Weeks (Omitting Christmas) Hours Billed Revenues Medicare Payor: 3335 $136,751 Medicaid Payor: 6763 $142,015 Insured Payor: 643 $37,271 Self Payor: 1499 $23,990 TOTAL $340,027 Sixteen Clients Annual Biling Hours: 24,480 480 Weekly Hours 51 Weeks (Omitting Christmas) Hours Billed Revenues Medicare Payor: 6671 $273,503 Medicaid Payor: 13525 $284,029 Insured Payor: 1285 $74,542 Self Payor: 2999 $47,981 TOTAL $680,054 Clinic Operating Cost: $661,168 At full census, the program covers operational costs of staff, as it does, at a conservative payor mix of reducing Medicare and Commercial Insurance. Because day treatment is cost-reporting eligible, the small remaining gap may be further reduced depending on cost settlement outcomes through Medicare during the ramp up period. Financial Strategy Opioid settlement funds would be used as a one-time startup investment to: • Cover ramp-up operating gap • Support initial staffing and recruitment • Fund program development and implementation Once enrollment reaches 14–16 clients per day, reimbursement offsets nearly all ongoing staffing costs. This approach: • Uses settlement funds for infrastructure development Page 7 of 8 • Avoids long-term structural dependency • Builds a sustainable treatment model Conclusion With $1.7 million currently available and $3.7 million allocated through 2038, Ozaukee County has a rare opportunity to convert restricted opioid settlement funds into lasting treatment infrastructure. At full enrollment, the program approaches financial sustainability while: • Expanding opioid and dual-diagnosis treatment capacity • Reducing pressure on law enforcement and courts • Improving recovery outcomes • Filling a critical regional service gap This is a strategic, time-limited investment with long-term public safety and public health returns. Page 8 of 8