10-4 vote puts county in lucrative Medicare rehab biz

LACONIA — The Belknap County Convention last night approved a supplemental appropriation of $200,000 to enable the nursing home to offer rehabilitative services to Medicare patients, but only after another bid to gain the upperhand in its struggle with the Belknap County Commission over control of the operating budget failed.
The commission first broached the subject of the supplemental appropriation in April, explaining that the funds would defray the cost of providing physical, occupational and speech therapy, along with medications, testing and x-rays, to a limited number of short-stay patients. The services would be provided by independent contractors, not additional staff, and reimbursed by Medicare at 14-percent above cost.
Matt Logue, director of the nursing home, projected the program would return some $414,000 in revenue, representing net revenues of $200,000, which would offset property taxes. Beds that are currently empty would be used.
Logue presented the proposal to the convention at a public hearing last month, but a procedural flaw in posting the meeting, required that both the hearing and vote be rescheduled to last night.
When Rep. David Huot (D-Laconia) moved to approve the request, Rep. Colette Worsman (R-Meredith), who chairs the convention, linked the request to the dispute over the budget, which has dogged relations between the convention and commission since December.
From the outset of the budget process, the convention claimed authority to add or delete, raise or lower specific line items and insisted the commission cannot shuffle funds from one line to another without its approval. The commissioners, on the other hand, counter that the authority of the convention is limited to the appropriations for particular departments, within which they can allocate funds to different line items in the course of managing the day-to-day operations of the county. The issue came to the boil when the commissioners reallocated money within department budgets to fund employee benefits that the convention stripped from the budget.
Worsman raised the issue by asking if the convention approved the supplemental appropriation, would the $200,000 be added to the line item budget adopted by the convention or to the budget being administered by the commission. Commissioner John Thomas of Belmont, the chairman, replied that the funds would be added to the commission's budget.
Rep. Frank Tilton (R-Laconia) went a step further by proposing to reduce the supplemental appropriation by $50,000, from $200,000 to $150,000. He explained that by adjusting the budget adopted by the convention, the commissioners had decreased or eliminated appropriations amounting to $179,609. "There is plenty of money in the budget that we appropriated," he said, adding that as chairman of the Executive Committee of the convention he would schedule a meeting to approve any transfers commissioners recommended to fund the program at the nursing home.
Tilton reminded the commissioners that in 2012 they requested a supplemental appropriation of $160,000, but spent only 92.5 percent of the funds appropriated. "I'm still smarting from last year," he said. "The $160,000 could have come out of existing appropriations. I still remember that."
Commissioner Ed Philpot acknowledged that the commission "moved money around to meet contractual obligations to county employees. We have a disagreement about that," he continued, but it is inaccurate to say there $50,000 floating around out there." He said that if the supplemental appropriation was reduced, the program would not raise the projected the revenue.
Noting that members of the convention represent the taxpayers, Worsman said "you have to show that you will not take the money and put it wherever you like. That's what we're wrestling with."
"We represent the same taxpayers you represent," Philpot shot back. He said that the commissioners have presented a formal proposal, specifying the line items to which the funds will be applied and projecting the revenues they would generate.
Rep. Ian Raymond (D-Sanbornton) urged the convention to separate the request from the other outstanding issues between the convention and commission.
Growing impatient, Thomas told the convention "do what you have to do so we can get on with our work."
Tilton's motion was put to the vote and failed as the 14 members present divided evenly. Six Republicans — Reps. Richard Burchell of Gilmanton, Jane Cormier of Alton, Michael Sylvia of Belmont, and Bob Greemore, Herb Vadney and Worsman of Meredith — joined Tilton in favor. Three Republicans — Don Flanders of Laconia, Stephen Holmes of Alton and Chuck Fink of Belmont — voted with the four Democrats — Lisa DiMartino, Ruth Gulick of New Hampton, Huot and Raymond — against.
The original motion to approve the supplemental appropriation as presented carried by a vote of  10 to four, Worsman, Burchell, Cormier and Sylvia in opposition.
Rep. Beth Arsenault (D-Laconia), Bob Luther (R-Laconia), Dennis Fields (R-Sanbornton), and Guy Comtois (R-Barnstead) were absent.