Excused:  F. Proto

Staff: K. Fuller, Deputy Clerk of the Legislature; S. Whicher, County Administrator; J. Kippola, Contractors Coordinator; P. Carey, Commissioner of Social Services; R. De Luca, Interim Mental Health Commissioner; B. Crosby, S. Connors, M Setuli, Health Department; B. Falcao, Health Planning Council

Called to Order

 The meeting was called to order at 1:30 p.m.

Changes to Agenda

 Ms. Robertson noted that due to conflicts, the Mental Health and Health Departments are swapping time slots.

 A budget adjustment for the Office for the Aging is being added as well.
 
Minutes of December 8 and 21, 2004

 It was MOVED by Ms. Blanchard, seconded by Mr. Winch, and unanimously adopted by voice vote of members present, to approve the minutes of December 8 and 21, 2004, as amended.

Retirement Announcement

 Ms. Robertson announced to the Committee that Marge Dill, Human Services Coalition Executive Director, will be retiring at the end of April following thirty years of service in human services, with thirteen as the Executive Director of HSC.  She spoke of the community's reliance on Ms. Dill and the Coalition for guidance, support, and leadership.  Ms. Dill thanked everyone and said she has had a wonderful time while working at the Human Services Coalition and said that she may work in a limited capacity after her retirement.  She indicated that she has faith that the agency will carry on as it has to assist the community and that she looks forward to good times for all.

Prescription Drug Card

RESOLUTION NO. 5 - SUPPORTING THE COMMUNITY PRESCRIPTION DRUG DISCOUNT CARD PROGRAM
 
 It was MOVED by Ms. Blanchard, seconded by Mr. Winch, to submit the following resolution to the full Legislature for approval.  Ms. Robertson said the card will be available to all, with no restrictions based on age.

 Ms. Kiefer arrived at this time.

 Ms. Robertson said the cards will be delivered to the HSC within the week, and the Health Planning Council will begin distributing the cards and accompanying information right away.

 Ms. Falcao reported she had stopped by a pharmacy in Collegetown and priced a drug through the card; she would have received approximately a $20 reduction from the retail price.  Although the pharmacy was not familiar with the cards, they were able to call the number on the card to obtain the necessary information to grant the discount.  Ms. Falcao spoke of using VISTA workers to help distribute the cards at sites throughout the County, including pharmacies, town halls, libraries, senior citizen centers, primary care physicians, and other points of contact for the public.  Ms. Robertson said there will be a media release on Friday, January 21, which will provide additional information to the public regarding the card.

 Ms. Kiefer asked whether the Spanish language on the card had been specifically done for Tompkins County.  Ms. Robertson said that the basic card only had one or two sentences in Spanish, so Tompkins County requested additional Spanish language for the card.

 A discussion followed regarding the card's use by non-residents.  Ms. Robertson said the card can be used by anyone and with no restriction on residency.  Tompkins County is marketing this to local residents; however, the card may be used nationwide as approximately eighty percent of all pharmacies participate in this program.  Members discussed how telephone calls with questions or problems would be handled, and Ms. Falcao said a toll-free number for assistance is located on the card.  Ms Carey said that some of the DSS staff, and possibly Health Department staff as well, would need orientation as to what the card is and how it works.  Ms. Robertson asked that Ms. Falcao work with Ms. Carey and Ms. Cole, and any other departments where the cards will be available for clients, so staff will have the appropriate information to answer questions about the program.  Ms. Falcao mentioned that Bev Chin of the Health Planning Council has met with the Office for the Aging and Lifelong, and all pharmacies have been contacted.  At this point all pharmacies in Tompkins County are participating, including Palmer’s in Trumansburg.

 Ms. Falcao said that by next Friday, January 21,  all pharmacies will have the cards.  Additionally, because the Health Planning Council  received a Park Foundation grant of $6,500, the drug discount cards will be inserted into the local Pennysaver newspaper on January 26.  In response to an inquiry  Ms. Falcao noted that no particular group of medications was exempt and that questions should be directed to the company through the toll-free number.

 A voice vote resulted as follows:  Ayes - 4; Noes - 0; Excused - 1 (Legislator Proto).  MOTION CARRIED.

WHEREAS, health care costs have been rising yearly far above the rate of inflation, and the cost of prescription drugs is the fastest-growing factor contributing to this growth, and
WHEREAS, many individuals, such as senior citizens, self-employed people, part-time workers, and workers in low-to-moderate wage jobs, have inadequate or no insurance coverage for prescription drug costs, and
WHEREAS, according to a report from the National Center for Health Statistics, more than 40 percent of Americans take at least one prescription drug, and 17 percent take three or more (New York Times, 12-3-05), and
WHEREAS, several counties in New York State have entered into agreements with pharmacy benefits managers (PBMs) who negotiate discounted prescription drug costs with pharmacies and other suppliers to provide county residents a discount card to purchase prescription drugs at a reduced price, and
WHEREAS, the Health and Human Services Committee investigated the various PBMs and the programs they offer, to address this critical need within the community and seek financial relief for the uninsured and underinsured, and
WHEREAS, the discount card offered by CaremarkRx requires no application fee or application process for residents to use the discount card, and there is no cost to taxpayers or users for the CaremarkRx program, now therefore be it
RESOLVED, on recommendation of the Health and Human Services Committee, That the Tompkins County Legislature supports the prescription drug discount card program offered by CaremarkRx of Nashville, Tennessee, to provide prescription drug discounts for uninsured and underinsured Tompkins County residents,
RESOLVED, further, That any resident may use the discount card, and publicity and outreach efforts will be made to distribute the cards and publicize their value.
SEQR ACTION:  TYPE II-20

Mental Health - Request to Fill Position

 It was MOVED by Mr. Winch, seconded by Ms. Kiefer, to approve filling the position of Caseworker in the Mental Health Department.  Mr. De Luca explained that the individual in  the position is responsible for assisting clients who have severe mental health problems.  He explained this position has varied duties, which may include assisting with shopping, paying monthly bills, transporting to and from appointments, etc.  The caseload is determined through an Office of Mental Health formula that indicates a full caseload is twenty individuals.

 A voice vote was unanimous to approve the position.  POSITION APPROVED.

Update on SRO

  Mr. De Luca informed the Committee that the request for proposals (RFP) for the single room occupancy facility has been distributed; the deadline to respond to the RFP is January 28th.  Thus far, there is at least one party interested, while some recipients of the application have declined to bid. .  Mr. De Luca noted the RFP requires the vendor to develop and manage the facility as well as work with the Office of Mental Health to build the physical facility itself.  A small committee will review the proposal(s).  The choice will be made by the County with a review from the Office of Mental Health.  Mr. De Luca also said he has confirmation from the state of funding for 20 beds for Tompkins County.  The additional allocation of five beds would be brought by the provider.  Mr. De Luca will expand on this topic at a later date.

Health Department - Request to Fill Position

 It was MOVED by Ms. Kiefer, seconded by Ms. Blanchard, to approve filling the position of Community Health Nurse.

 Ms. Connors, Director of Patient Services, provided graphic information to the Committee that documented the need for an additional staff member.  She pointed out that as a result of budgetary cuts and significant increases in requests for services, it is imperative to fill the position.  Ms. Gatch reported that in 2004 the Health Department was had to turn away 28 cases because of staff shortages; to date in 2005 they have already had to decline 11 cases.  Exacerbating this staffing shortage is the fact that Visiting Nurse Services, a private firm that also provides home health aides, has lost staff and is declining to take any new patients at the present time.   Tompkins County has only two Certified Home Health Aides, Visiting Nurse Services and the Health Department.  Ms. Connors said as a result these patients are required to be at home without care, enter a nursing home, or remain in the hospital.  Ms. Connors has discussed this situation with Mary Agnew, Director of Patient Services at the hospital. The inability of County staff to take on additional workloads during the Visiting Nurse Services freeze, is creating a situation where the hospital is rapidly reaching a capacity point that will require canceling elective surgery.

 In response to inquiries from the Committee, Ms. Connors spoke of her efforts to hire per diem nurses to assist in an on-call capacity.  These efforts have not been successful.  Ms. Connors expressed concern for her staff as they presently show low morale and are over-worked due to this short-term "crisis." Ms. Connors said that on-call visits have almost doubled in 2004 compared with the previous year, forcing mandatory overtime for nurses.

 Ms. Robertson asked whether cases covered by our Health Department during this period of shortage would continue with us, even after upon the private home nursing agency begins accepting clients again.  Ms. Connors felt that was possible, but that if some clientele shifted back there would not be a lack of work; the Health Department has consistently had to decline services to individuals in the past several years.  Ms. Connors also stated that for the first time in her thirteen years with the program, she has had to ask for approval to use Cortland County staff to help take some of the clients.  At this time each individual request is being reviewed on a case-by-case basis to determine how to best serve the client.

Executive Session

 It was MOVED by Ms. Blanchard, seconded by Mr. Winch, and unanimously approved by voice vote of members present, to enter into an executive session to discuss personnel matters.  Executive session began at 2:15 p.m.

 On motion, Executive Session ended at 2:27 p.m.

Continuation of Health Department Request to Fill Position

  Ms. Connors said that it would take about a month to fill the position, and about six months for the new hire to be comfortable working in the program.  She added that the market for nurses is such that it is very difficult to recruit for a half-time position or for one that is temporary.  She also pointed out that a new half-time nurse would not be adequate for the need.  Additionally, it was pointed out that once Visiting Nurse Services continues operations there will still be a need, as they do not cover wound care (dressing changes).

 A voice vote on the motion to approve filling the position of Community Health Nurse resulted as follows:  Ayes - 4; Noes - 0; Excused - 1 (Legislator Proto).  POSITION APPROVED.

Department of Social Services

Request to Fill Position

 It was MOVED by Ms. Kiefer, seconded by Mr. Winch, to approve the request to fill the position of Financial Investigator in the Department of Social Services.  Ms. Carey pointed out this request is due to a retirement, and funding is in place in the 2005 budget.  A voice vote on the motion to approve filling the position of Financial Investigator within the Department of Social Services resulted as follows:  Ayes - 4; Noes - 0; Excused - 1 (Legislator Proto).  POSITION APPROVED.

Health Department

 Budget Adjustment

 It was MOVED by Mr. Winch, seconded by Ms. Kiefer, and unanimously adopted by voice vote by members present, to approve and submit the following budget adjustment to the full Legislature for approval.  (Ms. Blanchard temporarily out of room).

Health Department
Revenue Acct           Title             Amt   Approp Acct     Title(s) ___________
4016.41610 Home Nursing Charges $25,438  4016.51580     Salary
4016.41610 Home Nursing Charges  $14,800  4016.58800     Fringes
4016.41610 Home Nursing Charges $  1,825  4016.52206     Hardware
4016.41610 Home Nursing Charges $  2,375  4016.54442     Professional Service Fee
4095.43401 Public Health Work $12,509  4016.51580     Salary

Explanation:  The Home Care Program continues to see a surge in referrals past our capacity.  In 2004 we declined service to over 20 clients due to lack of adequate staffing.  This budget adjustment reflects the additional revenues to be realized based on approval to hire an additional nurse.

Liaison Roles

 Ms. Robertson asked about the status of the Department of Social Services Advisory Council.  Ms. Carey explained that the Advisory Council had been created by former Commissioner Dolan, who disbanded it on  her retirement.  This Council is not required by State Law, although it is recommended by the State Department of Social Services.  Ms. Carey said that the focus during her first year in the position has been to review internal structure and procedures.  She does not believe there would be any repercussions if this Council, which is clearly advisory with no authority, were not formed.  Mr. Winch noted that as a former member of the Council he did not see a great deal of value in it.  Ms. Carey said in the future an Advisory Council may be formed, however, she feels it is important that it have a distinct purpose rather than just meeting without one.  She noted that at present, she pulls together various groups with similar interests to discuss system changes in the department.

 Committee members volunteered for liaison roles for 2005 with the many community agencies and boards that report to HHS.  A final list will be circulated when all positions are assigned.

Office for the Aging

 Budget Adjustment

It was MOVED by Mr. Winch, seconded by Ms. Kiefer, and unanimously adopted by voice vote by members present, to approve and submit the following budget adjustment to the full Legislature for approval.

Office for the Aging
Revenue Acct           Title             Amt   Approp Acct    Title(s) ___________
6777.44772 Federal Revenue     $ 4,515 6777.51000571     Salary
6777.44772 Federal Revenue     $ 1,760 6777.58800     Fringes
6777.44772 Federal Revenue       $    225 6777.54414     Local Mileage

Explanation:  Adjustment needed to cover Aging Services Planner's salary, fringes, and mileage for Performance Outcomes Measures Project (POMP), freeing up County monies.

County Administrator Report

 Mr. Whicher reminded members of the Committee that candidates for the Mental Health Commissioner position will be having introductions, interviews, and tours beginning at 9:00 a.m. on January 14, and legislators are encouraged to attend.  He noted each one would be meeting individuals within the department and then be taken on a tour of the building.

 Ms. Robertson asked Mr. Whicher about the question of the state not paying its obligated share of overburden aid for the past two years.  Mr. Whicher told the committee that he had contacted Ken Crannell at NYSAC, to find out if that organization is planning to take any action, but he did not have an answer yet.

Request for Tours in 2005

 Ms. Kiefer requested a tour of the Mental Health Building; Ms. Carey offered a tour of the Department of Social Services.

Adjournment

 The meeting adjourned at 2:55 p.m.