Present:   D. Winch, Chair;  N. Schuler, D. Booth, M. Robertson, F. Proto (arrived 9:28 a.m.)

Staff:  Irene Stein, Office for the Aging; A. Cole, Health Department; N. Zahler, Youth Bureau; J. Johnson, Youth Bureau; K.
         Smithers, Administration; M. Dill, Human Services Coalition Director; B. Grinnell-Crosby, Health Department; M.Dolan,
         Social Services Department; F. Croteau, Public Health; S. Robinson, Probation Department; E. Brazauskas, Health
         Department; J. Andersson, Health Department;  B. DeLuca, Mental Health; S. Kerr, Health Department; K.
         Fuller, Recorder

Call to Order

Chair Winch called the meeting to order at 9:00 a.m.

Additions to the Agenda

 The following items were added to the agenda:

Mental Health Department
1. Resolution – Budgeting Unit Reconfiguration Change and Fiscal Target Adjustment – Mental Health and Public Safety
2. Revised Budget Adjustment – Mental Health

Approval of Minutes

 It was MOVED by Ms. Robertson, seconded by Mr. Booth and unanimously approved to accept the minutes of April 9, 2002 as amended.

Office for the Aging

Appointment
  It was MOVED by Mrs. Schuler, seconded by Ms. Robertson and unanimously approved by those present to submit the appointment of Lizabeth A. Norton to the Office for the Aging Advisory Board for a term to expire December 31, 2003 to the full Board for consideration.  MOTION CARRIED.

Department of Social Services

Medicaid Managed Care Presentation

    Ms. Mulvey provided the Committee with information on Medicaid Managed Care Programs, and in particular, the proposed program for Tompkins County.  In 1997 New York State was granted a Federal waiver to implement a State-wide program where Medicaid recipients would be required to enroll in a managed care plan in order to receive services.  She said that the intention was to improve recipients’ access to medical care through use of provider networks, reduce reliance on emergency rooms for non-emergency services, and to provide preventive medical procedures.  At the present time there are twenty-one counties and the five boroughs of New York City who have mandatory Medicaid managed care programs requiring all Medicaid recipients, with few exceptions, to enroll in a managed care plan.  Tompkins County had not been able to offer the managed care program previously as there was not an approved carrier.  At this time, Total Care, a prepaid health services program, is approved by the State and may provide the voluntary Medicaid managed care program in Tompkins County.  Ms. Mulvey explained that in order to have a mandatory program two approved managed care providers must be available to clients for them to choose from; at this time Total Care is the only carrier approved for the County.  She explained that the program will operate along the same lines as a regular managed care program.  Each enrollee would have a fixed cost for the benefit package.  Any services not covered by the package would be covered by the fee-for-service Medicaid program.  There are approximately 5,300 Medicaid recipients in the County who would be eligible for the managed care program; of these approximately 4,000 receive Medicaid through TANF/ADC categories and are comprised primarily of women and children.  She said that experience in other counties has indicated that the group comprised of women and children are the most likely to opt for the coverage.  Clients in nursing homes and health care facilities would not be able to participate in the program.

    Next, Ms. Mulvey explained that Total Care would have a promotional program, sending out brochures, presenting local advertising, etc. as well as having information available at provider sites.  All marketing material and proposed marketing services must be approved by the Department of Social Services and there are restrictions on the marketing procedures.  Also, a member of the Total Care marketing staff would be available at the Department of Social Services to provide information at group presentations as well as assist in the enrollment of clients.  She said that the distribution of materials to clients would be done within the Department of Social Services in order to maintain confidentiality and that the provider would cover the cost of the mailings.

    Committee members inquired why a client would choose to participate in the program.  Ms. Mulvey said that the program would provide a consistent medical care provider as well as guaranteed coverage for six months, should the recipient become Medicaid ineligible.  Ms. Dolan said that the purpose of the program is to provide enhanced rates to physicians through utilization of the program, that in turn, provides consistency, a more accurate tracking of medical history, and less frequent use of high-cost emergency room treatment.  Ms. Mulvey also said that there are case managers for certain instances when an individual requires a more extensive coordination of medical services due to illness.

RESOLUTION NO.  - AUTHORIZING THE DEPARTMENT OF SOCIAL SERVICES TO CONTRACT WITH
                                      A PROVIDER OF VOLUNTARY MEDICAID MANAGED CARE

     MOVED by Mrs. Schuler, seconded by Ms. Robertson.  Mr. Booth inquired about the cost of the contract (cost to the County is essentially the same as traditional Medicaid coverage), and indicated that an explanation should be attached when being presented to the Board for approval.  A voice vote was taken by all members present and it was unanimously approved.  MOTION CARRIED.

     WHEREAS, many healthcare providers in and around Tompkins County do not accept Medicaid recipients as clients due to the program’s relatively low fee-per-service rates, and
     WHEREAS, New York State encourages local districts to offer voluntary Managed Care for the purpose of improving client access to care while reducing long-term per-client costs, and
     WHEREAS, Total Care, Inc., of Syracuse, New York, the only provider presently interested in running a program in our area, recently had its Managed Care plan approved by the State, now therefore be it
     RESOLVED, on recommendation of the Health and Human Services Committee, That the Department of Social Services is authorized to contract with Total Care, Inc., for the period June 2002 through September 2003.
SEQR ACTION:  TYPE II-20

Monthly Report

     Ms. Dolan said that although there had been concern that difficulties might arise when reaching the five year mark for transition off TANF funds there have been very few problems with it.  She said the Safety Net program has experienced an increase in first-time clients who have issues of substance or alcohol abuse.  She feels that it is partly from individuals who are transitioning after having been incarcerated, or from another location due to a Tompkins County connection.  It was reported that substance or alcohol abuse cannot be a primary reason for individuals to receive benefits from SSI which may be part of the increased numbers in this category.

     Medicaid expenditures are continuing to be reviewed to determine what areas are creating the over-run.  At this time it appears that hospital charges, home care, and pharmacy are the three major elements driving the cost over-run.

     Ms. Dolan reported that the Tompkins Consolidated Area Transit is working with her department to provide transportation to and from outlying areas through the use of special bus passes.  Individuals need to be at or below the two hundred percent of poverty level.  The route expansion will allow other individuals to ride, with options other than full-size buses.  She also spoke of the automobile loan program that provides funding to guarantee payments for used vehicles or repairs in order to maintain employment.

 Mrs. Schuler inquired whether the transportation would also be available to youth workers.  Mr. Proto said that it is his understanding that the transportation service will be available to all members of the community served.  Eligible individuals will receive a special bus pass that is indistinguishable from others to use this service.

 Ms. Dolan responded to a question on shelter invoicing to say that the procedure was reviewed to streamline and verify eligibility of individuals within the shelter.  The purpose was to provide a faster turn-around in payments to the agencies providing this service.  She also said that additional transitional housing will be required in the future to assist those individuals who have a variety of problems such as criminal history, substance and/or alcohol abuse, etc.

Discussion of Rollover/Budgetary Meeting Schedule

     Mr. Winch expressed a desire to discuss budget scenarios at program level for 2003 and the 2003 rollover requests.  It was agreed that it would be beneficial and that a date will be set later in the meeting.

Budget Adjustment and Appropriation of Unspent General Funds from 2001

     MOVED by Ms. Robertson, seconded by Mr. Proto to approve the request to use $2,000 of 2001 rollover funds for the purchase and installation of two security cameras.  Ms. Dolan explained that the request will cover the purchase and installation of two security cameras needed in an area outside first floor interview rooms.  Ms. Dolan informed the Committee that although there is presently a renovation project underway the security cameras are an additional item and therefore her Department must provide the funding.  A brief discussion occurred regarding the proper accounting for the installation.  It was advised that the funds were the responsibility of DSS as it was new equipment and not a maintenance issue.  A voice vote was taken by all members present and it was unanimously approved.  MOTION CARRIED.

     Ms. Dolan reminded Committee members of the Foster Parent Appreciation Dinner taking place May 17, 2002.

Health Department

Budget Adjustment

     MOVED by Mr. Booth, seconded by Ms. Robertson and unanimously approved by members to approve the budget adjustment submitted.  MOTION CARRIED

Community Health Services (#32)
Revenue Acct  Title   Amt       Approp Acct      Title(s) __________
4016  44959  Federal Grant      $10,359       4016  51763         Salary, Health Educator
4016  44959  Federal Grant      $  2,693       4016  58800         Fringe Benefits
4016  44959  Federal Grant      $  1,185      4016  54303         Office Supplies
4016  44959  Federal Grant      $     275      4016  54330         Printing
4016  44959  Federal Grant      $  6,740      4016  54333         Education/Promotion
4016  44959  Federal Grant      $  8,015      4016  54442         Professional Services
Explanation:  Renewal of Tobacco Grant, fiscal year starting June 1, 2002.

Youth Bureau

Budget Adjustment and Appropriation of Unspent General Funds from 2001

     MOVED by Mr. Booth, seconded by Mrs. Schuler to approve the request to use $2,140 in 2001 rollover funds for the purpose of accurately maintaining the Recreation Partnership funds being held in trust.  Ms. Zahler explained that the request is to place the funds in trust by the County for the municipalities involved with the Recreation Partnership.  This adjustment would make the funds available for the Partnership use.  A voice vote was taken by all members present and it was unanimously approved.  MOTION CARRIED.

     Ms. Zahler will provide members of the Committee with the corrected request form.

RESOLUTION NO. - APPROVAL OF AMENDED RECREATION PARTNERSHIP BYLAWS

    MOVED by Mr. Booth, seconded by Mrs. Schuler.  This resolution changes the rules regarding the voting rules.  It would require a majority of the entire board to adopt a procedure.  Members requested that their desire to have future changes of the bylaws be done on an annual basis.  A voice vote was taken by all members present and it was unanimously approved.  MOTION CARRIED

    WHEREAS, the Board of Representatives is a member of the Intermunicipal Cooperative Recreation Partnership, and
    WHEREAS, the Intermunicipal Cooperative Recreation Partnership’s approved bylaws call for any changes to be approved by the Recreation Partnership’s governing Board and all participating municipalities, and
    WHEREAS, the governing board of the Recreation Partnership amended their bylaws to include several clarifications related to voting on April 23, 2002, now therefore be it
    RESOLVED, upon recommendation of Health and Human Services Committee, That the amended bylaws be and hereby are approved,
    RESOLVED, further, That a copy of the resolution approving the changes be sent to the County Youth Bureau as the department designated by the Recreation Partnership Board to provide administrative support.
SEQR ACTION:  TYPE II-20

     Ms. Zahler informed the Committee that part of their Charter is to work with municipalities to identify the needs of youth within their communities and ways to promote development and reduce delinquency and other risk behaviors.  She indicated that the Municipal Youth Service System was developed approximately twelve years ago in an attempt to assist youth who might not be involved in sports or other activities within their municipality.  Over the years the municipalities have come to the County to assist in the development of programs that will enable these youth to participate in activities that will enrich their lives.

     Ms. Johnson said that there are nine separate youth advisory boards within local municipalities with approximately seventy-four volunteers.  County staff (1.5 FTE) provides technical assistance and financial assistance for the programs.  This past year 3,821 different youths, of which 386 were young males employed, participated in the forty programs provided.  She provided Committee members with statistics indicating the type of programs and participation in each and shared materials distributed by several municipalities on the programs.  She explained that the municipalities assess their needs, often through the use of surveys, and set community and program goals in an effort to involve the community to provide the services needed.

     Ms. Johnson then indicated that the larger communities employ a full time program director and the smaller communities employ a half-time program director to operate their programs.  Each program is operated in a manner that best suits their individuality.  Some programs have coupled with the business community and provide life-skill training for youths such as cash register training and catering skills.  She said that participants in the programs are normally youth who are not participants in the regular activities provided by the educational facilities.  Statistically, these children may have a need for social connections, have an unbalanced home life, have a need for a safe location after school, or have difficulty participating in a regular program.  Ms. Johnson said that a number of the youth are responsible for day care of younger siblings after school and attempts are made to develop programs that will enable the participation of all the children.  Statistics were given regarding background information on participants in the program.

     Ms. Johnson said that the youth programs in the communities are closely working with the local governments, seeking funding for the programs as well as educating members of the community of the needs of local youth.  She said that there is also a level of involvement with the local parent-teacher associations and education programs designed to provide parents with information required to best assist their children to grow up in a successful manner.

     Mr. Proto asked how information is distributed to youth who may not be in the public education facility in a community.  Ms. Johnson said that information is widely distributed through a variety of methods such as distribution in housing developments, notification of home-school contact personnel, local advertising, etc.  She also said that many referrals are done by community members’ awareness of the programs and needs of the local youth.

     Ms. Zahler noted that the programs being operated by municipalities have a high level of local support and that the return is approximately $3 for every $1 the County provides.

     Mr. Booth inquired what level of involvement Cooperative Extension has in the programs and what programs they operate.  Ms. Johnson explained that some municipalities contract with Cooperative Extension to operate their programs.  She then explained that the programs are individualized to meet the needs and goals of each separate community.

Setting of Date for Budget Review

 Following discussion it was decided to set the date of May 21, 2002 at 1:00 p.m. in the Scott Heyman Conference Room to review budget scenarios.

 Mr. Proto was excused at 11:00 a.m.

Mental Health Department

    Withdraw Resolution – Adjust Mental Health Budget to Reflect $37,500 in RIV Monies for 2002 and Reducing Program Expense by $72,285 to Reflect 2001 RIV Funds Allocated to Contract Agencies

     Mr. Deluca requested that the resolution be withdrawn for the present time in order to make minor modifications in it.  It was agreed by the Committee to withdraw the resolution.

RESOLUTION NO.  - BUDGETING UNIT RECONFIGURATION CHANGE AND FISCAL TARGET
                                      ADJUSTMENT – MENTAL HEALTH AND PUBLIC SAFETY

     MOVED by Mrs. Schuler, seconded by Mr. Booth.  A brief discussion occurred regarding the change-over of the program from the Probation Department to the Mental Health Department.  Mr. DeLuca indicated that the Forensic Unit of his department will be able to provide this service without hiring of new staff.  When members of the Committee inquired what the ramifications of taking on this program would be, Mr. DeLuca said that it would mean a longer waiting period for sex offender group counseling.  The Committee was advised that individuals on the waiting list would still receive the individual counseling services until a group was ready.

     The Committee questioned why an adjustment would be made to increase the fiscal target for 2003 when it does not require additional staff.  Ms. Smithers informed the Committee that due to the nature of the budgetary formulas within Mental Health the manner in which the transfer of the program is occurring is a routine procedure.  Mr. Booth noted he would like to revise the resolution to indicate that the program funds were not through Probation Department and therefore will not see a decrease in their fiscal target.

     WHEREAS, Tompkins-Seneca-Tioga Board of Cooperative Education Services (T-S-T BOCES) has notified the County that they will discontinue their supervision of the Domestic Offense Offender Re-Education Services (D.O.O.R.S.) program effective June 30, 2002, and
     WHEREAS, Mental Health has agreed to incorporate the D.O.O.R.S. program into their clinic services effective July 1, 2002, now therefore be it
     RESOLVED, on recommendation of the Public Safety, Health and Human Services, and Budget and Capital Committees, That effective July 1, 2002, the D.O.O.R.S. Program 4506 shall be transferred from Public Safety as a stand-alone program to a Clinic Services Program 07376 within the Mental Health budget,
     RESOLVED, further, That the 2003 Mental Health Fiscal Target shall be increased by $31,411, and
    RESOLVED, further, That the Director of Finance be authorized and directed to make the following budget adjustment:
Appropriation: From: A6314.54400 D.O.O.R.S. Program Expense $15,705
                           To: A4311.54400 Mental Health Clinic  $15,705
SEQR ACTION:  TYPE II-20

     MOVED by Ms. Robertson, seconded by Mrs. Schuler.  Mr. DeLuca explained that this is one of six positions funded by a State aid grant for the purposes of coordinating services for individuals diagnosed with mental illness and substance issues.  This administrative position is guaranteed funding for three years and will be supervised by the Deputy Commissioner of Mental Health.  The scope of  the position is to work with mental health and substance abuse departments/agencies to enable coordination of services to clients.   At the present time the job description for this position is being designed and reviewed by appropriate personnel.  A voice vote was taken by all members present and it was unanimously approved.  MOTION CARRIED.
Mental Health Services (#31)
Revenue Acct  Title   Amt       Approp Acct      Title(s) __________
4310  43485  MICA Coordinator   $77,500       4310  51000         MICA Coordinator
Explanation:  Dual Addiction Coordinator new position.

 Adjournment

The meeting adjourned at 11:22 a.m.

Respectfully submitted:  Karen Fuller, Deputy Clerk