HEALTH AND HUMAN SERVICES COMMITTEE FEBRUARY 20, 2003 9:00 A.M. SCOTT HEYMAN CONFERENCE ROOM
Present: M. Robertson,
Chair; N. Schuler; P. Penniman; M. Koplinka-Loehr
Excused: F. Proto
Staff: M. Dill, Human Services Coalition;
B. Falcao, Health Planning Council; D. Herath, Women's
Opportunity Center; A. Cole, Public Health Director; S. Conners, Health
Department; J. Andersson, Environmental Health; M. Dolan, Social Services
Commissioner; B. DeLuca, Mental Health Commissioner; W. Skinner, Public Information;
S. Whicher, County Administrator; M. Goldstein, Challenge Industries; N. Zahler,
Youth Bureau Director
Others Present: T. Joseph, Chair of the Board
Called to Order
The meeting was called to order at 9:00 a.m.
Changes to Agenda
Ms. Robertson said she would like to replace the discussion
on Committee goals with a discussion about Senator Nozzolio's question that
if the State took over Medicaid what would the County want to take on in
its place.
Chair's Report
Ms. Robertson reported on the Human Services Cabinet
meeting she attended last week. One of the items discussed was budget
impacts and how they affect the clients in the various programs. For
example, if the Governor's budget were approved, the home health care program
in the Health Department's budget would be eliminated causing the clients
to move to other programs in Mental Health or Social Services.
Ms. Robertson also reported on a meeting of the Fiscal
Policy Institute Program where a discussion was held concerning their analysis
of the Governor's proposal. Two of the items she learned were:
(1) Medicaid has grown half as fast as private health care costs; and (2)
82 percent of the increase in Medicaid is in long-term care and care for
the disabled.
Mr. Penniman asked if there was additional information
available from the Fiscal Policy Institute meeting. Ms. Robertson
said she would make copies available of the packet of material she received.
She said she would also make copies available to all Board members of the
article Budget Cuts vs. Tax Increases at the State Level: Is One More
Counter-Productive than the Other During a Recession?
Approval of Minutes
It was MOVED by Mr. Koplinka-Loehr, seconded by Mrs.
Schuler, and unanimously adopted by voice vote by members present, to approve
the minutes of the February 5, 2003 meeting as submitted.
Health Planning Council
Access to Lower-Cost Prescriptions
Ms. Falcao presented a guide for finding lower-cost
prescriptions put together by a task force. The guide provides information
on all the programs available. There were 150 copies made from donations
received. Copies have been distributed to libraries, pharmacies, physician
offices, various human service agencies, etc. Copies are also available
upon request for $20 per copy. Ms. Robertson asked that Ms. Falcao
bring a copy to a Board meeting to present.
Ms. Falcao distributed information concerning the estimate
of 10,000 people who are uninsured in the Tompkins County. She noted
the COMPASS study group is putting together a household survey that will
help provide useful information. The hospital has a legal mandate
to provide care for someone who comes in that is uninsured.
Mr. Joseph asked if it was common for someone with Medicaid
to go the hospital because the individual was unable to find a doctor that
would provide the care. Ms. Falcao was not sure and said Ms. Dolan
might be able to answer the question. Ms. Dolan commented that it does happen,
but less frequently here than in other places. The Medicaid Managed
Care program is designed to reduce this problem.
Ms. Falcao said Medicaid reimbursements have not kept pace with actual
costs and as a result of Medicaid costs not increasing as much as private
insurance, people without insurance are generally being charged the most.
Ms. Falcao reviewed insurance coverage available for
individuals without health insurance and noted it is quite costly. She
also provided Committee members with information on income eligibility levels
for various programs. Additional information concerning County dollars
can be provided if requested.
Mr. Penniman said the escalating costs of health care
in general is the key issue and feels it needs to be addressed.
Human Services Coalition
Women's Opportunity Center
Ms. Herath distributed brochures on the two programs
offered by the Women's Opportunity Center (WOC): Bridge Program and
Displaced Homemaker Program. She commented that she will be going to
Albany on Monday to lobby the Governor. The Bridge Program is new and
began last year. Both programs served 584 people in 2002. She
spoke about the loss of funding for the programs and the rippling affects.
Every dollar received from the County leverages other funds; due to County
cuts for 2003, WOC lost State and federal monies as well.
Ms. Herath also spoke of success stories of two women's
personal experiences with the Women's Opportunity Center. She said
the programs offered through the Center not only help women on welfare become
self-sufficient but also prevent women from going on welfare.
Center for Crime Victims/Sexual Assault Services
(CVSA)
Ms. Dill reported on the progress of merging the Center
for Crime Victims/Sexual Assault Services (CVSA) with the Advocacy Center.
Several meetings have been held with CVSA staff and their board members.
She said there is also more than one agency interested in taking over the
services provided by CVSA. Ms. Dill said there are a number of issues
that need to be resolved including funding concerns and staffing.
However, following a meeting recently, the agency decided to dissolve itself
and find a home for the services. Ms. Dill said there is a meeting
tomorrow and will report back to the Committee.
Health Department
2002 Highlights and 2003 Challenges Environmental Health
Mr. Andersson submitted and reviewed the following accomplishments
and challenges for his division:
Accomplishment: Rabies Control Program 2002
We successfully prevented any human deaths due to this disease. The
Environmental Health staff investigated 348 animal bite reports, approved
the need for 106 people to receive rabies post-exposure treatment and submitted
164 animals to the New York State Rabies Laboratory for testing. Nine
raccoons, three skunks, one cat, one bat, one cow and one deer were confirmed
rabid. The division organized, ran and financed ten animal clinics,
at which 360 dogs and 405 cats got immunized against this disease.
The program requires cooperation between the Divisions of Environmental Health
and Cayuga Medical Center, the area physicians and veterinarians, wildlife
control officers, the S.P.C.A., and the New York State Rabies Laboratory.
Environmental Health Division staff responded to 1,250 rabies related telephone
inquiries and spent countless hour discussing exposures, need for treatment
and animal behavior with Tompkins County residents.
Challenge: Budget for 2003 and beyond
The challenge will be to live with the 2003 austere budget and develop
plans to submit an even more reduced budget and resulting cuts in services
for 2004. Besides the pressure to keep the county share of expenses
down, there will be increased pressure for the division to do more because
of the pending cuts to the state health department and Department of Environmental
Conservation staff who provide important services to Tompkins County.
These services will include sampling around spill sites (both environmental
and indoor air), meeting with individuals and public agencies, and ensuring
that clean up plans provide for neighborhood protection and effective remediation.
We do not have the staffing levels or the specific skills on staff to fill
the gap.
Community Health Services
At this time, Ms. Conners reviewed the accomplishments and challenges of
her division as follows:
Accomplishments:
Implementation of a comprehensive clinical and billing software upgrade.
A multi-disciplinary team developed a Request for Proposal to upgrade the
current billing and clinical documentation system. Multiple proposals
were evaluated, a vendor was selected and approved and training was completed
for a kick-off in the new year. Bioterrorism policies and procedures were
developed for public health response to cases of anthrax, smallpox, botulism,
plague, tularemia and hemorrhagic viruses. Staff participated in emergency
preparedness training, community emergency drills and extensive plan development
for community wide disasters and smallpox vaccination.
Challenges:
Smallpox vaccinations
Implementation of the phase one and two smallpox vaccination education
and vaccination programs. Planning involves training and allocating
resources and staff from Administration, Health Promotion, Maternal Child
and Home Health Care programs as well as multiple county and community partners.
Governor's Proposed Budget
The other challenge this year is the Governor's proposed
budget and how it impacts public health core services and the home health
care program.
Children with Special Care Needs
Ms. Cole provided an overview of the following accomplishments
and goals for the Children with Special Care Needs division:
Accomplishment:
The Early Intervention Program went through a process this year that has
directly impacted programming and “the way we do business” now and in the
future. The fair hearing process we were a part of this past fall
has propelled us forward in the area of services for children diagnosed
with Autism and/or Pervasive Developmental Disorders (PDD). The Early
Intervention Program is in the process of establishing contracts with various
providers of Applied Behavior Analysis (ABA). This is the accepted
form of treatment recommended by the New York State Task Force on Autism
in Early Intervention. Concurrently, we are establishing contracts
with organizations and health care institutions (i.e.: the Gallisano Children’s
Hospital at Strong Memorial Hospital, Rochester) that have the expertise
to properly diagnose these disorders. We are grateful to this opportunity
to continue to seek out and offer our clients in Tompkins County quality
diagnostic and developmentally appropriate services.
Challenge:
The largest challenge the Children with Special Care Needs Division will
be facing over the next year will be the restructuring of the supervisory
duties on this division. It is a challenge that we welcome.
We look forward to the opportunity and process of implementing positive
effective change within this division.
Ms. Cole brought to the Committee's attention an issue
raised by the Ithaca City School District (ICSD) claiming the County owes
the school district over $300,000 for past services within the Early Intervention
Program (3-5 year olds). However, in reviewing the records,
it appears the school district owes the County money. ICSD Superintendent
Pastel said she would like to continue reviewing this for another year.
Ms. Robertson spoke about a conversation she had with
Roger Sibley of the Racker Centers concerning a proposal to consider for
the Early Intervention Program. In order to bring Medicaid dollars
in, the model that has been used is diagnosis and cure. The idea he
is proposing is a human development model with significant implications for
how services would be provided. Ms. Cole said the proposal would have
to be accepted by the State Health Department.
Mental Health Department
2002 and 2003 Goals
Mr. DeLuca presented copies of the Department's 2002
and 2003 goals. First, he reviewed the 2002 goals and said the Department
looked at the following three general areas:
1. Implement evaluation and contract management
system for reinvestment allocations
2. Initiate conversion to electronic medical records
3. Financial: Establish a monitoring system
for revenue sensitive programs
Mr. DeLuca briefly reviewed the following list of 2003
goals:
1. Local Governmental Unit
a. Assure compliance of all
regulated agencies with federal HIPAA regulations on privacy and security.
(Deadlines of April 2003 and October 2003)
b. Monitor effects of state
budget 2003 and develop staff, committee, and board procedures to balance
anticipated 2004 budget shortfalls with funding realignment.
2. Mental Health
a. Pursue development of housing
for mentally disabled with the State Office of Mental Health to include
funding for a Single Room Occupancy facility.
b. Monitor and develop response
to state plan to substitute Medicaid, in place of 100 percent State Aid
for employment and social club program.
c. Additional goals from committee.
3. Mental Retardation/Development Disabilities
a. Publish and distribute services
roadmap.
b. Participate with and monitor county
taskforce to develop dental services for developmentally disabled on Medicaid.
c. Additional goals from committee.
4. Substance Abuse
a. Recruit committee membership
to include interests from other human services constituencies.
b. Develop county level regulations
and procedures to monitor provider agencies with regards to incidents and
program effectiveness. (Unlike other mental hygiene state agencies,
OASAS does not have this capability)
c. Additional goals from committee.
Mr. DeLuca feels that housing will become a very large
issue over the next ten years and involve other departments such as Social
Services. Ms. Robertson said that this issue will be discussed at
the June 19th Committee meeting. Mr. DeLuca also reported on the impacts
of the proposed Governor's budget. There is an attempt outside the
budget process to Medicaid several other services including employment services
and social club services. If this happens, it would allow State Aid
and Reinvestment money currently flowing through the human services board
to be turned into Medicaid. It is being stated that there will be no
local share involved, but Mr. DeLuca does not feel that will be the case
and that it could potentially cost the County $75,000.
Ms. Robertson asked about the loss of parking that will
accompany the Cayuga Green construction. During the recent one-week
archaeological dig, the Alcoholism Council had a 50 percent increase in
"no shows" for appointments. Mr. DeLuca said this is a concern for
his Department as well and feels there will be a number of no shows for appointments,
even though many of his clients walk to their appointments. Mr. DeLuca
spoke about the options being reviewed for parking alternatives and said
that Mr. Marx, Planning Commissioner, is the liaison to the City on this
subject.
Department of Social Services
Resolution - Employment Retention & Advancement
Program (ERAP)
It was MOVED by Mr. Koplinka-Loehr, seconded by Mr.
Penniman, to submit the following resolution to the Budget and Capital Committee
for approval. Ms. Dolan stated this item was withdrawn last fall as
a Budget request at the Committee level because of the budget situation,
but with the understanding she would come back with a request in 2003.
This also allowed the consortium lead by Challenge Career Resources to look
for and procure a more concrete proposal for grant funding for program continuation.
Ms. Dolan commented that Challenge Career Resources is at the heart of the
Department of Social Services' employment efforts. She spoke about
welfare reform and feels it will be reauthorized this year; this program
will be crtitical to our meeting federal requirements for job placement.
Mr. Goldstein briefly reviewed the grant funding history
for the program. As of April 1, 2003, the program will be paired down
from eight to four fulltime staff and continue to operate and serve the
TANF recipients until October 1. There is $200,000 federal money available
if $100,000 can be secured which will continue the program for another year
effective October 1, 2003. Of the $100,000, at least $25,000 must
be cash; $75,000 can be in kind. Mr. Goldstein reviewed other sources
of funding or "in-kind" services that are being explored. He explained
the breakdown of the $300,000 if received and noted Workforce Development
will receive a total of $60,000 and Office of Employment and Training will
receive $14,000. Committee members requested an explanation be added
to the resolution explaining in more detail the funding sources.
A voice vote resulted as follows on the resolution:
Ayes - 4; Noes - 0; Excused - 1 (Proto). RESOLUTION CARRIED.
RESOLUTION NO.______ - APPROPRIATION FROM CONTINGENCY FUND – ERAP PROGRAM
(EMPLOYMENT RETENTION & ADVANCEMENT PROGRAM) & BUDGET ADJUSTMENT
& AUTHORIZATION TO CONTRACT WITH CHALLENGE INDUSTRIES – DEPARTMENT OF
SOCIAL SERVICES
WHEREAS, the Employment Retention & Advancement Program (ERAP) is a
five-year old program that provides job readiness, job club, job placement,
mentoring and follow-up to some of the hardest to place Temporary Assistance
recipients, and
WHEREAS, the Program has served well over 100 individuals and has accomplished
a job placement rate of 43% and a job retention rate of 40%, and
WHEREAS, the Department of Social Services wishes to have this program
continued in order to provide the level of assistance and support needed
for this population, and
WHEREAS, Challenge Industries is the lead agency and partners with Catholic
Charities for experience and expertise in program components, and
WHEREAS, Challenge Industries, working with Workforce Development, has
secured funds to extend the program to no cost to the County for the 12
months ending September 30, 2003, and
WHEREAS, funds are now needed to extend the program for an additional 12
months that would end September 30, 2004, and
WHEREAS, a total $100,000 match is needed to draw down an additional $200,000
in Federal Dollars, of which $50,000 must be a cash match and the other
$50,000 will be provided by the partners through in-kind services, now therefore
be it
RESOLVED, on recommendation of the Health & Human Services’ and Budget
& Capital Committees, That the Finance Director is authorized to appropriate
$25,000 to Account Number A6010.54442 – Professional Services, (Department
of Social Services), for the purpose of the cash match for the ERAP program
for the period of October 1, 2003 to September 30, 2004,
RESOLVED, further, That the Department of Social Services is authorized
to enter into a contract with Challenge Industries for provision of the ERAP
services.
SEQR ACTION: TYPE II-20
Monthly Reports
Ms. Dolan briefly reviewed the Department's monthly
reports for the periods ending November 30, 2002 and December 31, 2002.
She noted the temporary assistance caseload is up to approximately 679 which
represents an increase of 75 cases in a two-month period and appears to be
growing. There are 140 people enrolled in managed care. The good
news is those people are having improved access to both primary care and
specialty care. The bad news is when someone enrolls in managed care,
the costs increase, as the client goes from fee for service to a per-member
per-month charge. There continue to be concerns with the number of
youth in institutions. It is anticipated the MST (Multi-Systemic Therapy)
program will begin on March 17th. The program is high intensity preventive
intervention and is geared at adolescents and pre-adolescents. She
has been working very closely with other County departments to make sure
the program is a success. She is in the process of trying to secure
some funding from the State through the budget that offers counties increased
state reimbursement for preventive services.
Ms. Dolan reported she has been monitoring week to week
expenditures in the Medicaid program and said a spreadsheet was prepared
and can be made available if requested. There are significant increases
in pharmacy, home health care, and nursing home expenditures. The
nursing home expenditures are a surprise and will be followed up.
A meeting is being held with Dan Brown of the Racker Centers to discuss
cost-of-living adjustments the Center has received that have an impact on
the Medicaid budget. Family Health Plus continues to grow. The
benefit waiver program began January 28th and has six approved cases and
30 cases pending.
Mr. Penniman asked Ms. Dolan to provide projections
again this year on Medicaid as last year the projections were fairly accurate.
Ms. Dolan also reported that a work group's meeting, consisting of representatives
from Mental Health, Youth Bureau, Planning Department, Human Services Coalition,
and Red Cross, to discuss homeless services. The one consistent theme
that emerged was the lack of affordable housing for people with special
needs. They are working on developing alternatives to discuss with
the Red Cross in terms of helping people obtain permanent housing.
Mr. Whicher recommended Mr. Nocera of the Red Cross be invited to the Health
and Human Services Committee meeting June 19th to discuss the housing issue
as mentioned above.
Office for the Aging
Budget Adjustment
It was MOVED by Mr. Koplinka-Loehr, seconded by Mrs.
Schuler, and unanimously adopted by voice vote by members present, to submit
the following budget adjustment to the full Board for approval:
From: 6775.44772
Federal Revenue $8,629.20
To: 6775.51000060
Title V Workers $8,629.20
From: 6775.44772
Federal Revenue $ 730.18
To: 6775.58800
Fringes
$ 730.18
Explanation: Reappropriation of unused Federal monies to be used
in 2003 for Title V Program (Senior Community Employment).
Discussion - Request of Senator Nozzolio
Ms. Robertson asked Committee members for suggestions
regarding the following question stemming from Chair Joseph's recent exchange
with Senator Nozzolio: "If the State were to take over Medicaid, what
would the County be willing to take control of and pay for in exchange?"
Mr. Penniman suggested focusing on what the criteria should be and asked
what areas would we want all counties to take control over, keeping in mind
it would be Statewide. Mr. Joseph said the Health Department is one
area that occurred to him. Another example maybe a department that
is hampered by State mandates and feels it can do a better job on its own.
Departments or a segment of a Department should be asked this question.
Mr. Whicher noted that he made a similar request to departments with responses
due Friday. Ms. Robertson suggested the Marchiselli Aid for roads be
considered, allowing local control of how well roads are maintained.
Mr. Joseph suggested swapping equal dollar amounts of CHIPS money for Medicaid
money.