HEALTH AND HUMAN SERVICES COMMITTEE MARCH 24, 2004 11:30 A.M. SCOTT HEYMAN CONFERENCE ROOM
Present: M. Robertson, Chair; T. Todd; N. Schuler; M. Koplinka-Loehr; B. Blanchard
Staff: R. DeLuca, Mental Health; A. Hovaguimian, Alcoholism
Council; A. Cole, Public Health Director; B. Crosby, Health Department; P.
Carey, Social Services; T. Herden, Social Services; C. Griep, Health Department;
S. Connors, Health Department; M. Gatch, Health Department; A. Fitzpatrick;
I. Stein, Office for the Aging Director; W. Skinner, Public Information;
S. Whicher, County Administrator; N. Zahler, Youth Services; M. Dill, Human
Services Coalition; B. Falcao, Health Planning Council
Called to Order
The meeting was called to order at 11:30 a.m.
Changes to Agenda
A budget adjustment from the Office for the Aging was added to the agenda for information only.
Chair's Report
Ms. Robertson reported on her visit to the Red Cross Shelter
and Friendship Center last Friday. Legislator Schuler and Ithaca Journal
reporter Andy Tutino also visited. Ms. Robertson said she was impressed
with the facilities and staff and every question asked staff was able to
answer. Following the tour, she met with four case managers and learned
the one thing that would help them or make a difference was supportive housing
for people with mental health issues. There was also a discussion about
having a special shelter geared to homeless youth. At the next Legislature
meeting, there will be a presentation by several youth presenting the results
of a survey of independent youth conducted last year. Ms. Robertson
said she has also nominated the young adults who helped do the survey for
the Distinguished Youth Award for the month of April.
She updated the Committee on the housing report she put
together; she has comments from Legislator Proto and will be addressing them.
When the report is finalized, she will have more copies printed and have
it posted on the County's website.
Ms. Schuler commented on the visit mentioned above and
said it was a real eye opener. She feels that if someone could shadow
a family for a period of time it would provide a good idea of how they work
through the County's systems. She also recommended Legislators go through
the process to fill out the forms to see what is required.
Ms. Robertson said she would ask a caseworker and a shelter
manager to come to a Committee meeting to give a presentation on the subject
of homelessness.
Ms. Blanchard commented that as liaison she has her first
meeting of the Homeless and Housing Task Force on April 7th and will keep
the Committee informed.
Mental Health
Mr. DeLuca updated the Committee on the Single Room
Occupancy facility and the Unity House proposal. He distributed a chart
outlining the status of the project. He is waiting to hear firm confirmation
from the State that the County will be receiving nine new beds, as part of
a 25-bed facility. Some allocations for apartment beds that have not
been fully utilized are being converted to be part of the SRO. Currently
negotiations are taking place between the Western Region and State Office
of Mental Health. He has heard verbally that the County will receive
the nine beds because the County's project is so small in comparison to others.
Mr. DeLuca briefly spoke about the funding, saying most
of the funding will come from the State Office of Mental Health and Social
Security. The program support cost is approximately $1,200-1,500 per
person per month. It is anticipated that the deficit the County will
be responsible for is about $5,000 annually. The State will choose
the architect, and will also issue a call for proposals from providers.
The County has no role as a contractor in the project.
Mr. DeLuca briefly updated the Committee on the Green
Street facility and said they are still moving forward with adding ten more
beds. Through the Supernova project, they are applying for HUD funding,
but they are still in need of capital dollars requiring $200,000 in matching
funds. Ms. Dill commented that the CDBG money is not appropriate for
this use. Ms. Carey said she has an appointment next week with the
staff of Unity House and will be discussing some of their issues.
In addition, Mr. DeLuca reported that Lakeview submitted
a proposal for CDBG funds that could help with site acquisition and business
relocation for the SRO.
State Budget Update
Mr. DeLuca feels the Governor's budget will not radically
impact County funding in the coming year, although there could be bigger
effects down the line. He distributed an updated resolution including
a list of funding concerns and legislative items that will directly affect
the County. He said the Mental Health Subcommittee approved the resolution
and has forwarded it to the Committee for consideration.
Following a brief discussion, Mr. Koplinka-Loehr recommended
making the back up bills referenced in the resolution available upon request.
It was MOVED by Mr. Koplinka-Loehr, seconded by Ms. Schuler,
and unanimously adopted by voice vote, to approve and submit the following
resolution to the full Legislature for approval. It was the consensus
of the Committee to add an explanation that explains the bulleted items and
what they mean in County dollars such as advocating for mental health bills
and costs and impact to Tompkins County.
RESOLUTION NO. - MENTAL HYGIENE LEGISLATIVE, POLICY AND BUDGET RECOMMENDATIONS
WHEREAS, there has been a significant reduction in funding for the Mental
Health system from 1980 to 2000 when adjusting for inflation (based on the
consumer price index of medical costs), and the Mental Health system has
increasingly become reliant on Medicaid for funding purposes, and
WHEREAS, counties recognize the benefits of community mental health services,
but counties should not be asked to assume the costs for services which have
been a historical state responsibility, and
WHEREAS, the state must maintain its financial commitment to mental health
services to ensure that people can live productive lives in the community
and avoid expensive stays in jails, hospitals, and other inpatient settings,
now therefore be it
RESOLVED, on recommendation of the Health and Human Services Committee, That
to ensure the continuation of high quality community mental health services,
the Tompkins County Mental Health Subcommittee and the Tompkins County Legislature
call upon the Governor and the New York State Legislature to:
Continue to fund and ensure mental hygiene services for all New York State citizens, regardless of ability to pay;
Maintain the state’s responsibility to mental health clients:
o Provide 100 percent state reimbursement of the non-federal share of all
Medicaid expenses for all Overburden-eligible individuals;
o Specifically, reinstate 19.5 million dollars in Overburden payments that
were eliminated from the proposed Executive budget (for Tompkins County this
translates to an estimated $72,000, in lost overburden payments, primarily
for services and supervised housing for individuals with mental retardation
and developmental disabilities);
o Provide 100 percent state reimbursement of expenses for new Overburden-eligible
individuals expressly when non-traditional Medicaid services are converted
to Medicaid. This includes but is not limited to new initiatives such as
New York State Office of Mental Health Personalized Recovery Oriented Services
(PROS) and NYS OMRDD Options for Persons Through Services (NYS OPTS);
Hold the counties harmless from the local share of Medicaid with new and expanded programs and services converted to Medicaid;
Support legislation to create a state funded distressed provider pool for
uninsured individuals in need of mental hygiene services especially where
the state converts net deficit funded mental hygiene programs to Medicaid;
Reauthorize Community Mental Health Reinvestment and direct a significant
portion of savings from state-operated service reduction to community based
services based on local need,
RESOLVED, further, That the Tompkins County Mental Health Subcommittee and
the Tompkins County Legislature call upon the Governor and the New York State
Legislature to:
Restore 10.1 million dollars in “local efficiencies reductions” from the
Governor’s proposed Office of Mental Health’s local assistance budget (7.7
million in 2004, 2.4 million in 2003).
This could affect contracted not-for-profit agencies or administration, with a possible loss of $50,000 locally;
Enact A.4085 (DiNapoli)/S.1152 (Seward) to limit the cost of court ordered charge backs to thirty days;
Thoroughly review true access and utilization of children’s psychiatric
hospital beds throughout all of New York State when considering elimination
of these services, before closing 20 children’s beds in state psychiatric
centers as proposed;
Support efforts to address the statewide shortage of child psychiatrists
and remove barriers that preclude access for services for children and their
families;
Amend Assisted Outpatient Treatment to clarify appropriate limitations
of county liability associated with the administration of Kendra’s Law on
the local level;
Amend New York Mental Hygiene Law 9.45, A.9826 (Rivera)/ S.6326 (Libous),
to allow intensive case managers and supportive case managers to report to
County Directors on the need for transport of a non-consenting person to
a psychiatric emergency room for mental health evaluation;
Enact Timothy’s Law A.8301 (Tonko)/S.5329 (Libous) which provides for
fair insurance treatment for diagnoses of mental, nervous or emotional disorders
or ailments and those disorders or ailments associated with alcoholism, alcohol
abuse, substance abuse, and substance or chemical dependence;
Simplify Medicaid regulations and billing rules to eliminate barriers to the development of integrated treatment;
Support efforts to integrate treatment for persons with co-occurring mental
health and substance abuse disorders including, but not limited to: allocation
of necessary resources, addressing separate administrative structures and
funding mechanisms; utilizing appropriate screening and assessment tools,
cross training of mental health and chemical dependency professionals, eligibility
criteria, co–licensing and co-location of programs.
SEQR ACTION: TYPE II-20
* * * * * * * * * *
Health Planning Council
Tracking the Effects of Health Care Reform in Tompkins County
Ms. Falcao provided an overview of the document she distributed
entitled Tracking the Impact of Health Care Reform in Tompkins County 1997-2003.
She said over several years there have been reductions in Federal Medicare
dollars and services, resulting in a significant increase in the Medicaid
local share. At this time she highlighted the changes in home care
services. The funding for the EISEP program has increased; the County
is required to pay 25 percent, but it funds much more than that amount.
This program helps fund in-home care services for people who are just over
the Medicaid level, so they can stay in their homes instead of going into
nursing homes.
Ms. Falcao spoke briefly about the personal care aides
and said the County's share is 10 percent, the State's share is 40 percent,
and the Federal share is 50 percent. She also reported that there are
still an unknown number of uninsured people. The number of children
without insurance seen at Cayuga Medical Center was 617 in 2003. She
does not know how many of these children might be eligible for Child Health
Plus.
Ms. Schuler asked if the shortage of aides has been identified
as an area of focus by TC3 or some other organization. Ms. Stein commented
that the Workforce Development Services Committee has identified the shortage
of aides as one of its focuses this year.
Ms. Connors spoke briefly about the cost of service and
said the Health Department contracts with all the agencies in the community
to provide home health aides. The private health care agencies have
their own home health aides. The charges are not based on the actual
costs for services; Medicare only pays a fixed rate regardless of whatever
service is provided
Ms. Blanchard reported that the Tompkins County Area Development
has a subcommittee that has been working on issues affecting the working
poor. In cooperation with the Workforce Development Board and Chamber
of Commerce, this committee is launching an education effort with employers
to get them to provide more information to their employees about existing
programs, such as Child Health Plus, and to make sign up easier and less
uncomfortable.
Ms. Falcao explained that Child Health Plus A requires a 25
percent County match while Child Health Plus B is for people with slightly
higher income for which the County pays no share.
Department of Social Services
Resolution
It was MOVED by Ms. Schuler, seconded by Mr. Koplinka-Loehr,
to approve and submit the following resolution to the full Legislature for
approval. Ms. Carey explained that she did not realize action was required
on the approval of the plan by the Legislature. The plan is due to
the State April 1st but said the deadline has been extended as the Legislature
is unable to act until April 20th. She provided copies of an outline of what
the plan will include. She did not feel it was appropriate to distribute
copies of the plan, as a public hearing is being held tomorrow followed with
a ten-day period for public comments to be made and incorporated into the
plan. The plan will be available prior to the next Committee meeting
and if approved it will be forwarded to the full Legislature.
Ms. Blanchard asked what the impact would be if funding
is not approved for some of the programs included in the plan. Ms.
Carey said the State requires the County to have a plan to address mandated
areas. It was noted that the plan does not commit the County to any
specific level of funding.
Mr. Todd requested a list of mandated programs and non-mandated
programs. Ms. Robertson said she would like the list of mandated programs
being presented to the Budget and Capital Committee to be available for the
Health and Human Services Committee.
It was unanimously adopted by voice vote to approve the
following resolution pending receipt of the three-year Consolidated Services
Plan.
RESOLUTION NO. - APPROVAL OF THREE-YEAR CONSOLIDATED SERVICES PLAN – DEPARTMENT OF SOCIAL SERVICES
WHEREAS, the New York State Office of Children & Family Services (OCFS)
has required the Department of Social Services to develop and submit a three-year
Consolidated Services Plan which identifies program priorities in the areas
of adoption, foster care services for children, preventive services for children,
protective services for children and adults, and other children and family
services, which covers these services for the period January 1, 2004 to December
31, 2006, and
WHEREAS, County Administrative Policy 01-35 states that “…plans prepared
by County departments and which require the signature of the chief elected
official of the municipality prior to submission, or those plans whose public
participation requirements mandate advertising in the municipalities’ newspapers
of general circulation, must be approved by the Board of Representatives
[Legislature] upon review by the County Administrator and the appropriate
program committee,” and
WHEREAS, such signature and advertising for public participation is required with regard to the Plan’s development, and
WHEREAS, a Public Hearing will be held on March 25, 2004 at 2:00 p.m., for
the purpose of seeking public comments regarding the “Plan,” now therefore
be it
RESOLVED, on recommendation of the Health & Human Services’ Committee,
That the Department of Social Services’ Three-Year Consolidated Plan for
Children’s Services be approved.
SEQR ACTION: TYPE II-20
* * * * * * * * * *
Monthly Financial Reports
Ms. Robertson began with stating the 2003 expenditures
and encumbrances are incomplete at this time; however, Mr. Herden will provide
an update for the Committee when a report is finalized.
The Committee reviewed the following reports:
- Fiscal Report - December 2003 - January 2004
- Appropriation Balance for Month Ending January 2004
- Projected Program Expenditures - January 2004
- Caseload Statistics Chart
Ms. Carey briefly spoke about the caseload numbers and
said caseworkers are handling approximately 394 family assistance cases,
338 safety net assistance cases, 513 public assistance food stamps cases,
and 1,182 cases of non-public assistance food stamps. Ms. Carey said
this information would be incorporated into future reports, along with emergency
shelter nights information.
Home Health Care Program
Ms. Connors provided a thorough overview of the Home Health
Care Program. A detailed report is on file with the original minutes
located in the Legislative Clerk's Office and is available upon request.
Request to Fill Vacancy
It was MOVED by Mr. Koplinka-Loehr, seconded by Ms. Schuler,
to recommend to the Budget and Capital Committee that the vacancy of Community
Health Nurse be filled. Ms. Connors explained the reason for filling
this position. The program has seen a reduction in the number of nurses
from 8.8 in 2001 to 7 in 2004. This position is critical for the maternal
child program and communicable disease program. Following a brief
discussion, a voice vote resulted as follows: Ayes - 5, Noes - 0.
MOTION CARRIED.
Bioterrorism Update
Ms. Cole introduced the new Bioterrorism Coordinator,
Carol Griep, who gave an update on activities relating to bioterrorism and
her role as Coordinator. On February 24th, there was a Strategic National
Stockpile (SNS) training held concerning the stockpile of medical equipment
and medications by the Federal government in the event of a bioterrorism
incident. The Health Department participated along with other various
agencies involved, such as the hospital and Sheriff's Department. During
this training, it was learned that some of the people in these roles will
be used elsewhere during an event and therefore the rules need to be altered.
Ms. Griep will be meeting with appropriate Public Works staff to discuss
use of their resources.
Ms. Griep also reported on a training held at Ithaca College
concerning weapons of mass destruction and how weapons could be used.
The training focused on mitigation, preparedness, and drills and just being
prepared in the event of a terrorism event or natural disaster. She
is working with a consultant group along with Onondaga County and other counties
in coordinating a June 15th drill. This drill will incorporate
use of SNS assets and setting up clinics that will focus on post events.
The scenario will be a small pox incident beginning at Hancock Airport.
She also updated the Committee on various other activities she is working
on.
2004 Goals
At this time, Ms. Robertson distributed copies of the
revised Committee goals as discussed at the last meeting.
Youth Services
2004-2006 Comprehensive Youth Services Plan
Ms. Zahler updated the Committee on the proposed Youth
Services Plan and said the Youth Services Board approved the plan with some
minor modifications for clarification.
It was MOVED by Mr. Koplinka-Loehr, seconded by Ms. Schuler,
to approve and submit the following resolution to the full Legislature for
approval. Ms. Blanchard clarified that by approving the Plan that it
does not commit the County to approve the funding for the programs.
Following a brief discussion, a voice vote resulted as
follows: Ayes - 5, Noes - 0. RESOLUTION CARRIED.
RESOLUTION NO. - APPROVAL OF 2004-2006 COMPREHENSIVE YOUTH SERVICES PLAN - YOUTH SERVICES
WHEREAS, the New York State Office of Children and Family Services requires
the Tompkins County Youth Services Department to prepare a multi-year plan
identifying youth needs and goals for a three-year period to qualify for
state aid reimbursement, and
WHEREAS, the Tompkins County Youth Services Board has analyzed demographic,
statistical, and opinion data gathered by the Youth Services Department over
the past two years, and
WHEREAS, the Youth Services Board has prepared a set of priorities to guide
the planning, resource allocation, and coordination efforts of the Youth
Services Department, now therefore be it
RESOLVED, on recommendation of Health and Human Services Committee, That
the 2004-2006 Comprehensive Youth Services Plan be approved,
RESOLVED, further, That the County Administrator be, and hereby is authorized
to sign the final plan to be submitted by April 1, 2004.
SEQR ACTION: TYPE II-20
* * * * * * * * * *
Note: An abstract of the Plan is available in the Office of the Legislature
and a copy of the full Plan will be on file in the County Youth Services
Department and Office of the Legislature after submittal.
Appointment
It was MOVED by Ms. Blanchard, seconded by Ms. Schuler,
and unanimously adopted by voice vote, to approve and submit to the full
Legislature for approval the appointment of Trina S. Newton as an at-large
representative to the Youth Services Board for a term expiring December 31,
2006.
Ms. Robertson reminded Committee members that the Youth
Services Board is still in need of a liaison. Ms. Blanchard suggested
asking Legislator Booth as he continues to be interested in youth activities.
Approval of Minutes
It was MOVED by Mr. Koplinka-Loehr, seconded by Ms. Schuler,
and unanimously adopted by voice vote, to approve the minutes of the February
25 and March 10 meetings.