HEALTH AND HUMAN SERVICES COMMITTEE APRIL 28, 2004 11:30 A.M. SCOTT HEYMAN CONFERENCE ROOM
Present: M. Robertson, Chair; N. Schuler; B. Blanchard; M. Koplinka-Loehr
Excused: T. Todd
Staff: B. Crosby, Health Department;
A. Cole, Public Health Director; W. Skinner, Public Information; S. Whicher,
County Administrator; R. DeLuca, Mental Health; P. Carey, Social Services
Commissioner; M. Dill, Human Services Coalition; A. Balander, Environmental
Health; B. Falcao, Health Planning Council; S. Connors, Health Department;
K. Bishop, Health Department; T. Husick, Social Services; M. Alridge, Social
Services; N. Zahler, Youth Services
Guests: R. Elgie, Health Care Task Force;
B. Fetterly, Health Care Task Force; W. Baez, Health Care Task Force; L.
Roberts, Finger Lakes Independent Center; T. Miller, Catholic Charities;
A. Cooper, Multicultural Resource Center
Called to Order
The meeting was called to order at 11:34 a.m.
Changes to Agenda
The following items were added to the agenda:
- Transfer from Environmental Health
- Budget Adjustment - Youth Services Department
- Request to fill vacancy - Public Health Department
Report from the Chair
2004 Calendar
Ms. Robertson noted an updated 2004 calendar was distributed
for Committee members. She said that, following up on Mr. Whicher’s
work on a countywide prescription drug program, Norma Jayne is working on
setting up presentations with prescription drug and insurance company representatives
for the Health and Human Services Committee. The company Arxcel will
be attending the next meeting to give a presentation.
In addition, she reported on a meeting held yesterday of municipal officers
to discuss the Recreation Partnership called by Town of Ithaca Supervisor
Cathy Valentino. Ms. Robertson said she will invite Ms. Valentino to
the next Committee meeting to provide an update.
At this time, guests, staff, and Legislators introduced themselves.
Health Insurance 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. Robertson thanked Reverend Baez for putting together
information and drafting the resolution. Mr. Baez said the health care
system has become a difficult situation; costs for health insurance continue
to increase and many people are uninsured. Ms. Elgie stated young people
are being hurt by not being able to get the care they need. Mr. Fetterly
feels the health care system will need to go to a national health care plan.
The current state system needs to be changed soon as it is a barrier to the
economy.
Ms. Schuler felt a number for uninsured local people could
be added to the resolution. Ms. Falcao said she could provide that
information.
A voice vote resulted as follows on the resolution:
Ayes - 4; Noes - 0; Excused - 1 (Todd). RESOLUTION CARRIED.
RESOLUTION NO. - DECLARATION OF MAY 10-16, 2004, AS TOMPKINS COUNTY “COVER THE UNINSURED WEEK”
WHEREAS, the United States has the most expensive health care system in the
world in terms of absolute costs, per capita costs, and percentage of gross
domestic product (GDP), and
WHEREAS, despite being first in spending, the United States has been ranked
by the World Health Organization as 37th among all nations in terms of meeting
the health care needs of its people, and
WHEREAS, 44 million Americans, including 8 million children, are currently uninsured, and
WHEREAS, tens of millions more Americans are inadequately insured, including
Medicare beneficiaries who lack access to prescription drug coverage and
long term care coverage, and
WHEREAS, racial, income, and ethnic disparities in access to health care
threaten communities across the country, particularly communities of color,
and
WHEREAS, health care costs continue to increase, jeopardizing the health
security of working families and small businesses and increasing the cost
of local government, and
WHEREAS, dollars that could be spent on health care are being used for administrative costs instead of patient needs, and
WHEREAS, the current health care system is a significant barrier to the growth
of our economy, and significantly damages the quality of life of the citizens
of Tompkins County, and
WHEREAS, the Robert Wood Johnson Foundation has announced that May 10-16, 2004, is national “Cover the Uninsured Week,” and
WHEREAS, former Presidents Gerald Ford and Jimmy Carter, and former Surgeons
General and Secretaries of the Department of Health and Human Services call
upon the country to provide adequate health care services to all Americans,
now therefore be it
RESOLVED, on recommendation of the Health and Human Services Committee, That
the Tompkins County Legislature declares that May 10-16, 2004 is Tompkins
County “Cover the Uninsured Week,”
RESOLVED, further, That the Tompkins County Legislature calls upon the House
of Representatives and the Senate to enact legislation to guarantee that
every person in the United States has access to health care, regardless of
income, age, or employment or health status,
RESOLVED, further, That copies of this resolution be sent to Senators Clinton
and Schumer, and Congressmembers Boehlert, Hinchey and Houghton.
SEQR ACTION: TYPE II-20
* * * * * * * * * * *
Report from the County Administrator
Room Naming Request
Mr. Whicher said he received a request to honor Stuart
Halber by naming the Mental Health Board Room after him. Upon review
of the request, Mr. Whicher said it was unique as the individual was not
a County employee. He felt it would be more appropriate to consider
another part of the Mental Health Building.
Mr. Koplinka-Loehr MOVED the resolution for discussion,
seconded by Ms. Schuler. Mr. Koplinka-Loehr said he was a member of
the Government Operations Committee when the County policy for naming County-owned
facilities was reviewed. He feels there could be a more appropriate
space such as the Starlight Advocacy Center that would be more in-line with
Mr. Halber's contribution. Mr. Roberts does not feel the Center is
appropriate space as it is a separate non-profit organization. He noted
the Mental Health Subcommittee supported this request unanimously and said
Mr. Halber made unique and important contributions during his lifetime.
Ms. Schuler noted that Mr. Halber was a regular attendee at the mental health
board meetings and was a dedicated spokesperson for the mental health community.
She also stated that when this topic was being discussed at the mental health
board meeting, Marty Luster referred to Stuart Halber as a "constituent consultant."
Mr. DeLuca understands the request is unusual, but agreed Mr. Halber was
a strong advocate and presence in the community. However, he also agreed
that other space or material item could be considered. Mr. Roberts
commented that the Mental Health Subcommittee is considering ideas for memorials
for other members of the Subcommittee who have left, but the sense is Mr.
Halber rises above and needs a unique recognition.
Mr. Koplinka-Loehr said he can not support this request
at this time as he feels there could be another space or material item that
better expresses Mr. Halber's contribution and would like to refer this back
for further review. He agreed to work with a subgroup to brainstorm
ideas.
Ms. Robertson feels it is an important statement to name
something after a consumer and would like unanimous support for this recognition,
and so she asked that this item be withdrawn at this time. Mr. Roberts agreed
to work on this with Mary Hutchens. Mr. Koplinka-Loehr agreed to withdraw
his motion. MOTION WITHDRAWN.
Health Department
Rabies
Ms. Balander gave an overview of the responsibilities
of the rabies control program. Pursuant to Public Health Law adopted
in 2002 the Health Department is required to develop and implement rabies
protocol. The law requires staff to be available 24/7 to investigate
reports of any human pet or livestock exposure to rabies and submit specimens
to a rabies lab. The month of March was a very busy month for rabies
reports. To date, there has been one rabid bat, three rabid raccoons,
a rabid cat and skunk confirmed. Currently, the Department contracts
with the SPCA which handles the collection of animals. When there is
an exposure, the Health Department is contacted and is authorized to provide
post-exposure treatment. One other requirement is holding free rabies
clinics every four months. Several clinics have been scheduled for
the month of May.
Ms. Bishop explained the procedures for providing the
vaccines required for post-exposure treatments. Five injections must
be given for rabies exposure over the course of a month. Other vaccines are
also given on as needed basis such as Tetanus. She noted these vaccines
are extremely expensive. Mr. Whicher asked if there was any consideration
to go back to the owner of the rabid animal (dog or cat) and have them pay
for the vaccines. Ms. Balander believes the Health Department is required
to pay, and it would probably be hard to collect, but she agreed to look
into it. Ms. Bishop stated that in 2003, 115 clients were served which
equates to 460 visits to the Health Department for rabies shots. Ms.
Balander noted that the SPCA has been great to work with; their new facility
will include a new room just for the prep work needed to examine suspect
animals.
Resolution
Ms. Cole explained the resolution below and said the State
grant funds the Dental Case Manager position at the Department of Social
Services. The grant began last summer and the contract was received
last week.
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. Cole said we are three-quarters of the way through
the first year of a three-year grant, and they just received notification
that the grant is being renewed at the same amount as year one. Ms.
Carey commented that the staff person, Holly Stevenson, has been working
to put the program together, including outreach to dentists and clients.
The current caseload is 240. Ms. Stevenson is the key staff person
for this program as she is able to connect with dentists. The Medicaid
billing process is frustrating, but Ms. Stevenson is able to act as a buffer
and help the dentists’ offices, as well as to connect very personally with
the clients, which helps eliminate the no-shows.
Ms. Robertson asked if the Committee could have an update
from Ms. Stevenson at a future meeting. Ms. Carey noted a written report
is due to the State in July and will ask Ms. Stevenson to attend the July
14th meeting to give a presentation.
A voice vote resulted as follows on the resolution:
Ayes - 4, Noes - 0, Excused - 1 (Todd). RESOLUTION CARRIED.
RESOLUTION NO. - AUTHORIZATION
TO ACCEPT INNOVATIVE DENTAL HEALTH SERVICES GRANT FUNDS AND ASSOCIATED BUDGET
ADJUSTMENT – HEALTH DEPARTMENT AND DEPARTMENT OF SOCIAL SERVICES
WHEREAS, the Tompkins County Health Department has been
awarded $32,109 by New York State to support the Tompkins County Department
of Social Services’ program to increase accessibility of dental care by private
Tompkins County providers for Medicaid clients, now therefore be it
RESOLVED, on recommendation of the Health and Human Services
Committee, That the Health Department is authorized to accept and transfer
said funds to the Department of Social Services,
RESOLVED, further, That the Director of Finance is authorized
to make the following budget adjustment on his books:
REVENUE A4010.43489
Other State Grants $ 32,109
APPROPRIATION A4010.54442
Professional Service Fees $ 32,109
SEQR ACTION: TYPE II-20
* * * * * * * * *
Explanation: The County applied for this grant to support DSS’ Dental
Care Access and Case Management program last year, but NYS DOH only last
month finalized the contract and distributed instructions for claiming the
funds.
Social Services’ 2004 approved budget includes the expenditures eligible
for reimbursement from this grant. No new spending authority is required
for DSS, and the net result of the grant’s acceptance will be greater-than-budgeted
reimbursement rate for those costs.
The grant can only be accessed through Public Health. Neither the grant
nor the transfer payment to DSS was anticipated in Public Health’s 2004 budget,
necessitating this resolution.
Resolution
It was MOVED by Mr. Koplinka-Loehr, seconded by Ms. Schuler,
and unanimously adopted by voice vote by members present, to approve and
submit the following resolution to the full Legislature for approval:
RESOLUTION NO. - IN RECOGNITION
OF THE TOMPKINS COUNTY HEALTH DEPARTMENT CERTIFIED HOME HEALTH AGENCY – TOMPKINS
COUNTY HOME HEALTH CARE
WHEREAS, the Tompkins County Health Department Certified
Home Health Agency (Tompkins County Home Health Care) has recently completed
the recertification process with the New York State Department of Health,
and
WHEREAS, the recertification process, which is not announced, involved five
days of onsite work, fifteen intensive chart reviews, five home visits with
staff, ten personnel chart reviews and policy and contract reviews, and
WHEREAS, the agency has earned the state’s highest level
of approval on their recertification survey and has been found to be in substantial
compliance with all State and Federal Statutes, Rules and Regulations that
govern the agency, and
WHEREAS, the agency participated in a recent Medicare quality outcomes survey
by Island Peer Review Organization (IPRO) and was able to demonstrate patient
improvements from our care in thirty-seven out of forty possible outcomes,
and
WHEREAS, the agency has scored at or above the state and national averages
in ten out of eleven quality indicators according to the National Medicare
Home Care Comparison Reports, and
WHEREAS, the agency had a ninety-eight percent satisfaction rate based on
satisfaction surveys of clients in 2003, now therefore be it
RESOLVED, on recommendation of the Health and Human Services
Committee, That the Tompkins County Legislature commends the Tompkins County
Health Department Certified Home Health Agency for their efforts in providing
quality home care to the residents of Tompkins County.
SEQR ACTION: TYPE II-20
* * * * * * * * * *
Position Request
Mr. Koplinka-Loehr reported briefly on the discussion
held at the Budget and Capital Committee on this request, and whether the
individual left due to overload and stressful circumstances or more pay elsewhere.
Ms. Cole stated the resignation was based on the stress of the budget process
and the added workload. Ms. Connors noted the individual accepted a
position at Cayuga Medical Center and that the hospital has increased salaries
for all of their nursing staff. They pay $4.00 more per hour and some
of their benefits, such as a tuition benefit, are very attractive to staff.
Ms. Cole expressed her concern with the new salary schedule offered by the
hospital and the impact it may have on her Department.
It was MOVED by Mr. Koplinka-Loehr, seconded by Ms. Schuler,
and unanimously adopted by voice vote by members present, to approve the
request to fill the position of Community Health Nurse at the Health Department.
2003 Deficit
Ms. Crosby updated the Committee on the status of the
report concerning the Department's 2003 deficit. She said the accountant
arrived today and in a few days she hopes to have some general information
from him. The Department continues to look at the reporting systems
and see where they are this year. Referrals were up in March and appear
to be continuing to increase in April. They have a total of $210,000
in accounts receivable to be paid. Ninety-two percent of billing is
to Medicare. The department has two staff people who do billing, and one
has been on medical leave. There was concern expressed about whether
the department has been cut too deep.
Mr. Whicher said there are two stages: (1) explain
and analyze what happened and what the program looks like going forward;
and (2) the Department has a responsibility to repay the general fund if
it is capable. He said this needs to be addressed when the final report
is received.
Social Services Department
Financial Reports
Mr. Herden distributed copies of the Department's financial
reports and noted there are no significant changes. Mr. Koplinka-Loehr
asked if the Committee would consider having Mr. Herden only provide a presentation
when there are significant changes to highlight. Ms. Robertson asked
if the Committee could receive a year-end report from the Department when
the information is available. She would also like to know the direction
of caseloads and any concerns in particular programs. Ms. Carey said
she has requested staff to begin preparing the monthly report again.
She also noted that the most expensive parts of Medicaid are long-term care,
the pharmacy, and Home Health Care.
Mr. Whicher asked about the pharmaceutical program and
if there were a way to control costs internally. Ms. Carey said patients
are required to purchase generic brands unless a physician receives approval
from the State for name brand prescriptions. Mr. Herden noted that
the State sets the rates of pharmaceutical purchases just like any other
Medicaid service. He does not believe it is possible to control the
costs locally. Mr. Whicher said he would like to get more information
on this, specifically the prices paid for various drugs; this may be relevant
for use in designing a county-wide drug program and for the jail medical
services as well.
Child Protective Services
Ms. Carey introduced the following individuals involved with Child Protective Services:
- Madi Alridge, Child Protective Services, Social Services employee
- Todd Husick, Child Protective Services, Social Services employee
- Tommy Miller, Catholic Charities - Community/Connections Program
Ms. Alridge said the Child Protective Services program
serves children 0-18 years of age and is responsible for carrying out three
primary duties as follows:
- Receiving reports of abuse and maltreatment
- Investigating suspected abuse and maltreatment
- Providing or arranging for, coordinating, and monitoring rehabilitative services for children and parents
She said that the two supervisors provide community outreach and education
to many agencies and the public, and provide assistance to mandated reporters
to help understand their roles. At this time, she reviewed the process
of an investigation when a report is made. The program focuses on minimizing
recurrence and subsequent reports made.
Ms. Blanchard asked if training is provided for staff making personal home
visits. Ms. Alridge explained the requirements and training necessary
for caseworkers prior to employment. She said ongoing training programs
and supervisory support are also provided. When there are concerns
such as substance abuse and domestic violence known, law enforcement is contacted
to escort.
Ms. Dill asked how long unfounded cases are held. Ms. Alridge said
records are maintained until the child is 28 years old; however a family
may request to have their records removed from the system if appropriate.
Mr. Koplinka-Loehr was excused at 12:55 p.m.
Ms. Robertson asked that the information distributed be made available to the full Legislature.
Ms. Carey briefly explained the contract for the service provided by Catholic
Charities. The program is available for people upon their request to
help when Child Protective Services (CPS) staff is involved.
Mr. Miller explained the program offered by Catholic Charities
and said it is a proactive preventive program. He said the program
was borne out of the community identifying a gap in services, in that there
was a need to provide assistance for individuals subject to a CPS investigation.
The basis of the program is to help parents, families, and relatives being
evaluated have a greater understanding of the process, with the intent that
it will improve communication and collaborative relationships, and improve
the resolution of the problem.
He said families are not mandated to participate in Community
Connections; it is a voluntary program. Brochures are made available
with the materials families receive from CPS.
It was noted that in the CPS unit there are ten employees
handling more than 700 cases and in the Community Connections program through
Catholic Charities there are two employees.
Human Services Coalition
Program Updates
Ms. Dill reported on some training workshops offered that
have been well attended. She has been going out to the towns to inform
them of Compass II and the services provided by the Coalition. The
first town she visited was the Town of Groton and was please with how much
the Town knew about the services offered. She has also been advocating
at other meetings for preventive and homeless services as well as Child Health
Plus. Ms. Blanchard also noted that TCAD has been working with Betty
Falcao and the Workforce Development staff in helping eligible people sign
up for health care programs.
Multicultural Resource Center (MRC)
Ms. Cooper distributed copies of the 2003 Annual Report
and provided a brief overview. She thanked the Legislature for the
support and funding for 2004. It has been a difficult year and she
continues to look for funding from other sources. She is the Center’s
only paid staff person and there is a hardworking volunteer board of directors.
The Multicultural Resource Center is constantly bringing to the table issues
of race, class and sexual orientation that happen in the community every
day. Much of the work by MRC is diversity education and trying to work
with young people. Some of the more recent incidents have resulted
in working more closely with the Ithaca High School, Ithaca Downtown Partnership
and the City of Ithaca.
Ms. Cooper spoke briefly about funding concerns and said
there is no extra funding available in 2004. The Center lost $6,000
from the City and $4,000 from the County. She commented that MRC is
the only agency that provides this type of service. She also mentioned
several upcoming events in the community, including a play on May 28 by Leslyn
McBean-Clairborne.
Youth Services
Overview of Youth Services Budget 2004-2005
This item was deferred.
Budget Adjustment
It was MOVED by Ms. Schuler, seconded by Ms. Blanchard,
and unanimously adopted by voice vote by members present, to approve and
submit the following budget adjustment to the full Legislature for approval:
Revenue:
7021.42770 Misc. Revenues
$9,528
Appropriation: 7021.54400
Program Expense
$9,528
Explanation: This reflects the accurate 2004 appropriation and revenue
for the Recreation Partnership. When the County reduced their contribution
to the Partnership, the other partners (municipalities) increased their contributions
to offset the County's cut. The 2004 total appropriation will be $190,552
with total revenue of $152,442. Therefore the County contribution is
a total of $38,110.
Approval of Minutes
It was MOVED by Ms. Blanchard, seconded by Ms. Schuler,
and unanimously adopted by voice vote by members present, to approve the
minutes of the April 7 and April 14 meetings as submitted.