HEALTH AND HUMAN SERVICES COMMITTEE MAY 7, 2003 11:30 A.M. SCOTT HEYMAN CONFERENCE ROOM
Present: M. Robertson,
Chair; N. Schuler; F. Proto; M. Koplinka-Loehr; P. Penniman (arrived at 11:40
a.m.)
Staff: S. Whicher, County Administrator; A.
Hovaguimian, Interim Executive Director for Alcohol and Drug Council; B.
Bush, Social Services; H. Stevenson, Social Services; A. Cole, Public Health
Director; B. Crosby, Public Health Administrator; S. Kerr, Health Department;
T. Lysko, Health Department; I. Stein, Office for the Aging Director; K.
Schickel, Office for the Aging; N. Zahler, Youth Services Director; J. Thomas,
Administration
Guest: T. Joseph, Chair of the Legislature
Called to Order
The meeting was called to order at 11:37 a.m.
Changes to Agenda
An appointment to the Office for the Aging Advisory Committee
was added to the agenda. A budget adjustment for the purchase of Personal
Emergency Response System (PERS) machines was withdrawn.
Update on State Budget
Mr. Whicher provided the Committee with a brief update
on the State Budget. He believes the Health Department's budget is
being restored. Social Services staff is looking at the impacts and noted
there are many discrepancies. There is also disagreement between the
State Legislature and Governor's budget office with what was approved.
The County should have a clearer idea of the State Budget in the next couple
of weeks.
Mr. Penniman arrived at this time.
Mr. Whicher informed the Committee that Lakeside Nursing
Home filed bankruptcy which then requires them to keep all expenditures current.
This action allows the bankruptcy judge to have certain financial control
rather than the receiver. He feels the County will receive the money
it is owed. However, he said this action does give them protection
for two years. The receiver believes they will end up with the property.
He learned that the State Health Department's interest is not in the finances,
but the care of the patients. In order to get a new Medicaid rate,
there needs to be a change in ownership before maintaining 90 percent occupancy
for a minimum of one year which is why the facility was decertified reducing
the number of beds to 160.
Introductions
At this time, Ms. Robertson introduced Arpy Hovaguimian,
the Interim Executive Director for the Alcohol and Drug Council.
Mary Agnew has accepted a job as Vice President of Patient Relations at Cayuga
Medical Center.
Approval of Minutes
It was MOVED by Mr. Koplinka-Loehr, seconded by Mrs. Schuler,
and unanimously adopted by voice vote, to approve the minutes of the April
2, 2003 meeting as submitted.
Department of Social Services
Dental Case Management Program
Ms. Stevenson updated the Committee on the progress of
the Dental Case Management Program. She said the program is off to
a good start and on target with the operational plan. Thirteen local
dentists have agreed to participate in the program and seven are currently
accepting patients upon referral. Seven local dentists will provide
emergency care upon referral from the case manager. A database has
been developed to assist in creating reports as specified in the operational
plan such as client participation, no shows, dental feedback, etc.
Ms. Stevenson briefly explained the two brochures available. One is
designed to inform dental office staff and the other is designed for Medicaid
recipients and low-income seniors. The brochures have been distributed
to various locations including the receptionist area of Social Services,
Health Department, Tompkins Community Action and participating dentists.
Ms. Stevenson said the goal of the program is to serve 600 people by the
end of2004.
Committee members also suggested other locations for placing
the brochures including: food pantries, TCAT, town halls and community
centers, Office for the Aging, drug courts, and the Alcoholism Council.
Mr. Proto suggested periodic meetings be held with the
dentists to hear feedback and that the Committee also receive an update on
the program in six months. Ms. Robertson said she will discuss with
staff the appropriate time for a report.
Ms. Robertson said she would like to have a report on
the additional reimbursement costs for this program for the individuals that
would not have received dental care otherwise. Ms. Bush said that information
should be available, however, the cost benefits for transporting people out
of county will be difficult to show. Ms. Robertson also said having
the costs of treating people in the absence of this program would be useful.
Mr. Proto agreed that having information on cost avoidance
of traveling out of the County and geographic location of dentists will be
very helpful.
Medicaid Managed Care
Ms. Bush provided the Committee with a progress report
on Medicaid Managed Care. Approximately 40 people a month are being
enrolled, more than they had anticipated. She said Tompkins County
is a voluntary county and not a mandatory county. A marketer comes
periodically to provide information during group re-certifications.
She noted some of the issues the Department is trying to resolve are people
switching back and forth between Medicaid, Medicaid Managed Care, and Family
Health Plus Managed Care. The provider base is different and this is
causing some problems. Beginning in April, people no longer have to
come in to the Department to re-certify for Medicaid; the process will eliminate
short-term case closings.
Mr. Proto asked if assistance was provided to help people,
in particular seniors, review their bills to prevent duplication. Ms.
Bush said that service is only provided upon request. Ms. Robertson
asked that this be looked into and report back to the Committee if necessary.
It was noted that the Senior Citizens Council and Office for the Aging provide
such a service.
Ms. Bush said a client survey is in the process of being
developed, but based on the type of phone calls received, it appears to be
a positive program. Following is a list of services (carve outs) that
are not included under Medicaid Managed Care: dental,
prescriptions, out-patient drug and alcohol services, and non-emergency
medical transportation. For these services, the County has to pay on
a fee-for-service basis. DSS had thought that Medicaid Managed Care
would save the County some money, but with the carve outs this is not turning
out to be the case.
Health Department
Ms. Cole distributed copies of an emergency preparedness
guide to assist people in preparing for an emergency. She said the
document is very useful and was paid for with bio-terrorism grant money.
In addition, she said with the grant money they are subcontracting with the
Red Cross to do presentations on emergency preparedness. The Red Cross
will also be developing a brochure and doing a lot of outreach for the Health
Department.
Discussion on Prioritizing Programs
Ms. Cole reviewed the following questions and answers
discussed between Chair Joseph, Legislator Robertson, and herself:
1. What is being asked of the Health Department in terms of terrorism
work?
- Through bio-terrorism grant there are 55 deliverables to answer that
include a full health related emergency operations plan and drills of that
plan (drill planned in September)
- Attending numerous trainings
- Dissemination of information to local providers
- Participation in many meetings of county partners
- Smallpox pre-and post event planning
- Smallpox vaccine education
- Smallpox vaccination clinic planning
- Frequent NYSDOH conference calls
- Weekly communicable disease conference calls with NYSDOH
- Daily active surveillance of CMC emergency department (7 days a week)
- Carry cell phone 24/7
2. In what ways does it interfere with other work?
- Information is time sensitive-need to drop what we are doing to distribute
information
- Trainings and phone calls scheduled on short notice that bump other
activities
- Supervisors not as available to staff
- Inability to take on new projects
- Constant re-prioritization of workload
3. In what ways does it compete for resources with other work?
- Pushes other work to back burner
- 34 percent of two nurses’ and one team leader's time was spent on
preparedness in first quarter 2003
- Ms. Cole’s time on bioterrorism work cannot be reimbursed by the grant.
4. What parts does the department regard as valuable?
- Information is good but doesn't always need to be conveyed by travel
to Syracuse or Albany
5. What parts are valuable, but not as valuable as what it's displacing?
- Some trainings and conference calls
- Redundancy of paper flow
6. What parts are being funded separately and what isn't?
- Grant will not supplant existing activities, will only pay for pre-event
and new hours/positions
- Giving us stuff we don't want, such as radios, just to spend the money
7. Where and how is the department resisting?
- Saying no to trainings
- Wrote to Senator Seward about the proposed cuts in the state budget
- When Burhans, State Director of Emergency Response, complained about
Ms. Cole’s letter to Seward, reported this to NYSACHO
- Reported O'Donnell to Syracuse Regional Office
A brief discussion followed concerning grant funding being
used to hire a bio-terrorism coordinator.
Mr. Joseph explained the reason he posed the questions.
He feels some of the bio-terrorism work is not useful and is interfering
with other important work that needs to be done. He wanted the Committee
to hear this information and grant the Director and Health Department permission
to deny certain requests or requirements to the extent possible if the staff
and Director feel the work is not necessary.
It was the consensus of the Committee to allow the Department
Head, Alice Cole, to determine departmental priorities based on guidance
from the County Legislature (meaning the Department will do if appropriate,
has time, and funding). Mr. Proto suggested creating a paper trail
to make sure there are back-up material and justification.
State Budget Update
Ms. Cole said she has not heard officially if the funding
for public health has been restored in the State Budget.
Mr. Proto asked what impact expanding the non-smoking
law will have on the Department. Ms. Cole said the Health Department
will handle any complaints filed through the Environmental Health Division.
Ms. Lysko reported that as part of the tobacco control coalition, there needs
to be outreach with educating the community and worksites about the law.
Ms. Cole announced the County received the grant for $32,000
from the Department of Health for the dental program.
Cayuga Medical Center Annual Meeting
Ms. Cole reported briefly that she attended the Cayuga
Medical Center's annual meeting as the County's representative at the request
of Chair Joseph. There was a demonstration of the new radio technology
facility and a tour of the ambulatory care unit. She had an opportunity
to meet the new Medical Director, Dr. Grier, and Mary Agnew, Vice President
of Patient Services.
Appointments
Mental Health Services Board Substance Abuse Subcommittee
It was MOVED by Mr. Koplinka-Loehr, seconded by Mrs. Schuler,
and unanimously adopted by voice vote, to submit to the Legislature the appointment
of Amy Chaffee to the Mental Health Services Board Substance Abuse Subcommittee
as a community member representative for a term that expires December 31,
2006.
Office for the Aging Advisory Committee
It was MOVED by Mr. Koplinka-Loehr, seconded by Mrs. Schuler,
and unanimously adopted by voice vote, to submit to the Legislature the appointment
of Wanda Beardslee to the Office for the Aging Advisory Committee for a term
that expires December 31, 2003.
Office for the Aging
Project Care
Copies of the brochure explaining the Project Care program
were distributed to Committee members. Although a Friendly Visitor
program existed, Ms. Stein said this program was developed to create a volunteer
core that could make more of a difference than what has been done.
She said some Federal money was received to assist in training the volunteers
to provide respite to caregivers.
Ms. Schickel commented that last year (2002) 160 seniors
were served with 103 volunteers. In the year March 2000 to March 2001,
84 clients were served. Last year, volunteers donated 4,651 hours.
Volunteers assist seniors in many ways including: friendly visiting,
errands and transportation, grocery shopping, light housekeeping, light yard
work, and respite for caregivers. She noted that there are more volunteers
from the community than students. One of the biggest challenges with
the program is getting the seniors to feel comfortable and accept the assistance
offered by volunteers.
Rollover
Recreation Partnership
It was MOVED by Mr. Koplinka-Loehr, seconded by Mr. Penniman,
and unanimously adopted by voice vote, to approve the following rollover
request:
Youth Bureau - Recreation Partnership
7021.54400 $11,088
Ms. Zahler noted the Recreation Partnership will be a
separate budgeting unit next year. The $11,088 is money that was contributed
by participating municipalities and they want to have access to it, so it
needs to be moved into the Youth Services budget.
Youth Services
Ms. Zahler briefly explained where the rollover funds
came from and commented that she attended three meetings in Albany but did
not request reimbursement for mileage. She said there may be an opportunity
to request reimbursement through the State organization and will look into
it. Following a brief discussion, Ms. Robertson requested that she
be informed of the reimbursable amount that was not submitted.
Health Department
Ms. Robertson commented the Health Department is not requesting
use of their rollover funding in 2003.
Social Services
Ms. Robertson asked what the service was for the contractual
expense postponed for $421,176. Mr. Penniman asked about the revenue
received over budget and said he would like more information. He said
it would be useful to have this information for all the departments that
received revenue over budget.
Mr. Whicher commented that he will request the information
being requested from the department heads and report back at the next meeting.
Office for the Aging
Ms. Robertson asked about the $22,019 revenue over budget
and Mr. Whicher commented that he thought it was a member-item received that
had not been budgeted.
Mr. Proto clarified that the discussion on the Recreation
Partnership facilities will be held at the next Committee meeting.
Ms. Zahler said that was correct and distributed material related for review.
She said an op-ed piece was prepared and submitted explaining that discussions
are taking place. The City has revised the costs for 2004 and hopes
to request that municipalities increase program expense by $50,000 for facility
maintenance and operation costs, at the next Recreation Partnership
meeting.
At this time, Ms. Zahler distributed copies of the Summer
Guide Camp information.
Guest Editorials
Ms. Robertson asked for updates on the guest editorials
Committee members are writing. She understands it is a lot of work
and thanked the people who assisted her in writing her piece that was published
in April.
Mr. Penniman said he will be contacting Social Services
Commissioner Dolan to discuss a specific topic that is in transition or at
risk. Ms. Robertson noted that Commissioner Dolan and Tom Herden will
be giving a presentation on Medicaid at the June 3rd Legislature meeting.
Mr. Proto said he will be preparing a draft editorial
for Health Director Cole and Office for the Aging Director Stein to review
on home health care.
Mrs. Schuler was excused at 1:20 p.m.
Mr. Koplinka-Loehr said he will have an editorial by June
1st on Compass II.
Unfinished Business
Mr. Proto asked if the question of residency could be
followed up prior to Ann Chaffee's appointment to the Mental Health Services
Board Substance Abuse Subcommittee. Mrs. Covert agreed to follow up.