Health Committee

July 13, 2004 – 8:30 a.m.

DRAFT Minutes

 

Members present: Dr. Paul DiGiovanni, Chairman; Larry Cornell, Vice Chairman; Mike McKee; Tamara Wyant, Newell Willcox; Carol Tytler; Steve Dafoe

Others present: Ann Homer, Jackie Gailor, Public Health Director; Linda Medeiros, Administrative Officer – Mental Health; Scott Schrader, County Administrator; John Helgren, Health Department; Karen Mastronardi, PSY

Absent: Carol Tytler

Dr. DiGiovanni called the meeting to order at 8:30 a.m.

On the motion of Mr. Cornell, seconded by Mr. McKee. All members voting in favor; none opposed; minutes of the June 9, 2004, meeting were approved as printed.

 

RESOLUTIONS:

 

     

  1. Authorize Agreement/Accept Funds-Health Department/Environmental Health (Drinking Water Program) – Mr. Cornell moved adoption; Mr. Dafoe seconded. Mrs. Gailor explained the services that will be provided under this grant. Much of this grant is related to well testing; the primary purpose is for water preservation. Mr. Dafoe requested a copy of the work plan; Mrs. Gailor will provide the plan to Mr. Dafoe. Mrs. Gailor clarified this is for the public water supply. Dr. DiGiovanni asked how this ties into the other budget dollars for protecting the water supply. Mrs. Gailor explained that this supplants the Engineer already in place as we could not cover the Engineer’s salary with the grant as the position was already in place. Dr. DiGiovanni asked what else the Health Department does for water monitoring other than this grant. Mrs. Gailor explained that most all water monitoring activity in conducted under this grant. The question was posed as to who drilled the well. Mrs. Gailor indicated she could research that information and get it back to committee. Mr. Willcox suggested that perhaps if we put the well drilling out to bid, someone would drill two wells for the price that the current company is charging for drilling one well. Mr. McKee asked how long we have had the grant and how long we expect to receive it. Mrs. Gailor indicated this is our third year; it was indicated that we would receive this grant forever, but that is not always the case. Mr. Helgren indicated that we received $94,000 in the drinking water grant from the state. He explained that it is up to the County how to utilize the money. It was an enhancement grant to improve whatever was being done prior to the grant to preserve drinking water. There is a full-time sanitarian and a half-time clerical person paid out of the grant. Mr. Dafoe indicated that there is approximately $37,000 to use after paying the staff time. How is that money used? Is it for drilling, monitoring, etc.? Mr. Helgren indicated that it is used for equipment for sampling; for lab fees (which is substantive); for extra sampling that is done (last year we did sampling of 30 private wells around the County that have never been tested before); the drilling program (there is one slated this year – and we will probably need to go out to bid or negotiate with the current provider; the site for drilling this year has not been decided); travel expenses; two vehicles; cell phones; radio expenses; general operational supplies such as copier, copies, and postage. Mr. Willcox asked what would have happened if we did not receive the grant. Mr. Helgren indicated that the State calls this a grant so they don’t have to give it forever, yet they tell us we will receive it forever. Mr. Helgren further clarified that we use this grant to meet all state and federal requirements. If we did not receive this grant, we would be scraping to meet state and federal requirements and we would not be able to do the extra things, such as well drilling. Mr. Dafoe asked where the well this year will be drilled. Mr. Helgren indicated that it has not yet been decided but it will most likely be in the Preble area. Mr. Dafoe asked if this program had anything to do with air quality. Mr. Helgren indicated that this is for water quality only. Mr. Dafoe asked where air quality comes in. Mrs. Gailor indicated that per our Environmental Code, air quality is handled by the DEC. Mr. Helgren indicated that air quality complaints are forwarded to the DEC. Mr. Willcox asked if the State of New York would be able to help with this. Mr. Helgren indicated that the State is available for phone consultation, but the State will not go out and do the testing; that is why they provide the grant. If we did not provide the services, the State will not provide them and the services would not be done. Mr. Willcox asked what the State does do for us. Mr. Helgren indicated that they serve as a resource for us. All members voting in favor; none opposed; motion adopted.

    2.  

    Mr. Cornell moved consideration of resolutions 2 through 10 as a block. Seconded by Mr. Willcox; all members voting in favor; none opposed; resolutions 2 through 10 adopted.

     

     

  2. Amend 2004 Budget/Transfer Funds-Health Department/Administration (Bioterrorism Grant)

    3.  

  3. Amend 2004 Budget/Transfer Funds-Health Department/Administration (Breast Health Partnership)

    4.  

  4. Amend 2004 Budget/Transfer Funds-Health Department/Administration (Cancer Screening)

    5.  

  5. Amend 2004 Budget/Transfer Funds-Health Department/Administration (Eat Well Play Hard Grant)

    6.  

  6. Amend 2004 Budget/Transfer Funds-Health Department/Administration (Rabies Program)

    7.  

  7. Amend 2004 Budget/Transfer Funds-Health Department/Administration (Drinking Water Grant)

    8.  

  8. Amend 2004 Budget/Transfer Funds-Health Department/Administration (Healthy Heart Grant)

    9.  

  9. Amend 2004 Budget/Transfer Funds-Health Department/Administration (Tobacco Grant)

    10.  

  10. Amend 2004 Budget/Transfer Funds-Health Department/Hospice (Patient Expense, Transportation, Revenues)

    11.  

  11. Authorize Agreements, Mental Health Department Prevention Services for Youth (CAPCO)- Mr. McKee moved adoption; seconded by Ms. Wyant. Mrs. Medeiros explained that this is a program under the auspices of PSY whereby we hire a consultant to work with the Head Start program and we pay the consultant the going rate that we pay all CSWs and then Karen Mastronardi supervises that person in the Head Start program and charges CAPCO a slightly higher rate than we pay our consultant, so we earn a little money. We have been doing this approximately 5 to 6 years; it works well and because it is on an academic year, this resolution is presented at this time so the program can start in September. This authorizes the contract with both CAPCO and the consultant. All members voting in favor; none opposed; motion adopted.

    12.  

  12. Abolish/Create, Mental Health Department, Staff Social Worker, Staff/Certified Social Worker – Mr. Cornell moved adoption; Mr. Dafoe seconded. Mrs. Medeiros indicated that there is one Staff Social Worker position in the Clinic. The remainder of the positions are CSW. The MSD Study recommends that all positions be CSW positions. The Staff Social Worker position gave some flexibility to hire someone with an MSW who has not yet passed the certification exam. Once the individual passes the exam, when a CSW position becomes vacant, that person is moved into the position. This resolution gives the department the flexibility to hire at either level – the Staff Social Worker or the CSW position. The Staff Social Worker position will be vacant soon upon promotion of the individual to CSW. Dr. DiGiovanni asked about the vacancy posting for CSW he received yesterday. Mrs. Medeiros indicated that the position being advertised is the position the incumbent in the Staff Social Worker position will be filling. All members voting in favor; none opposed; motion adopted.

    13.  

  13. Increase Hours (temporary),Mental Health Department (Coordinated Children Services Initiative) – Mr. Dafoe moved adoption; seconded by Mr. Cornell. Mrs. Medeiros indicated this is the additional $6,000 received from the State. The money was received too late to spend it by June 30, 2004, as originally required. The State has authorized the spending of the funds by the end of 2004. .This authorization was previously given; this is a request to extend the end date. All members voting in favor; none opposed; motion adopted.

 

Discussion:

1. Mrs. Gailor indicated that everyone should have received a copy of the declaration of public health threat in Cortland County due to the positive bird being found in Cortland County. Mrs. Gailor indicated that prior to the positive bird, we send 2 to 3 birds per week. Once a positive bird is found, we are only allowed send 1 bird per week. However, once a positive bird is found, our reimbursement rate goes us to 50%. Ms. Wyant asked if a dog could get West Nile Virus if it ate a positive bird. Mrs. Gailor said that at this time, the only way that the virus is known to spread is through a mosquito.

2. Mrs. Medeiros updated the group about the grant application to work with the college level for review of alcohol use. Cortland County has been awarded $244,000 for three years for the program. There are six grants in the State and we received one grant. The lead agency is the College.

3. Personal Recovery Oriented Services (PROS) Program Model, Office of Mental Health. Potential impact on local services. This is a new program that OMH is delivering. This is a way for the State to shift 50% of the funding to the federal government. There will be no County match in this funding stream. It is requiring that vocational services in the County be converted to this PROS model. Services are currently being provided by the JMMC, Catholic Charities, and OMRDD. It has allowed the agencies to hire individuals recovering from mental illness who are in different stages of recovery to prepare them for working in the community. The concern locally is that by making this a Medicaid funding program, it will provide strict guidelines to follow and will remove the flexibility the agencies have had in gearing the service to the needs of the consumer. It requires that consumers working, work 15 hours a week or they are not eligible for the program. The 15 hours per week is sometimes not manageable for the consumers in recovery. This means that the program can not bill Medicaid, so the program will not be able to serve the clients. Cortland County has applied to OMH for a waiver requesting flexibility and receive the reinvestment funding. The State has said this is a possibility. PROS is going to be implemented in two stages; Cortland County is suggesting we participate at Stage 2. Now the State has taken away the chance of any waiver in Stage 1. The other part of this PROS is to say that the vocational programs are mandated to convert. Continuing day treatment programs, such as Horizon House, are an optional conversation to PROS. We have not made a decision whether it is wise to convert Horizon House or not. The draft regulations are out, so staff are studying them to see if fiscally and programmatically it would be a wise move. Phase 2 starts in about a year, so this committee will be asked to make a decision in about a year on whether on not to covert the CDT program. Mrs. Medeiros has additional information if the committee would like it. Mr. Schrader indicated that this does concern him, because since it is being put under Medicaid, there is always a chance of a County share. Mr. Schrader does not see the State providing the waiver, but he said it is worth a shot. His real concern is that we don’t have the flexibility at the local level to do the job in the way it needs to be done. The models don’t always fit the small rural communities. He indicated that as far as CDT and Horizon House are concerned, Horizon House must break even at a minimum. Mr. Schrader indicated that Horizon House does have the capability to make a small profit, which can then be funneled to other mental health services and that needs to continue; he is not certain that the PROS model will allow that to happen. It may be in our best interest to NOT choose the PROS model. The regulations just came out so we have not been able to analyze them to see what will happen with the funding stream. Mr. McKee indicated that this is making us jump through so many hoops to get any benefits. Mr. Schrader indicated that there is no flexibility in the Medicaid regulations, so we are greatly restricted.

4. 2005 Local Service Plans for Alcohol & Substance Abuse Services and Mental Retardation/Developmental Disabilities Services. Mrs. Medeiros indicated that we must look at all of these services in the community; looking at gaps in services; and do some planning around those services and service needs. In reality, we have little control over how the funding is used that comes from the State in these two particular areas. The State has a heavy hand in telling us how the funds are to be utilized. It comes in a specific funding stream for this purpose or that purpose. This is the way we can tell the State what we feel the County needs and how we would like to see services provided. However, our recommendations are not always those that are put in place. One of our recommendations is that we want to see smaller residential homes throughout the community instead of large 15 bed facilities. We have been asked to identify one goal for alcohol/substance abuse. The Communities that Care goal was adopted, since the comprehensive work has already been conducted. For a treatment goal, a broad goal was adopted. More specifically, we would like to look at the need to provide treatment for alcohol and substance abuse in the rural communities. The current providers are all in the city and the need is known in the rural areas, so they will be looking at the goal over the next three years. (This is a three-year plan.) Mr. Dafoe asked when the services are provided and clients go to the centers for treatment and they make poverty level income, they are still charged the high level fee. A young man he knows, makes $150/week and he was court-mandated in to treatment. This young man had to pay $53 to even be seen. Mr. Dafoe went to see Mr. Gardner and he could not get Mr. Gardner to see him. Mrs. Medeiros indicated that she understands there is a sliding scale fee. There is a publicly funded organization and a private organization. The private organization has to make it on its own; the publicly funded agency receives public funding and should have an appropriate sliding fee scale. Mrs. Medeiros will look in to this situation regarding sliding scale fee.

5. Mrs. Medeiros reviewed the revenue report for the Mental Health Department and its various divisions.

6. Ms. Mastronardi indicated that the Communities that Care Key Leader Breakfast will be held August 23 from 8:00 to 9:30 at the hospital. An e-mail will be forthcoming.

7. Dr. DiGiovanni indicated that he is meeting tomorrow with the Racker Center individuals regarding rates and unanticipated rate increases. Dr. DiGiovanni indicated that in communities where this is competition, Racker Center has altered its rates to better serve the community. Mr. Schrader indicated that there is a barrier to entering competition in Cortland County and that is space. Also, you need to partner with a day care provider to spread costs over a wide range of clientele. Right now, there are not any locations where a day care could expand operations and incorporate a special needs program. Ms. Feuerherm is going to provide Mr. Schrader a listing of all day care providers; he will then contact them to see if expansion is possible. The School Districts also need to partner with this program with universal Pre-K. The School Districts are not doing universal Pre-K themselves – they are contracting with providers. There are impediments that need to be overcome. The private organization is interested in moving in to the community, but we need to help them with organizational/research issues. Racker Center has now created a half-day program, based on our complaints and our research in to alternative programs. There is about a $75,000 unanticipated exposure for the County.

Mr. Dafoe moved to go in to Executive Session for personnel discussion. Second by Mr. Cornell. All members voting in favor; none opposed. Committee went in to Executive Session at 9:50 a.m. and minute recorded was excused.

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