1. Authorize Agreements, Health Department/Children with Special Needs (Contract for Services) –Mr. Cornell moved adoption, seconded by Mrs. Tytler. Ms. Feuerherm indicated that this is a general resolution for contracts. She provided a few more specifics about particular contracts. Dr. DiGiovanni expressed his concern about giving blanket approval for contracts and not bringing each individual contract to the committee. If a contract comes up that is not on the supporting list of service providers for this resolution, Ms. Feuerherm will notify the committee of the addition. All members voting in favor; none opposed; resolution adopted.

2. Authorize Agreement/ Accept Funds – Health Department/ Children with Special Needs (EIP/CSHCN NYS Grant) – Mr. Cornell moved adoption; seconded by Mrs. Tytler. All members voting in favor; none opposed; resolution adopted.

3. Authorize Agreements, Health Department/ Hospice (Program Services) – Mrs. Tytler moved adoption, seconded by Mr. McKee. Mrs. Gailor indicated that this resolution is due to the change in regulations regarding hospice services. This is for provision of services when a hospice patient leaves Cortland County and goes to another county. Mr. Dafoe moved to strike "Administration of the Health Department" and insert "Public Health Director or designee"; seconded by Mrs. Tytler. All members voting in favor; none opposed; amendment adopted. All members voting in favor; none opposed; amended resolution adopted.

4. Authorize Agreements, Health Department/ Environmental Health (Contracted Services) – Mr. Cornell moved adoption; seconded by Mrs. Tytler. Mrs. Gailor explained that this is for services related to rabies. All members voting in favor; none opposed; resolution adopted.

5. Create One Staff Psychiatrist (part-time) and Amend Budget, Mental Health Department – Mrs. Tytler moved adoption; seconded by Ms. Wyant. Mrs. Medeiros indicated that this is the psychiatrist for Horizon House. She works 8 hours per week and has agreed to accept this hourly rate with no benefits. This will eliminate the issue about professional liability insurance including Cortland County as an additional insured. All members voting in favor; none opposed; resolution adopted.

1. Mrs. Gailor indicated that Mrs. Uttech had met with John Bardsley last week regarding translators. We need to use translators on a case-by-case basis and often don’t know in advance. John Bardsley is willing to work on a case-by-case basis with each translator with a letter of agreement, however, he wanted it discussed at committee to ensure that the committee agrees. Dr. DiGiovanni asked how frequently we use one and what the cost burden to the County is. Mrs. Gailor indicated that usage is infrequent and the cost is minimal. John Bardsley does not feel that the professional liability insurance will be required for the translator. The agreement that the translator signs will include HIPAA language.

2. CHHA Auditor’s Report – Ms. Feuerherm reviewed the auditor’s report with the committee. The projection on the expense and revenue is coming in under what was anticipated. We are currently running about 70% Medicare. Ms. Feuerherm indicated that she has reviewed the report with nearly all the staff to cover strengths and weaknesses and they will target areas that need improvement. Mrs. Tytler asked if this program is expected to run in the black. Mrs. Gailor indicated that Mr. Schrader would like it to run in the black, however, the goal is to have it at least break even. Mrs. Gailor indicated that our travel costs and the fact that our wages must be competitive with Syracuse cut in to our ability to turn a profit. Therefore, our goal is to have the CHHA break even. Mrs. Gailor indicated that the 5% rural add on expired on October 1. There is legislation to reinstate it, however, the funding will not be retroactive. Mrs. Tytler asked if there is anyone we can advocate with to make the payment retroactive. Mrs. Gailor will find out who is sponsoring the legislation at the state level so we can advocate for retroactive payment of the 5% add on. Dr. DiGiovanni asked if the audit is financial or if it is financial and procedural. Mrs. Gailor indicated that Mr. Vanesky is a CPA so he audits the financials, however, he is very knowledgeable about how the agency needs to operate to receive the most reimbursement. He gives advice on how to look at cases critically so that reimbursement can be maximized. Mrs. Gailor indicated that this is Mr. Vanesky’s interim cost report. He does the interim in September or October so that if we need to change the rates, we can change them before the end of the fiscal year so that revenue can be maximized. Mrs. Tytler asked if the 2005 budget is set up so that we break even. Mrs. Gailor and Ms. Feuerherm indicated that it is not set up yet to break even. Dr. DiGiovanni asked if relative to last year, we are anticipating an increase in revenue. The response was yes.

3. Diagnostic & Treatment Center Survey – Mrs. Gailor indicated that the response is ready to go back. She has met with the people in the two clinics. Chairman Steve has reviewed it and has made some changes. Mrs. Gailor indicated that there are five (5) citations. Advanced directives is something that by regulation you are required to educate the staff on – in some personnel files there was notation that the staff have received training but other files did not have the notation. All staff will undergo training by November 19, 2004. The big this is that it appears that the clinics under nursing document well and the clinics under JCRH don’t document as well. The same documentation will be carried through all clinics. Child Abuse reporting and what is done – the survey indicated that there was not indicated documentation in Mrs. Gailor’s file and Dr. Eberly’s file that they had received the training needed for their licensure. Mrs. Gailor has gotten the documentation that was required and will be taking this issue higher at the State level. After speaking with the state folks, their was clarification that they did not receive the orientation, not that there wasn’t documentation. All training and documentation is complete. The patient rights issue was that the pamphlet given to patients didn’t clarify that we will not use them in research. This is because we don’t do research. However, the brochure has been updated to include all information they require. The last item is that there were holes in the wall in the boiler room that the State wanted repair. The holes have been repaired, the surveyor looked at them and found another hole in the wall that they want repaired. Mr. Parker indicated that this can be repaired by the end of the year. Fire drills are supposed to be held quarterly; we have been holding them annually. The Safety Officer has contacted the City, and we will be holding the fire drills quarterly. Mrs. Gailor indicated that in all reality, they had to look deep to find the items they did find, which makes her feel positive about the survey overall. Mrs. Tytler asked if we have a form that documents the fire drill process. Mrs. Gailor indicated that there must be some type of documentation that was shown to the state. Mrs. Tytler indicated there is paperwork that must be completed showing not only that it was done but how long it took and other pertinent details. Mrs. Gailor indicated that the department is looking at orientation/training procedures so that training/orientation is not missed. All the information is maintained in a computer database. Mr. McKee asked if fire drills, documentation, etc. is done at the Mental Health Clinic as well. Mrs. Medeiros indicated that the regulations are very similar and the Mental Health Clinic is undergoing very similar procedures. Mrs. Tytler asked about the semi-annual fire training. Mrs. Gailor indicated that she does not believe it is being done semi-annually, but she will talk to Mr. Huttleston about this. Mrs. Tytler complemented the department on the survey as it was really very good.

4. Lead Program Review – Mrs. Gailor thought we would have the written report by now but we do not have it. This was concurrent with the first day of the Diagnostic & Treatment Center Survey. The leader surveyor was very complimentary to the staff regarding the things we have done about education about lead poisoning. Overall, they were very pleased; it was very supportive of the things that staff has done. There was nothing significant included in the survey. Mrs. Tytler asked how much money is available for lead abatement in the community. Mrs. Gailor indicated that there is no money available through the Health Department. She indicated that there is not a high level of lead poisoning the community. Ms. Feuerherm indicated that the state regulations are now going to require tracking of children through the teenage years, which may change the statistics.

5. Influenza Vaccine Update – Mrs. Gailor indicated that we have the first shipment of flu vaccines. It is being distributed to the high risk settings first. The federally-funded health center has received their vaccines. Most of the practices have not received any; a few have received some vaccines. Two of the three nursing homes did not have any. One of the nursing homes has been linked with an industry who had dosages and the other nursing home has received dosages. There have been two forums. What is being stressed is prevention. They are looking to put hand sanitizers in their offices as well as the wipes for the phones. There will not be enough dosages for the general population. There is about a 25% distribution of vaccines in relation to the requests from the hospitals, physicians, etc. Ms. Wyant asked if schools are being educated. Mrs. Gailor indicated that posters are being provided covering a variety of topics regarding preventive. We must focus on the preventive issue this year. There are also brochures available as well as posters. Mrs. Gailor indicated that flu mist is available. It has been recommended for health care professionals who are in contact with patients. It is limited to age 5 to 49. Staff who fit the category are being asked to consider this. Most hospitals refuse to use it even though the CDC recommends it for use in hospitals. Dr. DiGiovanni asked if Dr. Gillim has spoken about cutting the dosage in half for healthy people, which would be applicable to the staff. Mrs. Gailor indicated that Dr. Gillim has not spoken about this. Dr. DiGiovanni suggested that Mrs. Gailor pursue this with Dr. Gillim to see if it would be applicable for the staff.

6. Dr. DiGiovanni asked if Mrs. Gailor has had the opportunity to review the budget. Mrs. Gailor indicated that she has not had the opportunity to review the budget and is not certain about what the positions are to which Mr. Schrader is referring. Dr. DiGiovanni is inquiring about changes in Mr. Schrader’s budget as opposed to what Mrs. Gailor requested. Mrs. Gailor is concerned about the Medical Services Clerk being cut in Environmental Health. Most of the position is paid for by grants. Also, she is concerned about the amount of telephone calls that are coming in that are absorbing the time of the technical staff. Mrs. Gailor indicated that recruiting a part-time/half-time person for the Medical Services Clerk position is difficult. Mrs. Feuerherm spoke about the revenue expectations for both CHHA and CSN. Mrs. Tytler asked about the Rackers Center and the transport of the child to Binghamton. Ms. Feuerherm indicated that the Rackers Center is anticipating opening the autism center in Cortland in September. There was a discussion about whether we can tell the parents that there is a local program and if they opt for services other than the local program they will have to pay the difference. Dr. DiGiovanni asked if we don’t need to work with the Superintendents on this issue. The consensus is that we should and we should also include the CPSE Chairs. Mrs. Tytler indicated that we also need to work closely with the problems (if they exist) with the local programs – feedback to the Rackers Center, empowering the parents by inviting them to participate on a quality committee, etc. Mrs. Tytler stressed that it is imperative that we have a plan to look at these issues and move forward to solving some of these problems. Mrs. Tytler would like us to still consider "seed money" to assist someone in developing a program to keep the children in the community. Ms. Feuerherm indicated that that the Racker Center program is going to be very costly as the rate is going to be very high and it will be across the board for all programming. Mrs. Tytler asked Ms. Feuerherm to develop a list of highlighted issues and the status on each of the issues so that the committee can evaluate where they can best assist her.

7. Mrs. Medeiros distributed the quarterly revenue report to the committee. Basically, all is on target. There have been some billing issues but they are expected to be rectified today or in the very near future. She indicated that the expenditure report will be in the mailboxes later this week.

The meeting adjourned 9:05 a.m. and the committee toured Horizon House.

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