November 30, 2004 – 8:00 a.m.
Members present: Dr. Paul DiGiovanni, Chairman; Larry Cornell, Vice Chairman; Mike McKee; Carol Tytler; Tamara Wyant; Scott Steve, Chairman of the Legislature
Others present: Ann Homer; Linda Medeiros, Administrative Officer–Mental Health; Jackie Gailor-Public Health Director; Cathy Feurerherm-Director of Patient Services/Children with Special Needs; Elaine Lambert – Director of JCRH; MJ Uttech – Deputy Public Health Director; Scott Schrader – County Administrator; Brian Liberatore; Eric Mulvihill
Absent: Newell Willcox , Steve Dafoe
Dr. DiGiovanni called the meeting to order at 8:32 a.m.
On the motion of Mr. Cornell, seconded by Mrs. Tytler. All members voting in favor; none opposed; minutes of the November 9, 2004, meeting were approved as printed.
Mrs. Tytler asked about the Legislation regarding the CHHA for the Rural Add-On. Has it been adopted? Mrs. Gailor indicated that this is under her discussion items for this meeting.
1. Authorize Agreements, Health Department/Children With Special Needs (Contract for Service) – Mrs. Tytler moved adoption; seconded by Mr. McKee. Ms. Feuerherm indicated that we are adding an additional contractor; the rates are NYS approved rates. Dr. DiGiovanni asked when the bi-lingual add on kicks in. Ms. Feuerherm indicated when the service is used. All members voting in favor; none opposed; resolution adopted.
2. Authorize Agreement/Accept Funds, Health Department/Children With Special Needs
(NYS Facilitated Enrollment Program) – Mrs. Tytler moved adoption; seconded by Mr. Cornell. Mrs. Tytler asked what type of feedback we have about the work being performed by the person at CMH; how many enrollments are conducted? Ms. Feuerherm indicated that CMH is our highest enroller; the individual has a high rate of accuracy on the applications. Mrs. Gailor confirmed that there is a person at CMH who is providing the enrollment services. Mrs. Tytler would like to know how much of a person we are funding at each enrollment location and how much work that person is doing. Are we funding 40 hours per week per enroller and for the hours we are funding, how many enrollments are being conducted. Mrs. Gailor indicated that we were funding one full-time FTE at CMH; however, three years later, the funding is the same, so we are no longer covering the full salary of the individual; CMH is supplementing our funding. Chairman Steve asked if we know how much money we are providing each service provider. Mrs. Feuerherm indicated that until this resolution is adopted, she will not be able to give specific dollar amounts. Chairman Steve asked how much money goes to DSS. Ms Feuerherm indicated it is an administrative contract and there is no money provided to DSS. This agreement is required by law due to the confidentiality clause. Ms. Feuerherm indicated that the enrollers are actually doing much of the work that previously DSS staff had to do. DSS approves the application, but the enrollers are completing and submitting accurate applications, which frees us a DSS staff member from completing the application. Chairman Steve asked why in the resolution it doesn’t specify the amount of money we will be providing to the agency? Dr. DiGiovanni asked why DSS is doing work without compensation. Mrs. Gailor indicated that DSS is required to process and approve the Medicaid applications. Dr. DiGiovanni indicated that he doesn’t feel that it is fair of the State to require DSS to do the work without receiving funding. Dr. DiGiovanni asked where the $95,000 that remains after paying the providers is going to be spent. Mrs. Feuerherm indicated that she is working on the budget and the numbers have not yet been finalized; however, approximately $90,000 is funding Health Department staff; $42,000 is going to providers; and about $4,000 is going to non-personnel costs (supplies, postage, etc.). Ms. Wyant is asking if the WHEREAS clause should be amended to indicate that DSS receives no money. Mr. Cornell moved to accept the funding with a WHEREAS clause reflecting the account numbers for the funding; seconded by Mrs. Tytler; all members voting in favor; none opposed; new resolution adopted. (NOTE: New resolution forthcoming.)
3. Authorize Agreement/Accept Funds, Health Department/Children With Special Needs (Local Department of Social Services) – Mrs. Tytler moved adoption; seconded by Mr. Cornell. Mrs. Feuerherm indicated that the total expenses for the program are about $400,000 and NYS only provides $55,000 for administrative expenses and we have been told by the State that this will not increase unless the Federal government increases its amount of reimbursement. This agreement is between DOH and DSS. Dr. DiGiovanni confirmed that this money is in the budget; he would like a WHEREAS clause indicating in to what account the money will be received. Ms. Feuerherm will provide a new resolution. All members voting in favor; none opposed; resolution adopted.
4. Authorize Agreements, Health Department/Division of Nursing (Beacon Resource Group) – Mrs. Uttech indicated that this a periodical we receive that contains a great deal of information about regulatory issues, which also includes the right to make 10 copies of each issue to circulate to staff. Mrs. Tytler moved adoption; seconded by Mr. Cornell. A new resolution will be provided reflecting the account number. All members voting in favor; none opposed; resolution adopted.
5. Authorize Agreements/Accept Funds, Health Department/Health Administration (Traffic Safety and Injury Prevention Program) – Mrs. Tytler moved adoption; seconded by Mr. McKee. Dr. DiGiovanni asked what the three x’s are? Mr. Schrader indicated that there are many .4 accounts for which this money could be spent. All members voting in favor; none opposed; resolution adopted.
6. Authorize Agreements for 2005, Health Department/Jacobus Center for Reproductive Health (Auditor, Interpreter, and Consultants and/or Facilitators) – Mr. Cornell moved adoption; seconded by Mrs. Tytler. A new resolution will be provided with account numbers and indicating other interpreters as needed. Ms. Lambert indicated that we may need other interpreters than the two who are listed because of different language requirements. Mr. Schrader indicated that the information on the individuals with whom we are contracting should be attached to the resolution instead of being included in the resolution. Mr. Schrader indicated that if we were appropriately using purchase orders, many of the situations with the one-time providers would not be occurring. Mr. Schrader indicated that by mid-year we should be able to use the purchasing system as designed. All members voting in favor; none opposed; resolution adopted.
7. Authorize Agreement/Accept Funds, Health Department/ Jacobus Center for Reproductive Health (State Grant) – Mrs. Tytler moved adoption; seconded by Ms. Wyant. Mrs. Gailor indicated that this is the major funding for the JCRH. A new resolution will be provided with account numbers. All members voting in favor; none opposed; resolution adopted.
8. Accept Funds, Health Department/Jacobus Center for Reproductive Health (HIV/AIDS SUNY Walkathon Funds) – Mr. Cornell moved adoption; seconded by Mr. McKee. Dr. DiGiovanni asked if this was going in to general funds. Ms. Lambert indicated that this is going in to oral HIV testing materials. All members voting in favor; none opposed; resolution adopted.
9. Abolish/Create, Health Department, Administrative Assistant/Principal Medical Services Clerk – Mr. Cornell moved adoption; seconded by Mr. McKee. All members voting in favor; none opposed; resolution adopted.
10. Authorize Agreements, Mental Health Department (Mental Health Services) – Mr. Cornell moved adoption; seconded by Mr. McKee. Dr. DiGiovanni asked if these rates are in line with historical rates. Mrs. Medeiros indicated that they are in the 2005 budget; there are slight increases over the 2004 rates for the mental health consultants and the medical transcriptionist. Mrs. Tytler asked if Dr. Mehrhof is being compensated for covering the County on his insurance. Mrs. Medeiros indicated that we paid it in 2004; it is in the budget for 2005, but it is not included in this resolution. Chairman Steve asked if Mr. McNeilly did the audit last year? Mrs. Medeiros indicated that he has provided this service for several previous years. Chairman Steve indicated that he feels that Mr. McNeilly should be removed from this resolution because we need a scope of services. This scope of services will be required for services provided by all auditors. Mrs. Tytler moved to strike the line reflecting Mr. McNeilly; seconded by Mr. McKee. Chairman Steve asked if this service in then part of the Single Audit. Mr. Schrader indicated that it is different. All members voting in favor; none opposed; amendment adopted. All members voting in favor; none opposed; amended resolution adopted.
1. Mrs. Medeiros indicated that we have $58,500, which will pay for several hours of psychiatric services for the clinic. We are looking for either a psychiatrist or a nurse practioner, who meets the specialized services for mental health. We would need to create such a position that would make it competitive with similar positions in other counties. Mr. Schrader is working on this with Mrs. Barber so it would be competitive. We also have two psychiatrists who will interview for the job as well. The intent is to come to some decision quickly and interview for the position.
Dr. DiGiovanni moved to go into executive session for a personnel discussion; seconded by Mr. Cornell. In to executive session at 9:15. Out of executive session at 9:25.
2. Nursing/Children With Special Needs re-organization – Ms. Feuerherm indicated that the Administrative Assistant resigned in October going to another local agency for $7,500 more. This has left a void in CSN that she took are of independently. She has been told that it is not in the best interest to fill the position as an Administrative Assistant, due to the reclassification study; the title will be changed. Mrs. Feuerherm feels she needs to move on this as things are being left undone and there is staff without direct supervision. She has also proposed that for better management, CSN be moved to the first floor; switching locations with Environmental Health, so that the staff for which she is responsible is located near her. Ms. Feuerherm feels that the Director of CSN can be modified and done in a different manner. She would prefer to bring on another Supervising Public Health Nurse rather than fill a Director position. That would free her time up to jump into CSN and make certain that all is running smoothly on that end. Mrs. Gailor indicated that the proposal is the Admin Assist/Principal Medical Services Clerk resolution and the switching of space with Environmental Health. Then to look at looking at using the half salary for Director of CSN and other available funding to create a Supervising PHN. Mr. Cornell asked if the move is feasible without a great deal of cost. Mr. Schrader feels that it can be coordinated with Buildings and Grounds without a great amount of cost as staff will do this. Mr. Schrader feels this is a reasonable request. He indicated that Mrs. Feuerherm is not yet comfortable abolishing the Director of CSN; it will be evaluated in the first half of next year. Mr. Schrader indicated that the loss of the institutional knowledge of the Administrative Assistant causes a need for reorganization.
3. CHHA Rural Add on – Mrs. Gailor indicated that Mr. Vanesky has indicated that we should wait until January pending the change in the Legislative bodies. Mrs. Gailor asked if the committee would like a resolution prepared for the January encouraging adoption of this legislation with a retroactive implementation date. Mrs. Gailor distributed information she received from Mr. Vanesky. Mrs. Gailor will bring a resolution to the January meeting.
4. Mrs. Gailor distributed a year to date budget report for the Health Department. State aid is behind, but Ms. Webb has been in touch with the State and first and second quarter money should be forthcoming very soon. Mrs. Gailor indicated that our first quarter payment is normally our largest payment. Dr. DiGiovanni asked about the administration number. Mrs. Gailor indicated that this is due to rollovers. Mr. Schrader indicated that the administration line is the line reflecting the largest payments that we have not yet received. Chairman Steve asked what system is in place to ensure that all aid is received. Mrs. Gailor indicated that there is a system in place to follow all the funding streams. Mr. Schrader asked about Nursing. Ms. Feuerherm indicated that we are billing October right now. Mr. Schrader asked that columns for amount billed and amount received be added to the report. Dr. DiGiovanni suggested that perhaps the Health Department could model their report after the one prepared by DSS, also including a narrative explaining differentiations from expectations. Mr. Schrader indicated that Hospice is doing fantastic and the JCRH is not doing badly, either.
5. Mrs. Gailor discussed a report she has received on the tobacco usage by adults in Cortland County. She will be e-mailing this to all members of the committee. This provides good data and information and reflects what has worked and what has not worked. Andrea Rankin and Jen Hamilton will be at the next Board of Health meeting to talk about the Cortland Counts document regarding smoking rates. Jen will be bringing someone from the State to discuss this as well.
The meeting adjourned at 9:53 a.m.