May 10, 2005 – 7:30 a.m.
Members present: Dr. Paul DiGiovanni, Chairman; Mike McKee, Vice Chairman; Carol Tytler; Newell Willcox; Larry Cornell; Tom Williams; Scott Steve, Chairman of the Legislature
Others present: Ann Homer; Jackie Gailor; Linda Medeiros; Scott Schrader, County Administrator; Suzanne Parson; Brian Liberatore; Elaine Lambert; Cathy Feuerherm; MJ Uttech; Audrey Lewis; Harriet Webb
Absent: Ron VanDee
Vice Chairman Mr. McKee called the meeting to order at 7:33 a.m.
Chairman Dr. DiGiovanni joined the group at 7:45 a.m.
Mr. Cornell moved adoption of the minutes of the April 12, 2005, meeting; seconded by Mr. Willcox. All members voting in favor; none opposed; minutes approved as printed.
1. Authorize Agreements, Health Department (SCHC Total Care Inc.) which was tabled from the April 12, 2005, meeting. – Dr. DiGiovanni asked if we know any more information about this. Mrs. Gailor indicated that in conducting her research, she has found that there are contracts with all but two physicians who have left ECPO as well as contracts with two dentists. There is not a contract with the FHN Dental Clinic and there is not a contract with CMH. Mrs. Gailor is not certain administratively where this organization is in finalizing things. It is possible that as of the fall of this year, local DSS may not have any involvement in contracting with Medicaid Managed Care providers. Mr. Schrader indicated that he agrees with Mrs. Gailor and he can see no reason for now moving forward with this. Mrs. Tytler asked why CMH is not on board with this company. Dr. DiGiovanni indicated that it has to do with reimbursement rates and with some reluctance/dissatisfaction on the parts of the physicians with regards to reimbursement. This has been an on-going conversation for five years. Mrs. Tytler asked how we can contract with someone from whom the clients cannot receive services from the local hospital. Mr. Schrader indicated that that is the reason that they are not an authorized Medicaid Managed Care provider. Mr. Schrader indicated that this resolution allows the Health Department to provide services under the program; however, until SCHC becomes an authorized Medicaid Managed Care provider, the Health Department cannot provide services anyway. Mr. Williams asked if we are getting out ahead of the curve; where is the curve? Mr. Schrader indicated that this resolution is not out of line at this point, as we cannot provide services under this plan until DSS signs the contract. Dr. DiGiovanni’s expressed that his concern is that this company doesn’t have any motivation to be a good partner during the next five months, as there is the chanced that the State is going to assume control of the program in October. Mrs. Gailor indicated that we want this resolution in place in case the State assumes control, as we won’t be able to get reimbursed from this company if this resolution isn’t adopted. Mr. Willcox asked if this is a bureaucratic mess. Mr. Schrader indicated that he does not believe the State of County has done anything wrong; he believes that Total Care does not have its act together. Mr. Schrader indicated that this protects us in the event that Total Care goes directly to the State and asks for certification. Until Total Care gets CMH on board, they are not going to get certification from the State. We are still protected if we adopt this. All members voting in favor; none opposed; resolution adopted.
2. Authorize Agreement/ Accept Funds/ Amend Budget, Health Department/Environmental Health (Drinking Water Program) – Mr. Cornell moved adoption; seconded by Mr. Willcox. Mrs. Gailor indicated that this is an on-going grant; it comes down from the State every year. We have a half-time clerical position and a full-time sanitarian position who work on the water program, whose salary are covered out of this grant. Mrs. Gailor will amend the dollar amounts in the second whereas to total $95,000 instead of $94,000. She will get this done before the Budget and Finance Committee. Mr. Schrader indicated that the budget amendment doesn’t need to be a part of the resolution. Mr. Cornell moved to strike the third WHEREAS and the first RESOLVED; seconded by Mrs. Tytler; all members voting in favor; none opposed; amendment adopted. All members voting in favor; except Mr. Willcox opposed; resolution adopted.
3. Authorize Agreement/ Accept Funds/ Amend Budget, Health Department/ Nursing (Immunization Action Plan Grant) – Mr. Cornell moved adoption; seconded by Mrs. Tytler. Mrs. Gailor explained that this is an annual grant; we have received this for approximately 15 years. By general consent the third WHEREAS and the first RESOLVED were stricken. Dr. DiGiovanni asked about results from this service. Mrs. Gailor indicated that those children entering school have an immunization percentage of 90%. She also reported on some other positive results of the program. Mr. Schrader asked if we have an opportunity to caution and educate parents about the mercury-carrying agents in our vaccines. Mrs. Gailor indicated that we do not focus on that. Mr. Schrader asked if we could. Mrs. Gailor indicated that she does not know, but she will check. The indication from the State is that the potential is not actually existent. Ms. Uttech inquired about what Mr. Schrader is asking that we do. Mr. Schrader indicated that he feels that we should educate the physicians to use vaccines that do not carry the mercury content. Ms. Uttech responded that we do not use the mercury content vaccines at the clinic. Mr. Schrader stated that what he means is that the physicians participating in this program should be educated to not use the mercury carrying vaccines as there are physicians who are using the mercury carrying vaccines. Ms. Uttech responded that the individuals who go to the physicians’ offices can certainly work with the physicians about using the mercury-free vaccines. Chairman Steve asked why the Board of Health can’t write to the physicians to encourage them to use mercury free vaccines. Dr. DiGiovanni will follow up with this at the Board of Health. Mr. Schrader isn’t certain that all the physicians are aware that there are mercury free vaccines. Mrs. Uttech indicated that we can follow up on this; it will be dependent on how open the physicians are to accepting our input and guidance. Mrs. Gailor feels that in fairness to the physicians, we should see if they are using vaccines with mercury. Mr. Schrader indicated that they are. Dr. DiGiovanni indicated that he can get this information rather easily and will do so. All members voting in favor; none opposed; resolution adopted.
4. Authorize Agreement/ Accept Funds Health Department/ Administration (Susan B. Komen Breast Cancer Grant) – Mr. Cornell moved adoption; seconded by Mrs. Tytler. Ms. Parson explained that these funds are used to augment the funds provided by the State for breast cancer health services. Although we have received this funding for years, there is a big jump in funding this year. Dr. DiGiovanni abstained from voting due to a conflict of interest. All members voting in favor; none opposed; resolution adopted.
5. Authorize Agreement/ Accept Funds/ Amend Budget Health Department/ Administration (Healthy Heart Disabilities Initiative) – Mr. McKee moved adoption; seconded by Mr. Cornell. Ms. Parson explained that the funding comes to us since last year’s funding was not utilized by everyone and we were provided the opportunity to "bid" on the additional funding. This is to help the J. M. McDonald Center perform some work to make the Sports Complex more accessible for the disabled. It is anticipated that there will be some funding left to allow the Marketing Director to make the facility more inviting to people with disabilities. Dr. DiGiovanni asked how this really fits in with the Healthy Heart initiative. Ms. Parson indicated that Healthy People 2010 has the philosophy that anyone, regardless of ability or disability, can do something to improve their cardiovascular health. Chairman Steve asked if there isn’t a more direct application of the funding to improve heart health for the disability. Ms. Parson indicated that the State has an initiative to ensure that there is a facility that the disabled can use to improve their heart health. Mrs. Tytler hopes that one of the things that this money is to be utilized for is to purchase some actual exercise equipment that will be accessible to those with this disabilities. Mrs. Tytler will provide Ms. Parson with a contact for this type of equipment. Dr. DiGiovanni asked to what extent the J. M. McDonald Center allows the public to use the complex for this purposed. He knows there are fees involved; will the target population be allowed to use this fee-free? Mrs. Tytler believes there will still be a fee involved; it is merely making the facility accessible. There will be clarification by B & F of where the professional services are going. ($957 for skating program instructor; $1,250 to convert doorknobs, install ramps, upgrade bathroom facilities.) All members voting in favor; except Mr. McKee and Mr. Willcox opposed; resolution adopted.
6. Authorize Agreements Health Department/ Children with Special Needs (Contract for Services) – Mr. Cornell moved adoption; seconded by Mr. McKee. Ms. Feuerherm indicated that the Pre-K contracts expire on June 30. These are educational services, evaluations, and related services. Evaluation and educational services are set by State Ed; we negotiate related services fees. Mrs. Tytler asked if this list adequately addresses the need. Ms. Feuerherm indicated as a need arises, we add providers as needed. All members voting in favor; none opposed; resolution adopted.
7. Authorize Agreement, Mental Health Department (Excellus Blue Cross Blue Shield) – Mrs. Medeiros indicated that there is no cost involved in this resolution. Mr. Cornell moved adoption; seconded by Mrs. Tytler. All members voting in favor; none opposed; resolution adopted.
8. Increase Hours, Mental Health Department (Mental Health Practitioner) – Mr. McKee moved adoption; seconded by Mr. Willcox. Mr. Schrader indicated that there is a waiting list for services. He has been looking in to the cost for totally eliminating the waiting list and this is a component of elimination of the waiting list. Mrs. Tytler asked what we know about the volume of services provided by this position as the hours have been jumped up. Mrs. Medeiros indicated that although the hours were increased on paper, the hours being worked have not actually increased. The incumbent is employed elsewhere part-time as well as at the Mental Health Clinic. Because of workload, the Psychiatrist is not able to schedule follow up appointments in a timely manner, so this would enable the follow up appointments to be schedule on a more timely basis. The medications that are being prescribed need closer follow up, and this position will be able to handle that. This is an attempt to try to deal with the volume of the business.
9. Resolution in Support of Bringing Dialysis to Cortland County – Dr. DiGiovanni explained that CMH has been trying to years to bring dialysis to Cortland County. To date, no one has been willing to offer it due to financial considerations. The bottom line is that a free-standing dialysis clinic with overhead wouldn’t be able to function. However, a satellite center could operate efficiently here. There isn’t a nephrologist on staff at CMH; there are consulting nephrologists who are in the community during the week. There would need to be a full-time nephrologist on staff for a clinic to operate. The Certificate of Need is required to receive the governmental funding. Mr. Cornell moved adoption; Mrs. Tytler seconded. All members voting in favor; none opposed; resolution adopted.
1. Board of Health Activity reports from each division of the Health Department
2. Mrs. Medeiros presented the revenue report for the Mental Health Department through April 2005. This reports reflects the cash received in the Mental Health Department through April. The clinic is slightly behind the target for the year mainly due to Medicaid and the change in processing Medicaid billing. Mrs. Medeiros reported that the new software is working for them; they have received their first check through the new system. The vendor has reported that they are finding that things (process) are being changed every week. Horizon House is in the same situation – one month behind on the revenue generation of Medicaid. COPS is based on Medicaid, so when Medicaid payments are down, COPS will be down as well. This should catch up in the next few months. Mrs. Medeiros also reported on the expenditures for the department through April. The out-of-title account has utilized 80% of the budgeted amount to date due to the departure of an employee. This is because we paid accrued benefits to the employee who left. The usage is also because the clinic receptionist was on vacation for two weeks, and other support staff had to fill in that position, which resulted in the payment of out of title pay to those individuals filling in for the receptionist. Mr. Williams asked for clarification on the out of title payment for the staff filling in for the receptionist. Mrs. Medeiros indicated that the position being utilized as the receptionist was actually a Medical Assistant who went out in the field and did some evaluations. Under the MSD study, the position will be changed to an appropriate title. Dr. DiGiovanni asked why professional services are relatively low. Mrs. Medeiros indicated that it will not be low if the resolution today to pay for the full-time Nurse Practitioner is adopted. Mrs. Tytler asked if the reduced hourly rate covers the increased cost for insurance? Mrs. Medeiros indicated that the new hourly rate was the rate that the incumbent indicated she would accept. Mrs. Tytler asked if this position must be posted as it is going from part-time to full-time. Mr. Schrader indicated that it does not as it was originally posted. All members voting in favor; none opposed; resolution adopted.
3. Ms. Parson distributed a "Move for Life 2000" flier and explained the program. She encouraged the Legislators to form their own team. 1,265 individuals participated last year.
4. Ms. Parson distributed the Health Education Division monthly activity report. She highlighted the activities for the Division for the last month.
5. The Hospice Director’s report was distributed, as she was on vacation.
6. Elaine Lambert distributed the report for the JCRH. Ms. Lambert reported that Mary Dykeman from her department received the "Humanitarian of the Year" award from the J. M. Murray Center. The ZAP coloring contest winners will be presented at the May Legislative session.
7. Audrey Lewis presented the report of the Environmental Health Department. One of the highlights of the report is the Division’s response during the recent flood in Cortland County. The Division has been moved, so they are unpacking and settling in to its new offices. Mrs. Tytler asked about radon in people’s basement; if there is flooding in the basement, it is likely to be affect the radon content. Ms. Lewis indicated that if there was water in the basement, soil gases would most likely decrease, so it may be that radon levels would decrease. Ms. Lewis is thankful for the permission to hire the new sanitarian.
8. Cathy Feuerherm presented the Nursing Division/CSN Division report. One of the recommendations from Mr. Vanesky’s audit is that the rate for physical therapy services be increased. The report suggests that things are going in the right direction relative to the CHHA. FHN and CMH collaborated to produce the cost-analysis for Facilitated Enrollment, which was requested by this committee. Ms. Feuerherm asked if this report is acceptable? If this is acceptable, she would ask that we proceed with signing the contract. Dr. DiGiovanni asked how the time can vary so much. Ms. Feuerherm believes that it is due to the different types of populations being served by the providers. The numbers in pencil on the report are the actual amounts billed to date this year. Mrs. Tytler asked for an explanation of the mileage under FHN. Ms. Feuerherm indicated that is how many miles and how much driving time. By general consent, the committee accepted the report. Ms. Feuerherm asked if she can now sign the contracts? By general consent, the committee gave Ms. Feuerherm permission to execute the contracts.
9. Dr. DiGiovanni asked for an updated on Family Enrichment Network. Ms. Feuerherm indicated they have met with the Y; they plan to meet with HeadStart this week; they will be meeting with CMH. They should be able to have a classroom by September. One of the concerns is why the Y has slots when there is a childcare crunch in the County. They are anxious to get started in the fall. They are hopeful they can start the program in the fall; they are willing to take their chances in September. Dr. DiGiovanni asked what the alternative for services to the children is if the program does not start in September. Ms. Feuerherm indicated that it is difficult to say; some children are on a waiting list, some children receive services in their homes, some children do receive out of County services if demanded by the parents and recommended by CPSE. Chairman Steve doesn’t feel we have any obligation to the program for the fall, since Family Enrichment has delayed any action for two months. Mrs. Tytler indicated that she spoke with Children’s’ Therapy Network last week (they are in Onondaga County), and they have not heard anything about this program. Chairman Steve asked how many agencies are in contiguous counties that provide services. Ms. Feuerherm indicated that Onondaga probably has 10 to 12 providers and Broome County probably has 5 or 6 providers. Chairman Steve asked why we couldn’t send letters to providers asking for their interest. Ms. Feuerherm indicated that program services have been diminishing; however, we can send letters to the providers to see if there is any interest. There was discussion about services being requested by a family at a provider who is out of County and expensive and CPSE’s agreement to provide services in that program. This will be very costly to the County – approximately $30,000 to $35,000 annual additional cost to the County. Ms. Feuerherm indicated that the CPSE Chair will be happy to come and speak to the Health Committee.
10. Mrs. Gailor indicated that the State send an e-mail she must respond to this week. The State is requiring that every County have a printer that can be used for forms during an "event." The State will purchase the HP 2430tn printer for every County who wants it. They will provide it; we must sign that we want it and that we will provide the maintenance of the program. The extended on-site warranty is three year for $269.00. The equipment is free; we must make certain that it is available for use during any emergency clinic type set up. By general consent, the committee granted Mrs. Gailor permission to obtain the printer.
11. Mrs. Gailor briefly reviewed the Department financials. At this point, everything is basically in line and on target where it was projected. The committee agreed that the report was an acceptable format.
The meeting adjourned at 9:50 a.m.