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HomeMy WebLinkAboutBOH minutes 012109MINUTES ORANGE COUNTY BOARD OF HEALTH January 21, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 1 January 21, 2009 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality of life, promote the health, and preserve the environment for all people in the Orange County community. THE ORANGE COUNTY BOARD OF HEALTH MET ON January 21, 2009 at the Southern Human Services Center, Chapel Hill, North Carolina. BOARD OF HEALTH MEMBERS PRESENT: Chris Harlan, Chair; Anissa Vines, Vice-Chair; Jim Stefanadis; Tim Carey; DeWana Anderson; Michael Wood; Sharon Freeland; Jessica Lee; Ernie Dodson BOARD OF HEALTH MEMBERS ABSENT: Matt Vizithum, out of town STAFF PRESENT: Wayne Sherman, Personal Health Services Division Director; Tom Konsler, Environmental Health Services Division Director; Donna King, Health Promotion and Education Services Division Director; Angela Cooke, Dental Health Services Division Director; Anne Miles Cassell, Administrative Assistant; Jaymin Patel, Environmental Health Specialist GUESTS PRESENT: Christopher Burns, graduate student at UNC School of Public Health I. Welcome and Introductions Chris Harlan, Chair, called the meeting to order at 7:00 P.M. I. Approval of January 21, 2009 Agenda Rosemary Summers requested Item IV.E. NACCHO Funding Grant Acceptance be added to the Agenda. The motion to approve the Agenda of January 21, 2009 as amended was made by Jim Stefanadis, seconded by Jessica Lee, and carried without dissent. II. Public Comment for Items NOT on Printed Agenda None III. Action Items on CONSENT Agenda A. Minutes approval of November 20, 2008 meeting. B. Funding Application Renewals for Smart Start Projects for 09-10 The Health Department has three projects/programs funded with Smart Start funds allocated by the Orange County Partnership for Young Children (OCPYC). All three projects (Dental Preschool Screening Project, the Families in Focus Program, and the Child Care Health Consultant/NAPSACC Program) have received multi-year funding approval from the Partnership. Despite the multi-year approval, each fiscal year the projects must submit a renewal application and final funding for the upcoming year is determined based on the allocation received by the local Partnership from the State of NC’s allocation to local Smart Start Partnerships. This year, the renewal applications were asked to prepare two budget scenarios, on a flat budget based on the amount MINUTES ORANGE COUNTY BOARD OF HEALTH January 21, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 2 January 21, 2009 approved for this year and a second budget that includes a 10% reduction. The Dental Preschool Screening Project this past year had requested a change in the traditional method of conducting this project and had received approval from Commissioners to move forward with a full-time dental hygienist position to provide both project support funded by the grant and clinical services to prenatal patients funded through a combination of fee reimbursements and county funding. Due to the inability to quickly recruit a hygienist, staff requested a temporary return to the old model of contracting for the coordination services required by the grant and suspension of the prenatal portion of the position. Because of the need to cut budgets both for Smart Start and the county at 10% , this project is requested to return to the prior method of project delivery for the 09-10 fiscal year, delaying the implementation of a full time coordinator/hygienist. This will have impacts on the delivery of the follow- up services required by these grant funds. The Families in Focus Program has been partially funded by the OCPYC since 1999. This is the only child abuse prevention program focusing on at-risk parents currently in place in the county. Other funds that have been used to fund parts of the program in previous years have either not been available (state reductions in 2002 and 2003) or reassigned to mandated functions in the department. In 2008-2009 OCPYC funding was consolidated to fully support the salary and benefits of one full-time equivalent (FTE) public health nurse II to meet the program deliverables. A social worker II that had been partially funded by these grant funds was transferred to full-time responsibilities as a child service coordinator where our demand was outstripping our ability to meet needs. A 10% reduction in Smart Start Funds for 2009-2010 would necessitate additional county support to be able to conduct this program. As this program is not a mandated program, a 10% cut would likely result in a health department decision to discontinue this program and the staff person either be reassigned if there is an available opening, or subject to a reduction in force. It is too soon to tell at what level Smart Start will experience funding reductions. The Child Care Health Consultant/NAPSACC Program has been fully grant funded for the past two years. Even with a 10% reduction in overall funds, the program will be affected only by its ability to purchase educational materials and other supplies. It will not affect the staffing. The Department will not know about state funding until July. C. Acceptance of Grant Renewal Funds for Teen Tobacco The Health Department received a grant renewal award letter from the Health and Wellness Trust Fund for the Teen Tobacco Prevention Projects for the period beginning July 1, 2009 through June 30, 2012. This will mark the second three-year renewal of the project, providing the county with a solid nine year track record by the end of the grant period. The total amount of funding for the program for the three year period is $277,000. This will support the total costs of the project and will not require county general fund support. D. New Medicaid Co-Payment Fee MINUTES ORANGE COUNTY BOARD OF HEALTH January 21, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 3 January 21, 2009 In November when new fees were approved by the Board, a new requirement to collect a $3 co-pay from all adult Medicaid service recipients was inadvertently left out. This is a requirement from the Medicaid program, however we must have a fee established to be able to collect it. Motion to accept items on the Consent Agenda was made by Tim Carey, seconded by Ernie Dodson, and carried without dissent. IV. Reports and Discussion with Possible Action A. Preliminary Budget for 09-10 Fiscal Year a. Budget Reductions: The County Manager has directed each department to prepare a budget with a 10% reduction in operating expenses. The desire is to cut operations rather than staff at this time. Each division has prepared a budget that represents a 10% cut. In all Divisions, except Personal Health Services, the cuts have been taken from various operational line items. For Personal Health Services, we are proposing savings through cutting programs and a currently vacant but recently authorized position. Dental Health has a reduction through holding the dental hygienist position approved in this current year budget open for the entire year. Central Administrative Services are proposing a 16% cut in order to restore some of the cuts proposed by Divisions providing direct services. In addition, staff will be sharing an estimate of revenue projections for next year which may further impact our budget. The Department will not receive revenue estimates from the State until February 15. The Board of Health will be reviewing the final budget at the February meeting and recommending any final adjustments that will be forwarded to the County. Tim Carey asked about the cost difference in percentage of personnel over operations in the overall budget for the department. Dr. Summers replied that roughly 80% of the cost is personnel and 20% operating expenses. It is anticipated that there will be no cost of living or salary increases for staff next year. b. Fees: Personal Health Services and Dental Health Services have examined all of their fees and prepared a chart for the Board’s consideration. The Board of Health adopted policy on setting fees is to increase the fees by the Consumer Price Index to ensure that fees keep pace with growth but remain affordable for patients. The policy also states that fees will be at a minimum aligned with Medicaid reimbursement levels since that is the lowest cost based reimbursement. It has been a number of years since a true cost study has been done to assess the appropriateness of our fees for services. The staff sought input from the Board Committee on setting fees and discussed that proposal (increasing fees 25% above the Medicaid rate) with the Health Director. By statute and by Medicaid policy, the Department should be considering setting fees based on the costs of actually delivering each service. A number of factors impact those costs, including the numbers of each service actually performed, staff salaries, how staff actually report their time, and the operational expenses associated with a particular procedure. Each year when the NC Division of Public Health prepares the documentation for the Medicaid cost settlement MINUTES ORANGE COUNTY BOARD OF HEALTH January 21, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 4 January 21, 2009 funds, a comparison of costs across the state is prepared for each clinical procedure code (CPT). The State believes that this is the best cost representation for a health department to utilize in determining fees. The Board may elect to set fees lower than costs but must provide a rationale for doing so and must apply that rationale to like services. If fees are set below Medicaid rates then Medicaid will only pay the set fee level. If the Board wishes to set fees on a basis other than the Consumer Price Index increase, then the policy for setting fees will also need to be changed. Tim Carey asked if the budget must be balanced for each division. Rosemary Summers replied that revenues as well as expenses will be looked at therefore each division will have to submit a balanced budget. Dr. Carey also stated that elimination of a resident position in dental health did not make sense because a resident generally brings in more revenue than the cost of the position. Chris Harlan commented that the chart provided with the dental services was a good illustration of safety net provider services and the impact that curtailing services or availability would have on the community. Carla Julian reported that cuts were being made in Risk Management/Quality Assurance in travel expenses, training and other expenditures. Rosemary Summers stated that proposed state legislative action will ask that preparedness be added to local health department as a mandated service. Jessica Lee stated that there has to be a limit to cutting expenses to the point where the department would not be able to provide the mandated services. Sharon Freeland asked for clarification of the fee system for low income or zero- pay patients. Angela Cooke explained that the patients in that category would pay $25 per visit. Chris Harlan asked if there is a protocol for doing cost studies and how frequently they should be done. Rosemary Summers explained that and accepted best practice is to repeat a cost study every 3-5 years to ensure that personnel costs are captured as well as changes in service delivery. It is more difficult to establish a “new fee” cost since there is no actual experience in delivering the new service. In the past those fees have been established by comparing fees from other public agencies providing the same or a similar service. Staff will re-work the fee calculation methods and place this on the agenda for February. Environmental Health has not proposed fee changes for this coming year, but may examine the fees more closely before the February meeting. Tom Konsler reported that environmental health staff has been moving to digitalizing files and email of scanned documents to help defer postage and copy costs. Due to the economic slow down, there has been a decline in onsite and well permit program applications and therefore in revenue. Sharon Freeland commented that she realized that all areas had to make budget cuts, but programs such as HIV and other community services that are so needed are being impacted. Dr. Summers stated that due to budget cuts all MINUTES ORANGE COUNTY BOARD OF HEALTH January 21, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 5 January 21, 2009 services except mandated services have been considered for elimination. She stressed that the Commissioners will be faced with some tough decisions this year on budget cuts, therefore support and input to the Commissioners from the Board of Health will be critical to the department’s budget. She added that other departments will more apt to have community advocacy, but clients of Health Department services are not as likely to be willing or be able to attend a budget hearing and advocate for the services they receive at the department. B. Committee Reports Each of the standing committees met since the Board last met. Jim Stefanadis gave a brief report of the Clinical & Community Programs Committee and the Board was provided with a copy of the minutes from that meeting. Ernie Dodson reported that the Environmental Health, Preparedness and Quality Assurance Committee also met and discussed potential revisions to the on-site rules which will be presented at the February meeting. C. Informational Items a. Internal Transfer of Staff Positions: Rosemary Summers stated that In order to improve efficiency in billing and collections of fees and to foster more productive team work in personal health clinics, the front desk support staff unit and the Billing Specialist are being transferred to Personal Health Services from Central Administrative Services. The department is requesting that the personnel and operating costs associated with the transfer of this unit be transferred before we prepare the final budget for 09-10. This effectively reduces Central Administrative Services Division to six positions. b. Budget Reductions for 08-09: The Manager has requested that all departments reduce their operating budget by 2%. Carr Mill rent was excluded from this budget cut. Each division has proposed line items for these cuts. In addition, each division is closely monitoring their revenue earnings for 09-09 and will be making budget adjustments to compensate for lower revenues as stated in IV.B. The Board will receive more information on this in February. We have not received guidance from the state on budget reductions for the funds that we had budgetary commitments for. With the exception of the Aid to County funds, we have drawn down most of the state money allocated to the department. c. Funding Matrix to Commissioners: The attached funding matrix by department was prepared and sent to the Board of Commissioners (BOCC) in January for their retreat. It was prepared from the Inventory of Services that each department submitted to the budget office in December. At their recent retreat the BOCC chose as one of their top four priorities for the year, “assuring that safety net services are maintained”. This will be an important document both this coming year and in the future as the BOCC considers funding for mandatory services and discretionary services. MINUTES ORANGE COUNTY BOARD OF HEALTH January 21, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 January 21, 2009 d. Child Health Report Card: The report card prepared by North Carolina Institute of Medicine and Action for Children North Carolina was provided as information to the Board. e. State Health Director Resignation: Leah Devlin, the State Health Director is retiring as of January 31. This will be a time of transition at the state in a difficult budgetary climate. Regionally, the Wake County Health Director is moving to the slot open in Buncombe County, and the Durham County Health Director is retiring in the next month or so. Alamance County has a new Health Director, a transfer from Davie County. D. Pending and Recurring Items Review The pending and recurring items review allows Board members to plan future agendas and direct the staff on special work items. Two non-recurring agenda items have been added for either December or January. Several items were flagged as either being on this agenda or on the meeting agenda for next month. E. NACCHO Grant Funding Rosemary Summers reported that grant funding of $5000 has been received from NACCHO. The award money will be used for emergency preparedness. A budget amendment will be submitted to reflect this funding. V. Board Comments None VI. Adjournment Motion to adjourn was made by Ernie Dodson, seconded by Sharon Freeland, and carried without dissent. The next Board of Health meeting will be held on Wednesday, February 25, 2009 at the Government Services Center, Hillsborough, North Carolina at 7:00 PM. Respectfully submitted, Rosemary L. Summers, MPH, DrPH Health Director Secretary to the Board