LIVINGSTON COUNTY BOARD OF HEALTH



LIVINGSTON COUNTY BOARD OF HEALTH

MEETING MINUTES

December 9, 2013

|PRESENT: |Board of Health |Katherine Austman M.D. |

| | |Janine Boggs, J.D. |

| | |Jeanne Elliott R.N. |

| | |Armin Groom (Buzz) |

| | |Pat Platz R.N. |

| | |Joe Steichen (Co. Bd.) |

|ABSENT: |Board of Health |James Day D.D.S. |

| | |Nathan Holt M.D. |

|PRESENT: |Health Department |MaLinda Hillman, Adm. |

| | |Jackie Dever, Director of Nursing |

| | |Donnie Simmons Director of Environmental |

| | |Health |

| | | |

| | | |

I. Call to Order

The meeting was called to order by Board Secretary Armin (Buzz) Groom in the absence of President Dr. Jim Day, at 7:00 PM in the health department’s conference room.

II. Approval of September 9, 2013 Board of Health Meeting Minutes

Kate Austman made a motion, seconded by Pat Platz, to approve the September 9th meeting minutes as submitted. Motion carried.

III. Reports

A. Administrative Report by MaLinda Hillman, Administrator

The Livingston County Board passed the Community Health Care resolution

23 to 1 to continue with the Home Services and Home Nursing programs. This did include the slight fee increase.

The Livingston County Health Department’s web site continues to be developed. Two staff members have been trained on the software and are inputting our data. We hope to go live in December with the redesign.

The Livingston County Board voted to utilize the outside audit firm of Mack & Associates out of Morris. Our initial meeting to discuss how we are set up and accounting procedures occurred on November 25. They will be back to in January and hope to complete the entire county audit in February. Our county audit for 2012 has been submitted to the state agencies who award us grants and is under review.

Sevocity has purchased Nuesoft which is the company that furnishes our electronic health record and billing component. The electronic health record is utilized in the school based health center, family planning, women’s clinic, and employee wellness. We utilized the practice management module for all insurance billing including immunizations. The price is locked into the contract but I expect an increase in 2014 of approximately $200 a month. Dawn Thorson, FNP was finally able to attest for the Medicaid incentive program and was just approved. We should receive $21,250 and the next step is to submit meaningful use data.

IPHA requested that MaLinda do a short presentation on our experience with contracting. There are currently two Medicaid Managed Care plans (Meridian and Illinois Health Connect) in our county and we have contracts with both of them. We also have contracts with Blue Cross/Blue Shield, Human, Health Alliance, United Health Care, Medicare and Multi Plan. Cigna, Aetna and Assurant will just reimburse us on a case by case basis. With the advent of Accountable Care Entities, it could become more challenging for health departments to obtain reimbursement. Billing insurance has increased our revenue and we continue to evaluate/update our procedures. Currently there isn’t any provision to have health department services “carved out” and reimbursed on a fee schedule for Medicaid services.

Staff continue to assist clients applying for Medicaid and health insurance. It’s been very challenging working with the Marketplace for health insurance. The website continues to be challenging for health insurance. Outreach has been done to provide education about the requirements of the Affordable Health Care Act. We have two certified “in-person” assistors for a .75% FTE for this grant. More Medicaid applications have been submitted than insurance applications. Appointments are slowly being made for assistance in applying.

The Illinois Department of Public Health has completed a strategic plan. There priorities are: enhancing stakeholder engagement (partnerships); improving data quality & dissemination; reducing health disparities; improving regulatory compliance; and broadening agency branding, marketing & communication.

MaLinda has been serving on the OSF Saint James Community Health Needs and Implementation Strategy Workgroup. The top community health needs identified were: Community Misperceptions, Healthy Behaviors, Mental Health, Obesity, Risky-Behaviors – Substance Abuse and Dental. Community misperceptions cover the fact that people think they are healthier than they truly are.

Our health insurance rates for employees went down for the second straight year with Blue Cross and Blue Shield being the carrier. The county continues to pay 90% of the premium for the employee but not for any family members. Meetings were held to explain choices between two options offered. One was the same as this year with a $250 deductible and the other had a $3,500 deductible. Both include a basic dental low plan and vision plan, which may be upgraded at the employee expense. For single coverage an employee pays $35.86 twice a month. Family coverage would cost $534.09 twice a month. If the higher deductible is chosen, that an employee doesn’t have a premium cost.

B. Nursing Report furnished by Jackie Dever, RN, Director of Nursing

Flu clinics were held through-out the county this year. Clinics were held at every school this year for staff. Dwight and Odell also had clinics for students during parent/teacher conferences. We added a few new businesses this year and will continue to explore other sites for next year. To date, we have given 1,844 adult flu vaccines and 186 children flu vaccines for a total of 1,860. Insurance billing has been much smoother this year. We have approximately 50 doses left.

The vaccine shortages that were occurring the last several months are slowly resolving. We are able to get all vaccines now through the VFC program, but still have some issues with the private pay side. We expect the problems to be resolved in the next month.

FCM and IPCM programs are looking very closely at outcomes and will probably be changing focus to primarily pregnant women and high risk infants only. There has not been anything definitive on when this will happen. The goal is to put more dollars toward preventing premature births, thus saving more Medicaid dollars currently going to treatment and hospital care.

LCCHCP:

The following graph shows the admissions, discharges, and unduplicated clients for both programs from September 2013 – November 2013.

| |Start |Admitted |Discharged |End |< 65 years |> 65 years |Unduplicated Clients |

|PH Nurse |24 |5 |0 |29 |6 |23 |29 |

|Homemaker |48 |6 |4 |50 |15 |39 |54 |

|HHA |0 |0 |0 |0 |0 |0 |0 |

|Total |72 |11 |4 |79 |21 |62 |83 |

The following graph shows the number of visits per program by quarter.

|1st quarter |2nd quarter |3rd quarter |4th quarter |Total

FY13 |Total FY12 |Total FY11 | |PH Nurse |218 |255 |214 |240 |927 |639 |496 | |Homemaker

|821 |881 |1,029 |912 |3,643 |2,865 |2,576 | |HHA |18 |11 |0 |0 |29 |96 |160 | |Supervisory Visits |53 |49 |66 |51 |219 |182 |N/A | |Total |1,110 |1,196 |1,309 |1,203 |4,818 |3,782 |3,232 | |

C. CLIA

All clinics are performing quality assurance testing as required and documenting on the log sheets.

D. Environmental Health Report by Donnie Simmons, LEHP, Director of Environmental Health

New rules to the Private Sewage Code became effective September 13, 2013. Some of the adopted rules have an effective date of January 1, 2014. A meeting was held with sewage installation contractors to discuss the rule changes on October 1, 2013. Some changes to our Ordinance and applications will need to be made.

New rules to the Private Water Well Construction Code were just adopted. What all the changes are at this time is unknown since several changes were made at the end of the process without any review. The main focus of these changes is the incorporation of closed loop wells, a.k.a. Geothermal, rules. Some changes to our water well ordinance will be necessary with changes to our Application to Construct a Water Well and the possible creation of several other forms as required by the rules. More changes to the Water Well Construction Code are currently being drafted.

The Retail Food Code has been incorporated into the Foodservice Sanitation Code with recent rule changes. Proposed changes in the Foodservice Sanitation Code addressing legislation requirements of the Foodservice Sanitation Manager Certificate Course content and administration are in discussion. These rules change the required training course from 15 hours to 7 hours, eliminate the availability of a state provided exam, require an ANSI approved exam be used, eliminate certificate renewal, implement a recertification requirement, and changes to reciprocity. Additional changes to the Food Sanitation Code are forthcoming to implement rules for the new Food Handler Training. An additional rule set is being worked on to incorporate the FDA Model Food Code.

The Tanning Facilities Code is being changed primarily to incorporate new legislation that prohibits persons under the age of 18 either alone or the presence of another individual to use tanning equipment.

The West Nile Virus Surveillance Program ended up with multiple mosquito pools in Pontiac positive for mosquitoes, 1 human West Nile Virus case, and positive birds in Odell, Dwight, and Pontiac.

We were notified by Pontiac Police of a food truck operating in the parking lot of Exact Packaging. A site visit was made where it was confirmed that individuals were selling tacos, etc. prepared in a panel truck. The individuals were asked to discontinue selling food until they obtain a permit to operate a foodservice establishment. Rules require they operate out of a permitted commissary, have pressurized potable water within the truck with hot water to wash hands, clean utensils, and clean equipment in addition to other requirements. We are waiting to hear back from them so an inspection can be made and a permit issued.

E. Advisory Board Reports

1. School Based Health Center

The minutes of the October 23, 2013 meeting were distributed.

2. Healthy Families Advisory Board

The minutes of the November 6, 2013 meeting were distributed.

3. CCU Advisory Board

The minutes of the November 21, 2013 meeting were distributed.

F. Quarterly/Annual Financial Report by MaLinda Hillman, Adm.

The balance on hand, as of September 1, 2013: $742,017.60. Fourth quarter receipts: $553,952.41. Fourth quarter disbursements: $609,433.19. The balance on hand as of November 30, 2013: $686,536.82. Quarterly detailed financial information was available. Annual: beginning balance December 1, 2012: $628,838.25. Annual receipts: $2,357,348.28. Annual disbursements: $2,299,649.71. Ending balance for FY 13: $686,536.82. The date was corrected on the annual financial to say 12/1/12 not 12/1/11. Currently there is approximately $191,183 outstanding from the state for our grant contracts, which doesn’t include Medicaid or third party reimbursements. This report is on a cash basis, which is how the accounting system is set up. It also does not include the value of the inkind WIC food instruments or government vaccines. For fiscal year 2013, we are a positive $57,699 over expenses.

G. Quarterly Wellness Financial Report by MaLinda Hillman, Adm.

The balance on hand, as of August 31, 2013: $11,917.61. Fourth quarter receipts: $7,416.05. Fourth quarter disbursements: $10,573.31. The balance of the fund, as of November 30, 2013: $8,760.35. Annual: beginning balance December 1, 2012: $16,924.35. Annual receipts: $42,984.57. Annual disbursements: $51,148.56. Ending balance November 30, 2013: $8,760.35. This fund will need to be closely monitored next year to evaluate whether fee increases are needed. Policies and procedures of the clinic were available/updated.

H. Gladys Kohrt Memorial Fund by MaLinda Hillman, Adm.

The balance on hand, as of September 1, 2013: $6,360.26. Fourth quarter receipts: $75.00. Fourth quarter disbursements: $160.00. The balance of the fund, as of November 30, 2013: $6,275.26. Annual: beginning balance 12/1/13: $6,151.91. Annual receipts: $350.00. Annual disbursements: $226.65. Ending balance 11/30/13: $6,275.26.

I. Donation/Cancer Fund by MaLinda Hillman, Adm.

The balance on hand of the Donation Fund, as of August 31, 2013: $34,335.65. Fourth quarter receipts: $834.01. Fourth quarter disbursements: $790.00. The balance of the fund, as of November 30, 2013: $34,379.66. Annual: beginning balance: $29,957.27. Annual receipts: $6,130.92. Annual disbursements: $1,708.53. Ending balance as of 11/30/13: $34,379.66.

The balance on hand of the Cancer Fund, as of August 31, 2013: $12,147.13. Fourth quarter receipts: $245.00. Fourth quarter disbursements: $965.22. The balance of the fund, as of November 30, 2013: $11,426.91. Annual: beginning balance: $13,005.95. Annual receipts: $1,666.51. Annual disbursements: $3,245.55. Ending balance as of 11/30/13: $11,426.91.

Kate Austman made a motion, seconded by Janine Boggs, to approve the above financial reports as presented. Motion carried.

IV. Old Business

A. Livingston County Health Department Budget

Information was furnished on the 2014 county tax levies from the county’s budget book for fiscal year 2014 along with a history of the levies for public health and TB. The county board passed the budget submitted for public health and TB.

V. New Business

A. Grant Approval/Update

The health department was awarded a Heart Smart for Teens grant from IDPH for $12,500. The men’s health grant application was not awarded funds.

B. Personnel Policies

Voluntary Flexible Hour Work Week Policy has the following statement added: “No one should start their work day prior to 6:30 AM or beyond 9:30 PM unless there are extenuating circumstances and on an infrequent basis. Supervisors must approve any changes in the employee’s customary starting/stopping time prior to it occurring. If the supervisor is off that day, the chain of command must be followed for approval.” The building security section was updated with additional clarification on Safety Code Red and Safety Code Yellow along with the After Hours Lock Down section. Joe Steichen made a motion, seconded by Janine Boggs, to approve the policy changes. Motion carried.

C. Policy Review

1. Retention of Records

The local records internal policy along with the Records Disposal Certificate listing the records and dates to be destroyed was furnished.

2. Family Case Management

No changes.

3. Better Birth Outcomes

No changes.

4. Freedom of Information Policies

The form was updated to mirror the county’s form. A summary of available records was furnished.

5. Home Services

Manual had minor changes made for clarification.

6. Home Nursing

No changes.

7. Linguistic & Cultural Competency Plan

Our IDPH and IDHS contract requires that we have a Linguistic & Cultural Competency plan. An assessment was done per plan requirements for the period of 12/1/12 – 5/31/13. The plan was furnished.

Joe Steichen made a motion, seconded by Janine Boggs, to approve the policies listed above. Motion carried.

D. Allocation for FY14

The indirect cost allocation plan was presented for FY14. It is utilized for the allocation of general expenses that serve the good of all programs, such as for the copier, phone, postage meter, and general office supplies. The allocation plan is based on a variety of factors and based on percentages. Kate Austman made a motion, seconded by Pat Platz, to approve the allocation plan for FY14. Motion carried.

E. Fees

MaLinda Hillman reviewed the hardship policy to go along with the immunization fees. Janine Boggs made a motion, seconded by Joe Steichen, to approve the fees/hardship policy. Motion carried.

F. Budget FY14

1. Holiday Schedule

MaLinda Hillman presented the proposed Holiday Schedule that has been adopted by the county board.

2. Staff Raise

The county board recommendation for staff’s salary increases is 2.5 % for all non-probationary employees, effective January 1st. This was incorporated into our budget. The IRS rate for mileage decreases to 56 cents per mile effective January 1, 2014.

Pat Platz made a motion, seconded by Jeanne Elliott, to approve the Holiday Schedule, staff raises and mileage rate, effective January 1, 2014. Motion carried.

G. FY 2014 Board of Health Meeting Dates

Janine Boggs made a motion, seconded by Joe Steichen, to approve the following dates for the 2014 Board of Health meeting along with moving the meeting time up to 6 PM instead of 7 PM. March 10, 2014, June 9, 2014, September 8, 2014 December 8, 2014. Motion carried.

VI. Other

There was a discussion about making the meeting materials available electronically. MaLinda will research options and the board can discuss at the March meeting.

VII. Adjourn until March 10, 2014

Kate Austman made a motion, seconded by Jeanne Elliott, to adjourn the meeting till Monday, March 10, 2014. Motion carried.

Respectfully submitted,

Armin (Buzz) Groom

Board of Health Secretary

AG/mh

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