| Board Meeting Minutes-March 10, 2003 |  |
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Meeting Held at Members Present Peter L. Sheras, Ph.D., Chairman Members Absent Stephen Wunsh
James R. Peterson, Executive Director Evelyn Cotton, Mental Retardation Residential Services Sally Rinehart, President, Blue Ridge Family Alliance I. CALL TO ORDER Dr. Sheras, chairman, called the meeting to order at 6:01 p.m.
Dr. Sheras welcomed Ms. Sally Rinehart, president of the Blue Ridge Family Alliance. Mr. Pezzoli introduced Ms. Martha Maltais who was recently appointed director of habilitative services. Mr. Pezzoli said that the competition for the position had been very tough, both from internal and external candidates. He added that Ms. Maltais’ background included serving as the director of mental retardation services for the Piedmont Community Services Board in Danville, and then she worked in many positions at Region Ten including direct care. Her extensive experience will give her a very broad perspective for her new position. Ms. Maltais said that the recognition party for Ms. Ann White, twice canceled due to snow falls, has been rescheduled for Friday, March 21, from 2:00 p.m. to 4:00 p.m. at the Meadowcreek Center.
Dr. Sheras asked if there were any comments from the public. Ms. Evelyn Cotton said she would like to speak following the presentation by Ms. Pam Fisher on transportation which is on the agenda.
Dr. Sheras asked if there were other items to add to the agenda. No items were added to the agenda.
Dr. Sheras said that he was announcing with regret the resignation of Dr. Rudolph Kaufmann, but that Dr. Kaufmann has missed--and will continue to miss--so many meetings that it was necessary for him to make this decision. Dr. Sheras asked Rev. Cameron and others to let him know if they could identify any candidates for Dr. Kaufmann’s replacement. Dr. Sheras thanked everyone for remembering his birthday at the last board meeting.
Dr. Sheras asked if there were any corrections, additions or deletions to the minutes. Ms. Wernstrom said that with regard to the discussion on the PACT services in Section VII, page 3, her point was that given the intense level of treatment required for PACT participants, by definition they would not be functional enough to be employed. Also, with regard to the vote taken on the strategic plan (Section XII, page 5), the reason she voted “nay” on the strategic plan was because she felt she did not know enough about it, and was therefore not prepared to vote on it at that time. She added that perhaps she should have abstained rather than voting “nay.” Dr. Sheras said that it should not be expected that votes will always be unanimous, and indeed that is the reason to vote on issues. ON A MOTION BY MS. REBHOLZ, SECONDED BY REV. CAMERON, THE MINUTES OF THE FEBRUARY 10, 2003, BOARD MEETING WERE UNANIMOUSLY APPROVED AS REVISED.
Dr. Sheras introduced the planning process by saying that we were beginning by providing time for a discussion with the public. He noted that Ms. Garrett had worked on this in the past, and we needed to continue to build on that. Mr. Peterson gave an overview of the process indicating that the input to the State Comprehensive Plan Update must be sent to the Department of Mental Health, Mental Retardation and Substance Abuse Services following the May board meeting, but since the procedures for that are so limited, the board would couple this with its own local strategic planning process. Dr. Sheras said that since there is not an externally imposed deadline for the local strategic planning process, the board may wish to consider having a retreat to explore the elements of the local plan. Ms. Garrett asked if members from such groups as the Blue Ridge Family Alliance should be invited to participate since they really know what is needed. She also asked how staff input would be sought, would it come through the executive director. Dr. Sheras responded that he agreed it would be valuable to include representatives from other groups, but with regard to staff input, we now have a data window in order to base our plans on outcomes. This opens countless opportunities, and the board could determine which areas upon which to focus. Mr. Peterson suggested it would be useful to also look at the CARF requirements. Dr. Sheras added that the CARF self study should feed directly into the strategic plan. He asked for feedback from the board members as to how they would prefer to proceed. Ms. Wernstrom asked if the plan was to look at the community unmet needs or at our own organization and what we want to strengthen internally. Ms. Rinehart asked if this was something that was undertaken every year, and Dr. Sheras responded that some aspects are addressed every year but not everything every year. Ms. White suggested that the board go back and look at what has not been done--what we said we were going to do--and why and what resources would be required. Ms. Barrett asked if a needs assessment has been conducted recently, and Ms. White said that the Charlottesville-Albemarle Commission on Children and Families has recently completed a community-wide needs assessment and that should be reviewed. Dr. Sheras asked if a meeting were needed to design what we look at, and what would a needs assessment mean in the context of what we are doing. Mr. Belair said that over the past two years, a complete reorganization has been undertaken and also the CARF accreditation. He cautioned about going off in too many new directions, but rather he suggested the board should evaluate what has been done over the past two years and look ahead to the next two years. There has been incredible progress, but “we haven’t finished the book.” Ms. Garrett agreed that was part of strategic planning, but we must also look at what we are missing--to keep our own vision out in front. Mr. Belair said that when you look at the changes that staff have been asked to absorb over the past two years, he would not like to see staff further burdened, but to justify the dollars that have been spent, an assessment should be conducted. Dr. Sheras said that the collection of data under the new system began in January, and so by the summer, with six months of data to work with, the summer might be a good time to pursue this. In the meantime, he would like to put together a planning committee. Ms. Wernstrom said that there are groups, such as the homeless, that do not have families nor organizations to provide input. Dr. Sheras said that the scope of what the board should be paying attention to should involve a regular, annual process. Ms. Barrett reported that the Mental Retardation Services Advisory Committee is looking at having a community forum to see what the needs are, and possibly that could be expanded to look at areas we are overlooking or overlapping. Mr. Murphy said that he was not so sure about a community needs assessment at this time, but rather to look at what progress has been made. He sees three internal components of strategic planning: (1) look at the David Lloyd process to see how it is going, possibly employing a staff survey; (2) see key agency people making presentations about key issues; (3) and to reach into some of the data and look at outcomes. Mr. Peterson suggested that these components could be organized according to the categorization of CARF services. Dr. Sheras asked for volunteers to form a committee to talk about what might be a possible structure for a meeting, and to suggest possible alternatives such as reviewing the previous retreat, goals, status, etc. Ms. Wernstrom and Mr. Belair were volunteered for the committee. Ms. Rinehart asked if there was a list of all of Region Ten’s programs, and Mr. Peterson responded that there was, and also persons could also be made available to present to her group. Dr. Sheras said that board members could play that role, to go to meetings of advocacy groups and answer questions. Ms. Cotton suggested that you could also call intake and go through the access process. Dr. Sheras said we need to make the 972-1800 telephone number understood as an information line. Ms. Barrett commented on the need for public relations. Mr. Belair added that public relations serves two purposes, (1) to let people know they can get help; and (2) to engender an understanding in the community among politicians and others of what Region Ten is doing. Also, the 972-1800 number is not as useful in the counties, and there is no reason why there shouldn’t be a person in each of the counties to respond to questions or direct persons for answers. Dr. Sheras proposed that one of the tasks would be to look at how to handle public information in the counties as contrasted to Charlottesville-Albemarle, possibly through newspapers, posters in businesses, presentations to local service clubs, etc. Ms. Rebholz noted that there is no longer a secretary at Region Ten’s Fluvanna office, and so anyone who calls gets voice mail. Dr. Sheras suggested that the board go on to the next agenda item on the CARF survey which is very closely related to the discussion of the strategic planning process.
Dr. Sheras reported that he had met individually with the surveyors, and he was extremely proud to be chairman of this board. The surveyors were lavish with their praise of what they had seen and what they had learned from us. Dr. Sheras said that he especially wanted to thank Ms. Garrett and Mr. Murphy for everything they had done to prepare the board for what was needed. He also wanted to thank all of the staff who had been involved during the process, and in particular the preparation of the board manual. The clients have been very well served, and this was clearly evident throughout the review. Mr. Belair said that he attended the opening orientation meeting and the closing ext session. He has been involved in many similar surveys, and he himself has served as an evaluator. He was impressed by how the surveyors remained on task and with what they needed to do. There were no gratuitous remarks, and he couldn’t help but feel incredibly proud of the people who work for Region Ten. Ms. Rebholz said that the surveyors were surprised that the board members included their e-mail addresses on the web site. Dr. Sheras said that the surveyors were also impressed by seeing in the minutes the regular reports by board members of program visits. Dr. Sheras said that the next step would be to complete the accreditation process for the other Region Ten services. Rev. Cameron said that he would not be supportive of this if it were just another burden. Dr. Kibler asked what period was covered by the accreditation, and Dr. Sheras replied that if a full accreditation is granted, it is for three years. ON A MOTION BY MS. JOHNSTON, SECONDED BY MS GARRETT, IT WAS UNANIMOUSLY VOTED TO SEEK CARF ACCREDITATION FOR ALL APPLICABLE SERVICES.
Mr. Pezzoli said that this agenda item was prompted by concerns raised over the past two months by Mr. Belair. Mr. Pezzoli distributed copies of a pamphlet from LogistiCare entitled, “How to Access Non-Emergency Medical Transportation (NET) for Virginia Medicaid Recipients,” and a four page history and update beginning in June 2001 of local efforts to impact on the Medicaid transportation problems. He reviewed the steps outlined in the handout, and then asked Ms. Pam Fisher, director of Meadowcreek Day Support Services, to speak because she deals with the day-to-day situations. Mr. Pezzoli added that for Region Ten, Meadowcreek Day Support Services and Blue Ridge House are the main pinch points requiring good, reliable transportation. Ms. Fisher sat on a committee along with Senator Creigh Deeds and Delegate Mitch Van Yahres to address the transportation problems. Ms. Garrett asked if there has been any improvement in the transportation situation. Ms. Fisher recapped some of the problems such as the lost revenues from billable services; vehicles with no inspection stickers; Mom and Pop providers who continually turn over--12 in total of which three remain; unmarked vehicles showing up with drivers who are unknown to the consumers; no seat belts; not English speaking; and clients falling. LogistiCare had originally maintained that this was an isolated situation here, but they have since opened a local office in Charlottesville. The problems outlined above have been corrected but reliability is still and issue. Ms. Rebholz asked who owns the vehicles, and Ms. Fisher responded that the service is contracted out. JAUNT is the most expensive because they maintain their vehicles, train their drivers, and equip the vehicles with proper safety equipment. Contracts are made with cheaper drivers from all over the state who come here. Ms. White asked about other areas, and Ms. Fisher said that they were just as bad, and that other companies had been dumped because they were even worse. Mr. Pezzoli said that transportation for persons with disabilities is a key service, and that the current service in Louisa County is decent, and that the service in Nelson County was O.K. but now there are new operators. Mr. Pezzoli said that Ms. Fisher remains on the case, and Ms. Maltais and he will join the committee. Ms. Wernstrom commented that a patient released from the UVa hospital paid $1.50 at every stop. Ms. White asked about the cost of JAUNT. Ms. Fisher said that for in-town trips, the cost is actually less than the other providers, but in rural areas it is more expensive. Mr. Pezzoli reported that a recent clarification was issued stating that if Community Services Boards choose to become Medicaid transportation providers, they can now limit their service to their own consumers, and so this possibility is now being explored. Ms. Cotton described a situation from a residential services perspective that involved the transport of a client to Fishersville to get a motorized wheelchair, and how the process was delayed for three weeks. The operator was called at mid-night the night before for an 8:00 a.m. pickup, and was only told that the consumer needed “transport to a facility on Rt. 250.” The operators get lists faxed to them at midnight. JAUNT was contacted after 3 weeks for transportation that day, but JAUNT does not provide service to Fishersville. The consumer has been waiting since November to get his wheelchair. The provider said since they could not accommodate the wheel chair, they could transport him on a stretcher. To finally resolve this, Region Ten will use its own van. Ms. Cotton concluded by saying that there is zero accountability for the transportation providers.
Ms. Johnson referred to the minutes of the committee meeting and noted that the schedule to receive bids for next year’s health insurance contract has been modified. Also, the committee will look again at the change that was made for the current year that reduced to zero the employees’ share for those employees with single coverage. One possibility would be to return to the previous monthly share of $15.00 but increase it to $24.00 to reflect the subsequent overall premium increases. Then, any future rate increases would be shared on an equal percentage basis by all employees and the board. It is important to let the insurance committee know what direction the board will take, because that will affect the types of plans that employees will tend to migrate toward or away from. Ms. White asked if the board was looking at a policy question or talking about a specific dollar amount. Mr. Murphy said that the question should be, “Should single people be paying if the agency is subsidizing others,” and that is inequitable to him. If everyone was capped, that would be O.K. He said that the elimination of the single coverage payment was a middle ground to protect families last time around. Ms. Johnston said that currently four different plans are offered with each having four different subscriber classes, and this makes it extremely complicated. Dr. Sheras said that the board needs to make a decision, but this is an issue for which there will not be agreement: will the board support families vs. complete equity for individual employees. Rev. Cameron said that he would need to know the employee base to know how individuals vs. families would react, and the board must consider the work force and who might leave and who might be attracted. Ms. White said the county of Albemarle conducted a market survey, and the average individual share is $30.00. Albemarle County is currently $27.00. Dr. Kibler said that the County of Greene pays a flat amount for all employees. Ms. White moved that the committee be directed to increase the individual share and look at the impact of decreasing the subsidies for dependent coverage over time and provide a couple of scenarios. Mr. Belair seconded the motion. Following some discussion regarding whether a motion was needed for this, Ms. White withdrew the motion, with the concurrence of the seconder, Mr. Belair. Dr. Sheras asked the committee to create a set of scenarios including the current plan, reinstatement of shares for single coverage, and no subsidies for dependent coverage, and to project these ahead for five years. He asked that this information be made available to the board members prior to the April board meeting. Mr. Murphy said that a fourth scenario would be to cap the subsidy at a particular dollar figure. Mr. Peterson said he would develop these scenarios.
The Mental Retardation Services Advisory Committee did not hold a meeting.
Dr. Sheras suggested that the reports be deferred until the next meeting.
Ms. Rebholz reminded members that the next VACSB meeting will be held in Willliamsburg on May 8 and 9.
Ms. Garrett reported that she had brought a young man to Region
Ten’s emergency services at 5:30 p.m. on Friday, and she wanted
to commend the staff saying that they had been marvelous in responding
to the emergency. Dr. Sheras asked that other reports be deferred.
REGION TEN COMMUNITY SERVICES BOARD EXECUTIVE COMMITTEE MEETING April 2, 2003
Peter Sheras, Ph.D., Chairman Other Board Members Present Carol Johnston, Personnel James Peterson, Executive Director
Ms. Garrett reported that she will be unable to attend the board meeting, and Dr. Sheras said that he has a scheduling conflict which will require him to leave the meeting no later than 8:00 p.m. Copies of the proposed agenda were distributed. Once again, a public input session will be held at the beginning of the meeting to receive input to the State Comprehensive Plan update and the Region Ten strategic plan. John Beghtol, State Hospital assistant director for community relations, will provide a status report on the hospital and related issues. A closed session will be held following the meeting of Region Ten, Inc., meeting to discuss the annual evaluation and contract renewal of the executive director.
The next meeting of the Executive Committee will be held on Tuesday, May 6, 11:30 a.m., at the Hardware Store Restaurant, 316 East Main Street, Charlottesville. The meeting was adjourned. REGION TEN COMMUNITY SERVICES BOARD STRATEGIC PLANNING COMMITTEE MEETING Carole Wernstrom, Chair James Peterson
The members reviewed the draft minutes of the March 10, 2003, board meeting which included the charge to the committee as follows: Dr. Sheras asked for volunteers to form a committee to talk about what might be a possible structure for a meeting, and to suggest possible alternatives such as reviewing the previous retreat, goals, status, etc.
Ms. Wernstrom distributed copies of the listing of items entitled “What we need to do” growing out of the May 4, 2002, board retreat, and also the “Region Ten Board Retreat Actions” (May 4, 2002). Mr. Peterson distributed copies of the materials that had been provided by Ms. Garrett for the planning for the current strategic plan, “Region Ten CSB -- Strategic Planning/Notes for a draft,” and “What is Strategic Planning?” He also distributed copies of the draft minutes of the March 21, 2003, meeting of the HPR-I (Health Planning Region One) Regional Stakeholder Forum which was held in Culpeper to kick off the planning process for the regional restructuring and reinvestment initiatives. Discussion was given to the need to integrate CARF requirements and more community information into the strategic planning process, and also consideration of to how best structure a meeting or retreat to set the direction for the strategic plan. An evening meeting (or meetings) was considered as well as an all-day Saturday retreat. The use of an external facilitator was discussed as compared to having the chairman conduct the meeting. There was consensus that if an external facilitator were to be engaged, that rather than use a generic facilitator, the facilitator should have a good knowledge of the field and the issues to be addressed. Other considerations included possible locations for the retreat and also the time of the year. Finally, the committee members agreed it would be more productive to provide the board with a specific recommendation, rather than possibly prolong the process by offering up a list of alternatives.
The committee recommends the following: (1) A day-long retreat be held on Saturday, June 7 (from 9:00 a.m. - 5:00 p.m.), and that the board consider folding in its regular June meeting (scheduled for June 9) for a half-hour at the beginning of the retreat in recognition that it is likely that a special end-of-June meeting will once again be required to approve the state Performance Contract. (2) The retreat be held at Mr. Belair’s home on Lake Louisa with refreshments provided by a local caterer. (3) Seek a board member or executive director from another community Services Board to serve as the facilitator. (4) Participants would be the board members, management team and six or eight advocates and other knowledgeable persons (e.g., AA/Alanon, Blue Ridge Family Alliance, consumer advocate, Mental Retardation Services Advisory Committee, Salvation Army, etc.). (5) Among other topics, the issue of the roles of the standing committees (Executive, Finance and Personnel) should be addressed to evaluate if expanded definitions and/or responsibilities should be outlined. (6) The members of the committee are willing to be responsible for the retreat plans including planning the agenda and welcoming input from the board. The meeting was adjourned. REGION TEN COMMUNITY SERVICES BOARD PERSONNEL COMMITTEE MEETING Carol Johnston, Chair James Peterson
1. Health Insurance The committee members reviewed the draft minutes of the March 10 board meeting which read in part: Dr. Sheras asked the committee to create a set of scenarios including the current plan, reinstatement of shares for single coverage, and no subsidies for dependent coverage, and to project these ahead for five years. He asked that this information be made available to the board members prior to the April board meeting. Mr. Murphy said that a fourth scenario would be to cap the subsidy at a particular dollar figure. Mr. Peterson said he would develop these scenarios. Recognizing that staff have been given the option to choose among four different plans, and that within each of those plans there are four subscriber classes, the process and parameters employed to develop the set of scenarios was limited to the “Platinum” health insurance plan which is the middle-cost plan and the one that was established as the standard plan. Also, the scenarios portrayed two of the four classes of employees--the two extremes--Employee-Only and Employee-Family. All scenarios were based on the assumption that there would be an 18 percent increase in the premium rates beginning with the next contract period (October 2003) followed by four years of increases of 12 percent. The current annualized total premium is $1,406,763 of which Region Ten pays $1,170,744 and the employees pay $236,019. For all of the scenarios, the total premium in FY 2008 would be $2,612,012, an 87 percent increase, and the monthly premium would be a total of $423.28 for single employees and $1,193.67 for family coverage. However, the distribution of the shares between Region Ten and the employees would vary widely depending upon the scenarios, with Region Ten’s share varying from $1,395,994 to $2,173,782, and the employees’ share varying from $438,230 to $1,216,018. The first scenario (A) would continue the current distribution of subsidies, with the single employee always paying zero, and then all future increases prorated against the board and the employees with dependents. Because the subsidy for family coverage would increase to $933.72 per month, this option was not seen as acceptable. Scenario B would continue the current distribution of subsidies except that beginning in October, the single subscriber would pay $24.78 out-of-pocket (this figure was based on returning to the previous years’ amount of $15.00 and increasing this to account for the current premium increase and the anticipated increase in October). For subsequent years, the increases in premiums would be shared proportionately between the Region Ten and all subscribers. This scenario was not accepted because once again, the subsidy for the family coverage would increase over five years to $933.72 per month. Scenario C modifies Scenario B by totally eliminating any additional subsidy for family coverage. In this scenario, the out-of-pocket cost to families would increase in October from $140.00 per month to $514.38 (or on an annual basis from $1,680 to $6,173). At the five year mark, the employee with family coverage would be paying $809.38 per month out-of-pocket ($9,713 per year). This option was seen as unacceptable because the impact on employees with dependents would be catastrophic both immediately and in the long run. Scenario D seeks to eliminate the subsidies for dependents over a four year period. This scenario was viewed as too accelerated, and the end result would be monthly payments by employees with families of $812.72. Scenario E modifies Scenario D by calculating the reduction in subsidies for families by an annual amount of 10 percent of the difference between the two subsides. After five years, the employee with a family would pay $780.65. that amount, and the first year jump from $140.00 to $283.21, were seen as too extreme for employees with families. Scenario F modifies Scenario E by capping the annual amount of increase to families at 50 percent per year. Although the monthly out-of-pocket increases for families are moderated, the family would pay $647.31 in the fifth year. Scenario G caps the monthly increase to families at 30 percent, and at the fifth year, the monthly out-of-pock cost for families would be $519.80. The difference in the amount of subsides made available to families as compared to single subscribers would have been reduced from currently over twice the amount (120 percent) to 77 percent. On a motion by Mr. Trippel, seconded by Ms. Wernstrom, it was unanimously voted to recommend to the board that beginning with the new contract year for health insurance, individual subscribers pay 10 percent of the premium, and the amount of the subsidy for family coverage be decreased by 10 percent per year for the next five years provided that the annual increase to families not exceed 30 percent in any year (Scenario G). 2. Performance Evaluation Process of the Executive Director The next meeting of the Personnel Committee will be held on Thursday, April 29, 2003, 4:15 p.m. The meeting was adjourned. March 10, 2003, BOARD MEETING MINUTES Members Present Peter L. Sheras, Ph.D., Chairman Members Absent Stephen Wunsh
James R. Peterson, Executive Director
Dr. Sheras, chairman, called the meeting to order at 8:20 p.m.
On a motion by Ms. Barrett, seconded by Ms. Wernstrom, the minutes of the February 10, 2003, board meeting were unanimously approved as distributed.
The architects are still in the process of preparing the application for funding through the Rural Development Fund.
Further input has been received from the staff with regard to the
proposed size and design of the facility, and these changes have
been incorporated into the design. Mr. Bob Smith is continuing to
seek suitable sites. Respectfully submitted, Paul Belair |
