2010-2763-Minutes for Meeting July 19,2010 Recorded 7/28/2010DESCHUTES COUNTY OFFICIAL
NANCY BLANKENSHIP, COUNTY
COMMISSIONERS' JOURNAL
111111111111111 1111111111 111 III
2010-2763
RECORDS
CLERK. CJ 2010-2763
07/28/2010 08;17;41 AM
Do not remove this page from original document.
Deschutes County Clerk
Certificate Page
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Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
MINUTES OF WORK SESSION
DESCHUTES COUNTY BOARD OF COMMISSIONERS
MONDAY, JULY 199 2010
Present were Commissioners Dennis R. Luke and Tammy Baney; Commissioner
Alan Unger was out of the office. Also present were Dave Kanner, County
Administrator; Erik Kropp, Deputy County Administrator; David Givans, Internal
Auditor; Timm Schimke, Solid Waste Department; Scott Johnson, Health Services;
Mark Pilliod, County Counsel; and three media representatives from KOHD TV
and The Bulletin. No other citizens were present.
Chair Luke opened the meeting at 1:35 p.m.
1. Consideration of Authorization of County Administrator's Signature of a
Change Order regarding the Cell 5 - Area A Landfill Closure Contract.
Timm Schimke indicated that there is a significant amount of rock that was not
anticipated, much of which has been crushed for Road Department uses.
Commissioner Baney asked if it is possible to send it out to bid. Mr. Schimke
said that the crusher is already there and there are timing issues as well.
BANEY: Move County Administrator's signature of the Change Order.
LUKE: Second.
VOTE: BANEY: Yes.
LUKE: Chair votes yes.
2. Discussion of Upcoming Meeting with Jefferson and Crook Counties
regarding a Proposed Regional Health Authority.
Scott Johnson spoke about the proposal, which poses three questions, which all
relate to how they plan for, fund and set policy for health care and services in
the region.
Minutes of Board of Commissioners' Work Session Monday, July 19, 2010
Page 1 of 6 Pages
In the simplest form, considering all that is underway on the federal level in
response to federal laws, and State reform issues, the question is how the
counties should prepare for this. The 2009 session brought up a single point of
contact concept and some of those legislators are still working on this.
Commissioner Luke said that the State is having problems funding the existing
programs. He asked if this is part of the discussion - how to fund something
new if you can't fund what you already have. Mr. Johnson stated it is a difficult
time to manage change but they need to look at efficient and cohesive ways to
handle what is needed. More cuts might happen and no one knows for sure
how that will impact health care. The challenge is there in any case.
Commissioner Baney said that the hope is that ultimately it will save money.
Commissioner Luke asked which other counties are doing this. Mr. Johnson
stated that right now Deschutes, Crook and Jefferson are leading the way.
Commissioner Luke asked if other areas will see a push-back, or whether
Deschutes County will have to spend more money to get this going.
Mr. Johnson stated that everyone knows change is coming, and there is some
uneasiness as to what is going to be required and whether it will ultimately be
beneficial. There needs to find a new way of delivering service. The question
is how to get there through a transparent and public process. Much might
depend on what new legislators and a new Governor hope to do.
Commissioner Baney said that there should be an opt-out, re-set or hold
harmless provision so that they would not be penalized in any way.
Commissioner Luke suggested that certain dates be set for review in case that
kind of decision needs to be made. Mr. Johnson stated that ABHA is a carve-
out, and the re-set exists for those kinds of programs. If at any point it is
decided it is flawed, it can be addressed that way.
Commissioner Luke asked why other counties are not involved. Commissioner
Baney stated that Benton has something similar already in place. No one
knows at this point what will finally result.
Mr. Johnson said that each county will make opening statements, and the
presentation will follow with questions as to whether the group should proceed
and how the program should work.
The Commissioners asked what would happen if one of the counties decided to
opt out at some point. Commissioner Baney asked how the dollars would flow.
Commissioner Luke said that for-profit agencies like Pacific Source often do a
better job of handling this kind of thing than a government entity can.
Minutes of Board of Commissioners' Work Session Monday, July 19, 2010
Page 2 of 6 Pages
Mr. Johnson went over the proposed timeframe and the fact that legislation
might need to result to help with a health authority. This would be the first
time Pacific Source would be working with government agencies.
Commissioner Baney feels that if this is going to work, it has the best chance of
happening in this region where there is a lot of cooperation established already.
Mr. Johnson said that it needs to be well-reasoned and everyone needs to be
ready.
Dave Kanner said if an ORS 190 is formed and Commissioners from each
county are on the governing body, who will staff it - County staff or Pacific
Source? These would have to be public meetings and open to the public. Mr.
Johnson replied that they have done a policy option package to pursue this
proposal.
Mr. Kanner also asked how ABHA remains relevant in this proposal. It will not
be necessary if all the funds are channeled through COAS. Mr. Johnson stated
that these are mostly the same providers. Mark Pilliod said that if the shift were
made, if someone decides it is not working as planned, a new ABHA would
have to be started
Mr. Johnson referred to the draft letter of intent, showing a number of
conditions. ABHA is addressed in that document.
Mr. Kanner asked that about $4 million go into health and mental health from
the general fund. If a regional health authority over three counties are adhering
to the same policies and others are not, does this offer more supervisory
support. Commissioner Baney said that she does not want to use county funds
across county lines.
Mr. Johnson asked how much weight Deschutes County would have. Some
thought is whether something should carry at all if the County does not cover it.
There is nothing to keep them from contracting. There are major changes
happening at the State level, and all kinds of options need to be examined.
Mr. Johnson said there are many statutes and rules required before this is
established.
Mr. Pilliod said that the federal government is responsible for a lot, but most of
the work comes to the State and local entities.
Minutes of Board of Commissioners' Work Session Monday, July 19, 2010
Page 3 of 6 Pages
Commissioner Luke asked what they hope to see tomorrow. Commissioner
Baney said that questions need to be asked and answered. First, it is are we in
or not. If not, then nothing changes.
Mr. Pilliod said that if anything the letter of intent would be desirable, at least
from the State's perspective. A good question might be, how binding the letter
is. This is the only action that he can perceive. Then the question is, how much
of a commitment does it present.
Mr. Johnson stated they would like to have some kind of consensus or decision
by July 22. Mr. Kanner stated that the Jefferson and Crook county officials
cannot vote as they will be out of their jurisdictions, but they have meetings
coming up where they can address this.
Commissioner Baney asked that perhaps the State be available, at least by
phone. Mr. Johnson will find out if this can be arranged.
3. Repeal of Administrative Policies that are No Longer Current.
Erik Kropp gave a brief overview of the policies that are no longer current.
Most have been replaced by other policies or incorporated within other policies,
and some are no longer applicable.
There will be an Order written for adoption covering this issue.
4. Update of Commissioners' Meetings and Schedules.
Commissioner Baney said she would be part of a meeting regarding the ten-
year plan to end homelessness in Sisters on Thursday night.
Commissioner Luke stated that on Monday he would attend a meeting
regarding taking part in a new newspaper publication for the area.
5. Other Items.
Commissioner Baney said that she has reason to believe that the joint meeting
of the three counties tomorrow may include a discussion of solid waste
management. Commissioner Luke stated that if certain non-household garbage
went to Crook County with the remainder going to Deschutes County, it might
extend the life of the landfill. However, flow control agreements were
necessary before certain projects were begun at Knott Landfill so that there
were some assurances of debt coverage.
Minutes of Board of Commissioners' Work Session Monday, July 19, 2010
Page 4 of 6 Pages
Commissioner Baney stated that discussion may arise regarding jail beds at
well. Although the only item on the agenda at this point is a proposed regional
health authority, she feels that other issues of mutual concern may be brought
up.
Before the Board was Consideration of Approval of the Consent Agenda.
Consent Atienda Items
Approval of Minutes:
• Business Meeting of July 14
• Work Session of July 14
CONVENED AS THE GOVERNING BODY OF THE 9-1-1 COUNTY
SERVICE DISTRICT
Before the Board was Consideration of Approval of Weekly Accounts Payable
Vouchers for the 9-1-1 County Service District in the Amount of $22,436.90.
BANEY: Move approval, subject to review.
LUKE: Second.
VOTE: BANEY: Yes.
LUKE: Chair votes yes.
CONVENED AS THE GOVERNING BODY OF THE EXTENSION AND 4-H
COUNTY SERVICE DISTRICT
Before the Board was Consideration of Approval of Weekly Accounts Payable
Vouchers for the Extension/4-11 County Service District in the Amount of
$19,522.44.
BANEY: Move approval, subject to review.
LUKE: Second.
VOTE: BANEY: Yes.
LUKE: Chair votes yes.
Minutes of Board of Commissioners' Work Session Monday, July 19, 2010
Page 5 of 6 Pages
RECONVENED AS THE DESCHUTES COUNTY BOARD OF
COMMISSIONERS
Before the Board was Consideration of Approval of Weekly Accounts Payable
Vouchers for Deschutes County in the Amount of $2,821,763.81.
BANEY: Move approval, subject to review.
LUKE: Second.
VOTE: BANEY: Yes.
LUKE: Chair votes yes.
The Board went into executive session under ORS 192.660(2)(h), pending or
threatened litigation, at 2:40 p.m. The session ended at 3:05 p.m.
Being no further items addressed, the meeting adjourned at 3:05 p.m.
DATED this 19th Day of July 2010 for the Deschutes County Board of
Commissioners.
ATTEST:
Recording Secretary
- ,
Dennis R. Luke, Ch it
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Alan Unger, Vice Chair
J
Tammy Baney, Commissioner
Minutes of Board of Commissioners' Work Session
Page 6 of 6 Pages
Monday, July 19, 2010
Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
WORK SESSION AGENDA
DESCHUTES COUNTY BOARD OF COMMISSIONERS
1:30 P.M., MONDAY, JULY 199 2010
1. Consideration of Authorization of County Administrator's Signature of a
Change Order regarding the Cell 5 - Area A Landfill Closure Contract - Timm
Schimke
2. Discussion of Upcoming Meeting with Jefferson and Crook Counties regarding
a Proposed Regional Health Authority - Scott Johnson
3. Repeal of Administrative Policies that are No Longer Current - Erik Kropp
4. Update of Commissioners' Meetings and Schedules
5. Other Items
Litigation, called under ORS 192.660(2)(h), Pending or Threatened Litigation
PLEASE NOTE: At any time during this meeting, an executive session could be called to address issues relating to ORS 192.660(2) (e), real
property negotiations; ORS 192.660(2) (h), pending or threatened litigation; or ORS 192.660(2) (b), personnel issues
Meeting dates, times and discussion items are subject to change. All meetings are conducted in the Board of Commissioners' meeting rooms at
1300 NW Wall St., Bend, unless otherwise indicated.
ffyou have questions regarding a meeting, please call 388-6572.
Deschutes County meeting locations are wheelchair accessible.
Deschutes County provides reasonable accommodations for persons with disabilities.
For deaf, hearing impaired or speech disabled, dial 7-1-1 to access the state transfer relay service for TTY.
Please call (541) 388-6571 regarding alternative formats or for further information.
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HEALTH SERVICES
2577 NE Courtney Drive, Bend, Oregon 97701
Public Health (541) 322-7400, FAX (541) 322-7465
Behavioral Health (541) 322-7500, FAX (541) 322-7565
www.deschutes.org
To: Deschutes County Board of Commissioners
Dave Kanner, County Administrator
From: Scott Johnson, Director, Deschutes County Health Services
Date: July 14, 2010
Subj: Regional Health Authority topic: Work Session July 19; regional meeting July 20
We will be meeting in the work session on July 19 to discuss the Regional Health Authority /
Service Integration project in preparation for a regional July 20 meeting with the Jefferson
County Commissioners and the Crook County Court at the Deschutes County Expo Center.
BACKGROUND
With a policy decision to merge two county departments in 2009, Deschutes County is engaged
in efforts to improve health care for County residents. This includes promoting the Triple Aim
(i.e. better health outcomes, greater satisfaction and reduced costs), integrating primary care
and behavioral health in clinics and addressing a State interest in streamlining governance and
accountability, often referred to as "a single point of accountability." Also noteworthy, the
President has signed the 2010 Affordable Care Act into law and the 2009 Oregon Legislature has
created the Oregon Health Authority. It is a time of change, uncertainty and great promise.
DECISION POINTS - We are approaching several important decisions for our County and
region. I will brief you on each of these on Monday and am seeking Board direction.
1. Regional Health Authority (RHA) - Discussion of the concept of an RHA and an
indication from all three counties of whether you will consider forming an RHA, either
as a 190 organization or through new legislation. County governments would play a
central role in the creation and operation of an RHA. We have received early support
for this from a number of parties including Dr. Bruce Goldberg, Oregon Health
Authority (OHA), Jim Diegel, St Charles Health System and Megan Haase, Mosaic
Medical. Your direction will help us determine whether to move forward in developing
a more specific proposal. If we receive preliminary support, specific questions to
address or features you would like incorporated would be helpful.
Our Mission: To promote and protect the health and safety of our community.
Memorandum to County Commissioners
Scott Johnson July 14, 2010
2. If you support an RHA concept, realignment of OHP contracts through Pacific Source.
We will review current and proposed pathways for contracting OHP funds. Should we
seek a change, one that would eventually fall under the RHA, the State requires a Letter
of Intent to change the contracting through Pacific Source COIHS effective January 2011.
Pacific Source COINS would receive a comprehensive OHP contract and would
subcontract behavioral health services through ABHA. Undertaking this change in 2011
would require a Letter of Intent by July 22, 2010 and a final decision by September 15,
2010. In indicating we no longer wish to receive a direct State to ABHA OHP contract
for mental health services or a State to Deschutes County OHP contract for chemical
dependency, we recommend the following conditions be realized prior to September 15:
a. A legal agreement by Pacific Source COIHS and the State OHA to move the OHP
contracts and any other public funds of interest to the Central Oregon counties
through the new Regional Health Authority once it is formed and ready.
b. An ability to review the 2011 DHS contract with COIHS and the 2011 COIHS
contract with ABHA, with both found acceptable by ABHA and the Central
Oregon counties prior to September 15.
c. A legally binding document assuring a "reset button" through which the
participating counties can reform a Behavioral Health Organization, either
through ABHA or the Central Oregon counties for as long as Oregon continues
to operate with carve out options for any behavioral health services.
d. DHS, ABHA and COIHS adoption of a document titled DHS Oversight and
Reporting Processes to help ensure administrative efficiency.
e. A written methodology to guide how any financial savings from the new
delivery and administrative model will be shared by participants.
Executing this change by January 2011 will allow easier and more comprehensive care
coordination between providers and a method to finance more integrated clinics
throughout Central Oregon. It will also allow for a more comprehensive local process to
evaluate and monitor health care investments totaling more than $180 million.
3. Important Transitional Board meeting September 9 - Should you support moving
forward with reform efforts as outlined in items 1 and 2, this next meeting will include a
review of progress made on the items listed above, follow-up on any matters outlined at
the July 20 regional meeting and an early review of a possible legislative concept for a
Regional Health Authority. A final ABHA letter approving the contract change will be
required by September 15.
I look forward to our discussion on July 19 and July 20.
Date: July 6, 2010
To: Board of County Commissioners
From: Erik Kropp, Deputy County Administrator
Re: July 19th Work Session - Recommended Policies to be Rescinded
As part of the review of County policies, staff has determined that there are a number of policies
that are outdated, are no longer applicable, or have been replaced by an updated policy. A list of
these policies is attached along with a short summary and discussion of each policy.
Staff recommends that these polices be rescinded. The list was sent to Deschutes County
employee unions and there were no objections to rescinding these policies.
Please ask Dave Kanner if you would a copy of any of the policies listed.
Dave Kanner, County Administrator
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