Loading...
2017-5-Minutes for Meeting December 28,2016 Recorded 1/13/2017DESCHUTES COUNTY OFFICIAL RECORDS �J 20 +7�� NANCY BLANKENSHIP, COUNTY CLERK d COMMISSIONERS' JOURNAL 0111312017 02;36;39 PM 1111111111111111111111111 2017 -5 Deschutes County Board of Commissioners 1300 NW Wall St., Bend, OR 97703 -1960 (541) 388 -6570 - Fax (541) 385 -3202 - www.deschutes.org MINUTES OF WORK SESSION DESCHUTES COUNTY BOARD OF COMMISSIONERS WEDNESDAY, DECEMBER 28, 2016 Present were Commissioners Alan Unger, Tammy Baney and Anthony DeBone; and David Doyle, County Counsel. Attending for a portion of the meeting were George Conway, Health Director, David Inbody and DeAnn Carr, Health Services, Jennifer Clemens, Human Resources Director; Wayne Lowry, Finance; Whitney Hale, Information Officer; Keith MacNamara, Veterans' Services, Commissioner - elect Phil Henderson; and Roger Olson, NAMI (National Alliance on Mental Illness). No other citizens or representatives of the media were in attendance. CALL TO ORDER Chair Unger called the meeting to order at 1:30 p.m. Minutes of Board of Commissioners' Work Session Wednesday, December 28, 2016 Page 1 of 11 ACTION ITEMS 1. Finance - Treasurer Update. Treasurer Wayne Lowry explained that the portfolio has gone up in November due to incoming tax payments; most of this will be sent to the taxing districts. Many of the districts have a pool account and funds are transferred electronically per a schedule. Those that don't have a pool account, such as special road districts, receive checks. Chair Unger asked about the lock box process. Mr. Lowry stated that the system worked well and funds got deposited more quickly. The same as last time, 1.11% is the average yield; and investments went up to 1.18 %. The market has changed since the national election. Rates have gone up dramatically, starting volatile but settling. The yield for securities is higher than it was a couple of years ago. Vacant positions are at 51.5 — primarily 9 -1 -1, Sheriff and Health. CDD revenue is about $300,000 ahead of last year (about 10% more). Solid Waste is about $450,000 ahead of last year (12.2% more). The Fair /Expo,Center is doing well. The annual Fair turned out better than expected. Any excess for the Fair is transferred over to the Fair /Expo. They expect to add $171,000 to the Fair /Expo balance —this was a negative figure last year. There are a lot of positive things going on at the facility, and it is better than ever financially. Chair Unger said that transportation in and out of the Fair is always a problem, and feels more should be invested in this part of it for the public. Commissioner Baney hopes that the food and beverage piece is working well. Mr. Lowry said that if things remain this strong, the Fair /Expo should be able to start putting funds into reserves. Room tax has been collected through November (for October) — now at $4.26 million, far ahead of this time last year (increase of 8.8 %). Minutes of Board of Commissioners' Work Session Wednesday, December 28, 2016 Page 2 of 11 Commissioner DeBone noted that he is meeting with Sunriver Chamber of Commerce board members to talk about finances, membership and services. Another name, such as Three Rivers Chamber, might be more suitable for their situation. He is going to try to provide some guidance to them. The Board also receives a monthly report on room tax collections. Mr. Lowry said the increase is at about 8% due to more visitors and changes in room rates. 2. CCBHC Update. George Conway explained the handouts provided to the Commissioners, including a memorandum, letters of support, plus a support letter from Veterans' Services and a synopsis of what they need to keep providing adequate services. Dr. Conway said they learned last week that Oregon was one of eight states approved to participate in the demo project, which is the first extension in the federal mental health program. This would provide substantial funding, including funds for expanding veterans' services, helping those with mental health illness that cannot be served otherwise, assisting elders on Medicare, and providing services to certain groups of people that have some insurance but cannot receive adequate care. There will be an extension of non- traditional hours, and the County will be the provider of last resort. This also means they can accelerate information gathering on programs and services. There won't be explicit branding for this federal program, but just an expansion of services, and it will provide a financial buffer. In regard to timing, the go -live date is April 1. They need to hire by March 1, and recruitments should be posted by January 13. Chair Unger asked if they will hire everyone at once. Dr. Conway stated that it will be gradual. They are not obligated to have all in place, but will need help ramping up for services. Minutes of Board of Commissioners' Work Session Wednesday, December 28, 2016 Page 3 of 11 David Inbody said that it might make sense to establish a strategy for doing all of the postings. They have been working internally to determine which need to come first. Commissioner Baney asked where they will be housed. DeAnn Carr said that they will be housed at five different locations across the County. Space is always a challenge, but they have been working on this. Dr. Conway stated that some providers will be in close proximity to Veterans' Services as well. Dr. Conway said that they are gathering letters of support, as their colleagues are behind this. Commissioner Baney noted that sometimes the need for space is not usually funded through grants, and suddenly there are requests from the general fund to help with this. Mr. Inbody explained that they have $200,000 set aside for the Courtney space to remodel as needed, and the downtown office can accommodate some people. Many positions are outpatient related and they have space for that. Longer term, a solution is needed for administrative staff. The volume of services at the Antler Avenue location in Redmond has increased more than anticipated. He hopes they are part of the longer -term vision for the County in regard to space needs. Dr. Conway does not think this program is the event that is forcing this situation. He noted that when he came on board with the County that much of the space is already confining. They are sensitive that this is a two - year grant to increase capacity, but during that time they hope to figure out which of these services they might consider continuing, if possible. Commissioner DeBone asked if they need a decision today regarding staffing. Dr. Conway said they hope to be able to bring in up to 20 staff using these funds. After March, these costs would be covered by the grant. Ms. Carr said that with the PPS payments, there will be funding on an ongoing basis to cover staffing and the work being done. Dr. Conway confirmed that it is go or no -go, which is why they presented this in October and are now following up. They are running out of time. Minutes of Board of Commissioners' Work Session Wednesday, December 28, 2016 Page 4 of 11 Commissioner DeBone asked if the County has been asked to be a part of it. Dr. Conway replied that the State feels Deschutes County is an integral part. There are 13 counties, about one -third in the state, involved. Most of the smaller counties were unable to participate. Ms. Carr added that the requirements and programs the County already has in place put the County in a strong position. Not everyone has the programs, services or partners in place that Deschutes County does. The credentialing process from last summer was a very positive step. Most programs do not need to be built from the ground up. Dr. Conway said that they shifted some positions, with 16 being clinical and fewer administrative. Commissioner DeBone stated that he is still not comfortable with this. He wants to know who they are going to serve. Commissioner Baney said that the timing is a challenge, both with service delivery and sustainability. She wants to know what happens if someone is relying on a service that can't be continued after two years. Dr. Conway stated that some of the additional services would be provided for Medicare patients, veterans and others who are now falling through the cracks, and this requires billing expertise for reimbursement. He is not saying they will be able to keep all of the people and services in place, but they will be able to provide an expanded service base because they will then have the accumulated expertise from which to build. There is a very good chance that between this enabling of how these services work and are funded, this experience, and using new automated tools, they may be able to provide expanded services into the future, enhancing what is already in place. There may also be additional funding available. Commissioner Baney stated that it appears some positions are difficult to fill. She is concerned that they may not be able to get all of the new positions filled and will end up top -heavy with administration. Dr. Conway explained that there are always some applicants, but they are looking for a high level of expertise. Minutes of Board of Commissioners' Work Session Wednesday, December 28, 2016 Page 5 of 11 Mr. Inbody said that some of the positions' requirements are very specific. These positions sometimes are filled internally through a natural cycle. Ms. Carr added that they also contract for tele -care services, especially for psychiatric needs. They have backup plans in place. They have been able to bring in strong clinicians overall, but always need the right fit for the work and the location. Commissioner Baney asked about filling existing needs while adding more. She wants to know which will be filled first, or whether it matters. Ms. Carr replied that they will have a CMHP certification requirement. As they bring people in, they can determine coordination of care. Commissioner Baney wants to see expanded services but doesn't want to end up with a commitment that can't be maintained. She would like to know how they separate the lines of business so it is clear in two years what has to happen. She doesn't want to see a massive layoff at that time. Ms. Carr stated that those particular FTE's will know at the time of hiring that they are a part of this. The core services are already clear and distinct. The services are distinct enough to track, but on the surface they want it to appear seamless. As they look at the evolution of the organization, they will enhance billing processes, and all programs will benefit from this. It will be a transformational mechanism, and they can place a lot of public attention on the problem of parity for complex mental health and addiction needs. This will not be done alone, but with the help and support of community partners to maximize the effort. Commissioner Baney asked if there are outcome measurements on the federal side. Dr. Conway said that this has all been discussed at length. Most short -term people will be early or late in their career, and he wants to be sure proper supervision is in place. Those that show promise might be retained as other positions become available. Nurse practitioners work well overall. He does not feel they would be as financially exposed as some might think. Properly played, some of the negative effects would be buffered. Minutes of Board of Commissioners' Work Session Wednesday, December 28, 2016 Page 6 of 11 Commissioner Baney asked what the cost savings overall will be„ since the feds obviously think there will be a cost savings. Dr. Conway does not think this is the federal government's primary goal — instead, they want to develop efficiencies, gathering and reporting data, and serving people who are not being helped now. The Federal Excellence in Mental Health Act is supposed to result in a continuing increase in funding, for mental health issues to gain parity with physical health. There is an epidemic in addiction, with a huge cost to society. They hope for efficiencies of scale and organized reporting. Ms. Carr said that the savings will be seen in slowing healthcare costs and getting to the problems earlier, rather than having people show up instead in the emergency room, jail, or ending up homeless. Those situations result in a huge cost to society. The healthcare system is complex and hard for most individuals to navigate; this is especially true for those who are already battling mental health or addiction issues. Keith MacNamara said the Veterans' clinic is not accepting new patients due to a case overload. There was a six -week initial wait for even a mental health evaluation, and now is at four weeks. Many of these veterans need help and can't get to it. In the meantime, some end up exacerbating a substance abuse problem, with dire consequences. This type of treatment is not provided locally anyway. Veterans' Services can treat PTSD but not substance abuse, although many of these people self- medicate and it is hard to treat one without addressing the other. Dr. Conway added that they need to think about the indirect costs, such as those associated with overdose, suicide, violence, death, homelessness, crime, and other negative impacts. Those are harder to measure and less tangible, but they are real and very costly. The most compelling argument for this program is not economic. Also, many elderly people have multiple problems that are not being addressed. The department will accept the downside and risk of not knowing some of the results of this program, but want to proceed because it is the right thing to do, and this aspect of overall health has not been treated equally overall. The Federal government now recognizes this, and Deschutes County can be a part of the solution. Minutes of Board of Commissioners' Work Session Wednesday, December 28, 2016 Page 7 of 11 Chair Unger asked if there are any opt out opportunities if this program is not working well in the future; or whether there are times when it can be reevaluated. Ms. Carr said that technically there will be few opportunities for this once they start working with the State and are hiring people. It is a commitment and they intend to do the best they can with it. Dr. Conway added that they have to develop the position descriptions before going out to hire. To be able to perform within the parameters, they need a clear decision and soon. Commissioner DeBone is worried about the political environment. Dr. Conway said there is a bus and it is getting ready to leave the station. It is a cooperative agreement between the federal and State, and the State wants Deschutes County to be involved. The scale is the same as discussed previously. Ms. Carr stated that the deliverables are clear and the County cannot vary from this greatly. There is a lot to consider, and they have invested a lot of time to get to this point, because they believe it is in the best interests of the community. Chair Unger said they may be able to get to an answer by next Wednesday. Commissioner DeBone wants to know more about the Federal Excellence in Mental Health program. He worries there will never be enough money to help everyone who thinks they need help, and about setting up a system that doesn't really need to be there. Commissioner Baney would like to know how many veterans are not being helped. Dr. Conway stated that they have tried to get those numbers, but Veterans' Affairs is not open to providing this information. In the near future, with the help of Mr. MacNamara, he would like to survey veterans to find out more about this issue directly from them. There has been a great deal of development in this program since October, and it is part of the federal appropriations activity to expand services. He can answer some questions, but federal mental health law is incredibly complicated. Minutes of Board of Commissioners' Work Session Wednesday, December 28, 2016 Page 8 of 11 Phil Henderson said he would like to know some of the facts, like the breakdown of employees in Behavioral Health and how certain the funding sources are. He doesn't think this program will provide enough money. He sees it as a 10% increase in departmental staffing. The federal government has abandoned mental health services in the past, so maybe they are now trying to get back into it. He sees this as being bureaucratic with too much administration. He also wants to know what happens if they are unable to fill the correct amount of positions. He wants to be sure this is sustainable for the appropriate period of time. Dr. Conway said some of this was previously addressed with the Board. Regarding the distribution of work, this information was required as part of the application. The perception of a high administrative burden is correct — this is not something they wish to continue, but this is a pilot project, and those usually require more data tracking. Chair Unger sees the need for the team to get together with Mr. Henderson to answer some of his concerns. Mr. Inbody said he can compile relevant information for a briefing. Commissioner Baney wants to get on the bus as she knows there are people who are suffering and need help, and the community is already paying the bill for this. However, she wants it clear that the County can't backfill in the future. She would like clarity on how the hiring will happen and that they will be able to deliver on this part of it. Dr. Conway can't imagine going forward if they are not able to get the proper clinicians. The administrative burden is a cost of doing business. There are some unknowns, as there are with any demo project. If they are unable to fill positions, they will have to speak with the State on how to move forward. Strategically, he is in agreement. He wants it to work. Only about five out of the group would be administrative. Clinician positions will be harder to fill. Dr. Conway will detail how hiring will occur, with benchmarks. Commissioner Baney wants to be kept aware of what is happening and when. Minutes of Board of Commissioners' Work Session Wednesday, December 28, 2016 Page 9 of 11 3. Request for Approval of a Communications Position in the Health Department. Commissioner Baney is supportive of this specific communications position. This would free up part of Ms. Hale's time. Commissioner DeBone said that this might be very valuable in light of what is being considered with the pilot program. Commissioner Baney said that she'd rather Tom Anderson be a part of this discussion, so this will be addressed next Wednesday, Other Items. Commissioner Baney said she signed a State certification form for Neighbor Impact, as is required each year, and would like the Board to ratify this nunc pro tunc. BANEY: Move approval of a motion to ratify. DEBONE: Second. VOTE: BANEY: Yes. DEBONE: Yes. UNGER: Chair votes yes. Chair Unger indicated that the group "Reach" has submitted a proposal for grant funds. They were a part of the Boys & Girls Club at one point, but it is hard for them to meet the requirements of the overall institution. They need help in letting the community know what they are offering in the Redmond - Terrebonne area, and so they can pursue appropriate grant funds. BANEY: Move approval of granting them $3,000 under the events category. DEBONE: Second. VOTE: BANEY: Yes. DEBONE: Yes. UNGER: Chair votes yes. Minutes of Board of Commissioners' Work Session Wednesday, December 28, 2016 Page 10 of 11 Adjourn. Being no further discussion, the meeting adjourned at 3:10 p.m. A APPROVED this Day of �)XQ.UAbze 2016 for the Deschutes County Board of Commissioners. t1,,4-L U4�� - Alan Unger, Chair Tammy Baney, Vi Chair ATTEST: dA& Ov- 1,� Anthony DeBone, Commissioner Recording Secretary Minutes of Board of Commissioners' Work Session Wednesday, December 28, 2016 Page 11 of 11