2014-17-Minutes for Meeting December 11,2013 Recorded 1/2/2014 DESCHUTES RECORDS, COUNTY CLERK Cd �������
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QDeschutes 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
WEDNESDAY DECEMBER 11, 2013
Present were Commissioners Alan Unger, Tammy Baney and Anthony DeBone.
Also present were Tom Anderson, County Administrator; Erik Kropp, Deputy
County Administrator; and,for a part of the meeting, Scott Johnson, Sherri
Pinner, Linda Webb and Kate Moore, Health Department; Susan Ross,
Property and Facilities; and media representative Elon Glucklich of The
Bulletin.
Chair Unger opened the meeting at 1:35 p.m.
1. Discussion/Update regarding Sisters School-Based Health Clinic.
Scott Johnson explained that this is part of a system of centers, with the current
focus on Sisters, which is at a critical point regarding construction. They are
trying to show the financials going into 2015.
Kate Moore presented slides showing some of the key points. She stated that
there have been significant savings overall. No additional FTE's were needed.
Costs are covered by medical sponsorships and grants. Mosaic has been a good
partner, and St. Charles Medical Center promises to be also.
Scott Johnson said they are farther on the goal of sponsorships than they hoped
to be by this time.
Ms. Moore stated that regarding behavioral health services, they have secured
additional funding from the State for four FTE's, and this should be sustainable.
Mr. Anderson asked if they address just certain behavioral health issues. Ms.
Moore replied that they see more than typical youth issues. They see students
with suicidal tendencies, neglectful parents or parents involved in substance
abuse, family dysfunction, and bullying issues. It is not all related to poverty.
Minutes of Board of Commissioners' Work Session Wednesday, December 11, 2013
Page 1 of 7
They are working to change ideas about the stigma of accessing behavior health
assistance. Funding for this project is for 18 months.
Mr. Johnson stated these are the first in the flurry of grants applied for recently
that have been awarded. He said that Judith Ure put a lot of work into these
grants. There were about 15 grants written and the County got a huge amount
of the total allocated for the State.
Ms. Moore then went over the partnership list.
Linda Webb explained expanded services, including adult access, a public
health nurse at each center, dental screenings, establishing Teen Advisory
Groups for peer support; and increasing access and understanding of Cover
Oregon.
Ms. Moore gave an overview of the Sisters clinic. People assume Sisters is
wealthy, but there is a level of poverty there like in other places. They need
space for confidential consultations and other services.
Ms. Pinner distributed a handout detailing the revenue, expenses and other
information on the School Based Health Centers into Fiscal Year 2015. Most
costs have been reduced, but there will still be a need for general fund dollars.
Ms. Moore feels the potential is there to reduce the costs, but they need to build
on sustainability.
Mr. Anderson asked if sponsorship from the hospitals is included in these
figures. Ms. Moore said that in Sisters, St. Charles would cover staff costs for
two people. They are working on an agreement now. The hope is to have the
centers be self-sustainable through partnerships. The agreements are not all
signed yet, so they are being cautious. The agreement with Lynch School,
which is break-even, is for grant funds to keep things going.
The key component is outreach; not necessarily the medical role. They want to
be integrated and provide for overall public health. Mr. Johnson said providers
do more outside of the budget. Ms. Moore added that no one is denied services
at the SBHC; this is the State model.
Ms. Pinner noted that the new grants are not included in the handout. There is a
contract between public health and behavioral health.
Minutes of Board of Commissioners' Work Session Wednesday, December 11, 2013
Page 2 of 7
Chair Unger stated that they apparently are changing the model, but are saving
in some of the areas through partnerships. Ms. Moore said they hope to end up
budget neutral. It is hard to compute using the fiscal year model since not all
partners will come on board at the same time. She is pleased with the way it is
going, but most of all with the level of services they are able to provide.
Ms. Ross said that Advantage Dental in Sisters is building out their part of the
new structure, at their own cost.
Ms. Moore stated that in Sisters they were required to either remodel a building
or build new. Grant funds were obtained for the first part of the project. Ms.
Ross said McKenzie Development Group has donated property. The assisted
living center was to be the anchor tenant and would have put in the road and
utilities before now. However, they were unable to go forward at the time, and
the County cannot do anything without the infrastructure being handled.
The grant was extended, but expires in June. January 1 is the drop-dead date
for a commitment.
Commissioner Baney is concerned about increased costs. She asked if there
could be lot line adjustments. Ms. Ross stated that $1 00,000 was already
transferred, but there are additional funds needed and nothing was budgeted yet.
At this point, the cost estimates for the work need to be addressed.
The parcel needs to be segregated out through a partition. Instead of a platted
subdivision, the County's property would be partitioned out. The utility
upgrade requires oversizing for future growth. The power installation cost was
more than expected, at $70,000. The developers are willing to talk about a
reimbursement in the future as the properties are purchased and structures
established. This also needs to have a time limit for the reimbursement. She
will find out if there can be security established against the properties.
Mr. Johnson said that other services might be needed. They have to serve low
income, low risk populations.
Ms. Webb said if they couldn't move forward on the Sisters site, they would
have to relinquish the grants. Ms. Ross said they have spent about $100,000 on
design and other pre-construction work.
Mr. Johnson said that some funds would come out of a behavioral health fund
for the Oregon Health Plan. They cannot charge rent per the terms of the grant.
Minutes of Board of Commissioners' Work Session Wednesday, December 11, 2013
Page3of7
Commissioner Baney is very supportive of services in the Sisters area.
However, she is concerned about the resulting costs and what the budget
committee will decide. She is not sure that the partners will support these costs
at the level anticipated. She did not think the County would end up in this
much of a support function.
She added that the County might be best suited as a partner and not the lead
role. If the State grant is lost, to perhaps the CCO's who might support to
existing clinics, a system of services will be expected and the County will be
have to provide them. A lot of this falls into the health care arena as a
fundamental piece for coordinated care. She is worried about the long-term role
and commitment. She feels the Budget Committee will look to the County
being in more of a supportive role.
Ms. Moore said that Lynch School is the model they hope to replicate. They
anticipate having sponsorships on several of the schools this year, while
remaining certified to enable them to get grants. If Mosaic had not experienced
so much fast growth, they would have already been involved at Ensworth
School. Her preference is to hand these off to medical providers and let them
own the staff, with the County providing core County health services.
Mr. Johnson said that medical expansion of Medicaid will happen in January,
and the big ideas have been accurate. What is hard is changing direction
quickly. A 30% cut and nailing down medical sponsors to him is a good start.
Commissioner Baney was surprised about the level of contributions. There was
a hitch in the investment to start, though. They apply for grants to plan and line
up a medical sponsor, but there will be start-up costs.
Ms. Moore said it would be like Lynch School. They will not do business as
they have in the past. They ask the sponsor ahead of time whether to go out for
the planning grant, so that they have a commitment.
Commissioner Baney talked about Sisters and La Pine. She asked if this is a
shift in how revenue is spent or in increased funds. She wanted to know if the
same level of services will be provided, but is just being shown differently. It
could equate to a savings if this is the case.
Mr. Anderson asked if the same personnel are being used but just in a different
location. Commissioner Baney asked if there is a necessity, if they are not able
to provide the services that they should.
Minutes of Board of Commissioners' Work Session Wednesday, December 11, 2013
Page 4 of 7
Ms. Ross stated the net costs might be a lot lower. Ms. Moore stated that years
ago the line items were handled differently. They do not do childhood
immunizations at Courtney; they are done at SBHC, so they can give full
primary care. They tried WIC in Sisters without a building, but it did not work
out. They can quantify the need.
Mr. Johnson stated the charging out of indirects is being handled differently, to
get at the true costs of service. This showed a jump but it really has gone down.
Commissioner Baney asked if there are services that the County needs to
provide in these locations. It may be a real positive to do this work in the
communities. The priority is providing health services, but it appears to be an
added cost. It may not be an added cost after all, if the clients are coming to
Bend but could benefit from the same services in their community. By
providing these in a SBHC environment with partners, the contribution may
actually be much lower than if the County had to establish its own building and
space.
Mr. Anderson noted that this also means coordinated and integrated services.
Mr. Johnson stated that this kind of program does not exist anywhere else in
Central Oregon. Ms. Moore said there are a lot of opportunities at the Sisters
site for partnerships.
Commissioner Baney said that they need to tell the story differently. Chair
Unger stated that this is what the Budget Committee did not know at the time.
Mr. Anderson said that to be fair, they need to make it clear that the services
have shifted and they are elevating and coordinating the level of service. This
should continue to shrink costs.
Mr. Johnson stated that the contribution to the budget needs to show
proportional benefit to the Sisters part of the County. Commissioner Baney
said this gets them back to the core services the County is to provide. It needs
to be told differently.
Ms. Ross recommended Fund 142 be used for the infrastructure expenses.
There is a sufficient balance in that fund, and future reimbursements would go
back into that fund.
The Commissioners said they want to move forward with this project, but are
expecting the story to be told differently to the Budget Committee, so that the
general fund transfer can be clarified.
Minutes of Board of Commissioners' Work Session Wednesday, December 11, 2013
Page 5 of 7
2. 9-1-1 Staffing Request.
This item was removed from the agenda.
3. Other Items.
Executive Session, under ORS 192.660(2)(e), real property negotiations.
BANEY: Move approval of the direction given to Ms. Ross regarding the
Bethlehem Inn.
DEBONE: Second.
VOTE: BANEY: Yes.
DEBONE: Yes.
UNGER: Chair votes yes.
The Board received a ballot from the Sisters Chamber of Commerce, asking them
to vote for three of the five candidates for their board.
BANEY: Move that Commissioner DeBone decide the Sisters Country Board of
Directors' ballot selections on behalf of the County.
UNGER: Second.
VOTE: BANEY: Yes.
DEBONE: Yes.
UNGER: Chair votes yes.
Discussion took place regarding a date for the annual Board planning retreat.
Monday, February 3 will not work due to an additional meeting schedule at AOC.
Another date will be found.
Bev Clarno does not want to be reappointed to the Fair Board. Jerry Andres was
recommended and is willing. There is no formal process needed for this
appointment, although the Board has done a more formal selection in the past.
Chair Unger said he likes Mr. Andres and feels he has good business acumen and
would do a good job. Commissioner Baney agreed, but feels this should be opened
up to the community to see if there is other interest, to be fair to all.
Minutes of Board of Commissioners' Work Session Wednesday, December 11, 2013
Page 6 of 7
Mr. Anderson explained that contractor Del Barber plows parking lots and is an
excavator. Most businesses allow snow to be piled in a corner of their lot.
However, Costco wants the snow gone. Years ago, Mr. Barber was allowed to
collect the snow and put it on land behind the Road Department. There was no
arrangement for compensation. Timm Schimke was asked to monitor this and
oversee the agreement with Mr. Barber.
Apparently there is a problem with debris, such as litter and rocks, being deposited
along with the snow. Chris Doty of the Road Department is not happy having to
commit staff time to clean up the site, and would prefer the contract be terminated.
Mr. Anderson asked if the Board objects to canceling the agreement. They could
tell him this is the last year and to find another location next year. Alternatively,
they can wait until after the last snow so that maybe he will arrange for cleaning up
the site first.
The Board agreed to cancel the arrangement, but to wait until after the last snow to
do so. They asked that the contract be checked for terms regarding notice.
The Board is to meet with the Sisters City Council on Thursday, January 2. Topics
of discussion could be the airport and the School Based Health Center.
Being no further items discussed, the meeting adjourned at 3:45 p.m.
DATED this /b " Day of 2013 for the
Deschutes County Board of Commissioners.
Alan Unger, Chair
/
m g aney, e Chair
ATTEST:
(17b114kuu: Anthony DeBone, Commissioner
Recording Secretary
Minutes of Board of Commissioners' Work Session Wednesday, December 11, 2013
Page 7 of 7
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t.x. 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., WEDNESDAY DECEMBER 11, 2013
1. Discussion/Update regarding Sisters School-Based Health Clinic —Scott
Johnson
2. 9-1-1 Staffing Request—Erik Kropp, Rick Silbaugh, Sara Crosswhite
3. Other Items
PLEASE NOTE:At any time during this meeting,an executive session could be called to address issues relating to ORS 192.660(2)(0),real
property negotiations;ORS 192.660(2)(h),litigation;ORS 192.660(2)(d),labor negotiations;or ORS 192.660(2)(b),personnel issues;or other
issues under ORS 192.660(2),executive session.
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. If you have questions regarding a meeting,please call 388-6572.
Deschutes County encourages persons with disabilities to participate in all programs and activities. This event/location is
accessible to people with disabilities. If you need accommodations to make participation possible,please call(541)388-6571,or
send an e-mail to bonnie.baker @deschutes.org.
12/11/2013
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CENTERS
'DATE 12-1 1 -1 3
BOCC asked
...... ...............
Reduce county general funds
Add medical sponsorships
Partner with community organizations
1
12/11/2013
Our Response
Advocated for increased state support -additional $41,000
for system
Acquired medical sponsor at Lynch (Mosaic)
Gained planning grant for a Bend HS -$30,000. No
additional costs -medical sponsor committed to the new site
(Mosaic).
Gained medical sponsorships starting 7/1/14 at Ensworth
(Mosaic) Sisters and Redmond HS(St Charles).
Future sponsorship La Pine (La Pine Community Clinic FQHC)
Secured additional funding from state SBHC for 4 BH FTE
assigned to certified SBHCs and for BH focused projects
($846,830)or $ 564,553 annually
Partnerships
Advantage Dental St Charles Health System
FAN Mosaic Medical
Kemple Clinic La Pine Community Health
Redmond School District Center
Bend/ La Pine School District Secured medical sponsorship
Sisters School District
for Gilchrest
Klamath Public Health and
The Center (concussion
School District
screening)
OSU-Snap program Sisters Leadership Forum
FAN steering committee
Oregon Youth Challenge
2
12/11/2013
Expanded Services
Public health nurse at each SBHC to network with schools
Behavioral health - all sites
Adult access at Lynch
Liaison/increased access to Cover OR
WIC at Sisters SBHC
Expanded oral health screenings, fluoride varnish, sealants,
referral to dental home at Sisters-expand to Lynch ES and
La Pine ESs
Built Teen Advisory Groups at Sisters, La Pine and RHS who
are peer connectors to SBHC-healthy relationship work
La Pine teens visited the Legislature last year
School District Contributions
Space
Janitorial
Outreach, publicity
41116, 4t
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Sisters Building
Designated contact a
tt
re 6 as 4
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3
12/11/2013
Sisters New Building
Parity of county services to North county
WIC
Space for BH adult and youth
Expanded adult access to primary care
Increased dental access to adults, youth
Parent-Child Interactive Therapy in Sisters
Strong supportive school partnership
The Ask
Land donated
HRSA grant $500,000
Recommend we go forward
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