Loading...
2017-455-Minutes for Meeting June 14,2017 Recorded 8/4/2017Recorded in Deschutes County Nancy Blankenship, County Clerk Commissioners' Journal CJ2017-455 08/04/2017 8:52:42 AM Illl11uiiiimuiiumiiuii For Recording Stamp Only 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 Allen Conference Room WEDNESDAY, JUNE 14, 2017 Present were Commissioners Tammy Baney, Anthony DeBone and Phil Henderson. Also present were Tom Anderson, County Administrator; Erik Kropp, Deputy County Administrator; and Sharon Ross, Board Executive Secretary. No representatives of the media were in attendance. CALL TO ORDER: Chair Baney opened the meeting at 2:21 p.m. ACTION ITEMS 1. Consideration of Lease with WH Pacific James Lewis, Property Manager, Dave Inbody and Chris Weiler from Health Services presented the item for discussion. The Board directed the department to respond to various questions regarding the Certified Community Behavioral Health Clinic (CCBHC) as well as the proposed lease for office space on Columbia Street. A memo was provided answering those questions and staffing was reviewed. Commissioner DeBone inquired if the CCBHC grant was going to cover the staffing needs. Dave Inbody stated the department hasn't received the funding yet and based on money projected we would identify money to spend to the lease. Space considerations were Minutes of Board of Commissioners' Work Session June 14, 2017 Page 1 of 4 reviewed. When reviewing space needs it made more sense to the department to lease rather than remodel. Question raised whether services had been expanded. Mr. Inbody stated the department is providing service with the existing staff and have not seen a significant increase yet. Commissioner Baney stressed the importance of providing services to our community and for the expanded service and her concern is we would not duplicate what is provided today. Mr. Inbody stated that is not our intention. Commissioner Henderson expressed his feeling that the Board seems to be the last to know what the Health Department is doing with this process noting the CCBHC funding stream was not sold to us that way. He also stated the department told the Board about hiring clinicians but the hiring emphasis has been on administrative personnel. The department has filled two clinicians but have all administrative staff positions filled. What happens if you run out of money. Mr. Inbody stated the administrative staff would go away if the program was not be fulfilled or if the money is no longer there. The positions were reviewed and the employment offer letters state a limited duration of two years. Commissioner Baney inquired if the employment offers and the position descriptions had been reviewed by the legal department. Mr. Inbody noted the department went through HR. Commissioner Baney recommended the review with Legal. Discussion held whether to move forward or not. The conversations regarding services provided are unclear at this time and seems to have evolved to something different from the first conversations. The Board wants to see success with the program and wants to ensure community services. The original proposal included expanded services to the community. Discussion held on space needs. Mr. Lewis commented it was challenging to find a space to lease for a two-year term. Commissioner Baney inquired on the amount of clinical exam rooms necessary and the process of converting the space to the clinical design. Converting to office space isn't difficult but if needing to take it back it is a significant expense. The possibility of sharing space with Mosaic was considered. Commissioner DeBone inquired of the future of behavioral health and public health services. Mr. Inbody commented there were unknowns and the types of services may change. Commissioner Henderson expressed concerns with different locations for the staff. Commissioner Baney inquired if the CCBHC contract could be built for cost of space for CCBHC related services. Mr. Inbody responded yes. Commissioner Baney inquired if the department would be able to cover the costs for the CCBHC program to move staff through this program. Mr. Inbody reviewed the quarterly reporting abilities through the program. Minutes of Board of Commissioners' Work Session June 14, 2017 Page 2 of 4 Commissioner Henderson excused himself for another scheduled meeting at 3:39 p.m. Commissioner Baney inquired if the ask was to approve the lease as she is hesitant because two years down the road our needs could be something different and this would only buy time. Commissioner DeBone agreed commenting on the possibility of growing out of the space. Commissioner Baney inquired on converting space at the old Johnson Brothers building. The Board stated they inclined to move forward with the lease but the team that moves to this leased space is a temporary move. Commissioner DeBone requested there would be some reporting documentation showing the dollars are used for the betterment of the community. DEBONE: Move approval of Documents No. 2017-159 and 2017-324 BANEY: Second VOTE: DEBONE: Yes HENDERSON: Not present - Excused BANEY: Chair votes yes. Motion carried. At the time of 3:44 p.m., the Board took a short recess and reconvened at 3:53 p.m. At the time of 3:53 p.m., the Board went into Executive Session under ORS 192.660 (2) (e) Real Property Negotiation and ORS 192.660 (2)(d) Labor Negotiations. The Board came out of Executive Session at 5:56 p.m. Note: Commissioner Henderson was present at 4:24 p.m. OTHER ITEMS: • County Administrator Anderson noted the scheduled Joint Meeting with the City of Redmond next Tuesday. Included on the agenda is a discussion on the homeless camps and James Lewis, Property Manager is working on a management plan with various agencies. Discussion held on a road closure and gate installation for the property in question. Mr. Lewis stated the City of Redmond is pushing for a formal eviction and public notice will be announced regarding the road closure. Mr. Lewis noted the Road Department could place boulders blocking vehicle access and installing locking gates so Minutes of Board of Commissioners' Work Session June 14, 2017 Page 3 of 4 emergency personnel could get back there if needed. Another item on the agenda is the planning and update on the solar eclipse event. • NACO Conference: This year's annual conference will be held in Columbus Ohio in July. • July BOCC Meetings: County Administrator Anderson inquired on the meetings for BOCC during the July 4th holiday week. At this time, there are no agenda items and Commissioner DeBone is scheduled to participate in Grand Jury for the month. The meetings on Monday and Wednesday will be held if emergency items arise otherwise the first July meeting is July 12. OTHER ITEMS: None ADJOURN: Being no further discussion, the meeting adjourned at 6:11 p.m. DATED this .0'16 Day of 2017 for the Deschutes County Board of Commissioners. ATTEST: '<ecording Secretary C_Av Tammy Baney, Ch is .06 Anthony DeBone, Vice Chair Philip G. H erson, Commissioner -- Minutes of Board of Commissioners' Work Session June 14, 2017 Page 4 of 4 0 Deschutes County Board of Commissioners 1300 NW Wall St, Bend, OR 97703 (541) 388-6570 — Fax (541) 385-3202 — https://www.deschutes.org/ WORK SESSION AGENDA DESCHUTES COUNTY BOARD OF COMMISSIONERS 1:30 PM, WEDNESDAY, JUNE 14, 2017 Allen Conference Room - Deschutes Services Building, 2ND Floor — 1300 NW Wall Street — Bend Pursuant to ORS 192.640, this agenda includes a list of the principal subjects anticipated to be addressed at the meeting. This notice does not limit the ability of the Board to address additional subjects. Meetings are subject to cancellation without notice. This meeting is open to the public and interested citizens are invited to attend. Work Sessions allow the Board to discuss items in a less formal setting. Citizen comment is not allowed, although it may be permitted at the Board's discretion. If allowed, citizen comments regarding matters that are or have been the subject of a public hearing process will NOT be included in the official record of that hearing. Work Sessions are not normally video or audio recorded, but written minutes are taken for the record. CALL TO ORDER ACTION ITEMS OTHER ITEMS 1. Consideration of Lease with WH Pacific 2. EXECUTIVE SESSION: under ORS 192.660 (2) (d) Labor Negotiations and ORS 192.660 (2) (e) Real Property Negotiations These can be any items not included on the agenda that the Commissioners wish to discuss as part of the meeting, pursuant to ORS 192.640. At any time during the 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), litigation; ORS 192.660(2)(d), labor negotiations; ORS 192.660(2)(b), personnel issues; or other executive session categories. Executive sessions are closed to the public; however, with few exceptions and under specific guidelines, are open to the media. Board of Commissioners Work Session Agenda Wednesday, June 14, 2017 Page 1 of 2 ADJOURN riDeschutes County encourages persons with disabilities to participate in all programs and activities. To request this information in an alternate format please call (541) 617-4747. FUTURE MEETINGS: Additional meeting dates available at www.deschutes.ora/meetinacalendar (Please note: Meeting dates and times are subject to change. All meetings take place 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.) Board of Commissioners Work Session Agenda Wednesday, June 14, 2017 Page 2 of 2 MEMORANDUM To: Deschutes County Board of County Commissioners Tom Anderson Erik Kropp From: George Conway DeAnn Carr Date: June 8, 2017 Re: Answers to Follow -Up Questions on CCBHC Thank you for the opportunity to share additional information regarding the Behavioral Health division's certification as a Certified Community Behavioral Health Clinic (CCBHC). The following is intended to provide answers to questions regarding hiring status, service delivery amounts and patterns, reimbursement, and other CCBHCs within Oregon. How many employees have we hired and for which specific jobs? What are the plans for further hiring? Please see attached document "CCBHC Additional Staff Requirements." This document was created as part of the December 28, 2016, presentation to the BOCC and has been updated to reflect the current status of the positions. Have we provided services to any citizens/residents of Deschutes County at this date within this program? How many and what type of things? Yes, we have provided services to residents of Deschutes County. Between April 1 and May 31, 2017: • 2,211 individuals served • 12,621 services delivered (11,622 were billable services and the remainder were non -billable) Services included individual therapy, family therapy, group therapy, skills training, case management, coordination of care, Assertive Community Treatment (ACT) services, peer support services, supported employment, community based wrap-around services, medication management, assessments, screenings, and psychiatric evaluations. Please see attached document "Number of Billable Services Provided for April and May 2017" for additional information. Answers to Follow -Up Questions on CCBHC June 8, 2016 Page 2 Have we received any reimbursement from the Federal/State Government for services given to date? If so, how much have we received and for what services? If not, when will we be paid, how much is anticipated and how will it be determined? Reimbursement will happen in two different ways: • For CCO enrolled OHP members: A quarterly reconciliation process is being used by the State. The process will occur 45 days after the end of each quarter. That will place the first quarter (April —June) reconciliation in mid-August. During April and May we have provided 7,447 eligible events. Calculating the actual reconciliation amount is complicated by not having gone through the process before and some uncertainty about at least two of the variables. Best estimate at this time is $300,000 over and above the capitation we receive for these two months. • For OHP members not enrolled in a CCO (called Open Card): We bill the State directly and they send us the $286.92 for each eligible event. Once we have fully billed for the 661 eligible events in April and May, we should receive $189,654.12 (this does not include the anticipated reconciliation funds which will add to the total). Are we going to provide services within existing facilities for the County as we discussed during the decision-making process? Yes, we have and will continue to provide services within existing facilities. Of the 12,621 services provided, 11,023 were provided at a Health Services facility. The remainder were provided in the community. Services provided in the community are considered eligible events under the designation of "outside the four walls" of the certified sites. How many other Oregon Counties or entities are doing the same program and what are they? Oregon's CCBHCs: 1. Cascadia Behavioral Health — private non-profit in Multnomah County 2. Columbia Community Mental Health — private non-profit; designated Community Mental Health Program (CHMP) for Columbia County 3. Community Counseling Solutions — private non-profit; designated CMHP for Gilliam, Wheeler, Grant, and Morrow Counties (CCBHC designation appears to be only for Grant County) 4. Deschutes County Health Services — county run; designated CMHP for Deschutes County Answers to Follow -Up Questions on CCBHC June 8, 2016 Page 3 5. Klamath Basin Behavioral Health — private non-profit; designated CMHP for Klamath County 6. LifeWorks Northwest — private non-profit in Multnomah and Washington counties 7. Mid -Columbia Center for Living — private non-profit; designated CMHP for Hood, Wasco, and Sherman Counties 8. Options for Southern Oregon — private non-profit; designated CMHP for Josephine County 9. PeaceHealth — private non-profit in Multnomah County 10. Symmetry Care, Inc. — private non-profit; designated CMHP for Harney County 11. Wallowa Valley Center for Wellness — private non-profit in Multnomah County 12. Yamhill County Health & Human Services — county run; designated CMHP for Yamhill County Is the budget roughly 2.9 million for one year or two years? Roughly 2.8 million for one year/each 12 months (5.6 million total for two years). H:\My Dauments\ADMINISTRATION \Board of County Commissioners \BoCC Agenda Requests \CCBHC Implementation Status Report 05.22.2017\CCBHC Follow Up Q and A06.14.2017 \ Response Document 6-8.17.docx CCBHC Additional Staff Requirements Through a needs assessment, developed as part of the CCBHC review process, it was determined that in order for Deschutes County Health Services to meet the requirements of a CCBHC, 29 additional employees are needed. The following is a breakdown of the necessary positions: Clinical Positions (16) • 3 Psychiatrists/Psychiatric Mental Health Nurse Practitioners—These positions will enable increased outpatient services to be provided, including the expansion of child psychiatry services. o These positions will likely be filled through our contract with Iris Telehealth due to the national shortage in Licensed Medical Practitioners. The services are delivered via secure videoconference, and we contract with Iris Telehealth for a number of hours for a specified period of time. • 3 Public Health Nurse Is —These positions will support increased outpatient and medication related services o Still recruiting. • 3 Behavioral Health Specialist IIs —These positions will provide expanded outpatient services, including services for veterans and older adults o Two of the three have been hired. The older adult team clinician is still being recruited — requires a specific type of licensure which increases the duration of the recruitment. • 2 Behavioral Health Specialist Is —These positions will provide expanded outpatient services and supports o In the interview process for both positions. • 4 Peer Support Specialists —These positions will provide additional outpatient services and supports o Will be recruited this summer. These positions are required for all CCBHC certified sites. We have had discussions with the State regarding holding off on the recruitment until summer in hopes that the County's Classification and Compensation Study would be concluded and the State accepted our proposed alternate timeline. • 1 Quality Improvement Specialist —This position will support quality improvement efforts and ensure compliance to CCBHC clinical requirements o Interviews completed, offer made to internal applicant. BOCC Handout: Staffing Requirements 12-28-2016 Updated: 6-8-2017 Operational Positions (7) • 1 Management Analyst — This position will address CCBHC reporting requirements o Position filled by internal applicant. • 1 Administrative Analyst — This position will address increased electronic health record needs o Position filled by internal applicant. • 1 Administrative Assistant — This position will address client referrals and assist will OHP registration o Position filled. • 1 Patient Account Specialist 11 —This position will provide insurance -related expertise providing guidance and support to clients and staff, most notably for commercial insurance o Position filled by internal applicant. • 1 Patient Account Specialist II —This position will address increased billing obligations associated with CCBHC o Current part time employee increased from 0.50 FTE to 0.80 FTE instead of hiring additional staff. • 1 Senior Accounting Technician — This position will addressed increased fiscal requirement due to CCBHC o Position filled by internal applicant. • 1 Health Services Administrative Specialist I —This position will enable front office coverage during non-traditional hours o Position posted but not yet filled. Administrative Positions (6) • 6 Senior Secretaries — These positions will provide support to clinical staff and programs across five (5) sites in order to meet CCBHC requirements (e.g., tracking documentation/evaluation deadlines, data collection, generating program and staff specific reports, etc.) o Five out of six hired. The sixth position is designated for the Crisis team/Stabilization Center. BOCC Handout: Staffing Requirements 12-28-2016 Updated: 6-8-2017 Number of Billable Services Provided for April and May 2017 Visits by Procedure PSYCEIOTHEP,AE, 5651E5R574,N5 «NO 3EVELC.6ME57 ' 077!CE'PE7 AML PS+CH:7-HERP..Y • 576 PS.C+117,7R,CCPAGNO.S7:C 5555 503 CASE ,,IANAGEMENT 543 COMPREHEEISVE WU-15105 SERV -E,65 ' , 421 (0MMI.17.77,-55SE 35555.55005 0 SEEN .55.5 ; • 374 AE00:C0MM11N55EA5ME705 , „371 SELE-HELPIPEERSERV725.1! 219 35025 75517071-157507 05,Cr-10EOUCA7IONALSERV.CE 214 ACEPrire THERAPY ENV,305E.15t.17,71. !11757VE17710N, 0E0551 55770555, PSYCH 75715177 ! - 177 955177 105 1755065 AND 7901471 164 SUPPOR7EE EMPLO,ME177 ! 1715.5 7E7E5V.E7775N SEP \PCE 757 'EITERP5E7A7 0t4153PLANA7505 RES5L71 55057 57R,C".1EOICAL EYAM/pROC _20 55 .-745.05751. HEAL` 5156517.7.K, '00575011755 61051173 EOP 590 12:05 30 ,E410 COMP5.E315IISNE MUL7 0!31 . 99 55755035.7. -15.51000355175573315 - 31 MFD'C.A7.ON 055550071 51)75000 21 SCREE7:77G 70 DE7ERM'N5 THE4P5PE.WP 4055155 05 CONS 9ER37 ON Of AEI 1713 E:3.51 :6 34EE17A1HEAL, Ef .7.5555505317 571701.1.5-0SCAN 15 0111.7:.0104.7 PE7C,IC.rHE3.0, 6 7 7105.3,,LA5,1 5,1 U9 10513; QUAL 7a77/71511,1.0,1.1A717:TA7iVE, 5355000013505555' ! I 7355.70.35:05 555571.1,N11 A75PFS:DENTREV,EW ! 1 0E431 050,151707 5E77,3 Ep511575071 !7. 4110530. 560/06 DRUG 755E15051r 1 16:4 41!:,1 501 1010 1531 20.7+7 2501 517.0 3502 53317.) 4510 CCBHC Overview Clients by Age Client by Deportment '7 t" Clie,Its by Payer 69' Date Range Distract Cher As 2211 cii—t 12621 Avci Vit P_ Cheat Clients by Fayel 5.71 "Please see additional sheet for payer breakdown for Veterans VA Payers Self Pay Medicare Medicaid Veteran Insurance Breakout 12 26 There were 45 veterans who received service in April or May of 2017; 58% of these veterans had Medicaid. Health Services Facility & Staffing Considerations In spring 2014, a Health Services facility utilization plan was presented to the Board of County Commissioners. This plan provided five means to address the anticipated increase in staff of 16.80 FTE through FY 2015. At that time, staffing was projected to be 260 employees on July 1, 2014. Health Services had 159 offices and 25 cubicle spaces for staff. Here is the breakdown of staff by facility provided at that time: Location Employees Offices Cubicle Spaces Other Main Clinic (Courtney)* 170 86 21 2 Records Rooms; 2 Front Desks DCDC 37 30 0 Front Desk WSSB 27 21 4 Front Desk Mike Maier 7 6 0 Front Desk Becky Johnson Center 7 7 0 Front Desk Gateway (Redmond) 7 4 0 La Pine 5 5 0 TOTAL 260 159 25 *Includes 12 SBHC and KIDS Center staff. Means Identified in 2014 to Address Growth 1. Remodel Annex (now DCDC) to meet growth of Intensive Adult Services and provide clinical space for Mosaic co -location [REMODEL COMPLETED IN 2014] 2. Find a new location for Behavioral Health services in Redmond to replace Gateway Building — North County Hub located on Antler Road [PURCHASED IN 2014] 3. Remodel Wall Street Services Building to address Intellectual & Developmental Disabilities expansion, accommodate Intensive Youth Services and Clinical Services & Sexual Health program [REMODEL COMPLETED IN 2016] 4. Assign full-time staff to La Pine and remodel South County Services Building [LA PINE REMODEL COMPLETED in 2016] 5. Utilize space at Mike Maier Building vacated by CASA and currently occupied by United Way — In 2016, existing office space converted to enable three staff to work in offices previously occupied by two or one. [NOT PURSUED] Current/Future Considerations 1. During FY 2017, these additional positions were added: a. Environmental Health Specialist II (+1.00 FTE) added with funds from increased fees. b. Jail Diversion/Crisis Forensic Team (+4.00 FTE) funded through Oregon Health Authority c. Diabetes Prevention Program (+1.00 FTE) funded through Central Oregon Health Council d. Perinatal Care Continuum (+3.50 FTE) funded through Central Oregon Health Council e. Living Well program (+1.00 FTE) funded through Central Oregon Health Council 2. The Clinical Services & Sexual Health program (formerly Reproductive Health) moved 11 staff members from the Main Clinic to WSSB on October 1, 2016. 3. A needs assessment for CCBHC was submitted that included 29 additional positions. It may also require primary care services at all facilities, which would require remodeling at the North County Hub and providing space for these services at the Main Clinic. WSSB, DCDC and South County Hub are all either providing these services or outfitted to provide these services. 4. There have been discussions with the Sheriff's Office about establishing a Crisis Center on the public safety campus. The 12 members of the Crisis team would be moved from the Main Clinic to this facility. 5. The implications of Public Health Modernization will likely be determined in the 2017 legislative session. This could result in additional positions—most likely in Environmental Health, Communicable Disease and Emergency Preparedness. They would be located at the Main Clinic. 6. Discussion have begun with Redmond School District about WIC vacating the Becky Johnson Center. 7. Pharmacy services will be expanded at DCDC from a pharmacy technician dispensing medication to a full pharmacy. The cost for associated facility changes will be born by Genoa, the pharmacy vendor. Location Main Clinic (Courtney) DCDC WSSB Mike Maier Becky Johnson Center North County Hub South County Hub KIDS Center SBHC Crisis Center TOTAL Future Needs and Current Space Availability Employees Offices Cubicle Spaces 136.5 104 27 52 36 0 64 11 48 13 6 0 4.5 6 0 18.5 16 0 10.5 10 0 6 6 0 5 5 0 12 ? ? 322 200 75 Exam/Consult Front Desk 16 10 4 2 12 3 0 1 0 1 0 0 1 1 0 0 0 1 0 0 33 19 Suggested Means to Address Future Growth 1. Remodel of the Main Clinic on north end of first floor to enable the repurposing of the space vacated by the Clinical Services & Sexual Health Program. 2. Remodel or replacement of North County Building to address the potential need for clinical space for primary care services, larger lobby space, additional therapy spaces. 3. Increase in available office spaces at Mike Maier Building. 4. Increased use of tele -psychiatry to temper additional space or staff needs. Staff Comparison Location Courtney DCDC WSSB Mike Maier Becky Johnson Center North County Hub South County Hub KIDS Center SBHC Crisis Center TOTAL 2014 158 37 27 7 7 7 5 7 5 0 260 Current Future (1-2 yrs) 143 136.5 48* 52 51 64 12 13 4.5** 4.5 15.5** 18.5 9 10.5 6 6 5 5 0 12 294*** 322 *DCDC also contains co -located Mosaic Medical staff (5-7) and one pharmacy technician from Genoa. **There are two employees who split their time, one between Main Clinic and Becky Johnson Center and one between Main Clinic and North County Hub. Each is represented as a 1/2 employee. ***These 294 employees represent 258.45 FTE, 8 on-call employees and 8 contracted employees. Temporary employees and interns are not included. Facility Utilization as of July 1, 2017 2014 2016 Current Location Employees* Employees* Employees* Courtney 170 143 178 DCDC 37 48 54 WSSB 27 51 51 Mike Maier 7 12 10 Becky Johnson 7 4.5 4.5 North County Hub 7 15.5 16.5 South County Hub 5 9 12 KIDS Center 7 6 0 SBHC 5 5 5 TOTAL 260 290 331 Location Employees* Offices Cubes Front Spaces Exam/ Desk Available/ Consult (Needed) Main Clinic (Courtney) 167 104 27 10 (26) 16 DCDC 54 36 0 3 (15) 4 WSSB 62 11 48 4 1 12 Mike Maier 10 7 0 1 (2) 0 Becky Johnson 4.5 5 0 1 1.5 0 North County Hub 16.5 16 0 2 1.5 1 South County Hub 12 10 0 1 (1) 0 School Based Health Ctr 5 7 0 0 2 0 TOTAL 331 196 75 22 38 33 *Employees data represents regular, on-call and contracted positions. It does not include temporary employees, remote workers or interns. Employees working in two locations are represented as 0.5. Health Services Facilities Timeline • 2014 Q1 – Health Services provided County Administration with facilities utilization plan. This plan identified the need for additional facilities space due to staff expansion. Recommendations included the remodeling of the Downtown Clinic (DCDC), Wall Street Services Building (WSSB), South County Services Building, a new facility space in North County and expanded use of Mike Maier Building. • 2014 Q3 — DCDC remodel completed to address expanded Behavioral Health Adult Intensive Services and co -location with Mosaic Medical. • 2014 Q3 — North County Building located on Antler Road in Redmond purchased to replace leased space in Gateway Building to address need for expanded staffing in North County. • 2016 Q1 — Kaizen event held to discuss future needs for Main Clinic resulting in proposal to remodel first floor of Main Clinic. Discussions begin with Property & Facilities. • 2016 Q2 — $200,000 set aside in FY 2017 budget for Main Clinic remodel. • 2016 Q3 — WSSB remodel completed to address expanded needs of Intensive Youth Services (previously at Main Clinic), Intellectual & Developmental Disabilities and Public Health Clinical Services (previously at Main Clinic). • 2016 Q3 – Health Services provided updated facilities utilization plan to County Administration. This included the remodeling of the Main Clinic, assessment of North County facility needs, expanded use of Mike Maier Building and expanded use of tele - psychiatry. • 2016 Q3 – Initial planning began with Property & Facilities on Main Clinic remodel. • 2016 Q4 — South County Services Building remodel completed to address expanded, full-time staffing in La Pine/South County. • 2017 Q1 - Due to uncertainty in health care at the federal and state levels, Health Services, County Administration, and Property & Facilities agree that leasing space is a better option than remodeling Main Clinic. Health Services Facility & Staffing Considerations In spring 2014, a Health Services facility utilization plan was presented to the Board of County Commissioners. This plan provided five means to address the anticipated increase in staff of 16.80 FTE through FY 2015. At that time, staffing was projected to be 260 employees on July 1, 2014. Health Services had 159 offices and 25 cubicle spaces for staff. Here is the breakdown of staff by facility provided at that time: Location Employees Offices Cubicle Spaces Other Main Clinic (Courtney)* 170 86 21 2 Records Rooms; 2 Front Desks DCDC 37 30 0 Front Desk WSSB 27 21 4 Front Desk Mike Maier 7 6 0 Front Desk Becky Johnson Center 7 7 0 Front Desk Gateway (Redmond) 7 4 0 La Pine 5 5 0 TOTAL 260 159 25 *Includes 12 SBHC and KIDS Center staff. Means Identified in 2014 to Address Growth 1. Remodel Annex (now DCDC) to meet growth of Intensive Adult Services and provide clinical space for Mosaic co -location [REMODEL COMPLETED IN 2014] 2. Find a new location for Behavioral Health services in Redmond to replace Gateway Building — North County Hub located on Antler Road [PURCHASED IN 2014] 3. Remodel Wall Street Services Building to address Intellectual & Developmental Disabilities expansion, accommodate Intensive Youth Services and Clinical Services & Sexual Health program [REMODEL COMPLETED IN 2016] 4. Assign full-time staff to La Pine and remodel South County Services Building [LA PINE REMODEL COMPLETED in 2016] 5. Utilize space at Mike Maier Building vacated by CASA and currently occupied by United Way — In 2016, existing office space converted to enable three staff to work in offices previously occupied by two or one. [NOT PURSUED] Current/Future Considerations 1. During FY 2017, these additional positions were added: a. Environmental Health Specialist II (+1.00 FTE) added with funds from increased fees. b. Jail Diversion/Crisis Forensic Team (+4.00 FTE) funded through Oregon Health Authority c. Diabetes Prevention Program (+1.00 FTE) funded through Central Oregon Health Council d. Perinatal Care Continuum (+3.50 FTE) funded through Central Oregon Health Council e. Living Well program (+1.00 FTE) funded through Central Oregon Health Council 2. The Clinical Services & Sexual Health program (formerly Reproductive Health) moved 11 staff members from the Main Clinic to WSSB on October 1, 2016. 3. A needs assessment for CCBHC was submitted that included 29 additional positions. It may also require primary care services at all facilities, which would require remodeling at the North County Hub and providing space for these services at the Main Clinic. WSSB, DCDC and South County Hub are all either providing these services or outfitted to provide these services. 4. There have been discussions with the Sheriff's Office about establishing a Crisis Center on the public safety campus. The 12 members of the Crisis team would be moved from the Main Clinic to this facility. 5. The implications of Public Health Modernization will likely be determined in the 2017 legislative session. This could result in additional positions—most likely in Environmental Health, Communicable Disease and Emergency Preparedness. They would be located at the Main Clinic. 6. Discussion have begun with Redmond School District about WIC vacating the Becky Johnson Center. 7. Pharmacy services will be expanded at DCDC from a pharmacy technician dispensing medication to a full pharmacy. The cost for associated facility changes will be born by Genoa, the pharmacy vendor. Future Needs and Current Space Availability Location Employees Offices Cubicle Spaces Exam/Consult Front Desk Main Clinic (Courtney) 136.5 104 27 16 10 DCDC 52 36 0 4 2 WSSB 64 11 48 12 3 Mike Maier 13 6 0 0 1 Becky Johnson Center 4.5 6 0 0 1 North County Hub 18.5 16 0 0 0 South County Hub 1.0.5 10 0 1 1 KIDS Center 6 6 0 0 0 SBHC 5 5 0 0 1 Crisis Center 12 ? ? 0 0 TOTAL 322 200 75 33 19 Suggested Means to Address Future Growth 1. Remodel of the Main Clinic on north end of first floor to enable the repurposing of the space vacated by the Clinical Services & Sexual Health Program. 2. Remodel or replacement of North County Building to address the potential need for clinical space for primary care services, larger lobby space, additional therapy spaces. 3. Increase in available office spaces at Mike Maier Building. 4. Increased use of tele -psychiatry to temper additional space or staff needs. Staff Comparison Location 2014 Current Future (1-2 yrs) Courtney 158 143 136.5 DCDC 37 48* 52 WSSB 27 51 64 Mike Maier 7 12 13 Becky Johnson Center 7 4.5** 4.5 North County Hub 7 15.5** 18.5 South County Hub 5 9 10.5 KIDS Center 7 6 6 SBHC 5 5 5 Crisis Center 0 0 12 TOTAL 260 294*** 322 *DCDC also contains co -located Mosaic Medical staff (5-7) and one pharmacy technician from Genoa. **There are two employees who split their time, one between Main Clinic and Becky Johnson Center and one between Main Clinic and North County Hub. Each is represented as a'/2 employee. ***These 294 employees represent 258.45 FTE, 8 on-call employees and 8 contracted employees. Temporary employees and interns are not included. Health Services Lease —123 Columbia Street Office Space — Bend • Limited office space available to accommodate approximately 25-30 staff. • Approximately 9 available space options that fit initial search parameters — there are not many large office spaces available. • Visited 3 different sites that best fit the needs. • The rejected spaces either required tenant improvements (construction) or had space divided among floors and separate portions of the building. Others did not have adequate parking. • Limited number of owners willing to do a 2 -year lease (most want 5 years min.) • Existing lease rates for similar space are approximately $1.50/s.f. as base rate, with $0.50 to $0.60 for CAM's or NNN (similar space is approximately $2.00 to $2.10 /s.f. overall). • Owner was agreeable to lease space at the rates and timeframe proposed (2 - years at $1.55/s.f.) — this is approximately % of the going rate. • 7,500 s.f. is approximately 300 gross s.f. per person, including personal work station, conference rooms, copy/mail rooms and common areas (recommended average gross square footage per employee in a large office is 200 to 400 s.f. including personal work station and common areas). • Negotiated lease and sublease with tenant and building owner, presented to BOCC.