2018-125-Minutes for Meeting March 14,2018 Recorded 4/5/2018BOARD OF
COMMISSIONERS
1300 NW Wall Street, Bend, Oregon
(541) 388-6570
1:30 PM
Recorded in Deschutes County CJ2018-125
Nancy Blankenship, County Clerk
Commissioners' Journal 04/05/2018 9:00:46 AM
1111111111111111111111111111III
FOR RECORDING STAMP ONLY
WORK SESSION MINUTES
WEDNESDAY, March 14, 2018 ALLEN CONFERENCE ROOM
Present were Commissioners Tammy Baney, Phil Henderson and Anthony DeBone. Also present were
Tom Anderson, County Administrator; Erik Kropp, Deputy County Administrator; David Doyle, County
Counsel; and Sharon Ross, Board Executive Assistant. No representatives of the media were in
attendance.
CALL TO ' RR: Chair DeBone called the meeting to order at 1:33 p.m.
ACTION ITEMS:
1. Update from the City of Redmond on HB 4079 / Affordable Housing Project
Redmond Mayor George Endicott, Redmond City Manager Keith Witcoksy, and Planning
Manager Debra MacMahon presented this item for discussion. House BHI 4079
authorizes a process whereby cities may apply for state approval to utilize lands outside
of city limits for development of affordable housing. In this context the City of
Redmond is asking the County to convey to the City a 40 acre parcel of land owned by
the County. Applications for the pilot program are due June 1st ; annexation would
occur later.
The City has been in the process of reviewing roads and developments to fit within the
parameters of HB 4079. The goal is to create a complete neighborhood consisting of a
variety of household incomes. Land cost is the biggest barrier in creating affordable
housing. Mayor Endicott reviewed the framework plan for the parcel.
MARCH 14, 2018 BOCC WORK SESSION PAGE 1 OF 7
The development includes attached single-family homes, cottages, and open space.
The state goal is for 12 units per acre. The template will guide developers to design the
structures to appear like single-family homes. A small area will also include a
commercial structure for convenient store space. The design involves a series of loops
to access parks to provide a good neighborhood. The closest school is available via bus
transportation. There is a golf course, ballpark, and mufti -use park just north of the
property.
The City is required to set the vision and development requirements. The final
application will include the deed restrictions and list of developers. According to the
requirements of the house bill, there are points allowed for a narrow street for parking
on each side of the streets. However, the width required for emergency services
vehicles is wider than the program requirement. The cottage design of 1200 square
feet and below will be 20% of the development. The City has received requests for
smaller designs. The design is considered to meet the Redmond standard.
Commissioner Baney requested information on the demographics for the future. Ms.
MacMahon spoke on the Community Development Block Grant Program that provides
data of what is needed in the community. Mayor Endicott reported on the state of
income of the community shows 40% of their students are on the assisted lunch
program.
Ms. MacMahon noted they are working on Memorandums of Understandings of
interest for developers. There are market rate townhomes in the development.
Commissioner Henderson spoke on models of affordable housing and inquired on the
developer's designs and the process of the developer bids. The phases of the design
need to match the development code. After approval, the project can be phased and
managed by the City. The City has two years to annex the land into the urban growth
boundary. As part of the phased development, the utilities would be required to be a
to -and -through design. A master plan will sequence the development.
The land values for the parcel outside the UGB would be different then the value once
it is annexed with utilities, County Administrator Anderson noted this discussion of the
Board's decision on the a price for the parcel could be reviewed at an Executive Session
and since the City is on a timeline the discussion could be as early as this afternoon.
Commissioner Henderson commented he went to the property with Mayor Endicott,
2. "C.C.0.101"
Commissioner Baney explained the general history of the provision of Medicaid
MARCH 14, 2018 BOCC WORK SESSION PAGE 2 OF 7
services in Deschutes County and Oregon's transition to the Coordinated Care
Organization (CCO) model. The Governor put together a group of partners during the
time the Oregon Health Authority was being formed. A pilot project was created based
on the need with the partners that provide Medicare and Medicaid services. Senate Bill
204 set the structure of the Coordinated Care Organization for our region.
Present for the discussion from Pacific Source were VP of Medicaid Programs Lindsey
Hopper, Director of Central Oregon CCO, Leslie Newbauer, as well as Executive Director
of the Central Oregon Health Council Donna Mills, CEO of Best Care Rick Treleaven,
and Health Services Director George Conway. A slide presentation on Medicaid and the
history of Coordinated Care Organizations was given. (Presentation slides are attached
for the record).
Discussion held on the income threshold of Medicaid eligibility. CCO services are
provided for individuals on Medicaid and dual Medicaid and Medicare.
Discussion held on the state budget with a legislation sunset in the year 2021. There
are 16 CCOs within the state of Oregon. The local CCO governance structure was
reviewed explaining the community governance, joint management agreements, and
health council structure. The joint management agreements include payments for
operations, capped profits above 2%, reinvestment, and roles and responsibilities.
Commissioner DeBone inquired on the notation regarding the 2% profit mentioned
what is the pool of dollars and what are the profits? The state gives the global budget
and the providers are negotiated with and the claims are paid and if there is a profit or
shared saving. Commissioner DeBone suggested the term profit should not be used
based on health care being considered non-profit. Collaborative meetings occur twice
a month to review the metrics of the partners. Commissioner Baney commented on
the most recent legislative session and her concern of political challenges creating
reduction in the global budget even through there is hard work being done for our
community. Of the budget, the County receives approximately $8.5 million annually to
serve over 5,000 individuals per year with approximately 79% being Oregon Health Plan
Provider clients.
3. Approval of Proposed Reductions in Reproductive Health Clinic Services
Present for this discussion were Hillary Saraceno, Health Services Deputy Director and
Dr. George Conway. Public health assesses services to identify the community's needs.
This recommendation brought to the Board today was regarding reproductive family
planning services provided by the County. Health Services primary concern is to
provide services to their clients. The increase in health insurance available for clients is
MARCH 14, 2018 BOCC WORK SESSION PAGE 3 OF 7
one reason for the decreased level of patient visits to Health Services. As of April 1St the
state will implement a new contract mechanism to provide fee-for-service funding for
any health care provider offering reproductive health services to Title X clients
traditionally served. Title X is the federal family planning program element.
Health Services is requesting to reduce reproductive health services effective July 1,
2018. One recommendation is to keep the Redmond clinic open due to a lack of
services available in that community. The recommended changes only impact
reproductive health services and will not impact local public health clinical services.
Explanation of Title X grant provides funding for clients that are not Oregon Health Plan
clients. Providers in the area need to apply to be eligible for those funds.
Another recommendation of Health Services is to give proper notification to staff and
clients ahead of time to allow for a transition plan. Commissioner Baney commented
having the new agreement in place with Mosaic in the same building that should help
with the transition for the clients. Mosaic is not a provider eligible for Title X funding.
With the number of patient visits decreasing, in Bend last year there were 1600 visits
for a number of clients. La Pine had 43 clients that used the service last year. Health
Services will be in contact with the clients to help them with the transition.
Health Services ask of the Board is to approve the department's recommendation. The
number of staff involved in this departments services are hard to separate as it is
spread across other services. Staff will be absorbed into other services. Commissioner
DeBone supports the ask. Commissioner Henderson noted he would support if there
was more than one provider in the Bend area. Ms. Saraceno noted there is one
provider applying for the Title X funds but there are other providers for this service.
Health Services noted the necessity of providing these services but they are not
receiving reimbursement. If the Board wants Health to continue to provide the services
then they would require additional funding through the budget. Commissioner
Henderson explained he would like to see the budget and wants to make sure the
population is well taken care of before dropping this service. Dr. Conway noted this
information is prepared for the budget and is happy to share that information now with
the Board. Commissioner Baney noted 58% of service is not sustainable but we could
be mindful of services provided to the community and the possibly consider a phased
approach.
4. Discussion: Cohesive Strategy Coordinator
Joe Stutler, Senior Advisor presented this item for consideration. He noted the two
decisions he requests from the Board would be regarding the County's share of the
MARCH 14, 2018 BOCC WORK SESSION PAGE 4 OF 7
allocation and the approval of the request for proposal. Mr. Studer met with the Forest
Service and they have agreed to a contribution of $35,000 per year and have requested
an intergovernmental agreement instead of a memorandum of understanding. A draft
of a personal services contract was also provided to the Board. Mr. Stutter stated a
signed MOU has been received from Klamath County. Once the RFP is done, Mr.
Stutter will work with Finance. County Administrator Anderson noted this position
would be funded similar to Mr. Stutter's position. This would be an independent
contractor agreement and there is an expectation there is an annual contribution to
fund this position. Deschutes County will build this funding into the 2019 budget. This
approval would be for an on-going commitment from Deschutes County. The amount
requested of the County would never exceed the proposed contribution of $34,500.
Greg Bryant from the audience asked if this position would also be a lobbyist. Mr.
Stutter replied this position will do work within the five counties and the western region.
Commissioner DeBone noted the responsibilities of the position would be similar to
that of Project Wildfire. Mr. Stutter stated if we do this right it is a legacy opportunity for
the Board.
Commissioner DeBone commented Klamath County has been looking for this
leadership for some time.
HENDERSON:
BAN EY:
Moves approval of the funding
Second
VOTE: HENDERSON: Yes
BAN EY: Yes
DEBONE: Chair votes yes. Motion Carried
Mr, Stutter stated the Request for Proposal will be prepared this week to advertise for
the position.
OTHER ITEMS:
® County Sale of Demolition Landfill to OSU Cascades:
James Lewis, Property Manager presented a timeline for the sale of the Demolition
Landfill to OSU Cascades starting with the week of March 19th. Closing is scheduled for
the week of April 2nd. The land use review process with the City of Bend begins March
12' and is scheduled for City Council final deliberation and decision on July 11.
MARCH 14, 2018 BOCC WORK SESSION PAGE 5 OF 7
Commissioner Henderson inquired on the questions raised on the PPA. Mr. Lewis
reported OSU Cascades had made all of the requested changes.
• County Campus Property
Mr. Lewis also reported the County had purchased the old Johnson Brothers building
and now the adjoining property of the Lawrence Erwin, law firm office on Lafayette is
now up for sale. Mr. Lewis will bring information back to the Board in consideration of
extending the County campus.
EXECUTIVE SESSION:
At the time of 4:22 p.m., the Board went into Executive Session under ORS 192.660 (2) (e) Real
Property. The Board came out of Executive Session at 5:07 p.m.
OTHER ITEMS:
O Leadership Bend/Redmond: Whitney Hale, Public Information Officer reviewed the
slide presentation for the Commissioners for tomorrow's Leadership Bend/Redmond
class.
• Media Release: County Administrator Anderson asked for the Boards feeling on the
draft press release for 9-1-1 Director Steve Reinke's resignation. Once approved by the
Board, Mr. Anderson will send the media release to the local public safety chiefs to
review prior to the public release. Mr. Reinke's last day is the 9-1-1 employee banquet.
Mr. Reinke has done a wonderful job with the department and with the trust built with
the User Board. The Board approved the draft media release.
• Crosswater HOA: County Administrator Anderson spoke on Crosswater HOA's Friday's
board meeting. The Board suggested to send one Commissioner representative.
Administrative Intern Chris Ogren presented the presentation on Harper Bridge.
Commissioner Henderson will attend with Mr. Anderson and Mr. Ogren.
MARCH 14, 2018 BOCC WORK SESSION PAGE 6 OF 7
COMMISSIONERS UPDATE:
® Commissioner Henderson went to the Sunriver La Pine Economic Development
meeting yesterday.
ADJOURN
Being no further items to come before the Board, the meeting was adjourned at 5:33 p.m.
DATED this 721,0 Day of NA2018 for the Deschutes County Board of
Commissioners.
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CO:1= SECRETARY
ANTHONY DEBONE, CHAIR
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TAMMY RAN EY,
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MISSIONER
MARCH 14, 2018 BOCC WORK SESSION PAGE 7 OF 7
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, MARCH 14, 2018
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
1. Update from the City of Redmond on HB4079 / Affordable Housing Project - Mayor
George Endicott and City Manager Keith Witcosky
2. "C.C.O. 101" - George Conway, Health Services Director
3. Approval of Proposed Reductions in Reproductive Health Clinic Services - Hillary
Saraceno, Health Services Deputy Director
4. Discussion: Cohesive Strategy Coordinator - Joe Stutter, Senior Advisor
COMMISSIONER'S UPDATES
EXECUTIVE SESSION
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.
Board of Commissioners Work Session Agenda
Wednesday, March 14, 2018 Page 1 of 2
Executive sessions are closed to the public; however, with few exceptions and under specific
guidelines, are open to the media.
OTHER ITEMS
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.
ADJOURN
®®Deschutes County encourages persons with disabilities to participate in all programs and
®Deschutes
To request this information in an alternate format please call (541) 617-4747.
ati
FUTURE MEETINGS:
Additional meeting dates available at www.deschutes.orq/meetingcalendar
(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, March 14, 2018 Page 2 of 2
Recreation/Buffer
Housing Housing
Housing Housing
Entry Plaza
Commercial Service
Area w/Housing Above
Recreation/Buffer
Recreation/Buffer
Deschutes County Board of Commissioners
1300 NW Wall St, Bend, OR 97703
(541) 388-6570 — Fax (541) 385-3202 — https://www.deschutes.org/
AGENDA REQUEST & STAFF REPORT
For Board of Commissioners Work Session of March 14. 2018
DATE: March 9, 2018
FROM: George Conway, Health Services,
TITLE OF AGENDA ITEM:
"C.C.O. 101"
RECOMMENDATION & ACTION REQUESTED:
Presentation is for information only; no staff recommendation.
ATTENDANCE: Donna Mills, Executive Director, Central Oregon Health Council; Rick
Treleaven, Board of Directors, Central Oregon Health Council; Lindsey Hopper, Vice President
of Medicaid, PacificSource Community Solutions; George A. Conway, Health Services Director
SUMMARY: An orientation about how Coordinated Care Organizations (CCOs) work,
particulary our Central Oregon CCO.
As reported in the OHSU Evaluation of Oregon's 2012-2017 Medicaid Waiver:
A Medicaid demonstration waiver allows state Medicaid programs to test new approaches to
health care delivery and payment. In 2012, Oregon executed a five-year extension and
amendment to its Medicaid waiver with the federal Centers for Medicare & Medicaid Services
(CMS). Under the 2012-2017 waiver, Oregon committed to achieving two primary goals:
• Limit increases in per capita spending.
• Improve health care access and quality.
To achieve these goals, Oregon enrolled most Medicaid members in coordinated care
organizations (CCOs), a new type of Medicaid managed care organization. CCOs were locally
governed and accountable for health care access and quality among their members. Each
CCO received a global budget covering physical, behavioral, and oral health care, and was
accountable for managing all services covered by the global budget. In addition, CCOs could
receive bonus payments from a state incentive pool for improving specific outcomes. The
waiver provided CCOs with broad flexibility to carry out activities that would improve health
care delivery and payment consistent with the needs of their local communities.
Medicaid:
An Overview
Lindsey Hopper
VP, Medicaid Programs
Paci f icSource
IiLALI.I FLAN'.
Who is eligible for Oregon Medicaid?
Families with household
incomes up to 138% of the
Federal Poverty Level*
Aged, blind, or
disabled individuals
OHA determines eligibility.
*$16,100 individual and $32,900 for a family of four
Pregnant women
or children
1
Oregon Health Plan History
• Original 1115 waiver in 1994 created the Oregon Health Plan (OHP)
• Extended multiple times through 2007
• Demonstration waiver was restructured/expanded to create "Healthy Kids"
• Major overhaul and health system transformation 1115 waiver in 2012
• Bending the cost curve
• Improved access to care
• Renewal waiver application submitted in 2016
• Approved in January 2017
• Few policy changes
Oregon Health Plan Today...
• Coordinated Care Organizations (CCOs)
• 15 regional CCOs
• Managed care contracts
• 80-90% of OHP members
• Fee-for-service ("Open Card") coverage
• Services contracted -for and paid by Oregon Health Authority directly
• 10-20% of OHP members
2
Key Characteristics of CCOs
• Medicaid benefits and service are integrated and coordinated
• One global budget that grows at a fixed rate
• Quality metrics/standards for safe and effective care (QIMs)
• Regional Health Assessments and Regional Health Improvement Plans
(RHA/RHIP)
• Local governance and accountability for health and budget (Health
Council)
• Flexibility
OHP Coverage by The
Numbers
• Central Oregon —50,000
members
• 1 in 4 residents and half of
children in the Central Oregon
region
• 15-20% ethnic minority, largely
Latino and Native American
• Across Oregon, 2/3 of OHP
members have at least one
household member working
full time
Coordinated Care Organization Service Areas
1 [calth
3
CCO Governance Structure
• Community Governance
• Defined scope and roles
• Oversight
• Collaboration
• Joint Management Agreements
• Payments for operations
• Capped profit (above 2%)
• Reinvestment
• Roles and responsibilities
• Health Council structure
• 501(c)(3) organizations
• Articles, bylaws, and staffing
• Medicaid +
Central Oregon CCO
Structure
Health Council
Governing Board
1
Community Provider Finance
rAdvisorytoundl IEngagementPanel Committee
Central Oregon Health Council
Staff Members
• Donna Mills
• Rebeckah Berry
• MaCayla Arsenault
• Nikki Lemmon
• Kelsey Seymour
�+J Pad icSource
DperationsCoundl CCO Provider
Network
COIPA Medal Hospitals Dental Care
Providers Organizations
Mental Healtii Transportation
PacificSource Medicaid Staff:
• Lindsey Hopper, Vice -President of Medicaid Programs
Leslie Neugebauer, Director, Central Oregon CCO
• Molly Tarolt, Central Oregon CCO Project Coordinator
• Ralph Summers, Behavioral Health Manager
• Heather Simmons, Dental Program Manager
• Dr. Alison Little, Medical Director
• Dr. Mike Franz, Behavioral Health Medical Director
4
Questions?
Deschutes County Board of Commissioners
1300 NW Wall St, Bend, OR 97703
(541) 388-6570 — Fax (541) 385-3202 — https://www.deschutes.org/
AGENDA REQUEST & STAFF REPORT
For Board of Commissioners Work Session of March 14. 2018
DATE: March 9, 2018
FROM: Hillary Saraceno, Health Services, 541-317-3178
TITLE OF AGENDA ITEM:
Approval of Proposed Reductions in Reproductive Health Clinic Services
RECOMMENDATION & ACTION REQUESTED:
Staff recommend the Board of County Commissioners, as the Local Public Health Authority,
approve proposed reductions in Reproductive Health Clinic services.
ATTENDANCE: Hillary Saraceno, Public Health Deputy Director; George A. Conway, Health
Services Director
SUMMARY:
Oregon Reproductive Health (RH) Program Changes:
The passage of HB 3391 resulted in changes to the entities eligible to provide RH services under the
Public Health Program Element (PE) 41 Title X Federal Family Planning program. Starting April 1, the
state will implement a new contract mechanism to provide fee-for-service funding for any health care
provider offering RH services to Title X clients traditionally served exclusively by LPH departments (low-
income, un- and under -insured, etc.). At least one Bend provider has already applied to be eligible for
Title X funds.
Recommended Changes to DCHS RH Services: Deschutes County Health Services is
requesting to reduce RH services (birth control, pregnancy testing, reproductive health well visits and
gynecological services) effective July 1 2018. The recommendation is to limit all RH services to two
days a week in Redmond (an approximate 75% reduction in overall RH staffing and a reduction of two
days a week in Redmond). The recommended changes will only impact RH clinical services and will
not impact any other LPH clinical services (i.e., STD testing and treatment, immunizations, WIC, etc.),
and would increase capacity to provide STD investigation and partner services.
Local Public Health (LPH) Reproductive Health Services (v. 7 3/8/2018)
Oregon Reproductive Health (RH) Program Changes:
The passage of HB 3391 resulted in changes to the entities eligible to provide RH services under the Public
Health Program Element (PE) 41 Title X Federal Family Planning program. Starting April 1, the state will
implement a new contract mechanism to provide fee-for-service funding for any health care provider offering
RH services to Title X clients traditionally served exclusively by LPH departments (low-income, un- and under-
insured, etc.). At least one Bend provider has already applied to be eligible for Title X funds.
Recommended Changes to DCHS RH Services: Deschutes County Health Services (DCHS) is
requesting to reduce RH services (birth control, pregnancy testing, reproductive health well visits and
gynecological services) effective July 1 2018. The recommendation is to limit all DCHS RH services to two
days a week in Redmond (an approximate 75% reduction in overall RH staffing and a reduction of two days a
week in Redmond). The recommended changes will only impact RH clinical services and will not impact any
other LPH clinical services (i.e., STD testing and treatment, immunizations, WIC, etc.), and would increase
capacity to provide STD investigation and partner services.
Why we recommend reduction in RH services:
• As our community has seen an increase in the number of people with insurance and access to primary
care, our RH clinic has seen a marked decline in the need for safety net services (35% decrease in RH
client visits between CY 2014 and CY 2017).
• As of July 1, LPH will no longer be the sole RH service provider for low-income clients. It is not the role of
LPH to compete with other providers, it is to ensure preventive health services are available to all who
need them and to serve as the safety net for clients who are unable to access services elsewhere.
• Over the past several months, 73% of available RH clinic appointments were booked but 12% to 15% of
these appointments were no shows, so only 58% — 61% of those were completed. As patient visits have
decreased, program revenue has also decreased significantly ($204,000 in first six months of FY 2018, and
the deficit amount is increasing monthly).
• RH services in La Pine were discontinued earlier this year due to lack of utilization and because clients
are able to access, and have been accessing, the La Pine Community Health Center for RH needs.
A community assessment of available RH services, along with meetings with providers, has further
shown that Bend and La Pine clients can access RH services from other providers in Bend and La
Pine.
• Our STD rates have been increasing at an alarming rate while our RH clinic utilization has decreased.
The recommended changes in RH services will allow us to re -assign some of the existing staff to help
address this emerging health threat to our community.
5000
4000
3000
2000
1000
0
4323
PH Clinical Services (visits by type)
3975
3408
CY2014
C.Y 2015
masa RH Visits amma STI Visits
1264
674
CY 2016
IMMz
CY 20:1.7
RI I Speciality
2500
2000
1500
1000
500
0
If approved, next steps and considerations:
• If funding is secured for essential RH services in Redmond, develop a transition and communication plan.
• Transition plan will include ongoing patient navigation services to ensure clients receive timely and
appropriate RH services within the community, through community partnerships and referral systems.
PROPOSED REPRODUCTIVE HEALTH PROGRAM CHANGES
Conference of Local Health Officials (CLHO), July 20 2017
Section 5 of HB 3391
The Oregon Health Authority shall administer a program to reimburse for the cost of reproductive health
services (listed below) for individuals who can become pregnant and would be eligible for medical assistance if
not for their immigration status (i.e. undocumented).
• Well -woman care
• Counseling and screening for STIs
• Screening for breast and cervical cancer
• Screening and counseling related to the BRCA1 and BRCA2 genetic mutations, if indicated
• Abortion
• Voluntary sterilization
• Full -range of contraceptive methods
Current RH Proeram Structure
• Title X grant funds are currently distributed, via a funding formula based on clients served in the prior
year, to all LPHAs and two Planned Parenthood affiliates through Program Element 41. PE 41 outlines the
Title X procedural and operational requirements for the provision of family planning clinical services.
• Oregon ContraceptiveCare (CCare) funds are distributed on a fee-for-service basis to enrolled CCare
providers, including all LPHAs (except one), Planned Parenthood clinics, FQHCs, University health centers,
and other community-based clinics, via a Medical Services Agreement (MSA).
Pronosed RH Proeram Structure
Separate the provision of RH clinical services from PE 41. PE 41 becomes the mechanism to fund LPHAs for
core foundational program deliverables (not clinical services). A new contract mechanism, open to LPHAs,
provides fee-for-service funding for the provision of clinical services.
Provider type
Provider RH
Public Health
RH Clinical
Services
Provider
Eligible
entity(s)
LPHA only
Non -clinical
services?
Yes, including
outreach/education,
partnership
development,
quality assurance
and monitoring
Any, including No
LPHA, PP,
FQHC, CHC,
etc.
Clinical
services?
No
Yes, broad
set of RH
services
based on
Title X &
CCare
standards of
care
Fund type(s) Mechanism
Title X: grant PE 41
Title X,
CCare, & HB
3391: feefor-
service
Application based
on program
certification
standards.
Contract via MSA
or Provider
Enrollment
Agreement
Provider type
RH Specialty
Provider
Eligible
entity(s)
Imaging
centers,
abortions,
clinics, female
sterilization
providers,
vasectomy
providers
Non -clinical
services?
No
Kev Points about Proposed Structure
Clinical
services?
Yes, speciality
services only
Fund type(s)
HB 3391 fee-
for-service
Mechanism
Application based
on specialty
program
certification
standards.
Contract via MSA
or Provider
Enrollment
Agreement
• PE 41 would be amended to reflect non -clinical service deliverables, in support of the Reproductive Health
program; including key functions of the following public health foundational programs - prevention and
health promotion and access to clinical services. Specific activities might include: outreach and education,
and/or partnership development. Funding for LPHAs would be determined based on expectations set
forthin the revised PE 41. A funding formula would be developed in consultation with CLHO.
• LPHAs could choose to continue to provide clinical services through a separate RH Clinical Services Provider
Contract. All reproductive health services provided would be reimbursed on a fee-for-service basis,
regardless of the fund source (CCare, Title X, HB 3391). All reproductive health clients would be eligible for
services.
• A separate RH Specialty Provider Contract would be available for specialty providers for a specific set of
services (abortion, mammography, female sterilization, etc.).
Reproductive Health Program: Program Element 41 and HB 3391
Draft Proposal September 28, 2017, from Oregon Reproductive Health Advisory Board
Overview
Two processes occurring simultaneously:
• Revision of PE 41
• Restructuring of clinical services supported through the RH Program
Current State
Statutes related to reproductive health and LHDs:
ORS 435.205 The Oregon Health Authority and every local health department shall offer family planning and
birth control services within the limits of available funds. Both agencies jointly may offer such services. The
Director of the Oregon Health Authority or a designee shall initiate and conduct discussions of family planning
with each person who might have an interest in and benefit from such service. The authority shall furnish
consultation and assistance to local health departments.
ORS 431.145 Clinical preventive services established under ORS 431.141 (Foundational programs) must provide
for the assessment of public access to:
1. Immunizations;
2. Prenatal care;
3. Screening for preventable cancers and other diseases;
4. Screening for sexually transmitted infections;
5. Evaluation of and treatment for tuberculosis and related latent tuberculosis infections;
6. Cost-effective preventive care; and
7. Laboratory services. [2015 c.736 §21]
Current Program Element 41:
• Mechanism in which Title X is operationalized.
• Allows LHDs to subcontract clinical services to other providers.
• Requires training and monitoring of "client care and adherence to all Title X program requirements."
• Funding formula: Base award ($5,000) + # of non -Medicaid clients in the previous year.
Title X Basics:
• Federal grant program dedicated to providing low-income (<250% FPL) and underserved individuals with
comprehensive family planning and related preventive reproductive health services
• Individuals may not be denied services or subject to any variation of services due to: income/inability to
pay, citizenship, residency or insurance status.
Benefits of Title X:
• Program emphasizes high-quality reproductive health care.
• Clinics have access to 340B drug purchasing.
• Funding amounts are determined prior to each fiscal year, i.e., known ahead of time.
Page 1 of 5
Challenges related to Title X:
• Requires parity in provision of care/services regardless of client's coverage or ability to pay.
Limitations in provision of services because of limited Title X funds—must be applied to all clients
regardless of their source of pay (e.g., monthly allotment of LARCs).
• Funding does not take into account differing costs of care for different clients. Each client counts
equally toward funding formula regardless of services provided (high-cost contraceptives versus
low-cost contraceptives).
Passage of HB 3391
HB 3391 Basics:
• Requires Oregon -based commercial health benefit plans to cover a suite of preventive health services—
such as pregnancy -related care, contraceptives, female and male sterilization, and abortion—without
any cost-sharing requirements to all eligible beneficiaries regardless of gender, sexual orientation, or
disability regardless of changes to Affordable Care Act at the federal level (DCBS, effective January
2019).
• Expands CAWEM Plus coverage for 60 -days immediately post -partum (OHA — Health Systems Division,
effective 2018).
• Requires that OHA administer a program to reimburse for a full spectrum of reproductive health services
for individuals who can become pregnant and who are not otherwise eligible for medical assistance (i.e.,
those not eligible for Medicaid because of their immigration status). Services include birth control,
preconception care, abortion as well as screening and/or counseling on a wide range of health issues
(OHA — Public Health Division, effective 2018).
o Focus of RH Program
o Population: low income, undocumented women
o Services: Preventive services related to reproductive health, STI screening, preconception care
and contraception, abortion
Benefits:
• Broad scope of services
Challenges:
• Covers a specific population (i.e., undocumented individuals who can become pregnant)
Why Change PE 41?
• Opportunity to enhance and leverage unique role of LHDs.
• Align efforts related to:
o PH Modernization — community partnership development, assessment of community needs,
assuring access to clinical preventive services.
o PHAB accountability metrics and associated process measures for effective contraceptive use.
• Provide targeted funding to do the above work.
• Reduce challenges associated with sub -contracting:
o More than 20% of counties have either subcontracted, are in the process of subcontracting, or
are considering subcontracting clinical services to other providers.
Page 2 of 5
o Have heard for many years that funding for family planning services, as currently funded, is
insufficient to meet all requirements. This makes it difficult to provide family planning services
directly or to find another provider with which to subcontract services.
• HB 3391 provides clinical service dollars for Title X priority population.
Guiding Principles for Restructuring Clinical Services
• Clients:
o No wrong door based on who they are and what services they are seeking (within scope of
services). Assures equitable access.
• Providers:
o Reimbursement source for most people and most services. Minimizes gaps by maximizing
flexibility in funding.
o Offers financial sustainability because reimbursement more closely matches cost of services
(e.g., LARCs reimbursed at cost as opposed to supported by grant funds).
o Payment that reflects and rewards increases in client volume. Supporting access.
Planned Model for Clinical Services:
• One program with three sources of funding: Title X, HB 3391, CCare
• Utilization of appropriate fund source determined by RH Program (using client enrollment and claims
data to draw from appropriate fund source).
• Expansion of current Medical Services Agreement/MSA (mechanism currently used for CCare) to
contract with providers for clinical services.
• Application, certification, and review process based on foundational Title X program requirements
(similar to current requirements/review process/review tool).
Timeline:
• Roll-out of abortion coverage —January 2018
• RH Program requirements/applications available —January 2018
• Review of applications/certification of providers — February/March 2018
• MSAs completed for April 1 roll-out
• FFS reimbursement of claims for reproductive health services —April 1
• Current Title X funding to continue through June 2018 (dependent upon possible changes in Title X grant
cycle funding at the federal level)
Current Work Related to Restructuring of Clinical Services:
• Abortion: new service, create OARS, determine reimbursement rates, identify and contract with
providers (stakeholder engagement: abortion providers, Health Systems Division, providers outside
Oregon for consultation)
• Breast cancer screening: alignment with ScreenWise (sister program) and determine best utilization of
different funding streams (stakeholder engagement: SW program, LHDs who are shared providers)
• Determine scope of services (stakeholder engagement: provider workgroup begins 9/28)
• Determine and document program requirements (stakeholder engagement: provider workgroup to be
scheduled)
• Future workgroups:
o Client forms/billing/data collection/OAR development/provider training
Page 3 of 5
Whv Pool Funding (Title X, HB 3391, CCare):
• HB 3391: specific population and wide array of services
• Title X: broad population for somewhat different set of services
• CCare: specific population and narrow set of services
• Allows funding for all eligible individuals for all covered services. Examples:
o Males not covered under HB 3391; Title X/CCare funds cover males.
o STI treatment and rescreening not covered under HB 3391; Title X funds cover these services.
• Utilize HB 3391 whenever possible; Title X funds needed to ensure others can receive services at no
cost.
What this Means for LPHDs:
• Change in contract mechanism for reimbursement for clinical services—no longer under PE 41, instead
through an MSA similar to current CCare MSA (CCare MSA will be retired).
• Certification and review process will likely be outside of triennial review process.
Benefits of FFS/Claims-Based Model of Reimbursement (vs. Grant Award):
• Payment more immediate
• Reflects costs of services
• No disincentive to provide higher cost methods
Challenges of FFS/Claims-Based Model of Reimbursement (vs. Grant Award):
• Loss of "guaranteed funding"
• Variability in payments based on client flow
• Increased financial processes due to transition to claims -based payment
PE 41 Considerations
Challenges of Current Subcontracting Requirements:
• For LHDs:
o Difficult to find a provider willing and able to take on Title X requirements with funding provided
o After transitioning from directly providing clinical services, minimal clinical staff able to train and
monitor a new clinical subcontractor.
Page 4 of 5
• For new subcontractor:
o Three-way relationship is more cumbersome, subcontractor needs to go through LHD to access
technical assistance from RH Program.
o In some instances, may receive less funding as LHD retains administrative/monitoring funds.
• For RH Program:
o Compliance findings are for LHDs, not subcontractor.
o No direct ability to assure that changes will be made, running risk of Title X non-compliance.
Proposal:
• Focus PE 41 on assuring access to reproductive health while supporting development/maintenance of
community partnerships and decision-making.
• Align with PHAB accountability metric and process measure by providing funding to support this work.
• Funding for PE 41 to be determined in collaboration with CLHO.
• Provide two options for provision of clinical services:
o Apply and become certified (via MSA) to provide clinical services, OR
o Work with RH Program to identify a provider who can provide access and will contract directly
with RH Program (to be defined).
Page 5 of 5
G
of -< Deschutes County Board of Commissioners
1300 NW WaII St, Bend, OR 97703
(541) 388-6570 — Fax (541) 385-3202 — https://www.deschutes.org/
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AGENDA REQUEST & STAFF REPORT
For Board of Commissioners Work Session of March 14, 2018
DATE: March 6, 2018
FROM: Joe Stutter, Natural Resources - Forestry,
TITLE OF AGENDA ITEM:
Discussion: Cohesive Strategy Coordinator
Road Department
61150 SE 27th St.•Bend, Oregon 97702
(541)388-6581•FAX(541) 388-2719
March 14, 2018
To: Deschutes County Board of Commissioners
Subject: Central OR Cohesive Strategy Initiative Coordinator
As a follow up to our previous meetings and referencing background documents previously
shared, the following information will facilitate a decision by the Board regarding the request
for funding for the position:
Discussion Points:
• Currently have in place:
o Staffing papers on "Values to be Protected."
o Cost distribution analysis based on values.
o Draft MOU between Deschutes County and four adjacent counties.
o Draft MOU between Deschutes County and Deschutes National Forest.
o Draft personal services contract, job description and estimated budget for
coordinator.
• Federal agencies (Deschutes and Ochoco National Forest & Prineville BLM) see great
value in the coordinator position assisting those agencies with Cohesive Strategy
implementation and are offering partial funding for the foreseeable future, that amount
is $35,000 annually.
• All five counties (Crook, Deschutes, Jefferson, Klamath and Lake) have been included
in the cost distribution analysis and Crook, Jefferson, Lake and Klamath counties
have approved their share of the position. Deschutes County has tentatively agreed to
their share and waiting final approval from the rest.
• Deschutes County will have two agreements (MOU's), one with adjacent counties and
one with Deschutes National Forest for remaining funding for Coordinator position.
Final draft MOU's were distributed and Lake and Klamath Counties have already
approved and signed the MOU's.
• Deschutes County will be responsible for these documents and the advertisement of
the Coordinator position, which will be by contract.
• The initial estimate for the coordinator was a $150,000 investment. Based on the
pledged contributions, the revised total for the coordinator is $110,000 annually and
will be the starting point. An annual program of work, approved by the Central OR
Cohesive Strategy Steering Committee, will drive requests for additional funding and
that additional funding will likely come from new sources. The current funding levels
from Counties will remain static.
• Decisions by Deschutes BOCC
o Approval of respective shares of Coordinator position.
o Based on the percentages identified in the Cost Analysis, the breakdown is as
follows:
Crook County, 27% or approximately $20,250.
Deschutes County, 46% or approximately $34,500.
Jefferson County, 16% or approximately $12,000.
Klamath County, 9% or approximately $6,750.
Lake County, 3% or approximately $2,250.
**Note, this totals to $75,000. With the Federal agencies contribution of
$35,000, brings the total to $110,000.
• Approval of advertising the Coordinator position by issuing an RFP.
Joe Stutter
Deschutes County Senior Advisor
CENTRAL OREGON COHESIVE STRATEGY INITIATIVE
The Value of Investment to Provide Public Safety, Protection
of Natural Resources and Maintain a Tourism -Based Economy
November 27, 2017
Values to be protected
Central Oregon's prosperity is directly tied to the character of its landscape and the ways the
communities integrate it into every aspect of life. People are drawn to Central Oregon for its world-
class scenery, outstanding recreation opportunities, and abundant wildlife — all within minutes of
the urban centers. Survey after survey has found that the region's quality of life is a key driver that
attracts the entrepreneurs and modern businesses that are helping to diversify the local economy.'
The Deschutes River in Central Oregon provides numerous ecosystem services benefits to the
region. A recent study analyzed the market and expressed values to six industries in the region:
agriculture, tourism, recreation, hotels, real estate, and commercial salmon fishing. Using revealed
preference methodologies to assess ecosystem services benefits to these industries, the study found
the river provides a total economic value to the industries of $185.2 million annually, of which
$134.7 million is direct revenue to the region, $28.0 million is revenue outside the region, and
$22.5 million is the expressed value of products and services that residents receive for free in their
market value equivalent. The benefits of the river to these industries create 3,433 full time
equivalent jobs for Central Oregon with an estimated value in wages of $73.0 million.2
Based on Oregon Blue Book estimates, the Real Market Value for Crook, Deschutes, Jefferson,
Klamath and Lake Counties is in excess of $38 billion.
The 2015 Oregon Travel Impacts study, the latest annual study commissioned by Travel Oregon,
the state's tourism agency, showed that visitors to the state generated $10.8 billion last year, up
$500 million, or 4.8%, from 2014. In Central Oregon, the growth was sharper still, as visitors
spent $701 million in the region in 2015, an increase of more than 6% from 2014. Both the state
and regional figures set records. Central Oregon is "leading the charge" for tourism growth in
2015. Tourism employed 8,900 people in the region, which included Crook, Deschutes and
Jefferson counties. In Deschutes County alone, visitors spent $660.2 million and the Central
1 Oregon's Playground Prepares for the Future: A Greenprint for Deschutes County
2 Value of Natural Resources: Deschutes River Corridor and Its Water
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Oregon region generated $14.3 million in lodging tax revenues. Crook and Jefferson counties
generated $41.8 million and $39.2 million in direct tourism spending in 2015.3
In the fall of 2015, DHM Research conducted a review of existing social and opinion research on
behalf of the Deschutes River Conservancy. This review explores the values and beliefs of Central
Oregon residences and is intended to inform future opinion research, planning and communications
efforts.4
Key findings are:
• Central Oregonians are positive about the future. They want to come together to address
critical issues we face as a state, but they do not believe this is likely to happen in the next
10 years.
• The environment is absolutely essential to Central Oregonians' sense of place. For many, it
seems to be the foundation of what they love about the state, and also their communities.
• Protecting a beloved natural environment is a top -tier public policy priority, and something
for which many Central Oregon residents are willing to pay, make lifestyle changes, or
reallocate funds, to maintain the natural environment.
• Central Oregonians are divided when it comes to economic growth vs. environmental
protection.
• In general, Central Oregonians want less tax and fewer regulations. However, some public
services resonate deeply with Central Oregonians' values and, depending on the specifics,
elicit backing for sustained or increased taxation.
Public Safety and Mitigation
Each county in Central Oregon (Crook, Deschutes, Jefferson, Klamath and Lake) have All Hazard
Disaster Mitigation Plans. Universally, the top two natural hazards are wildland fire and winter
storms. By definition, natural hazard mitigation is a method of permanently reducing or alleviating
the losses of life, property, and injuries resulting from natural hazards through long and short-term
strategies.
Both winter storms and wildland fires provide a direct threat to public safety. When comparing the
frequency of winter storms and wildland fires, clearly the frequency of wildland fires surpasses
winter storms in exponential fashion. In the past decade, wildland fires in Central Oregon average
450 fires, burning in excess of 50,000 acres for all jurisdictions. Preparedness by the public and
agencies offer some form of mitigation for both winter storms and wildland fire, but significantly
more opportunities to mitigate loss of life, property and injuries exists by reducing risks and
hazards from wildland fire.
3 2015 Oregon Travel Impacts Study
4 DHM Research review
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The National Cohesive Wildland Fire Management Strategy
The Federal Land Assistance, Management and Enhancement Act (FLAME) of 2009 directed the
US Departments of Agriculture and Interior to develop a cohesive wildland fire management
strategy to address the myriad of growing issues surrounding wildland fire (increasing losses to
lives, communities, budgets and economies, habitat, forests/landscapes, and watersheds).
A collaborative process that included a national scientific analysis, culminated in the National
Cohesive Wildland Fire Management Strategy. The vision of the Cohesive Strategy is to safely
and effectively extinguish fire when needed; use fire where allowable; manage our natural
resources; and as a nation, to live with wildland fire.
The Cohesive Wildland Fire Management Strategy (Cohesive Strategy) is a strategic push to work
collaboratively among all stakeholders and across all landscapes, using best science, to make
meaningful progress towards the three goals:
Restore and maintain resilient landscapes: Landscapes across all jurisdictions are resilient
to fire -related disturbances in accordance with management objectives.
Create fire -adapted communities: Human populations and infrastructure can withstand a
wildfire without loss of life and property.
Safe & effective wildland fire response: All jurisdictions participate in making and
implementing safe, effective, efficient, risk-based wildfire management decisions.
The ultimate success of the Cohesive Strategy effort depends on how strategic direction and
national priorities can be translated into the on -the -ground, local actions of agencies, organizations,
governments, and individuals with meaningful, cumulative effects. To fully realize the vision of
the Cohesive Strategy, stakeholders must understand and accept their risk, and be willing to
collectively share that risk through prioritized investment. Stakeholders must also be willing to
take on some short-term risk for the long-term gain of resilient landscapes, fire -adapted
communities and a safe and effective wildland fire response.
The Central Oregon Story
In Central Oregon, fire and land managers, cities, counties, Tribes, non-governmental
organizations and private citizens have a long and rich history of identifying shared goals and
cooperating to accomplish shared outcomes. Here, a culture of strategic alignment,
collaborative engagement and programmatic alignment has existed for decades and continues
to build. The challenges of an isolated, geographic location, limited budgets and diverse
interests helped steer stakeholders to work together under the concept that groups that
cooperate and coordinate efforts can achieve far more than one agency or organization alone.
When the Cohesive Strategy was framed in the West, it was quickly recognized as an
evolution of collaborative strategies and behaviors that already exist and are enjoyed in
Central Oregon.
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With this positive foundation in place, stakeholders in Central Oregon have witnessed much
success through current collaborative efforts:
• Increased hazardous fuels and restoration treatments on public lands in the WUI
through the Deschutes Collaborative Forest Project;
• Establishment of a Fire Adapted Communities Learning Network Hub through Project
Wildfire;
• BLM is working with NRCS on creating resilient landscapes across jurisdictional
lines;
• Comprehensive Community Wildfire Protection Plans across Deschutes, Jefferson
and Crook Counties;
• Integrated wildland fire response including mutual aid and cooperating agency
agreements;
• Local agreements between federal land managers and private landowners to treat
lands regardless of ownership;
• Consistent engagement and support by local elected officials, County Emergency
Management and law enforcement;
• Central Oregon Joint Information System for emergency information;
• Agreement between Upper Deschutes Coalition and Deschutes National Forest for
treatment both on private and public lands to create resilient landscapes and maintain
fire -adapted communities;
• Natural Resources Conservation Service is working collaboratively with other federal
and state agencies to create resilient landscapes on private, non -industrial forests near
communities.
• Private land owners with critical sage -grouse habitat have completed Candidate
Conservation Agreements with Assurances (CCAAs) and are working with federal
agencies to complete Candidate Conservation Agreements (CCAs) to protect greater
sage grouse while maintaining viable economies and grazing operations.
• Project Wildfire, through a collaborative steering committee, established by county
ordinance, continues to facilitate and lead hazardous fuels treatments to create and
maintain fire adapted communities, treating over 110,000 acres of private lands with
the cooperation and participation of private landowners.
Even with all these successful efforts, the risk of loss to lives, our natural resources,
economies, habitat, and communities is still extreme and there is much work before us. This
begs the question: Can stakeholders in Central Oregon continue to use this successful history
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of coordination and collaboration to achieve greater restoration and reductions of risk on a
landscape level, increase the community's understanding and acceptance of risk, and improve
the safety and effectiveness of wildfire response, and successfully implement the Cohesive
Strategy? The answer is YES.
Central Oregon Cohesive Strategy Initiative
The Cohesive Strategy provides a solid framework for making meaningful progress towards three
goals — Restoring Resilient Landscapes, Fire Adapted Communities and Safe & Effective Wildfire
Response. What is the method to achieve that progress? Collaboration... to manage vegetation
and fuels; protect homes, communities, and other values at risk; manage human -caused ignitions;
and Li safely, effectively, and efficiently responding to wildfire.
Stakeholders in Central Oregon now appreciate a solid platform from which to advance current
collaborative philosophies and efforts and integrate them under one umbrella for increased success
(the notion of "bigger, better, safer and faster") across jurisdictions.
The collective ambition is to bring federal, state, Tribal and local agency stakeholders
together with interested non-governmental organizations and private landowners across five
counties — Deschutes, Jefferson, Klamath, Lake and Crook — to embark on a collaborative
journey to identify shared values and goals, and implement prioritized actions to achieve
them. These will achieve meaningful progress towards resilient landscapes, fire adapted
communities and a safe and effective wildland fire response using the Cohesive Strategy as
guidance to continue successful implementation.
More than just successfully implementing the Cohesive Strategy, this coordinated,
collaborative multi -county project aims for recognition as a "regional learning laboratory" for
others to either replicate and/or utilize valuable lessons learned to create similar successful
environments throughout the western United States.
This level of integration, coordination and collaboration will require the following:
• Share and implement the purpose of our efforts:
o To collaboratively implement the Cohesive Strategy through an "all hands —all
lands" approach across five counties, and
o Provide the "regional learning laboratory" for success for the Pacific
Northwest and other areas in the west;
• Prioritized landscape treatments across jurisdictions;
• Increased, collective investments for these projects;
• Continue to identify and leverage resources among all stakeholders.
5
Next Steps:
• Create a Steering Committee consisting of senior agency and local government
leaders, private land stakeholders and non-governmental leaders. (Completed 10/2015
with ongoing stakeholder additions)
• The Steering Committee with the support and contributions of all stakeholders will
ensure strategic alignment, collaborative engagement and programmatic alignment as
the Cohesive Strategy Initiative is implemented.
• The Steering Committee will develop a coordinated approach to the three goals of the
Cohesive Strategy.
• Develop and implement a robust, inclusive communications strategy to strengthen
internal and external support for the collaborative efforts of the Initiative. (Completed
4/2016)
• Strengthen capacity to collect, analyze, interpret and integrate all types of data and
information, including recognized data gaps, to inform decision-making. (Relying on
scientific data and analyses, on the part of all stakeholders provides the best opportunity to
restore and maintain landscapes, protect communities from wildfire, and effectively
respond to wildfires when they occur. Using science and data analysis to support
implementation planning and decision-making will continue).
• Utilize performance measures and monitoring information to assess effectiveness and
accountability.
• Develop capacity and support training and utilization of support tools to better inform
decision-making and trade-off analyses at all levels of fire and land management.
• Document successes and determine common themes of successful projects. Maintain
knowledge and information resources that are easily accessible to stakeholders.
• Create incentives for all stakeholders to participate and embrace the principles of the
Cohesive Strategy.
• Continue to foster Cohesive Strategy behaviors to change behaviors and attitudes, and
ultimately change cultures.
• Continue to identify and engage all stakeholders.
• Identify political education and leveraging opportunities.
• Identify all current investments/programs/achievement and their value to truly
understand values to be protected and measures of achievement.
• Develop the concept of this Regional Learning Lab and how others might take
advantage of the learning opportunities here.
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The path forward
Success in Central Oregon depends on the collective commitment by all stakeholders at all levels
to take action toward meaningful reductions in risk in the short- and long-term. Looking ahead,
this will require:
• Prioritized investment and use of resources. Reducing risk significantly will require that
existing resources, including budgetary resources, are used more efficiently.
• Acceptance of increased short-term risk. Significantly reducing fuels across broad
landscapes will require expanded use of wildland fire to achieve management objectives.
Using fire as a tool carries inherent risks that must be considered in the short-term to
achieve the longer-term benefits.
• Achieve greater collective investment. Even with greater efficiency and acceptance of
short-term risk, current levels of investment may be inadequate to achieve the levels of risk
reduction desired. All who have a stake in the outcome, from individual property owners to
the federal, state, Tribal, and local governments, must share the costs and level of effort
necessary to redeem responsibilities for reducing risks posed by wildfire.
For the Central Oregon Cohesive Strategy Initiative to realize its full potential, there is an
immediate need for a full-time coordinator. A coordinator will be the essential point of contact for
all stakeholders, implement the communications strategy, facilitate the implementation of the
political leveraging strategy, identify new stakeholders and be the "voice" for Cohesive Strategy
implementation.
The cost for the coordinator will be approximately $150,000 per year, which includes salary and
associated travel, and program costs. It is recommended this be a contracted position and the cost
be shared by the five counties.
There will be no greater investment in the "values to be protected" in Central Oregon than
implementing the Cohesive Strategy.
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Date: January 23, 2017
Subject: Central OR Cohesive Strategy Initiative Coordinator
Discussion Points:
• Currently have in place:
o Staffing paper on "Values to be Protected."
o Cost distribution analysis based on values.
o Draft MOU between Deschutes County and four adjacent counties.
o Draft personal services contract, job description and estimated budget
for coordinator.
• Federal agencies (Deschutes and Ochoco National Forest & Prineville BLM)
see great value in the coordinator position assisting those agencies with
Cohesive Strategy implementation and are offering partial funding for the
foreseeable future. *Important to note that funding can be carried over and
accrue saving and is a workload that is currently without staffing. Initially
this was believed to be 50% ($75K) but due to budget shortfalls will be able
to contribute $35,000 at this point. We are hopeful that with the recent
request for additional funding, this amount will increase.
• All five counties (Crook, Deschutes, Jefferson, Klamath and Lake) have been
included in the cost distribution analysis and Lake and Klamath counties
have approved their share of the position. Deschutes has tentatively agreed
to their share and waiting final approval from the rest.
• Likely will have two agreements (MOU's), one with adjacent counties and one
with Deschutes National Forest for remaining funding for coordinator
position. Deschutes will be responsible for these documents and the
advertisement of the Coordinator position, which will be by contract.
• Decisions by Crook and Jefferson BOCC
o Approval of respective shares of Coordinator position.
o The initial estimate for the coordinator was a $150,000 investment
and likely to be reduced to $135,000 in subsequent years. A new
significant investor for the coordinator is now the federal agencies
(Forest Service and BLM) have committed to an annual contribution
of approximately $35,000, which leaves approximately $75,000 to be
covered. That revised total for the coordinator is $110,000 assuming
Crook and Jefferson will recognize the value in the coordinator
position and commit to their respective funding levels.
Based on those percentages, the breakdown is as follows:
Crook County, 27% or approximately $20,250.
Deschutes County, 46% or approximately $34,500.
Jefferson County, 16% or approximately $12,000.
Klamath County, 9% or approximately $6,750.
Lake County, 3% or approximately $2,250.
o **Note, this totals to $75,000.
There would be a formal agreement between the counties, which
Deschutes would complete. Deschutes is offering to complete the RFP
for the coordinator and attend to the contractual issues.
o Annual cost will vary depending on "carry over" money from federal
agencies but will never exceed the amounts for Crook ($20,250) and
Jefferson ($12,000) from Deschutes County.
Cost Distribution Analysis for the
Central Oregon Cohesive Strategy Initiative
The Central Oregon Cohesive Strategy Initiative (COCSI) aims to provide public safety,
protection of natural resources, and maintain a tourism based economy within Central Oregon
including all or parts of Crook, Deschutes, Jefferson, Klamath and Lake Counties. It provides a
framework for strategic collaboration using best science to restore resilient landscapes, expand
our fire adapted communities, and enhance our safe and effective wildfire response. Success
depends on the collective commitment and investment by the counties and stakeholders at all
levels. It is recommended that this investment be shared by the five participating counties. The
analysis described in this document endeavors to determine the fairest and most equitable
approach at sharing this cost.
Analysis 1: Comparison of Acres of Forest Canopy Cover
Data Source: LANDFIRE https://www.landfire.gov
LANDFIRE creates Landscape Fire and Resource Management Planning Tools. It is a
shared program between the wildland fire management programs of the U.S.
Department of Agriculture Forest Service and U.S. Department of the Interior.
Data Used in Analysis: Fuels Database/2014 (LF_140) _Fuel_us_140 Forest Canopy Cover
The Forest Canopy Cover (CC) layer describes the percent cover of the tree canopy in a
stand. Canopy area data were extracted from the dataset. The delineated tree canopy
areas within each county were compared with the total area within the COCSI boundary.
Results:
County
Crook
Deschutes
Jefferson
Klamath
Lake
Acres of Canopy
Cover
465,048
906,202
379,024
342,866
128,254
2,221,394
Percentage of
Total Acres
20.93%
40.79%
17.06%
15.43%
5.77%
100.00%
Forest Canopy Cover
Crook
Deschutes
Jefferson
Klamath
Lake
Wage
Analysis 2: Comparison of Prime Forest and Forest Use Zones
Data Source: Oregon Spatial Data Library
(http://spatialdata.oregonexplorer.info/geoportal/catalog/main/home.page)
The Oregon Spatial Data Library is a joint effort between the Department of
Administrative Services Geospatial Enterprise Office and Oregon State University that
provides public access to reliable and up-to-date spatial data. Currently, hundreds of
spatial datasets are accessible from the Oregon Spatial Data Library, including all of the
statewide framework data available for Oregon. These datasets serve as base data for a
variety of Geographic Information System (GIS) applications that support research,
business and public services.
Data Used in Analysis: Oregon Zoning (Partial 9/24/2014)
Analysis based on data designated as Prime Forest Zone (PF -80). Prime Forest Zone
areas were extracted from the zoning data. The delineated areas within each county
were compared with the total area within the COCSI boundary.
Oregon Zone Code Definition: Prime Forest 80 (PF 80): Higher Productivity Forest Zones
Note: Lake County is not in 2014 Statewide Zoning dataset. All of Lake County portion of project
boundary is within Deschutes National Forest and zoned F-1 (Forest Use) by Lake County
Planning Department. All Lake County acres are included.
Lake County Zone Code Definition: Forest Use Zone (F 1): The purpose of this zone is to
provide for the orderly management and development of forest land for the sustained
production of forest products.
Results:
County
Crook
Deschutes
Jefferson
Klamath
Lake
Prime Forest
Zone Acres
538,159
1,019,177
234,684
410,284
128,254
2,330,558
Percent of Total Pre FO `
23.09%
43.73%
10.07%
17.60%
5.50%
100.00%
Crook
Deschutes
Jefferson
Klamath
Lake
2 Page
Analysis 3: Comparison of Real Market Values of Taxable Properties
Data Source: Crook, Deschutes, Jefferson, Klamath and Lake Counties Assessors' Offices
Data Used in Analysis: 2016 County Assessment Rolls and Parcels
The parcel and assessment data from each county was aggregated. The land and
structure values (based on the 2016 information) were combined to determine the total
Real Market Value for each parcel within the boundary. Values were compared with the
total value within the COCSI boundary.
Results:
County
Real Market
Value
Percent of Total
Crook $3,276,106,470 8.04%
Deschutes $33,970,918,681 83.42%
Jefferson $2,812,449,913 6.91%
Klamath $547,936,240 1.35%
Lake $117,329,795 0.29%
$40,724,741,099 100.00%
Real Market Value
Crook
Deschutes
Jefferson
Klamath
Lake
31 g
Analysis 4: Comparison of Surface Water Rights
Data Source: State of Oregon Water Resources Department
https://www.oregon.gov/owrd/pages/wr/wris.aspx
The Oregon Water Resources Department is the state agency charged with
administration of the laws governing surface and ground water resources. The
Department's core functions are to protect existing water rights, facilitate voluntary
streamflow restoration, increase the understanding of the demands on the state's water
resources, provide accurate and accessible water resource data, and facilitate water
supply solutions.
Data Used in Analysis: Place of Use Summary Report, Water Right Information Search (WRIS)
Primary Surface Water Rights Place of Use Database, calculated by number of water
right acres per square mile section of land. Under Oregon law, all water is publicly
owned. With some exceptions, cities, farmers, factory owners and other users must
obtain a permit or water right from the Water Resources Department to use water from
any source. The bulk of surface water rights are used for irrigation and livestock.
Results:
County
Crook
Deschutes
Jefferson
Klamath
Lake
Surface Water
Acres
88425.92
59665.06
65847.8
1753.77
0
215692.55
Percent of Total
41.00%
27.66%
30.53%
0.81%
0.00%
100.00%
Surface Water Acres
Crook
Deschutes
Jefferson
Klamath
- Lake
4Page
Analysis 5: Comparison of River Miles
Data Source: Oregon Spatial Data Library
(http://spatialdata.oregonexplorer.info/geoportal/catalog/main/home.page)
The Oregon Spatial Data Library is a joint effort between the Department of
Administrative Services Geospatial Enterprise Office and Oregon State University that
provides public access to reliable and up-to-date spatial data. Currently, hundreds of
spatial datasets are accessible from the Oregon Spatial Data Library, including all of the
statewide framework data available for Oregon. These datasets serve as base data for a
variety of Geographic Information System (GIS) applications that support research,
business and public services.
Data Used in Analysis: ORRivers.shp, the GIS element of the Oregon Rivers Database System.
Statewide Rivers line features, extracted Deschutes, Little Deschutes and Crooked Rivers
from data. Calculated GIS miles of flowing river within county boundaries.
A recent study of the Deschutes River analyzed the market and expressed values to six
industries in the region: agriculture, tourism, recreation, hotels, real estate, and
commercial salmon fishing.
The complete study can be viewed at the following link:
http://waterwatch.orq/wp-content/uploads/2015/07/Value-ofNatural-Resources-
Deschutes-River-Cooridor-and-I ts-Water-Final-Report-vFinal. adfq.
Results:
County River Miles Percent of Total River Miles
Crook 148 40% ;
Crook
Deschutes 130 35% Deschutes
Jefferson 53 14% Jefferson
Klamath 38 10% "`'\`
Klamath
Lake 0 0% - Lake
368 100%
5JPage
Final Results
The final results are based on the average of the five analyses.
Total Percentages by County
County
Crook
Deschutes
Jefferson
Klamath
Lake
Forest
Canopy Forest Zone %
Cover %
20.93% 23.09%
40.79% 43.73%
17.06% 10.07%
15.43% 17.60%
5.77% 5.50%
100.00% 100.00%
Final Cost Distribution:
County
Crook
Deschutes
Jefferson
Klamath
Lake
Real Market
Value %
Total Average %
8.04%
83.42%
6.91%
1.35%
0.29%
100.00%
133.23% 26.65%
230.81% 46.16%
78.87% 15.77%
45.53% 9.11%
11.56% 2.31%
500.00% 100.00%
Surface Water
Rights %
41.00%
27.66%
30.53%
0.81%
0.00%
100.00%
Funding
Distribution at
$150K
$39,969
$69,243
$23,661
$13,659
$3,469
$150,000
Cost D s r bution
Crook
- Deschutes
Jefferson
Klamath
Lake
River Miles %
40%
35%
14%
10%
0%
100%
Funding
Distribution at
$100K
$26,646
$46,162
$15,774
$9,106
$2,312
$100,000
61Page
CLACKAMAS
COUNTY
Central Oregon Cohesive Strategy Initiative
Analysis: Comparison of Acres of Forest Canopy Cover
MARION COUNTY
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11 1Page
Road Department
61150 SE 27th St. -Bend, Oregon 97702
(541)388-6581•FAX(541)388-2719
March 14, 2018
To: Deschutes County Board of Commissioners
Subject: Central OR Cohesive Strategy Initiative Coordinator
As a follow up to our previous meetings and referencing background documents
previously shared, the following information will facilitate a decision by the Board
regarding the request for funding for the position:
Discussion Points:
• Currently have in place:
o Staffing papers on "Values to be Protected."
o Cost distribution analysis based on values.
o Draft MOU between Deschutes County and four adjacent counties.
o Draft MOU between Deschutes County and Deschutes National Forest.
o Draft personal services contract, job description and estimated budget for
coordinator.
• Federal agencies (Deschutes and Ochoco National Forest & Prineville BLM) see great
value in the coordinator position assisting those agencies with Cohesive Strategy
implementation and are offering partial funding for the foreseeable future, that amount
is $35,000 annually.
• All five counties (Crook, Deschutes, Jefferson, Klamath and Lake) have been included
in the cost distribution analysis and Crook, Jefferson, Lake and Klamath counties
have approved their share of the position. Deschutes County has tentatively agreed to
their share and waiting final approval from the rest.
• Deschutes County will have two agreements (MOU's), one with adjacent counties and
one with Deschutes National Forest for remaining funding for Coordinator position.
Final draft MOU's were distributed and Lake and Klamath Counties have already
approved and signed the MOU's.
• Deschutes County will be responsible for these documents and the advertisement of
the Coordinator position, which will be by contract.
• The initial estimate for the coordinator was a $150,000 investment. Based on the
pledged contributions, the revised total for the coordinator is $110,000 annually and
will be the starting point. An annual program of work, approved by the Central OR
Cohesive Strategy Steering Committee, will drive requests for additional funding and
that additional funding will likely come from new sources. The current funding levels
from Counties will remain static.
• Decisions by Deschutes BOCC
o Approval of respective shares of Coordinator position.
o Based on the percentages identified in the Cost Analysis, the breakdown is as
follows:
Crook County, 27% or approximately $20,250.
Deschutes County, 46% or approximately $34,500.
Jefferson County, 16% or approximately $12,000.
Klamath County, 9% or approximately $6,750.
Lake County, 3% or approximately $2,250.
**Note, this totals to $75,000. With the Federal agencies contribution of
$35,000, brings the total to $110,000.
• Approval of advertising the Coordinator position by issuing an RFP.
Joe Stutter
Deschutes County Senior Advisor
Job description for Coordinator/Community Leader for
Central Oregon Cohesive Strategy Initiative
The Coordinator/Community Leader* is responsible for the day-to-day business of the
Central Oregon Cohesive Strategy Initiative (COCSI) and for the facilitation and
implementation of the COCSI Program of Work. The Coordinator works closely with the
Steering Committee to accomplish tasks and with COCSI stakeholders to advance the
Cohesive Wildland Fire Strategy across Deschutes, Jefferson, Crook, Klamath and Lake
Counties. The Coordinator is the point of contact and network leader for the broadening
network of Cohesive Strategy stakeholders in the counties and serves as the spokesperson
and communications director for the COCSI.
Duties:
• Facilitate and implement the COCSI Program of Work.
• Coordinate in-person and phone meetings of the Steering Committee.
• Maintain administrative activities and facilitate the day-to-day business of the
COCSI.
• Attend collaborative meetings in each county that support local Cohesive Strategy
implementation efforts, as appropriate.
• Participate in the monthly meetings for the Western Region of the National
Cohesive Wildland Fire Management Strategy.
• Create and maintain a web presence for COCSI information for the Committee as
well as the public.
• Facilitate development of Learning Laboratory to share "how-to", experiences,
guidance, success stories and lessons learned. (Quarterly meetings for
stakeholders, webinars, web portal, town halls, ways for people to talk about how
they implement CS, etc.)
• Create and maintain other communications efforts such as Facebook, Twitter, a
regular eNewsletter and/or other emerging communications opportunities.
• Routine (daily) networking and relationship building with COCSI stakeholders,
partners and those agencies and organizations implementing the Cohesive
Strategy in the field.
• Facilitate grant research and grant writing to support the organization and
activities of the COCSI.
• Document success stories/lessons learned and regularly share with stakeholders
and the public.
1
• Facilitate development of performance measures and monitoring information to
assess effectiveness and accountability.
• Travel for attendance and presentation at appropriate conferences and meetings.
• Works under the supervision and direction of the COCSI Steering Committee.
Outcomes:
While specific outcomes in each county may vary, there are some broad outcomes that
will be achieved as a result of the work of the Steering Committee and the duties of the
Coordinator outlined above.
• Communication between county -level collaboratives and projects is
improved.
• Understanding is increased about what the Cohesive Strategy is, and how
it can, and is being implemented.
• The COCSI is the recognized "expert" entity on the Cohesive Strategy and
its implementation in Central Oregon.
• The pace and scale of Cohesive Strategy implementation by all
stakeholders is improved and increased.
• Stakeholders in all five counties will understand the concept of wildland
fire risk management, including risk sharing and transfer, and successful
mitigation of risk, both towards the goals of landscape resiliency and fire
adapted communities.
• COCSI will maximize the utilization of a Learning Laboratory
environment resulting in changes in attitudes, behaviors and culture thus
achieving the long-term vision of the Cohesive Strategy, "learning to live
with wildland fire."
2
Anticipated expenses for budgeting
Expense
Coordinator contract
Travel
• Coordinator visits among
five counties.
• Travel (air/mileage,
lodging, per diem) for
Coordinator and/or
Steering Committee
members to attend/present
at appropriate conferences,
workshops and meetings.
1 Communications
• Web design,
subscription and hosting
• Learning Lab portal
development to existing
site
Printing collateral materials that
cannot be printed in-house.
Calculation
$400 - 425/day
Lodging, per diem,
mileage $500 per month
$1,500 each for five
events (or five people to
one event)
Based on previous web
design experience.
Yearly
$96,000 — 108,000
$6,000
$7,500
1
$15,000
$11,500
$2,000
Subtotal ( $138,000 - $150,000
Note: there will be many opportunities for in-kind contributions to the overall
budget of the COCSI such as office space, utilities, phone, general mailing, etc.
3
MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding ("MOU") is between Deschutes County, a political
subdivision of the State of Oregon, and the United States Forest Service (USFS).
EFFECTIVE DATE: This MOU is effective as of March 14, 2018. Unless extended or terminated earlier in
accordance with its terms, this MOU shall terminate June 30, 2023.
DESCRIPTION: This MOU applies to operations of the Central Oregon Cohesive Strategies Initiative
(COCSI).
1. RESPONSIBILITIES: Each party to this MOU has equal rights with regard to appointments to
the COCSI Steering Committee.
2. STEERING COMMITTEE: A Steering Committee, comprised of 12 members, is authorized and
charged with administering all operations of COCSI. The Steering Committee shall: (a)
report periodically to each designated County contact person and each designated
representative of the USFS, (b) assist (by way of consensus recommendations) the
Deschutes County Administrator with recruitment, hiring and supervision of the COCSI
Coordinator; (c) undertake related functions as appropriate; and (d) assist the COCSI
Coordinator with grant and other fiscal solicitations.
3. COCSI COORDINATOR: The COCSI Coordinator shall be contracted with Deschutes County.
Compensation and other terms of retention shall be as provided in the personal services
contract that the COCSI Coordinator signs with Deschutes County. The COCSI Coordinator,
with input from the Steering Committee, shall report to and serve at the pleasure of the
Deschutes County Administrator.
4. FINANCIAL RESOURCES: Operations and activities of COCSI and the COCSI Coordinator shall
be funded by (a) designated contributions by the parties to this MOU, as well as
contributions by parties to a separate MOU between Deschutes County and other county
partners, and (b) grants and other available revenue sources.
5. DESIGNATED CONTRIBUTIONS: Annually in March, the parties to this agreement will meet
and ascertain the financial contribution due on or before August 1" from each party.
6. TERMINATION: Mutual Consent. Either party may terminate its participation in this MOU
for any reason by providing thirty (30) days' written notice to the other party.
7. INDEPENDENT PARTY: It is agreed and understood that each party subject to this MOU will
perform services and/or activities related to this MOU as an independent party, and not as
an employee or agent of the other party.
Document No. 2018-111
8. ENTIRE MOU: This MOU sets forth the entire agreement between the parties. The MOU
may be amended upon written approval of all parties.
9. This agreement may be signed and executed in counterparts.
USFS:
BY: Date
DESCHUTES COUNTY:
BY: Tom Anderson, Administrator Date
2
MOU - COCSI Document No. 2018-111
County Sale of Demolition Landfill to OSU Cascades - Timeline (estimated*)
Week of 3-19-2018
• Lot line adjustment separating property north of Simpson from remaining landfill property
south of Simpson (property to be sold) is completed.
• Resolution of title objections submitted by OSU-C is completed.
• Draft Bargain and Sale Deed for conveyance of landfill from Deschutes County to OSU-
C is provided by OSU-C for County review
Week of 3-26-2018
• Bargain and Sale Deed is scheduled for Board of Commissioners approval and
signature.
• B&S Deed is forwarded to Title Company and closing is scheduled
Week of 4-2-2018 throuah week of 4-9-2018
• Closing is scheduled/completed through Title Company.
• Deed recorded and formal ownership transfers to OSU-C
OSU-C Land Use Review Process (Master Plan) Through City of Bend*
• March 12th — Planning Commission Work Session
• April 9th — Planning Commission Public Hearing
• May 14th — Planning Commission final deliberation and recommendation
• June 6th — City Council Work Session
• June 20th — City Council Public Hearing
• July 11th - City Council final deliberation and decision
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