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2013-01-29 Disability Board MinutesEDMONDS' DISABILITY BOARD Meeting minutes January 29, 2013 MEMBERS PRESENT: Ken Jones, Chair Gary McComas, Board Member Joan Bloom, Council Member Adrienne Fraley-Monillas, Council Member STAFF -PRESENT: Carrie Hite, Reporting Director for HR Mary Ann Hardie, HR Manager Yvonne Chan, HR Analyst CALL TO ORDER: Chair Ken Jones called the Board meeting to order at 8:37 am. Yvonne Chan, the new HR Analyst (and HR staff assisting the Disability Board) was introduced to the Board. Chair Jones offered to provide additional information on the role and process of the Disability Board to Ms. Chan (at a time independent of the meeting). Citizen at Large Dr. Michael Deming was unable to attend the meeting. APPROVAL OF MINUTES Board Member Gary McComas made a motion to approve the meeting minutes of October 16, 2012. Council Member Adrienne Fraley-Monillas seconded the motion. The motion carried. DISCUSS AND APPROVE CLAIMS SUMMARY REPORT: HR Manager Mary Ann Hardie reviewed the Claims Summary of October 1, 2012 up to and including December 31, 2012 as follows: SUMMARY OF CURRENT COSTS: (10/1/12 - 12/31/12) SERVICE TOTAL NUMBER OF CLAIMS COST Prescription Co -Pays 12 $2,398.39 In Home Assisted Living Care 9 $44,365.25 Purchase of Eye Glasses 1 $150.00 Medicare Premium Reimbursement - - Dental Reimbursement 5 517.50 Payment of Annual deductibles - - Hearing Aids (batteries) 1 $13.99 Routine & Preventative Costs or costs associated with Annual Physical Exams _ Medical Equipment/Medically Necessary Services 2 $202.14 TOTALS: 30 $47,647.27 The total expense for the period 10/1/12 — 12/31/12 was $47,647.27 with 30 claims. Ms. Hardie explained that while the total amount of claims were similar to the same period in 2011, the total cost (for this period) was higher due to the continued increase in Visiting Angels Nurse Care costs (with two LEOFF 1 members using this service). The total Visiting Angels Nurse Care costs for the quarter was $47,647.27. Ms. Hardie distributed copies to the Board for the in home assisted living care costs for the 2012 period (broken down by cost per month). The total cost for in home assisted living care for 2012 was $174,606.55. Council Member Joan Bloom inquired as to whether these costs and the current in home assisted living care reimbursement costs were both for full time care (24 hour per day care). Ms. Hardie stated that she believed the costs were not for 24 hour care for either LEOFF 1 member using these services. Board Member McComas made a motion to approve the claims summary report for the period 10/1/12 up to and including 12/31/12 in the amount of $47,647.27. Council Member Fraley-Monillas seconded the motion. The motion carried. REQUESTS FOR REIMBURSEMENT Treatment for services - $4,159.66 Ms. Hardie explained to the Board that entire request for reimbursement type for treatment of services for a LEOFF 1 member had not been brought before the Board previously. While the Board approved $50.34 for treatment of services based on medical necessity at the October 2012 Board meeting for the LEOFF 1 member of discussion, there were additional items that were included in this request that had not been included in the last request approved by the Board. There was some discussion that followed by the Board as to whether or not the bill for treatment of services was reimbursable based on medical necessity. Board Member McComas made a motion to approve the reimbursement request in the amount of $4,159.66 based on medical necessity. Chair Jones seconded the motion. Council Member Bloom inquired as to whether or not a reimbursement request for court ordered treatment for services had been brought before the Board in the past. Ms. Hardie stated that in her work as staff liaison to the Board, that she had not been aware of such a request. Chair Jones further confirmed that in his experience on the Board, he could not recall a similar request that had been brought forward. Council Member Bloom inquired as to why the Board would make a determination to reimburse a request for reimbursement based on medical necessity if it were not a court ordered service. Chair Jones opined that since reimbursement request was: 1) based on a court order: 2) has been deemed by the court to be a medical issue and; 3) the LEOFF 1 member has a condition that requires medical treatment that this would seem to meet the criteria for reimbursement approval by the Board. Chair Jones further stated that, if the court determined that the LEOFF 1 member needed to go perform a service (instead of receiving medical treatment for services), that this would be [considered] a different situation. Council Member Bloom inquired as to whether or not the Board could make a [different] motion to approve a reimbursement request for treatment of services for the LEOFF 1 member of discussion in the amount of the treatment for services only, not to include the court ordered items [such as the required reports included in the reimbursement request]. Ms. Hardie reminded the Board that, under the RCW's, the Board alone had the authority to make a determination of approval based on medical necessity. The normal practice of the Board (in determining whether or not services for treatment were medically necessary) has been to see if Medicare and/or Regence insurance had provided any insurance coverage for these services. There was further discussion that followed by the Board as to whether or not reports to the court for treatment of services was considered to be medically necessary. Chair Jones pointed out that the request for reimbursement of services appeared to include costs that had been covered by Regence. Ms. Hardie confirmed and stated that the request for reimbursement for treatment for services was for $2,036.20 [not $4,159.66 as originally noted]. After further discussion by the Board, and a deadlocked motion on a vote to approve reimbursement [two Board members in favor, and two not in favor of the motion to approve the reimbursement request], the motion died on the floor. Board Member McComas made a new motion to: 1) approve the request for reimbursement for treatment of services in the amount of $446.20 based on medical necessity, not to include the $1508 for court ordered reports at this time; 2) for HR staff to contact the LEOFF 1 member of discussion and request that the LEOFF 1 member submit or resubmit the items that were not covered by insurance to Medicare and/or Regence insurance and; 3) to resubmit them for further consideration of reimbursement to the Board based on medical necessity (after re -processing by the insurance). Council Member Fraley-Monillas seconded the motion. The motion carried. Hearing Aid battery - $31.45 A LEOFF 1 member submitted a reimbursement request for a hearing aid battery in the amount of $31.45 [which had been purchased after the recent purchase of new hearing aids]. Board Member McComas made a motion to approve the reimbursement request for the LEOFF 1 member for the hearing aid battery in the amount of $31.45 based on medical necessity. Council Member Fraley-Monillas seconded the motion. The motion carried. UPDATE ON THE STATUS/PROGNOIS FOR TWO LEOFF 1 MEMBERS USING IN HOME ASSISTED LIVING CARE SERVICES As requested by the Board at the October 2012 meeting, Ms. Hardie provided the Board with two notes regarding the current status and prognosis of the medical condition(s) necessitating the assisted living care usage (from the medical providers of the two LEOFF 1 members using in home assisted living care). Ms. Hardie requested [if the Board was so inclined to make] a motion of approval for reimbursement based on medical necessity for the in home assisted living care reimbursements for the LEOFF 1 members of discussion. Ms. Bloom stated that she would like for the Board to have the doctor's name provided on the note that was submitted by one of the LEOFF 1 member's providers. Joan - would like to know the name of the doctor. The Board requested that HR contact the LEOFF 1 member who did not provide information for the attending doctor to confirm the name of the doctor who authorized the note. Chair Jones made a motion to approve [at this time] the continued requests reimbursement for in home assisted living care for the 2 LEOFF 1 members of discussion. Council Member Fraley-Monillas seconded the motion. The motion carried. ANNUAL REVIEW OF CURRENT CITY OF EDMONDS' DISABILITY BOARD POLICIES • Payment of Annual Deductibles (001.06) • Dental Expenses (002.05) • Purchase of Eye Glasses or Contact Lenses (003.02) • Hearing Aids (004.06) • Medicare Premium Reimbursements (005.06) • Nursing Home/Assisted Living (006.06) • In Home Care Assisted Living (008.11) Ms. Hardie stated that, as noted in the Board approved policies, the current policies needed to be reviewed and re -approved. Additionally, at the October 2012 meeting, the Board requested information from comparator cities' Disability Boards to review for this process [and possible further policy making]. Chair Jones made a motion to approve a change to the wording in policy no. 001.06 (Payment of Annual Deductibles) such that the wording "City provided insurance" be removed. Board Member McComas seconded the motion. The motion carried. DISTRIBUTION OF COMPARATOR/SURROUNDING CITIES/COUNTIES' DISABILITY BOARD POLICIES AND DISCUSSION OF ANY NEW POLICIES FOR 2013 There was further discussion about the best process to use to review the information on the policies provided from the comparator cities. Reporting HR Director Carrie Hite suggested that HR staff review the policies and procedures provided by comparator cities and provide an summary/analysis/comparison of them to the Board at the next meeting. Council Member Bloom made a motion to table review the review of the current policies and consideration of new policies until April 2013 meeting when HR may be able to provide the comparison analysis. Chair Jones seconded the motion. The motion carried. OTHER Ms. Hardie stated that the annual Washington State LEOFF Education Association (WSLEA) Conference (which one Board member usually attended) would be coming up in May 2013. Ms. Hardie further stated that she would contact the WSLEA and try to send the registration and agenda information to the Board in the next few weeks in case one member from the Board would like to attend the conference. The meeting adjourned at 9:35 am.