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2016-04-26 Disability Board MinutesEDMONDS' DISABILITY BOARD Meeting minutes 4/26/16 MEMBERS PRESENT: Ken Jones, Chair Gary McComas, Board Member Dave Teitzel, Council Member By phone: Adrienne Fraley-Monillas, Council Member @ 10:35 am PUBLIC PRESENT: Brian Henderson, LEOFF 1 retiree Mrs. Henderson, LEOFF 1 retiree's spouse STAFF PRESENT: Mary Ann Hardie, HR Manager Yvonne Chan, Sr. HR Analyst Sara Graham, HR Assistant CALL TO ORDER: Chair Ken Jones called the Board meeting to order at 9:35 am. APPROVAL OF MINUTES Council member Dave Teitzel made a motion to approve the meeting minutes of February 3, 2016. Board member McComas seconded the motion. The motion carried. DISCUSSION AND APPROVAL OF CLAIMS SUMMARY REPORT: Senior HR Analyst Yvonne Chan reviewed the Claims Summary of January 2, 2016 up to and including March 31, 2016 as follows SUMMARY OF CURRENT COSTS: 1/1/2016 through 3/31/16 SERVICE TOTAL NUMBER OF CLAIMS COST Prescription Co -Pays 19 $6,599.83 In Home Assisted Living Care 1 7,902.25 Purchase of Eye Glasses 3 419.00 Medicare Premium Reimbursement 13 16,363.60 Dental Reimbursement 3 475.20 Payment of Annual deductibles & co-insurance 10 1,437.49 Hearin Aids batteries 2 4,079.98 Eye Exam and Refraction 0 0.00 Out -of -Pocket Expense 0 0.00 Medical Equipment/Medically Necessary Services 0 0.00 TOTALS: 51 $37,277.35 The total expense for the period 1/1/16 through 3/31/16 was $37,277.35 with a total of 51 claims for the period. The total Visiting Angels Nurse Care costs for the quarter were $7,902.25. Chair Jones made a motion to approve the claims summary report for the period 1/1/16 — 3/31/16 in the amount of $37,277.35 based on medical necessity. Board member McComas seconded the motion. The motion carried. REVIEW AND APPROVAL OF LEOFF I RETIREE CLAIMS (REQUESTS FOR REIMBURSEMENT) Request for Additional Payment for Low Vision Aids - $1542.50 At the last meeting, the board members requested additional documentation from the LEOFF I member regarding other medical devices (recommended by the attending medical provider) that could be used for this medical condition and what the costs of each of those alternative devices were. The information provided by the LEOFF 1 member was then reviewed by the Board. Then Mr. Henderson presented the device and additional information about the device, including how it worked. He also explained how and why he used the device and that he had consulted with a specialist and the specialist recommended this device for his particular vision problem. The Board members present then asked additional questions to Mr. Henderson about the device. One of the inquiries included whether or not this was the only medical device that could have been purchased for Mr. Henderson's condition. After further discussion, Chair Jones called for a vote to approve the reimbursement request for the LEOFF 1 member of discussion for the remaining $1542.50 toward the purchase of the low vision aid based on medical necessity. Board member McComas seconded the motion. Of the members present, the vote was two votes in favor and one opposed. For this reason, the motion to approve the reimbursement request for the additional $1542.50 did not carry. After Mr. Henderson and his wife left the meeting, the Board called Council member Adrienne Fraley-Monillas for further discussion about this issue. Council member Fraley-Monillas inquired as to whether or not: 1) the LEOFF 1 retiree had provided the additional information from his medical provider about other alternative medical devices as requested, and 2) if this was the only medical device the LEOFF 1 member's attending physician recommended for use for his medical condition based on medical necessity. There was further discussion and it was noted that this information had not been provided. Chair Ken Jones stated that the Board could reconsider this request for reimbursement if Mr. Henderson was able to provide the information from his attending physician that had been previously requested by the Board. Board member McComas then made a motion that the reimbursement for the second half of the low vision device in the amount of $1542.50 be approved based upon the physicians' recommendation that the LEOFF 1 member needed a low vision device and that this device would be the best for his condition. There was further discussion by the Board that followed as to whether or not this motion met the criteria of the standard of approval by the Board based on "medical necessity." Chair Jones seconded the motion. The vote was two in favor of approval of the request for reimbursement and two opposed. Based on the vote results, the motion did not carry. Board member McComas asked if there was any need to take any further action on this issue since they [the Board] were deadlocked. He further requested that Ms. Hardie check to see if she would be able to provide a vote to the Board and check with legal about the legality of the Board vote by the three Board members. Ms. Hardie stated that her ability to vote was not allowed/authorized under the Board and that she would check with legal to confirm that the vote results were valid. After Ms. Hardie consulted with Patricia Taraday, City Attorney, she confirmed that the vote results were valid as there were not 3 members voting in favor of the motion. Board Policies about members attending Board Meetings when voting takes place There was some discussion that followed by the Board about not having members physically present when voting takes place on a reimbursement or appeal issue. Ms. Hardie stated she would bring back some other jurisdictions' Board policies regarding the appeals process for review by the Board (in order for the Board to be able to create a policy) at the next Board meeting in July 2016. Request for reimbursement for $800.00 for Toric Lenses The Board discussed a request for reimbursement from a LEOFF 1 member for the purchase of toric lenses in the amount of $800.00 and the cost savings of having these lenses implanted versus paying for glasses every two years. The LEOFF 1 member had provided additional information from his/her medical provider regarding the medical necessity of the toric lenses for the Board to review. Chair Jones made a motion to reimburse the LEOFF 1 member for the toric lenses in the amount of $800.00 based on medical necessity. The motion was seconded by Council member Teitzel. The motion carried. Request for payment for hearing aids - $4,250 The Board discussed a request for hearing aids for a LEOFF 1 member in excess of the policy limits of $2,600 for the purchase of two hearing aids (based upon the Board's hearing aid policy no 004-06). After further discussion by the Board, the Board expressed that they would further consider the request for reimbursement beyond the allowed policy amount if there was additional information/documentation of the medical necessity of the particular brand/type of hearing aids from the medical provider. Board member McComas then made a motion to approve up to $2600.00 plus tax toward the purchase of the hearing aids for the LEOFF 1 members of request based on medical necessity. Council member Teitzel seconded the motion. The motion carried. It was further noted b that the Board would further consider the request for reimbursement if additional information of medical necessity (for the additional purchase cost beyond the approved policy amount) was provided by the LEOFF 1 member's attending physician. Council member McComas requested that the Hearing Aid policy be reviewed by the Board at the next meeting. Continued discussion about assisted living care approval for a LEOFF 1 retiree (temporarily approved by the Board in April 2016). The Board agreed to continue to allow claims for reimbursements for the LEOFF 1 member using assisted living care based on medical necessity. The Board also stated that it was appropriate for updates to be provided on the LEOFF 1 member's continued prognosis and continued expectation or need to use assisted living care every six months. Review of Checklist for LEOFF I members The Board reviewed the checklist (that they had requested HR draft) and approved the checklist for distribution to members. The Board expressed that they hoped the checklist would be helpful since there have been a number of reimbursement requests submitted to the Board without documentation of medical necessity from the attending physician. Ms. Hardie stated that HR would send this checklist out to the LEOFF 1 retirees. Possible Board Doctors (second opinions)/Citizen-At-Large position The Board discussed the option of paying for a medical provider (not the "Board doctor") for a second opinion with more medically complex reimbursement requests. Ms. Hardie discussed her survey findings (from other Washington Disability Board jurisdictions) that retain a doctor (separate from the Board doctor) for a second opinion. Objective Medical Assessments Corp. is used by several cities surveyed. There was also further discussion about the need for the Citizen -At -Large position to the Board to be filled. Ms. Hardie stated that this position has been posted several times and that she has talked to many possible doctors about taking part on our Disability Board, but that this posting can be refreshed and reposted. The Board requested that this position be refreshed and reposted and that she would apprise the Board of the application process. Re-election of Fire Representative Gary McComas to the Board for another term. Board member McComas was unanimously re-elected to serve another term to the Board as the Fire representative. The new term is for the period 5/1/16-4/30/18. Upcoming WSLEA Conference The WSLEA Conference will be held in Lake Chelan at Campbell's Resort from May 11 th — May 13th, 2016. Chair Jones stated that he would be attending again and Council member Teitzel stated that he also planned to attend. Both stated that they would bring back information for the Board to review at the next Board meeting in July. LEOFF 1 Disability Boards Best Practices seminar — 8/24/16 in Leavenworth, WA The Association of Washington Cities (AWC) is offering a conference for Disability Board secretaries and staff to attend regarding Disability Board best practices in Leavenworth, WA on 8/24/16. Ms. Hardie inquired as to whether or not the Board would like her to attend as any travel and training registration costs would be reimbursed through the Board. The Board encouraged Ms. Hardie to attend and Ms. Hardie stated that she would do so and would provide information to the Board following the meeting. L & I Hearing Aids Policy limit Board member McComas requested that the hearing aid policy information limits established by L & I for hearing aids brought back to the Board for review at the next meeting. Board member McComas further stated that he would like the Board to review the policy again after they have the updated information. Ms. Hardie stated she will also bring this particular policy up at the Leavenworth seminar (Disability Boards Best Practices). Chair Jones adjourned the meeting at 11:12 am.