Loading...
2017-02-23 Disability Board MinutesOF EDP 0 MEMBERS PRESENT: Ken Jones, Chair Gary McComas, Board Member Dave Teitzel, Council Member Jim Distelhorst, Citizen -at -Large STAFF PRESENT: Mary Ann Hardie, HR Director Emily Wagener, HR Assistant Sharon Cates, City Attorney EDMONDS' DISABILITY BOARD Meeting minutes 2/23/2017 MEMBERS OF THE PUBLIC PRESENT: None CALL TO ORDER: Chair Ken Jones called the Board meeting to order at 9:30 am. APPROVAL OF MINUTES Upon review, Board Member Gary McComas questioned why the minutes from the 10/20/2016 meeting reflected the executive session discussion. Chair Jones indicated there was a question regarding whether it was necessary to reflect a discussion that took place over executive session. Ms. Cates confirmed that it is not necessary to have executive session discussions reported in the minutes. After some discussion that followed by the Board, Chair Jones made a motion to approve the minutes with the spelling corrections and omitting the executive session discussion, but including the resulting decisions. Council Member Teitzel seconded the motion. The motion carried. DISCUSSION AND APPROVAL OF CLAIMS SUMMARY REPORT: HR Assistant, Emily Wagener, reviewed the Claims Summary of October 1, 2016 and up to December 31, 2016 as follows: Summary Of Current Costs 10/01/2016 - 12/31/2016 Service Number of Claims Total Cost of Claims Appeal Approved 10/20/16 5 $ 4,924.03 Deductible 3 $ 455.42 Dental Expenses 3 $ 397.00 Eye Expenses 3 $ 320.00 Hearing Aid Repair 1 $ 140.00 Long Term Care 6 $ 27,837.50 Prescription Co -Pays 6 $ 1,838.89 Grand Total 27 $ 35,912.84 The total expense for the period 10/1/2016 and 12/31/2016 was $35,912.84 with a total of 27 claims for the period. The costs were comparable, albeit slightly higher, in comparison to the expenses paid for the same period in 2015. Ms. Wagener pointed out that the slight increase seemed to be due to higher reimbursements for Long Term Care services. Ms. Wagener asked the Board if there were any specific questions about the claim summary. Mrs. Hardie indicated that there are currently two LEOFF 1 members who are currently using assisted living services which would reflect the higher costs for this period. Chair Jones agreed and pointed out that the final number was still under the budgeted appropriation for the 2016 year. Chair Jones indicated he thought a document was missing to show the costs for Quarter 4 of 2015 and requested that this be provided with the next Board meeting claims summary. Ms. Hardie confirmed that it would be provided. Council Member Teitzel made a motion to approve the claims summary report for the period 10/1/2016 — 12/31/2016 in the amount of $35,912.84 based on medical necessity. Chair Jones seconded the motion. The motion carried. REVIEW AND APPROVAL OF LEOFF I RETIREE CLAIMS (REQUESTS FOR REIMBURSEMENT) C. Information as requested by the Board provided by a LEOFF 1 retiree's physician (regarding evaluation of current status and continued need to use assisted living care services) for the Board's review. Mrs. Hardie indicated she had some additional information regarding this LEOFF 1 member's correspondence and offered to go through the conversation she had with the member as follows: • On June 1st the LEOFF 1 member had been having hip issues and a steel ball was placed which fell out and the member had to have additional surgery. • Currently the hip is out of joint and is not working. Options were to: rebuild the socket or not have a hip. Doctors were not even able to place the ball due to the extensive breakdown of the hip. • The member no longer has a hip socket and is mostly wheelchair bound. In regards to the bills that came in for long term care services, there is a second caregiving agency that has been used at a slightly higher cost. • In addition there are some discrepancies in billings for the board to review. There have also been additional caregivers coming in for training. • This LEOFF 1 member's family has difficulty finding caregivers that work well with the member. They have gone through a number of trainees and end up paying for that turnover. • There are some equipment costs as well including an aspirator, which does not seem to be working. Member indicated they have gone through five nebulizers and have not submitted any of these bills. These nebulizers are supposed to have up to five year warrantees, but the LEOFF 1 member's family member indicated that they go through them quickly and they just don't work. • Additionally, a hospital bed was also purchased for $650 and reimbursement was not submitted for that. The spouse said that there are medical necessary purchases that they have been paying for but he is not planning on bringing them forward for reimbursement. • Other additional costs were: Medicare did not pay for bathroom equipment (a sliding bench, chair swivels and safety seatbelts). • Dr. Distelhorst indicated he was concerned that they were unable to hold on to their caregivers and also indicated that the nebulizers are pretty strait forward and user friendly. 2 • Mrs. Hardie indicated that the LEOFF 1 member's condition is very combative [due to a previous medical issue] and it has been an ongoing issue. Mrs. Hardie further indicated this was an update on the member's condition due to the Board's request for this information. • Mrs. Hardie further stated that HR Assistant Emily Wagener had completed an audit of reimbursements for this LEOFF 1 member's long term care costs. • Ms. Wagener explained the audit was conducted on reimbursements for services reimbursed from February 2016 through October 2016. • The "baseline" approved reimbursement was calculated by the member's regular hours of care per day for each day in a given month [monthly baseline amounts varied]. The overpayment amounts were indicated based on extra services such as: alternate facility charges, trainees, additional caregivers and holiday premiums. Ms. Wagener explained that she wanted to make sure that this was an approved expense by the Board in order to continue to reimburse it. There was some discussion that followed by the Board about the holiday alternate facility charges, trainees, additional caregivers and holiday premiums and the documentation provided by the attending physician. Board Member McComas made a motion to cover the amount determined in the audit to be an overpayment based on the holiday alternate facility charges, trainees, additional caregivers and holiday premiums (in the amount of $1,578.50). Council Member Teitzel seconded the motion. Chair Jones asked for any further discussion. Hearing none, the motion carried. D. Van seat repair/and or replacement for the same LEOFF 1 member of discussion (as in item C) in the amount of $1,445.00- potentially up to $12,000.00 Mrs. Hardie brought up an additional potential reimbursement request for the same LEOFF 1 member of discussion as follows: The member's spouse had contacted HR and notified them that the accessible van seat had malfunctioned. The spouse did not go back to the place where it has been repaired before due to previous customer services issues; he went to Absolute Mobility Center in Woodinville, WA. He was told that it would be a total of $1,445.00 to repair (not including the labor and tax) and that he will be informed by 4/3/17 (by Absolute Mobility) if the repair will fix the problem. Otherwise, if it could not be repaired, it could be around $12,000 to replace the seat due to the change in available technology (from manual to automatic) and the obsolescence of manual technology since the purchase of the original seat. Mrs. Hardie brought up Council Member Adrienne's suggestion from the previous meeting that D.A.R.T. could potentially provide transportation services. Board Member McComas indicated he had looked into the D.A.R.T. service online and it seemed reasonable and may be appropriate in this situation. Prior authorization is required to qualify; it is available 7 days per week with some limitations. There was some discussion that followed by the Board about this. Mrs. Hardie said she would request further information from the member regarding the van seat repair costs and likelihood of repair. Dr. Distelhorst also was curious about the frequency of use "continual medical and appropriateness". Mrs. Hardie stated that she would request additional information from the LEOFF 1 member and their doctor regarding the required use of the van as well as more concrete estimated costs of repair (if possible) for the Board to review at the next meeting. E. Additional assisted living care services (hour and days) for a LEOFF 1 member currently using this service for 12-18 months. Mrs. Hardie explained that there is a LEOFF 1 member who is currently requesting an increase in long term care services for up to 6 hours per day, 7 days per week. Ms. Wagener confirmed the current reimbursement costs are about 3 hours per day, 3 days per week, and a total cost of $188.55 per week. Council Member Teitzel re-entered the room and indicated he had attempted to call Adrienne [who was absent] and that he had been unable to reach her. Chair Jones indicated the increased cost would be about $900.00 for 6 hours per day 7 days per week of care. Dr. Distelhorst asked for confirmation if this was a terminal situation and Mrs. Hardie confirmed it was terminal and for a projected period of 12-18 months. There was further discussion that followed by the Board about holiday premiums paid for City employees. After further discussion, Teitzel indicated that 4 hours per day seemed to be an appropriate reimbursement amount. Council Member Teitzel made an amended motion to approve expanded care of current assisted living care services for 7 days per week up to 4 hours per day for the LEOFF 1 member of request. Dr. Distelhorst seconded the motion, indicating that it was increasing care from 9hrs/ week to 28hrs/ week. The motion carried. Council Member Teitzel then asked if a secondary motion was necessary for reimbursement of the overtime [holiday premium] amount. Mrs. Hardie indicated that this would be appropriate. Council Member Teitzel then made an additional motion to approve the additional holiday/differential pay for the period for this particular LEOFF 1 member. Dr. Distelhorst seconded. The motion carried. F. Dental Insurance coverage - $363.93. Ms. Hardie indicated that this request was submitted to the Board because the policy does not list dental insurance premiums as reimbursable, only dental services. Chair Jones indicated that he recalled that the Board had paid for dental insurance coverage up to the dental policy limit each year in the past for LEOFF 1 retirees. He indicated that he recalled that a LEOFF 1 member had previously shown documentation showing that he/she had paid the insurance premium cost. Chair Jones requested that FIR go back to review possible previous reimbursements for dental insurance. Ms. Hardie stated that HR will go back through the records to review previous reimbursement for this (if there are any) as Chair Jones recalls and will bring this information back to the next meeting (for further discussion by the Board). G, H, I & L. Medicare Insurance Premiums. Requested reimbursement for amounts over base amounts ($787.20, $1,664.40 & 10.80) and Medicare Part D prescription coverage amounts ($152.40 & $393.60). Ms. Wagener indicated the 2015 Medicare Part B premium amount had been $1,258.80 prior to 2016 and in 2016 that premium had increased dramatically (but that most beneficiaries did not see an increase because they were "held harmless"). Those who were exempt from being held harmless were in a higher income bracket and also pay a higher monthly Medicare Part B premium amount. The actual 2016 premium without the held harmless amount was $1,461.60. Ms. Wagener also indicated that the premiums for regular Medicare will be increasing again for 2017. There was further discussion that followed by the Board coverage for Medicare Part D [prescription insurance] premiums as it seems duplicative with the current, City -provided AMWINS LEOFF 1 Medicare supplemental prescription insurance plan. Chair Jones indicated it would be very difficult to find out if there was truly a cost savings to the city for LEOFF 1's being "double covered" for prescriptions. Mr. McComas proposed a policy for Medicare Part D M premium reimbursements to include information about the fact that the LEOFF 1's already have prescription coverage through the City's plan and that if they choose to enroll in Part D, the premium will not be reimbursable/reimbursed by the Board. Ms. Hardie indicated that she and City Attorney Sharon Cates would work together on a policy and provide some kind of notification to this effect to the LEOFF 1 members ASAP. Board Member McComas made a motion that, as long as the city provides prescription insurance coverage for the LEOFF 1 members, they will not be reimbursed for Medicare Part D premiums. Dr. Distelhorst seconded the motion. The motion passed. After further additional discussion on this topic by the Board about Medicare Part D premium reimbursement, Board Member McComas made an additional motion that the LEOFF 1 members of discussion who had already submitted their Medicare Part D premiums would be reimbursed for the amount of premiums paid that they submitted for reimbursement [as of the date of the February Board meeting under Item G, H, & 1]. Additionally, a notification letter would be sent to LEOFF 1 retirees indicating no further premium reimbursements under Medicare Part D would be approved by the Board or reimbursed. Dr. Distelhorst seconded and the motion carried. After additional discussion by the Board as to what total amount of Medicare Part B premium reimbursement the Board would provide to LEOFF 1 members, Board Member McComas made a motion that the already submitted Medicare Part B premiums for 2016 for LEOFF 1 members (above the typical $1,461.60 amount) submitted [as of the date of the February Disability Board meeting] would be reimbursed by the Board and the adjustments to the policies to reflect the previous Board's decision should be effective going forward. Chair Jones seconded the motion and the motion carried. J. DRAFT POLICY REVIEW/APPROVAL (from the October 2016 Board meeting) Ms. Wagener indicated that she noticed a need for clarification issue with draft policy #13-17 (Reimbursement of Prescriptions for Male & Female Sexual Dysfunction) in that the total reimbursement limit is $250.00 but it was not clear how often (i.e. annual, quarterly, per prescription, etc.) this was eligible for reimbursement. After some discussion on this topic by the Board, and given that Board Member Adrienne Fraley-Monillas was unable to be in attendance, Board Member McComas questioned having a standalone policy for Sexual Dysfunction medications as he believed it should be covered along with other medical conditions and should not require its own separate policy. There was further discussion that followed by the Board about the new draft policies on Reimbursement of Prescriptions for Male & Female Sexual Dysfunction and Generic Drug Requirements (#14-17). After some discussion by the Board, it was determined that these policies would be further reviewed at the next board meeting for further determination of approval. Chair Jones adjourned the meeting at 11:04am