2017-04-19 Disability Board MinutesOF EDP
0
EDMONDS' DISABILITY BOARD
Meeting minutes
4/19/2017
MEMBERS PRESENT:
Ken Jones, Chair
Gary McComas, Board Member
Dave Teitzel, Council Member
Jim Distelhorst, Citizen -at -Large
Adrienne Fraley-Monillas, Council Member
STAFF PRESENT:
Mary Ann Hardie, HR Director
Emily Wagener, HR Assistant
Sharon Cates, City Attorney
MEMBERS OF THE PUBLIC PRESENT:
None
CALL TO ORDER:
Chair Ken Jones called the board meeting to order at 9:30 am.
REVIEW UPDATED COMMITTEE MEMBER'S LIST
Ken Jones was re-elected as chair effective 5/1/17. List was reviewed by members and no major
concerns were voiced.
APPROVAL OF MINUTES
Limited discussion on the minutes no indicated concerns or proposed changes.
Chair Jones made a motion to approve the minutes. Council Member Teitzel seconded the
motion. Council Member Fraley-Monillas abstained. The motion carried.
DISCUSSION AND APPROVAL OF CLAIMS SUMMARY REPORT:
HR Assistant, Emily Wagener, reviewed the Claims Summary of January 1, 2017 and up to March 31,
2017 as follows:
Summary of Current Costs
Service
Number of Claims
Total Cost
Board Approval
7
$ 3,078.68
Co -Insurance
2
$ 134.88
Deductible
7
$ 1,077.38
Dental
6
$ 1,248.00
Eyeglasses
7
$ 790.39
Hearing Aids
2
$ 260.98
Long Term Care
4
$ 27,713.65
Medical Services
2
$ 316.15
Medicare Premium
18
$ 23,917.20
Prescription
19
$ 5,861.55
Grand Total
74
$ 64,398.86
The total expense for the period 01 /01 /2017 — 03/31 /2017 was $64398.86 with a total of 74 claims for
the period. The costs were comparable, albeit slightly higher, in comparison to the expenses paid for
the same period in 2016.
Ms. Wagener indicated that the largest increase was due to higher reimbursements for Long Term
Care services, which were 3.5 times more than that of the same time period in 2016. Mrs. Hardie
indicated that the same two LEOFF 1 members are currently using assisted living services which
would reflect the higher costs. Ms. Wagener also pointed out an increase in the Medicare premium
reimbursements due to the overall increase Medicare premiums for 2016. There was some brief
clarification discussion regarding the long term care costs.
Chair, Ken Jones made a motion to approve the claims summary report for the period 1/1/2017
— 3/31/2017 in the amount of $64,398.86 based on medical necessity. Dr. Distelhorst seconded
the motion. The motion carried.
CORRESPONDENCE & REQUEST FOR APPROVAL/AUTHORIZATION OF REIMBURESEMENT
FOR MEDICAL EQUIPMENT AND/OR SERVICES (PER POLICY)
C. Increasing care to 7 days 8 hours per day for current LEOFF 1 member using assisted living.
Mrs. Hardie indicated that although complete information was not yet provided or available, a
LEOFF 1 member's family requested additional time (up to 7 days, 8hrs.) be authorized for long
term home care. The request is due to the fact that the family is no longer able to provide the extra
care themselves. Ms. Wagener clarified that this is the same member the board approved
additional care (4 hrs. 7 days) for at the 2/23/17 meeting. Council Member Fraley-Monillas asked
if the additional charges were within the quote on file, per policy #008-11. Mary Ann indicated there
was no recent quote on file but the board can at any time request quotes from both Assisted Living
Patients to verify reimbursement approval amounts.
The Board had some discussion about long term care reimbursement amounts and potential
longevity of such reimbursements. The Board considered how dollar amounts and longevity
related to the growing increase in costs and the current request for increased time. Upon request,
Mrs. Hardie confirmed that HR would reach out to the member to clarify the Long Term Care policy
as well as request 3 quotes in order to determine future reimbursement amounts.
Council Member Fraley-Monillas motioned that the board approve the additional requested
expenses of up to 7 days 8 hours up to the next 30 days pending 3 quotes from an
appropriate care facility within the area that they live. Council Member Teitzel seconded the
motion. The motion carried.
REQUESTS FOR REIMBURSEMENT
D. Costs for an additional assisted living care provider for a LEOFF 1 member using assisted
living care services for the period 1/1/17 — 1/29/17 in the amount of $342.50.
Ms. Wagener indicated that this was being brought forward as a clarification from the last board
meeting. The board has previously approved additional caregiver charges for this LEOFF 1
member but it was not clear if that decision was to apply to future reimbursements as well. There
was some discussion and Council Member Fraley-Monillas recommended we obtain 3 quotes per
N
the policy #008-11 in order to determine future reimbursement amounts. Mrs. Hardie confirmed
that HR would reach out to the member's family to clarify the policy and request the 3 quotes.
Chair Jones motioned that the extra charges should be covered along with future excess
charges of up to $342.50 per month. Council member Fraley-Monillas seconded. The motion
carried.
E. Van seat repair reimbursement - $3,569.25.
The Board discussed the fact that the city originally purchased the vehicle. Throughout deliberation
and with the mention of alternative transportation it was determined that the current reimbursement
was specific to the transportations of the member, and not to the car's mechanics and should
therefore be covered at this time.
Council Member Teitzel made a motion to approve the cost of the van seat replacement in
the amount of $3,569.25. Dr. Distelhorst seconded. The motion carried.
DRAFT POLICY REVIEW/APPROVAL (FROM THE OCT 2016 AND FEB 2017 BOARD MEETINGS)
F. Sexual Dysfunction Prescription Reimbursement, #13-17
There was some discussion regarding the need for a specific policy for this drug or if it would be
covered by the existing policies. There was discussion about current procedure for reimbursing
prescription co pays and the process for uncovered prescriptions that the doctor deems is
medically necessary. Ms. Wagener indicated that prescription co -pays are automatically
approved and reimbursed according to policy, non -covered meds would be brought to the board
for approval. The board was agreed that a separate policy was necessary.
Dr. Distelhorst made a motion to approve policy #13-17 with a maximum reimbursement
of $250 per quarter for an annual max of $1,000.00 which does not carry over. Council
Member Teitzel seconded. Fraley-Monillas opposed. The motion carried.
G. Use of Generic Drugs, #14-17
It was discussed and clarified that this policy is meant to complement existing ones and is not
meant to disallow members from using brand name prescriptions when generics are not an option,
at recommendation from their doctor. There was much discussion about whether or not a brand -
name prescription covered by insurance, besides the co -pay, should be automatically reimbursed
or brought to the board for further review. Ms. Wagener and Mrs. Hardie indicated that HR would
review the prescription submissions carefully and pull any apparent name -brand submissions.
Chair Jones recommended that this policy should be reviewed again at the Quarter 2 board
meeting.
H. Medicare Reimbursement Policy Revision
HR will add "as determined annually by the SSA" to determine the maximum base reimbursement
amount for Medicare Premiums each year. Council Member Teitzel recommended indicating
specifically which parts of Medicare (Part B only) applied to the policy as well as specifically citing
that other prescription drug insurance premiums (including Part D) would not be reimbursed as
prescription coverage is already provided under the supplemental plan.
Dr. Distelhorst made a motion to pass the Policy Revision with the discussed alterations.
Chair Jones seconded. The motion carried.
OTHER
I. Upcoming WSLEA Conference — Chelan, WA 5/9/17 — 5/12/17
Chair Jones will be attending and will bring information back to review at the next Board meeting.
Chair Jones adjourned the meeting at 10:31am.
2