Loading...
2018-02-07 Disability Board MinutesOF ED4/ 0 MEMBERS PRESENT: Ken Jones, Chair Dave Teitzel, Council Member Jim Distelhorst, Citizen -at -Large EDMONDS' DISABILITY BOARD Meeting Minutes Regularly Called Meeting 02/07/2018 STAFF PRESENT: Mary Ann Hardie, Human Resources Director Emily Wagener, Human Resources Analyst Sharon Cates, City Attorney MEMBERS OF THE PUBLIC PRESENT: None CALL TO ORDER: Chair Ken Jones called the meeting to order at 9:34 am. It was noted that newly appointed Council Member Diane Buckshnis would not be in attendance as she had not been made aware of the meeting date. Board Member Gary McComas was also not in attendance. APPROVAL OF MINUTES: Council Member Dave Teitzel made a motion to approve the 10/31/2017 (regularly scheduled) meeting minutes. Citizen -at -Large Jim Distelhorst seconded the motion. The motion carried. Chair Jones made a motion to approve the 11/8/17 (specially called) meeting minutes. Council Member Teitzel asked whether Council Member Buckshnis had seen the minutes. HR Director Mary Ann Hardie indicated that she had not but that she would receive a copy once a draft was available. Council Member Teitzel seconded the motion. The motion carried. DISCUSS AND APPROVE CLAIMS SUMMARY REPORT Chair Jones asked HR staff for any particular insight to the claims summary report for the period. HR Analyst Emily Wagener explained that there were less reimbursements paid but the total reimbursed dollar amount was higher than the same period the year prior. Ms. Wagener indicated that this was due to the increase in Long Term Care costs. Citizen -At -Large Distelhorst indicated that with the demographics, he does not expect this trend to change. Summary of Current Costs 10/01/2017 - 12/31/2017 SERVICE Number of Claims Total Paid for Service Board Approval 2 $ 166.99 Co -Insurance 2 $ 242.62 Deductibles 1 $ 76.88 Dental 1 $ 106.00 SERVICE Number of Claims Total Paid for Service Hearing Aide 1 $ 2,643.61 Long Term Care 7 $ 67,894.75 Medical Services 2 $ 1,834.70 Prescription 5 1 $ 856.64 Grand Total 21 1 $ 73,822.19 Page 1 of 5 HR Director Mary Ann Hardie shared that there was a budget amendment approved by council for the 41h quarter of 2017. This adjustment was necessary due to the increase in Long Term Care costs and future amendments will depend on the Board's future decisions regarding Long Term Care reimbursements. Ms. Hardie indicated that the budget would be reviewed following the first quarter in case additional adjustments are needed. There was some discussion regarding the fact that this figure (for Long Term Care costs) is unlikely to go down due to the demographic of the LEOFF 1 group. Ms. Hardie added that Finance is currently working on the next actuarial report, which usually runs about a year behind, and that she will reach out to Finance and get additional information on the time period it will cover. Council Member Teitzel made a motion to approve the claims summary in the amount of $73,822.19 for the period 10/01/2017 — 12131/2017. Citizen -At -Large Distelhorst seconded the motion. The motion carried. FOLLOW UP from the 11/2017 Specially Called Meeting. Continued Assisted Living/Nursing Care for LEOFF 1 member. Chair Jones indicated that while this issue could be discussed by the Board, it would likely need to be deferred for future discussion as all the members were not present and it was important to have their input into this matter. Ms. Hardie explained the information that had been sent to the Board and was attached in the packet regarding the patient advocate's services (that the Board had requested HR staff look into). Ms. Hardie further explained that the service providers work for the facilities and are paid by the facility in which the patient is placed, and that there would be no cost to the City for this service. Ms. Hardie also indicated that upon following up with the other Boards there was one other Board who had used a similar service several years ago. Ms. Hardie indicated that, if the Board decided to defer this topic to a Specially Called Meeting, she would reach out for additional information from the Board that had used the service to see if there was any additional information they could provide. Chair Jones agreed that it was appropriate to defer this discussion to a Specially Called Meeting as there were two Board members who were not present. Ms. Hardie and Ms. Wagener requested that, in the interim, the Board consider an extension of approval for the LEOFF 1 member's facility charges through March 2018 (as the current approval expired with January's reimbursement). This would allow for reimbursement until the Board could hold their Specially Called Meeting. Ms. Hardie brought forward the additional expenses referenced later in the Agenda since it was related to the same LEOFF 1 Member of discussion. Ms. Wagener explained that the incidentals being brought forward for approval had been originally included in the large reimbursement that was approved at the September 2017 Specially Called Board Meeting. However, these incidentals were not approved at the October 2017 meeting, only the facility charges of $10,912 as indicated on the provided quote. Because the incidentals had not been specifically approved it was being brought to the Board for consideration. The reimbursements for the cost of the incidentals are pending for the period October 2017 through current. Ms. Wagener further explained that there were three line items in question for the incidentals with a total cost of around $750 per month. Council Member Teitzel asked whether ancillary charges (such as toothpaste, etc.) were also included in the incidental charges. Ms. Wagener indicated that those type of charges have not been billed as part of the incidentals before. There was further discussion among the Board regarding the incidental expenses. The Board appeared to unanimously agree that additional information was needed in order to determine medical necessity for all 3 line items. Ms. Wagener indicated that, for this reason, she would reach out to the Member and request additional information explaining the benefit and medical necessity of all three incidental line items. She stated she would also notify the member that the Board would like to review these items at the Specially Called Meeting, to be scheduled in March 2018. Ms. Hardie suggested reviewing possible dates for the upcoming Specially Called Meeting. The Board discussed some possible dates amongst each other. Ms. Hardie indicated she would reach out to all members of the Board with the possible dates to finalize the schedule. There was discussion among the Board regarding these incidental expenses and what the related medical necessity would be for such expenses. Dr. Distelhorst and Council Member Teitzel agreed that additional information would Page 2 of 5 be needed in order to determine if the expenses could be reimbursed. Ms. Hardie agreed that HR would contact the member and ask for additional information explaining the medical necessity for these items. Ms. Hardie further indicated that the member would be notified that the Board would like to review the information at the Specially Called Meeting, once scheduled. Council Member Teitzel brought up concerns regarding the patient advocates that had been discussed earlier. His concerns related to possible conflict of interested or bias if the service providers are paid by the facilities where the patient is eventually placed. Citizen -At -Large Distelhorst explained that these service providers contract only with acceptable facilities that offer a high level of care which does not always indicate that most expensive facility. Placement is based on the patient's needs and how the facility can meet them. Citizen -At -Large Distelhorst also added that the patient and families often have a large amount of weight [say] in the final placement. Chair Jones make a motion to approve the reimbursement request for the LEOFF 1 member of discussion (less the incidentals) in the amount of $10,917 per month for the months of January and February 2018 based on medical necessity with further additional discussion of reimbursement for such services and the incidental at the Specially Called Meeting (to be held sometime in March 2018). Council Member Teitzel seconded the motion. The motion carried. REQUEST FOR REIMBURSEMENT CNA expenses- $300.00 Chair Jones clarified that this request was for a different LEOFF 1 Member. Ms. Hardie explained that this particular member has had challenges keeping caregivers due to the LEOFF 1 member's combative nature. Because of this and availability reasons, this member's family has had some issues with not having a care provider for some dates that has created "gaps" in coverage despite the two approved Long Term Care providers (as currently authorized by the Board). There was discussion among the Board regarding the billing amounts, the qualifications of the CNA individual and a lack of proof of insurance and potential liability issues. Ms. Hardie clarified that the member's family is only using this person when all other options are exhausted as they still have a need for coverage in those circumstances. Ms. Wagener indicated that the Board recently approved similar expenses for this CNA at the October 2017 Board meeting. Ms. Wagener further explained that the LEOFF 1 member and their family would like to continue to use this person in order to cover the "gaps" they occasionally experience. Citizen -At -Large Distelhorst made a motion to approve the CNA bill in the amount of $300.00 based on medical necessity. Additionally, the Board requested that HR request the member for documentation of the CNA's license, insurance and qualifications for future consideration of reimbursements. Council Member Teitzel seconded the motion. The motion carried. OTHER Generic Drug Policy Ms. Hardie clarified that the request for this policy was from the Board, which combined the Board's "Generic Drug" and "Co -pay Reimbursement" into one policy. Council Member Teitzel asked for clarification regarding what documentation is required when a member submits reimbursement for a brand -name vs. a generic prescription drug. Ms. Wagener clarified that the reimbursement policy covers prescription co -pays. Because of this, the insurance company (RetireeRx) would verify this documentation. Ms. Wagener said she was waiting for more information from the insurance provider regarding how generic and brand -name coverage is determined and what documentation they require from the subscriber. There was further discussion regarding co -pay variances for different Tier drugs as well as the fact that non -covered or non -processed prescriptions are not reimbursed under this policy. Ms. Wagener clarified that these types of requests are forwarded back to the member or brought to the Board for consideration, depending on the situation. Page 3 of 5 Ms. Hardie suggested that since HR staff was still waiting for information on this item the Board may want to choose to defer further determination of approval it to a later meeting. Ms. Hardie also explained that the Board would also need to conduct an annual review of all the policies (as noted in the Board policies) later this year. The Board agreed that this discussion should be deferred to the next Board meeting so that all Board members could be present and engage in the discussion. Council Member Teitzel requested that any additional information received by the insurance provider be brought to the next meeting for further review. Ms. Wagener stated she would do so. Hearing Aid Reimbursement Ms. Hardie indicated that the reason this policy was being brought forward was to clarify if pre -approval is required for first-time hearing aid purchases only or also for replacement hearing aids. Ms. Hardie asked the Board if they would allow HR to process some of these reimbursements as long as all of the appropriate documentation required by the policy was received. There was further discussion by the Board regarding the cost and medical necessity of hearing aids. There as additional conversation regarding the importance of pre -authorization for first time hearing aid purchases. Ms. Wagener asked the Board to clarify if it would be acceptable for HR to approve the cost of reimbursement for replacement hearing aids only, so long as it complied with the rest of the Hearing Aid Policy. Chair Jones indicated that following the initial purchase of a hearing aid that was pre -approved by the Board according to policy, he would have no problem allowing HR to approve future reimbursements for replacements. Such replacement reimbursements would still be subject to the Hearing Aid Policy. Dr. Distelhorst agreed with Chair Jones suggestion. The Board determined that it was appropriate to amend the policy to allow HR the authority to approve replacement hearing aids according to policy. The Board also requested that language be added to indicate the replacement model must be "comparable" to the original. For this reason, the Board directed HR staff to review the Hearing Aid Policy as requested and to bring it back to the Specially Called Meeting, (to be scheduled in March 2018) for review and potential approval by the Board. Reimbursement Request — Shingles Vaccine [new] Ms. Wagener indicated a member had reached out via email asking about the Board's position (pre -approval authorization) on vaccination reimbursement. The member of discussion was inquiring about reimbursement of the new Shingles vaccine, which has been purportedly deemed to be much more effective than the current vaccine. At this time, Medicare and the Supplemental Insurance do not cover this vaccine under the plan so the member would be requesting 100% of the reimbursement cost, estimated to be around $300. Citizen -At -Large. Distelhorst shared that this vaccine did well in trials and the CDC is recommending all eligible adults get the shot, even if they have been vaccinated previously. Council Member Teitzel voiced concern over the medical necessity of the vaccine, indicating that a person might or might not still contract the shingles virus whether or not they receive the vaccine. He further expressed concern that it was "highly recommended" and not "required". There was further discussion that followed by the Board regarding the potential medical bills that could result from members who contract Shingles and required medical treatment and how the approval of the vaccine could potentially mitigate future medical costs. Ms. Hardie confirmed that the Board had historically not approved immunizations related to travel but has approved them in the event that the member provided documentation from their doctor that the vaccine was recommended. Chair Jones agreed that the Board should have a recommendation in writing from the LEOFF 1 member's physician for the approval determination process. There was additional discussion that followed by the Board about preventative services covered and how the shingles vaccine compares to a preventative service. Page 4 of 5 Chair Jones requested that a policy be created to address Shingles Vaccine Reimbursement, which would include that the policy would require documentation of medical necessity. Ms. Hardie Indicated that City Attorney, Sharon Cates would begin drafting the policy for review by the Board at the next regularly scheduled meeting. WSLEA Conference — Chelan — May 2018 Ms. Hardie mentioned that the annual Washington State LEOFF Education Association (WSLEA) Conference was coming up in May 2018 in Chelan, Washington. Chair Jones stated that he was planning to attend and Citizen -At - Large Distelhorst expressed interest in attending as well. Ms. Hardie stated that she has not yet received the information about the conference, but will notify the Board when this information comes available. Proposed Dates for the Next Meeting Ms. Hardie inducted that, since a Specially Called Meeting will be held in March 2018 the Board could propose dates for the next regularly scheduled meeting at that time. Chair Jones adjourned the meeting at 10:26 am. Page 5 of 5