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2016-07-05 Disability Board MinutesEDMONDS' DISABILITY BOARD Meeting minutes 7/5/16 MEMBERS PRESENT: Ken Jones, Chair Gary McComas, Board Member Dave Teitzel, Council Member Adrienne Fraley-Monillas, Council Member STAFF PRESENT: Mary Ann Hardie, HR Manager Emily Wagener, HR Assistant CALL TO ORDER: Chair Ken Jones called the Board meeting to order at 9:27 a.m. APPROVAL OF MINUTES Chair Ken Jones made a motion to approve the meeting minutes of April 26, 2016 with a minor correction [board member Gary agreed] on page 2, last paragraph. It originally stated that Mary Ann would vote and check with legal. It was agreed that "vote and" would be deleted as the intention was for Mary Ann to check with legal to see if she could vote. Council Member Adrienne Fraley-Monillas seconded the motion. The motion carried. DISCUSSION AND APPROVAL OF CLAIMS SUMMARY REPORT: HR Manager Mary Ann Hardie reviewed the Claims Summary of April 1, 2016 up to and including June 30, 2016 as follows SUMMARY OF CURRENT COSTS: 4/1/16 through 6/30/16 SERVICE TOTAL NUMBER OF CLAIMS COST Prescription Co -Pas 9 $2,486.83 In Home Assisted Living Care 5 27,084.20 Purchase of Eye Glasses 1 800.00 Medicare Premium Reimbursement 2 2,517.60 Dental Reimbursement 4 559.04 Payment of Annual deductibles & co-insurance 2 127.13 Hearing Aids (batteries) 0 0.00 Eye Exam and Refraction 0 0.00 Out -of -Pocket Expense 0 0.00 Medical Equipment/Medically Necessary Services 0 0.00 TOTALS: 23 $33,574.80 The total expense for the period 4/1/16 through 6/30/16 was $33,574.80 with a total of 23 claims for the period which were comparable to the expenses paid for the same period in 2015. Ms. Hardie further explained that the expenditures (by BARS numbers) were broken out by premium costs as had been requested with the LEOFF 1 actuarial audit. Council Member Dave Teitzel indicated that the Fireman's pension fund seemed to be lower by about $7,000 this year compared to last year and asked why it was different. Mary Ann indicated that the amount is adjusted based off what is spent the previous year but she would check with Finance to verify. Council Member Dave Teitzel made a motion to approve the claims summary report for the period 4/1/16-6/30/16 in the amount of $33,574.80 based on medical necessity. Chair Jones seconded the motion. The motion carried. REVIEW AND APPROVAL OF LEOFF I RETIREE CLAIMS (REQUESTS FOR REIMBURSEMENT) AREDS 2 supplements in the amount of $256.48 A LEOFF 1 member submitted a request from the Board for reimbursement for AREDS 2 supplements recommended by his/her attending physician. There was some discussion that followed by the Board as to whether or not there was a prescription from the doctor or information provided from the attending physician about the medical necessity of the recommended supplement as well as any previous supplement reimbursements by the Board in the past. After a short discussion, Board Member Gary McComas made a motion to deny the reimbursement request for the LEOFF 1 retiree for the AREDS 2 supplements in the amount of $256.48 [based on the lack of information as to medical necessity]. Council Member Fraley-Monillas seconded the motion. The motion carried. Hearing aids - $3270 At the April 2016 Board meeting, a LEOFF 1 member had submitted a request for reimbursement to the Board for the purchase of hearing aids in the amount of $4200.00. Based on the current Board Hearing Aid policy (Policy No. 004-06), the Board made a motion at that time to approve the reimbursement request up to the policy allowed amount (the Costco purchase price of hearing aids in the amount of $2,600 for two hearing aids). HR informed the LEOFF 1 member of the Board's reimbursement approval determination and the LEOFF 1 member submitted additional information to the Board for further reimbursement consideration for the July 2016 meeting. The new information included a decrease in the price of hearing aids from the hearing aid provider Avada Hearing Clinic (for a new total of $3,270) and a recommendation from the medical provider to purchase a specific model of hearing aid which could be purchased at Avada Hearing Clinic. Mary Ann indicated that there seems to be some strong push back and resistance from the LEOFF 1's about providing additional medical information. Council Member Adrienne proposed that HR put out a letter to clarify things. Mary Ann recommended that she would draft a letter that would come from the board because she believed it would have more impact. Adrienne agreed and indicated the letter should include something that clarifies need for medical necessity, something from a doctor and to indicate they should not pre -purchase but must get it preauthorized. There was some discussion that followed by the Board including whether or not the recommendation provided from the attending physician rose to the level of medical necessity to approve the additional $670 for the purchase of the hearing aids under the policy. Board Member McComas requested that Costco be contacted about whether or not they carried the particular model of hearing aid recommended by Avada Hearing Clinic for the LEOFF 1 member and the cost. After a short break and trying to contact Costco, the Board requested that Ms. Hardie let them know whether or not that hearing aid model could be purchased from Costco and that the Board could provide further instruction about pre -authorization for purchase based on the information from Costco (prior to the next meeting) after that information was provided. Ms. Hardie stated that she would provide that information to the Board for further consideration after the meeting. Low visual aid device- $1542.50 A LEOFF 1 member submitted information to the Board requesting that his/her reimbursement request for the additional half of the cost of a low visual aid device in the amount of $1542.50 be approved. At the April 2016 Board meeting, the LEOFF 1 member had provided an appeal to the Board and the Board had a split vote (two in favor of approval, one opposed) which resulted in the non -approval of the reimbursement request from the February 2016 Board meeting being upheld. In the information provided to the Board, the LEOFF 1 member inquired as to whether or not the vote was valid. Ms. Hardie stated that she had provided information to the Board in the packet from legal that confirmed again that the vote on the motion did not have a quorum to of approval based on the voting results (noted above). Ms. Hardie further stated that she had contacted the LEOFF 1 member of discussion following the April 2016 meeting. He was informed at that time that the Board would be willing reconsider the request if he was able to provide information from his attending physician stating that the low visual aid was the recommended device [as there were other devices that could be used] to be used by the LEOFF 1 member based on medical necessity. There was some discussion that followed by the Board about the consideration of "quality of life" in the request for reimbursement process and about the reason for Board policies. Council Member Fraley-Monillas inquired as to whether or not the LEOFF 1 member of discussion had provided the additional information from his medical provider requested. Ms. Hardie stated that the information provided to the Board from the member was the only information received. Board Member McComas made a motion to approve the reimbursement request based on medical necessity. Chair Jones seconded the motion. Council Member Fraley- Monillas stated that no further medical necessity information [that had been requested] had been received. Council Member Teitzel stated that he was interested in speaking with the City Attorney about the quality of life concern and would be willing to consider a vote on this motion after further guidance from the City Attorney had been provided. Chair Jones called for approval. The vote was split (two for approval and two not for approval). The motion did not carry. Dental Policy Clarification A LEOFF 1 member had asked for clarification on the Board's Dental Policy and whether or not "cleaning" was intended to be included in the policy (or whether it was for all dental services). There was some discussion that followed by the Board about the policy. After short discussion, Council Member Fraley-Monillas made a motion to approve the revised Dental Policy as follows: The City of Edmonds LEOFF 1 Disability Board approved a benefit in the amount of up to $350.00 (total) every 2 years for any dental cleaning service charges, or $175.00 per each dental Gleaning service change per every 2 calendar years. This benefit runs on a 24 month calendar year schedule from January 1 of the first year through December 31 the second year on a "use it or lose it" basis. The stated benefit expires at the end each second calendar year and cannot be "rolled over" to the following year. Chair Jones seconded the motion. The motion carried. 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. Information from the City Attorneys Office regarding quorums and Board rights regarding appeals processes Ms. Hardie provided information to the Board about the appeals process from the City Attorney's Office along with copies of other Board policies (Snohomish, Bellevue) for the Board to consider for an appeals process. Council Member Teitzel mentioned that, at the WSLEA Conference he attended, he had inquired about whether or not the Board could step into executive session when making a determination of approval when members of the public were present at the meeting. Council Member Teitzel stated that this appeared to be appropriate from the information he heard. The Board requested that Ms. Hardie provide a draft policy of an appeals process from the Board policies provided for the Board to review at the next meeting in October 2016. Possible Board Doctors (second opinions At the previous board meeting, there had been discussion by the Board about retaining the services of a Board doctor for second opinions for reimbursement issues if needed. There was further discussion by the Board about using a doctor (not the "Board doctor") for a second opinion or "Objective/Independent Medical Assessments" as needed for more medically complex reimbursement requests. Hearing Aid Policy Review At the April 2016 Board meeting, it had been requested that the Hearing Aid policy be reviewed and the L & I hearing aid reimbursement cost provided for L & I for hearing aid claims (as one LEOFF 1 member stated the reimbursement cost from L & I was $4700. Ms. Hardie stated that the L & I reimbursement rate that was noted in the L & I purchase policy for hearing aids was $900 per hearing aid and that she had followed up with the LEOFF 1 member to find out what the cost difference was. The LEOFF 1 member stated that the total cost of the hearing aid fitting and check-ups over a four year period by L & I was estimated by his/her provider to be $4,770.00 per client. Ms. Hardie suggested that the Board have a chance to review the Hearing Aid policies and discuss any policy revisions at the October 2016 meeting. Council Member Fraley-Monillas requested that the policies be updated to include a condensed version of the policies for easier comparison. Ms. Hardie stated that she would also contact the WSLEA board secretary and request a copy of the board policies from jurisdictions around the state. WSLEA Conference Council Member Teitzel stated that he had attended the conference in Chelan in early May 2016 and that he had provided information that he thought would be helpful for the Board (practices/policies) to review. The Board thanked him for the information. Ms. Hardie reminded the Board that she would be attending the Disability Board Best Practices training in Leavenworth, WA on 8/24/16. Ms. Hardie stated that she would provide information to the Board following the meeting. Citizen -At -Large Vacancy There were 5 applicants for the Citizen -At -Large to the Board vacancy. The Board discussed that their interest in interviewing the five applicants. Ms. Hardie suggested that the interviews be held prior to the next Board meeting in October due to the need to fill the position and that 15-20 minute interviews with each candidate by the Board may be appropriate. There was a short discussion that followed by the Board about meeting dates for the interviews. Ms. Hardie suggested that she could send out an e-mail on dates for the second week of August 2016. Chair Jones adjourned the meeting at 10:46 a.m.