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2017-07-19 Disability Board MinutesEDMONDS' DISABILITY BOARD Meeting minutes 7/19/17 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 Carly Derrick, 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 9:32 am. It was noted that Council Member Adrienne Fraley-Monillas would be arriving late due a conflicting appointment that was unable to be rescheduled. APPROVAL OF MINUTES Council Member Dave Teitzel made a motion to approve the minutes of April 19, 2017. Citizen - At -Large Jim Distelhorst seconded the motion. The motion carried. DISCUSSION AND APPROVAL OF CLAIMS SUMMARY REPORT: HR Director Mary Ann Hardie reviewed the claims summary report for the period 4/1/17-6/30/17 as follows: Summary of Current Costs 04/01/2017 - 06/30/2017 Type of Service Count of Claim # Total Paid for Service Board Approval 2 $3,604.17 Co -Insurance 2 266.23 Deductible 3 702.85 Dental 2 210.00 Long Term Care 6 28,229.38 Medicare Premium 2 2,517.6 Prescription 1 4 1 777.21 Grand Total 1 21 $36,307.44 The total expense for the period 4/1/17 — 6/30/17 was $36,307.44 with a total of 12 claims and 21 different reimbursements for the period. Ms. Hardie explained that the biggest expenditure for this period was the long term care costs (as it was for the same historic period last year in 2016). Chair Jones made a motion to approve the claims summary report for the period 4/1/17- 6/30/17 in the amount of $36,307.44 based on medical necessity. Council Member Teitzel seconded the motion. The motion carried. FOLLOW UP FROM THE 4/19/17 MEETING (ADDITIONAL INFORMATION/DOCUMENTATION REQUESTED OF A LEOFF 1 MEMBER) BY THE BOARD FOR CONTINUING REIMBURSEMENT FOR MEDICAL SERVICES (ASSISTED LIVING CARE, ETC.) At the 4/19/17 meeting, the Board had requested that a LEOFF 1 member using assisted living care services provide to the Board an update on his/her prognosis and estimated continued need to use these services. Additionally, information about: 1) whether or not the LEOFF 1 member could use DART transportation services and, 2) three nursing home care quotes (as noted in the long term care policy, #08-11). There was some discussion that followed by the Board about the information that was provided as follows: 1) a cover letter from the family member with power of attorney as to the LEOFF 1 member's situation, 2) information from the attending physician about current and continued prognosis for her condition requiring the assisted living care services, 3) information from the speech therapist as to her current status, and 4) three nursing care quotes in the living area of the LEOFF 1 member. After further discussion by the Board, it was noted that: 1) the nursing care facilities may not be viable for the LEOFF 1 member's condition, and 2) the cost of the nursing care facilities per month was higher than the cost of the assisted living care services the LEOFF 1 member was currently receiving. Board Member McComas made a motion continue to approve the assisted living care services (currently being used) by the LEOFF 1 member of discussion. Chair Jones seconded the motion. The motion carried. Ms. Hardie stated she would reach out to the LEOFF 1 member's family (with power of attorney for the LEOFF 1 member) to let them know of the Board's determination. The Board asked that Ms. Hardie communicate the appreciation on behalf of the Board for the provision of the information as requested and the service that the family members is providing for the care of the LEOFF 1 member as well. REQUESTS FOR REIMBURSEMENT LEOFF 1 member using long term care services from 9/7/16-current Chair Jones asked Ms. Hardie to share with the Board the conversation she had with the LEOFF 1 member about this request. Ms. Hardie explained that the first time she had been contacted about this was a few weeks ago when Joyce, from the LEOFF 1 Coalition called to inform the City that there was a LEOFF 1 member who was needing reimbursement for medical services since September 2016 (of a long term care facility cost). Ms. Hardie explained that she was given a contact name for someone acting on behalf of the LEOFF 1 member. Ms. Hardie further explained that she called the contact that she was given and was informed that the LEOFF 1 member had been in a long term care facility since September 2016 (as well as a period of time prior to that in August when he had been in an auto accident). This individual further explained that the LEOFF 1 member was in a physical condition that prevented his mobility (other than through the use of a 2 wheelchair) and that he was unaware of the Disability Board and his possible benefits as a LEOFF 1 member. Ms. Hardie explained that there was a process for reimbursement requests, and that the Board policies (for which there is a long term care policy) outline what is required (including pre - approval) and information about medical necessity. Ms. Hardie said she told the individual that very specific information would need to be provided to the Board in order for the Board to make any determination of approval on such a request. This information included: 1) information about the LEOFF 1 member's medical condition and prognosis and medical necessity for the use of the long term care facility (back to the original date of such use of services) as well as the information about the medical costs from the facility. Ms. Hardie further explained that she was told that the LEOFF 1 member's Medicare Part A benefits had been exhausted and that the LEOFF 1 member was no longer financially able to afford being in the long term care facility. Ms. Hardie reminded the Board that immediately after this, she had reached out to the Board via email to apprise them of this upcoming request and situation. Ms. Hardie received information from the LEOFF 1 member in a binder for the Board's approval process at the 7/19/17 Board meeting. In reviewing the information provided, there was no letter meeting the board's request of medical necessity or prognosis. Ms. Hardie said she called the individual who dropped the information off and was very clear that, while this could go before the Board for review, it may not be approvable (if anything was to be approved) based on the lack of information provided. Ms. Hardie said she also tried calling the LEOFF 1 member directly and when the LEOFF 1 member answered the phone, he handed the phone over to the individual who had been calling Ms. Hardie about the LEOFF 1 member's request. It was unclear to Ms. Hardie as to why the LEOFF1 member was unable to interact with her regarding his request. Ms. Hardie also stated that the HR staff was sending the bills that had come in (not including the nursing home care bills) to the LEOFF 1 insurance plan to make sure that they had been processed through the plan already. There was considerable discussion that followed by the Board about this LEOFF 1 member's request. It was pointed out that there was a letter provided by the current nursing care facility in February 2017 that stated that the LEOFF 1 member was not in need of nursing care services at that time. The Board expressed further concern that there was: 1) not sufficient information to be able to make a determination of approval, 2) that there needed to be written authorization for the Board and HR to continue to have further discussion with the individual assisting the LEOFF 1 member with his request, and 3) that the information had not been provided to the Board in a timely fashion. The Board requested that the City Attorney Sharon Cates draft a letter to the LEOFF 1 retiree specific to: 1) providing written authorization for HR to interact with the individual assisting the LEOFF 1 member, 2) information from the current physician as to the necessity of medical care for the LEOFF 1 member from September of 2016 (including the need for long term care). There was also further discussion by the Board about convening a specially called meeting once the information had been provided for the Board to review it and make a determination of approval. Ms. Hardie further stated that the LEOFF 1 member was expecting to hear back from the Board and requested that the Chair contact the LEOFF 1 member about this since it is not unusual for LEOFF 1 members at times to get upset with HR for communicating Board requests. Board Member McComas made a motion to convene a specially called meeting (before the October 2017 Board meeting) once the information had been provided (from the letter drafted by legal at the request of the Board) in order for the Board to make a further determination as to what, if any costs for medical care services would be reimbursable to the LEOFF 1 member of request. Council Member Teitzel seconded the motion. The motion carried. DRAFT GENERIC DRUG POLICY REVIEW/APPROVAL (FROM THE APRIL 2017 MEETING) The Board reviewed the updated changes to the draft of the Generic Drug Policy to the Board (as drafted by legal). Ms. Hardie recommended that as this relates to prescription drugs, that it be combined with the prescription co -pay policy, #05-06 and reviewed at the October 2017 meeting for approval. Council Member Adrienne -Fraley Monillas moved to combine the two policies into one for review at the next Board meeting. Citizen -At -Large Distelhorst seconded the motion. The motion carried. OTHER Recent passing of a LEOFF 1 member Chair Jones stated that he had talked to the daughter of the LEOFF 1 member who had passed away in June 2017. The Board expressed condolence to the family members of the LEOFF 1 retiree and appreciation for the member's service to the City. It was noted that there would be a few more reimbursement requests submitted for long-term care services as the invoices received (to -date) only went through May 2017. WSLEA Conference — Chelan, WA 5/9/17 — 5/12/17 Chair Jones stated that he had attended the conference and that there was discussion, information and a presentation provided by a retired police department detective guest speaker on the topic of elder abuse. It was pointed out that this is unfortunately prevalent and something to be aware of. Chair Jones further discussed that there was a review of HIPAA compliance for Disability Boards presented by law firm Ogden Murphy Wallace. Chair Jones stated that he believes that the City's Board is in compliance and that he believes that the HR staff does a nice job with being careful in compliance and this is appreciated. He further stated that, normally, the compliance issues arise during "restaurant" conversations that may occur outside of the Board meetings. Given that all of the LEOFF 1 member names are redacted with reimbursement requests submitted to the Board, this minimizes this risk and exposure. Chair Jones noted that there was an actuarial report on LEOFF 1 funding (through DRS) and that there were only 20-30 active LEOFF 1 retirees in the system to date. Chair Jones adjourned the meeting at 10:45 am. M