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2017-09-06 Disability Board MinutesEDMONDS' DISABILITY BOARD Meeting minutes Specially Called Meeting 9/6/17 MEMBERS PRESENT: Dave Teitzel, Council Member Jim Distelhorst, Citizen -at -Large Adrienne Fraley-Monillas, Council Member STAFF PRESENT: Mary Ann Hardie, HR Director Emily Wagener, HR Analyst Sharon Cates, City Attorney MEMBERS OF THE PUBLIC PRESENT: None CALL TO ORDER: Council Member Adrienne Fraley-Monillas called the Board meeting to order at 9:35 am. It was noted that Neither Board Member Gary McComas nor Chair Ken Jones were present. City Attorney Sharon Cates arrived at the meeting at 9:50 am due to car trouble. FOLLOW UP FROM THE 07/19/17 MEETING (Current and ongoing rehabilitative care expenses for a LEOFF 1 member) At the 7/19/17 meeting, the Board had requested additional documentation from a LEOFF 1 member for the continued use of a nursing facility. This meeting was called to review the submitted information. After review of the submitted documentation, there was discussion between Citizen -at -large, Dr. Jim Distelhorst and Council Member Fraley-Monillas about medical necessity and possible bias. This was indicated as a concern since the clinic doctor wrote the letter of recommendation and medical necessity. HR Director Mary Ann Hardie reminded the board about the policy for assisting living/nursing care which requires 3-quotes for semi -private room care within the LEOFF 1 member's living area. There was further discussion that followed by the Board about the necessity of having documentation from a provider from outside of the nursing facility that the LEOFF 1 member is living at (in the event that that he/she will need to continue to use long-term care services; at home or in a facility). The Board agreed that the LEOFF 1 member had serious medical issues and had been unable to transfer from the facility during the period of discussion. Ms. Hardie brought up to the Board their option to conduct a second opinion. Council Member Fraley-Monillas agreed. Ms. Hardie briefly explained to Sharon that there had been discussion about amending the Long Term Care Policy to add the option of requesting a second opinion which the Board would pay for the cost of. The Board continued to discuss this further in depth. A major concern that was expressed by the Board was the long term nature of this LEOFF 1 member's medical condition. There was also further discussion about the possibility of any amount of personal independence and the level of care that would qualify for reimbursement by the Board. Council Member Dave Teitzel asked if the Board physician would conduct the second opinion. Ms. Hardie indicated that the Board physician's function is only to certify a member for initial LEOFF 1 disability purposes. She then offered to reach out to her LEOFF1 contacts to find a suitable physician in order to obtain a quality second option, referred to as an IME (independent medical exam). The LEOFF 1 member's insurance coverage for the resubmitted reimbursement amount was further discussed. It was also discussed that the LEOFF 1 member was in an auto accident in August 2016 and the insurance company paid out for expenses under his PIP until that was exhausted, then the LEOFF 1 member also exhausted the Medicare benefits available. Ms. Hardie asked to clarify the Board's position for reimbursement for charges incurred for the LEOFF 1 member of discussion through July 2017, which are as follows: Long term care services $78,911.88 Other costs $3,33.91 Transportation $1,000 Total $79,948.79 Council Member Fraley-Monillas inquired as to whether or not the service cost (reimbursement) is paid directly to the facility or to the LEOFF 1 member. Ms. Hardie explained that the Board has not done a direct pay to the facility before, typically, they have reimbursed the member as allowed by policy, however the Board could discuss that and make a change to the policy if they chose to. Given that reimbursements provide proof of payment and that it has been processed through insurance, allowing payment directly to a provider could pose some issues. Citizen -at -Large Dr. Jim Distelhorst agreed. There was further discussion about how these types of costs are going to continue to increase with the aging demographic of the LEOFF 1 group. I was agreed that it was a good idea to [regularly] review the policies and make updates where necessary. HR Analyst Emily Wagener suggested that, if the Board chose to approve the submitted expenses, that they approve the expenditures through October 2017 (since that is when the next Board meeting will take place) and to review the three quote requested by the Board at the next meeting (for further reimbursement consideration). Ms. Hardie indicated HR would reach out to the LEOFF 1 member to indicate the intention to set him up for a second opinion IME at the Board's expense. Ms. Hardie further specified it would be communicated that his continued reimbursement relies on the documentation received from that medical examination along with the results of the 3 quotes requested by the Board. Council Member Fraley-Monillas made a motion to approve: 1) the LEOFF 1 member's reimbursement request in the amount of $79,948.79 (less any costs not processed yet through insurance) based on medical necessity, 2) reimbursement for base monthly nursing care service charges for August, September and at the facility the LEOFF 1 member is at, 3) for the LEOFF 1 member of discussion to provide 3 semi -private room nursing facility care quotes (within the living area of the member) by the next Board meeting, and 4) for the LEOFF 1 member to complete an IME (second opinion) through an independent medical provider as soon as possible (to be paid for by the City). Dr. Distelhorst seconded the motion. The motion passed. 2 It was then confirmed that the Board wished to amend the LTC policy to include language for a second opinion, but no motion was made or required. OTHER The next Board meeting was set for Tuesday, October 316t 2017 at 9:30am There was additional discussion about the Board doctor and the possibility of finding a new Board doctor for second medical opinion purposes.. Council Member Fraley-Monillas adjourned the meeting at 10:03am.