BOARD MEMBERS PRESENT:  Steve Kuhn, P.A.-C, President; Carl Heinisch, Vice President; Jean Gastiger, R.N., F.N.P.; John Olson, D.D.S.; Mary Beth Shear, M.D.; Steve Wolf, R.N.

BOARD MEMBERS ABSENT: Mike Groark, J.D; Russell Bishop, Psy.D.; Julia Fullerton; Rosemary Lane, M.D.; Debra Schelkopf, D.V.M. 
 

MINUTES

On a motion by Mr. Wolf, seconded by Mr. Heinisch, the minutes of the Board of Health meeting of May 25, 2004, were approved.  Motion carried.

DIVISION REPORTS

Mrs. Grush reported that a tentative State Budget has been approved by the Legislature, but our agency has not yet received any grant payments for the new fiscal year beginning July 1, 2004.  She explained that funding was added to the Medicaid line item for the addition of services, but money on the payment side was cut and will be paid in the 2006 budget.  A payment for Medicaid - Home Care was just received this week for services provided in October 2003. 

The Medicare Cost Report (MCR) for Home Care was submitted to Palmetto GBA in April 2004.  Mrs. Grush presented a chart which shows per visit cost calculated by the MCR formula using a percentage of agency costs as compared to her methodology that uses actual program costs.  The consultants project a cost per visit of $129.84 and she projects the cost at $105.21 per visit.  Mrs. Grush explained that the program appears to be losing money when using the consultant methodology, with revenue at $2.2 million and expenses at $2.4 million.  Mrs. Grush’s calculations show expenses of $1.9 million with a profit of $200,000 to $300,000.  She added that it is difficult to project revenue with the Perspective Payment System of reimbursement. 

There continues to be problems with the facility with major leaking of windows during heavy rains.  Resolution of this problem has been turned over to staff at Central Plant.  An independent water-testing contractor was hired to test the windows, and it appears to be a problem with the window manufacturer. During this process, two walls were torn out and all the insulation under the windows inside the walls was soaked. 

At the Maternal Child Health (MCH) Contractors meeting, Mrs. Grush and Mrs. Lux became aware of a new law, effective July 1, 2005, requiring all children in kindergarten, second and sixth grades to have a dental exam before May 15 of the school year.  A dental exam is currently a recommendation for kindergarten, sixth and ninth graders.  The law would require that a child’s report card be held if the child failed to present proof of the exam by May 15 or proof that a dental examination would take place within 60 days after May 15.  Illinois Department of Public Health (IDPH) will be establishing a rule to waiver children who can show an undue burden or a lack of access to a dentist.  It is anticipated that this will present a burden and access issue to many families.

Dr. Olson stated that he called the Illinois State Dental Society, and they reported that the Governor has not yet signed the bill and has one month to do so.  Mrs. Grush stated they were led to believe the Bill had been signed and was strongly supported by the Society.  She stated that dental care for Medicaid and low-income individuals is an issue of concern in DeKalb County, as it is in most counties.  She feels this will present a problem.  She is also opposed to the holding of report cards from children. 

Dr. Olson distributed a Dental Examination Record form and a Medical Assistance Fee Schedule for Children Participants from Doral Dental Services of Illinois, LLC with maximum allowance rates for reimbursement by IPA, as of July 1, 2003.  Mr. Kuhn read the mission statement of the Health Department, and questioned if the relationship between good or bad dental health is associated with general overall health.  He feels the Board does have a responsibility if the there is an association, and if not, the burden should fall on the local dentists.  Mrs. Gastiger stated that her husband is a minister involved with a group called Partners for Justice that has become aware of the lack of dental care available to low-income residents.  She indicated that there could be support from local churches if there were a way to administer the program.

Mrs. Grush repeated that access to dental care for Medicaid and low-income individuals has been of concern for many years.  Mary Uscian, former director of TriCounty Community Health Center, studied the feasibility of establishing a low cost dental clinic.  Her findings indicated it could not be financially sustained because of the number of working poor in the community versus individuals covered by Medicaid.  Mrs. Uscian visited many dental clinics and learned that there must be at least 60 percent Medicaid usage for clinics to survive.

Mrs. Grush stated, if the Governor does sign the bill, she would like Mrs. Uscian to attend a Board of Health meeting and provide a summary of the study.  She added that, at the MCH meeting, it was reported the Illinois Dental Society supported this project, and it was their belief that children that go in for screening and need considerable dental work would be provided the care by the dentist that did the screening. 

Dr. Olson stated that school requirements for dental allow for just an exam to be completed.  He has spoken with several dentists and has learned that the average cost of a periodic exam in this area is between $25 and $35. Dr. Olson distributed a 2004 NDAS Comprehensive Fee Report, which is a national survey of dental fees with a multiplier to adjust for different parts of the country.  He reported that local dentists did discuss the possibility of a group screening, and the majority were in agreement that it would not work from a dental standpoint because of the instruments and lighting needed and sterilization requirements.  In addition, parents would need to be present or at least sign a waiver because of HIPAA regulations.  If the screening were done in a school, there would be confidentiality issues to consider.  The consensus of the group was that the only place an exam could be done was in a private dental office.  Dr. Olson did report that the Haish Fund used to have funding that could be applied to a particular patient to receive dental care, but that money is now grouped into the DeKalb County Foundation and is not available for this type of service.  Dr. Olson reads the proposed law as evaluating the child’s needs through an initial triage as satisfying the requirement.  He added that if there were a diagnosis and no follow-up, that could create a liability problem for the dentist. 

Mr. Kuhn asked if there were disposable kits a dentist could use in a community screening.  Dr. Olson responded that there are mirrors, but not explorers.  He restated that lighting is the most crucial problem.  Another issue is that dentists are expected to provide the same standard of care at an off-site clinic as they do in their office.  Dr. Shear stated that, in her work in Well Child Clinics at the Health Department, she needs to make a dental referral every time she is here.  Other than one dentist in Hinckley, there are no resources locally that accept Medicaid.  Dr. Olson pointed out that Illinois Public Aid (IPA) does pay for children 18 years of age and under but does not pay for adults.  He added that his office does not complete the IPA forms any more and does not bill IPA because it is not worth the staff time needed and the inaccessibility of IPA. 

Dr. Shear asked if the County Dental Society, as a group, has discussions about this issue.  She feels the fact that a child on IPA cannot be referred to a dentist is wrong.  Dr. Olson agreed that there is a lot of need and that some patients are sent to Crusader Clinic.  Dr. Shear questioned why DeKalb County could not take care of its own.  She has also sent adults to Crusader Clinic, but her main concern is the children and the lack of resources for them.  She added that the medical community has worked out a rotating system for the medical care of obstetrics patients and children and adults on Medicaid called Partners in Health and possibly the dentists could do the same. 

Mr. Kuhn feels the Board of Health should have ongoing dialogue if the Governor signs this bill.  Mrs. Grush stated that the County Dental Society was approached years ago about a referral program and they were not interested.

Mr. Kuhn asked for the opinion of Board members in proceeding on this issue.  Options were discussing this further, speaking with the Dental Society or saying a discussion was held and no further action is needed.  Mrs. Gastiger supported pursuing the matter.  She questioned if there would be the possibility of a community clinic if there were space available and equipment could be donated.  Mrs. Grush pointed out that one dentist would not be adequate to meet the need given the number of children needing an exam.  She explained that Crusader Clinic is a federally qualified health center that is reimbursed their costs.  Since TriCounty was seriously considering the establishment of a dental clinic, she would like to have Mrs. Uscian attend a Board meeting to share what she has learned about this issue. 

Dr. Olson explained that there is high overhead with materials and supplies.  In the past, fairly comprehensive cases could be referred to dental schools.  He wondered if dental students that are spending their fifth year in general practice residencies could be contacted for care.  Mrs. Grush stated that Crusader Clinic has opened in Belvidere and are hoping to get a dental clinic going within a year.  She added that federally qualified health centers serve anyone and are not based on residency; however, she feels transportation and their charges may present obstacles for DeKalb County individuals. 

Mrs. Grush recommended waiting to see what happens in a month and if the Governor signs the bill.  In the meantime, she will invite Mrs. Uscian to a Board meeting to share what she has learned.  Mr. Kuhn stated that this issue would be tabled until the next meeting.

The first Electronics Collection in DeKalb County will be held on Saturday, August 14, 2004, from 8 a.m. to 1 p.m.  This event is cosponsored by the Solid Waste Management Program of the Health Department, the DeKalb County Farm Bureau and Kishwaukee Sunrise Rotary Club. 

Dr. Shear reported that meningitis reports are down as she recently had two patients with this illness in one week.  Mrs. Grush announced that the second case of West Nile virus in the state was reported today in a 36 year old woman in Jackson County.  The other case was in Jo Daviess County.  She added that the amount of rainfall received has been a big help with the mosquito population.  Mr. Kuhn stated that CDC has a great site where mosquito activity can be watched.  Most of the activity is toward the west, with a sprinkling in the east. 

Mrs. Baj, Director of Home Care, reported that her program is not experiencing the same slowdown as that of last summer.  Mrs. Grush added that Home Care is down one nurse and that all but two nurses have been trained on the laptop computers.  Obviously, nurses are working a little slower because of this transition. 

Mr. Kuhn asked if another meeting was to be scheduled to discuss a new Home Care building.  Mrs. Grush responded that another meeting would not be held at this time, but the initial planning for a building is included in the 2005 Budget. 

Mrs. Zanellato, Director of Health Education, stated that Mr. Kuhn had signed a certificate on behalf of the Board of Health to present to the Hispanic service sorority at NIU.  Janet Rodriguez, health educator, started this sorority to work with young Hispanic girls in the community.  There are currently nine girls in the program, and they attend every event that is held by this group. Mrs. Grush attested that this sorority is absolutely wonderful.  Mr. Kuhn indicated that he would like to be present when the certificate is presented.

Mr. Wolf questioned why office visits in the Maternal Child Health Program were down so much in June as compared to May, from 117 to 40.  Mrs. Grush responded that she would have Mrs. Lux check these figures and report back at the next meeting.

FINANCIAL DATA

On a motion by Mr. Heinisch, seconded by Mrs. Gastiger, the Financial Statements for the months of May and June 2004 and the Claims for the months of June and July 2004 were approved.  Motion carried. 

NEW BUSINESS

FY2005 Budget

Health Department

Mrs. Grush presented the 2005 Health Department Budget, revenue and expenses, which shows FY2002 Actual, FY2003 Actual, Board Adopted FY2004, 6 Months Actual FY2004, 12 Months Actual FY2004 and the Department Request FY2005.  Under Revenue, she explained that the most the County can levy for the Health Department under Property Tax is .0232 cents per $100 of assessed valuation.  Right now, the county is at $1.575 billion, which means the County can levy up to $365,400 on behalf of public health.

Currently, Environmental Health programs are costing more than the fees are generating.  Historically, fees have been raised every other year by about 5%, but that has not been enough to keep up with increased program costs.  Mrs. Grush presented a listing of proposed program fees for 2005 and explained the increase and the additional revenue that would be generated.  She further explained that in 1993, the State passed a law that counties could only charge $100 for a well permit.  The Illinois Association of Public Health Administrators and Environmental Health Association have worked hard to get this fee increased.  Some counties have added on an inspection administration fee, and Mrs. Grush is recommending that our agency add on a $100 administration fee in 2005, bringing the cost of a well permit to $200.  Since a septic permit takes more time to complete than a well permit, Mrs. Grush is recommending an increase from $220 to $250.  This permit does require an inspection to confirm that the information received is correct, the completion of a soil evaluation, and that staff be present during the time of installation.  Information on hookup fees if a house is being built in Sycamore and DeKalb were presented as information for the Board. 

Revenue for the Home Care Program should be around $2 million for Medicare – Home Nursing and $55,000 for IPA.  It is projected that insurance receipts will be down somewhat.

Mrs. Grush stated that, for the most part, the State grants would remain the same.  The only grant that has increased is the federally-funded WIC Grant.  Awards for the Bioterrorism Planning and Preparedness Grant and Tobacco Grant are still unknown at this time.  The State Budget did call for a 4% increase, but if this does not happen, it would have a $17,000 to $18,000 effect on our agency.

Mrs. Grush pointed out the concern with the State Medicaid programs as their slow rate of payment

Under the Private Pay line items, Mrs. Grush is recommending a $2 increase in childhood immunizations and T. B. skin tests from $8 to $10.  Immunization charges have not been increased since 2000 and T. B. skin testing since 1999.  These increases would generate an additional $8,000 in childhood immunizations and $3,500 for T.B. skin testing.

The total Department request for Revenue is $5,545,000.

The greatest expense in the FY2005 Budget is the Personnel/Salaries line items.  The request of $3,101,000 in the Salary line item includes current positions and a 1.9% COLA in December 2004 and 0 to 2% merit increase in June 2005.  Also built into this budget is $35,000 for possible nursing salary adjustments or retention bonuses.  Mrs. Grush stated that home health nurses feel they need a larger salary to remain competitive, but this is an even larger problem on the Public Health side.  These nurses leave our agency either because of money or a shortened workweek.  Dr. Shear stated that Kishwaukee Community Hospital recently increased their nursing salaries, and Mr. Kuhn stated that Delnor offers three-day workweeks.  Mrs. Grush does not feel that our agency can compete with that and does not have the financial capability to compete with the hospital in terms of salaries.  She stated, however, that the agency must do everything possible to retain the nurses it has.  By September, Mrs. Grush will know what the agency will be receiving from the County financially.  She did point out that the setting aside of monies for compensated absences payable and the possibility of paying off vacation leave for long-term employees is not included.  Both of these issues will also be looked at this year. 

Mrs. Grush pointed out another concern of the employer portion of IMRF increasing from 6% to 8.5% Since the County does have some money in reserve, they are only increasing department payments to 6.5% this year.  This figure will escalate over the next few years, and we will then be paying the 8.5%, which is a significant amount of money.  She has been told to budget a 12% increase in the Health Insurance line item.  Unemployment also increased this year from .09% to .13% of the first $9,500 of each employee’s salary.

Two requests have been submitted for funding from the Public Building Commission (PBC) for Special Projects: $30,000 for a storage shed and $8,000 for a tractor to help with snow removal.  Mrs. Grush anticipates that the recommendation will be to construct a shed at the time a Home Care facility is built.  The next special project for Home Care is a software program called “Insight.”  This will evaluate performance, profitability and productivity. 

Information Management Office staff are indicating that a new server is needed for our agency. 

In the Travel line item, $12,000 has been allocated to reimburse staff for the increased cost of gas in 2004.  

Software Maintenance, a new line item, will provide for maintenance on Home Care’s billing and laptop programs. 

The increase in the Rental of Space line item is due to the rent of $6,000 now being paid for the Sandwich site.  Our agency changed from subrenting from Safe Passage to renting the space on our own on July 1, 2004. 

Total Expenses in the FY2005 Budget are $5,468,200, up 5.4% from FY2004 Projected.

A recap of salary information for both Public Health and Home Care was presented.

The FY2005 Budget Summary shows a fund balance in FY2003 of $2,720,592.  At this time, $1 million was set aside for a Home Care building, leaving $1,720,592 for Health Department purposes.  At any given time, actual cash on hand is approximately $2 million, with $700,000 in Accounts Receivable and cash flow.  Mrs. Grush reported that, at the end of 2005, there should be almost $2.7 million, with another $200,000 placed in the building fund.  She is also recommending that any excess revenue over expenses this year also be added to the building fund.  This would leave a balance of $1.4 million.  Less the $700,000 for cash flow, the agency would still have approximately $700,000 for operations. 

Mrs. Grush reported that Opportunity House has approached the County regarding building a residential home on the land occupied by the Health Department, and there is also a request for a sheltered care facility.  While the area is slowly developing into a residential facility area, she has requested that the County save a desirable location for a Home Care building.

A summary of the 2005 County Request was reviewed.  $365,400 is being requested in the Public Health Levy.  The County pays IMRF and Social Security for Health Department staff, but not for Home Care, which amounts to $266,200, which is being requested.  These items are not paid for Home Care because the County feels they should be able to sustain themselves.  $200,000 is being requested from the PBC for utilities, building maintenance, janitorial and janitorial supplies, a storage building and a tractor.

$22,500 is being requested from the General Fund to pay the difference in the Animal Control Program that the sale of tags does not cover.  Since Animal Control is a mandated program, the County does have to pay these expenses.   The cost of the program is around $200,000, and the Health Department contributes approximately $30,000 of administration time as an in-kind service, which should be continued.  The request to the County is approximately 15% of the entire budget.

Mrs. Grush stated that this is a preliminary budget that will change by the September Board of Health meeting.  It will be submitted to the County by the 5th of August, and a meeting will be held in September with recommendations made. 

Solid Waste

Mrs. Grush reported that the Board of Health was given responsibility for the Solid Waste Management Program when the tipping fee was established.  Tipping fees of $87,000 to $90,000 are received each year.  While there is not much that can be done with this limited budget, a lot of education is done in schools and several events held, such as oil and tire recycling and the upcoming electronics collection.  Two oil recycling events are being proposed for 2005.  If our agency can contribute towards a hazardous recycling event, the Environmental Protection Agency will cosponsor such an event with us.

Dr. Shear made a motion to approve the FY2005 Health Department Budget, as presented, seconded by Mr. Heinisch.  Motion carried.

CORRESPONDENCE AND ANNOUNCEMENTS

Newspaper articles for the months of July and August 2004 included the announcement of Mr. Kuhn as Board of Health president, Career Night with Latina professionals speaking about teen pregnancy, teens offering advice to parents on talking about pregnancy issues, the threat of West Nile virus in the area, Used Oil Collection Day, implementation of the Internet as a means of paying for birth and death certificates through the Health Department, keeping food safe in the summer, the receipt of the Award of Excellence by Kishwaukee College by Christel Springmire, sanitarian, and the settlement of the discrimination case against the Health Department.

ADJOURNMENT

On a motion by Mr. Heinisch, seconded by Mr. Wolf, the Board of Health meeting adjourned at 8:47 p.m. Motion carried.

Carl Heinisch, Secretary

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