BOARD MEMBERS PRESENT:  Fred Peltz, D.D.S., President; Glenda Pecka, R.N., M.S., Vice President; Russell Bishop, Psy.D.; James Cole, M.D.; Mike Groark, J.D.; Carl Heinisch; Darrell Wiley, M.D.; Steve Wolf, R.N. 

BOARD MEMBERS ABSENT:  Sonja Conway, Ph.D.; Steve Kuhn, P.A.; Debra Schelkopf, D.V.M. 

ADDITION TO AGENDA:  Mrs. Grush requested that an agenda item, Generator, be added under New Business. 

MINUTES 

On a motion by Mr. Heinisch, seconded by Mr. Wolf, the minutes of the Board of Health meeting of September 24, 2002, were approved.  Motion carried.

DIVISION REPORTS 

Mrs. Grush reported that the preliminary work for closing out the financial books and statements for FY2002 has begun. 

Neither the national or state home care associations were successful in achieving the elimination of the 15% cut to home care rates effective October 1, 2002.  Medicare rates will now be approximately 7% lower for all episodes ending after October 1.  Based on last year’s Medicare revenue, the cut experienced by our program could be approximately $100,000.

Mrs. Grush stated that the State of Illinois announced in September that federal approval has been received to extend medical coverage to the parents and caretakers of children eligible for KidCare whose family income is below 50% of the federal poverty level.  This will have no effect on our agency as eligible individuals must sign up at the Department of Human Services (DHS) office and she does not think many DeKalb County families will meet these income requirements for coverage as this is extremely low. 

Implementation of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) at Home Care is progressing under the direction of Deb Rolf, Quality Improvement nurse.  This is a huge project requiring a number of changes to policies and procedures to meet the numerous requirements.  Progress on the Public Health side has been slower due to limited direction from DHS & IDPH.  the Illinois Public Health Administrators’ Association hired the law firm of Sorleng, Northrup, Hanna, Cullen and Cochran to develop a model for public health to follow.

The new state-contracted software from Ahlers Associates of Texas has been successfully installed in the Family Planning Program.  Installation and implementation of the software has gone quite well.

The first frost occurring this fall ended West Nile events for the year.  Mrs. Grush stated she is not sure what next year will bring, but does expect much of the same as experienced this past year.  DeKalb County had two diagnosed cases, but she suspects there were more cases that were not reported or not diagnosed.  The agency did receive $15,000 to purchase 17,000 larvicide briquettes to be deposited in catch basins throughout the county.  One batch was distributed, and then the agency was informed by the State to not distribute any more because of the decrease in temperatures below 60 degrees, which results in inactivity by the female mosquito population.  The agency still has enough briquettes on hand to treat catch basins two times next year. 

A great deal of time has been spent on development of the Bioterrorism Plan through three committees established by the Health Department.  The Medication Distribution Committee has been refining the medication distribution process should mass distribution be required.  Mrs. Grush hopes to have the Plan finalized by the January board meeting.  The agency has received approval from Northern Illinois University to utilize the Convocation Center should the need arise.  She reviewed some of the staffing issues involved in implementation of the plan. 

Mr. Drake attended the annual meeting of the Illinois Environmental Health Association in September where he requested that the Illinois Department of Public Health (IDPH) do everything possible to ensure that briquettes could be dropped in storm sewers without the individuals needing to be licensed to perform that function.  He also announced that the Animal Control staff was called to pick up a tiger and transport it to a zoo in Aurora. 

Mrs. Grush reported that the Personal Health Services Division has been facing difficult staffing transitions with the resignation of two full-time Spanish-speaking secretaries and the agency’s only full-time Spanish-speaking nurse.  The nurse, who desired more clinical experience, accepted a position in Aurora working in a clinic.  Advertisements have been running, but it is very difficult to find Spanish-speaking staff, and especially Spanish-speaking nurses.  Mrs. Grush reported that over 30% of agency clients are Spanish-speaking.  Mr. Wolf stated that non-professional translators have been paired up with professionals in Kane County to meet the needs of their Hispanic clients.  Mrs. Grush stated this is certainly an alternative, but not cost-effective or the most productive.

The agency received a report of a case of pulmonary TB in a young man in September, which was later confirmed.  A contact investigation revealed relatively few people involved.   The gentleman has been in the United States for three years.  Directly Observed Therapy (DOT) was started on September 24 and the gentleman was confined to his home.  Nine of his close contacts had positive skin tests and seven had negative skin tests. 

Mrs. Baj, Director of Home Care, reported that October 2002 was the biggest month this year in terms of visits.  A Medical Social Work Assistant was added to work with the contracted social worker.  A second psychiatric nurse was also contracted.  Lisa anticipates the addition of an assistant for the Occupational Therapist with the increase in those services.  In the last six months, a physical therapist has also been added in the four southern townships of DeKalb County, and it is anticipated that another physical therapist will be hired to serve as backup in this area.  Fortunately, staffing for nurses remains stable at this time. 

Mrs. Zanellato, Director of Health Education, has scheduled a Hispanic culture training for December 2 with Myra Walden, MA, LCPC, from Lifelink for Health Department staff and members of the Teen Birth Study Committee.

FINANCIAL DATA 

Mrs. Grush reported that the fiscal year ends in three days.  Grant money has been received slowly, but she is confident it will be received at some point.  Dr. Peltz asked if the state paid interest when payments were withheld or paid late.  Mrs. Grush responded that Medicare and private insurance companies do pay interest, but this is not the case with Illinois Public Aid or State grant payments.

On a motion by Mrs.Pecka, seconded by Dr. Bishop, the Financial Statements for the months of September and October 2002 and the Claims for the months of October and November 2002 were approved.  Motion carried. 

NEW BUSINESS 

Home Care Fee Increases 

Mrs. Grush presented a chart of Proposed Home Care Fee Increases.  She reported that skilled nursing fees were increased in 2000, home health aide fees in 1993 and all other fees in 1999.  Mrs. Baj contacted the Illinois Home Care Council asking if they had recently conducted a survey of fees, but they had no such information available.  She did contact a number of home care agencies, but many were reluctant to disclose their fees.  Mrs. Grush feels our charges are considerably lower than many other home care agencies in our area, especially in the Chicago market.

Mrs. Grush explained that if a Medicare patient is seen less than four times, the agency is paid per visit versus per episode.  Agency charges must be higher than what Medicare is reimbursing per visit, which is the case for all services except those of the Medical Social Worker (MSW).  The agency currently charges $155 for an MSW visit and Medicare is reimbursing $163.39. 

Mrs. Grush is proposing that fees be increased as follows: skilled nursing from $110 to $135 per visit, physical therapy, speech therapy and occupational therapy from $125 to $135 per visit, home health aide from $50 to $75 per visit and MSW from $155 to $175 per visit.  Admission skilled nursing visits will remain at $180 per visit.  All increases will be effective December 1, 2002.  She pointed out that this would only affect insurance-paying patients where no rate has been negotiated and whose insurance may pay 80% of the charges.  The same reimbursement will be received from Medicare, and IPA payments will remain at $61.34 per visit.  It is projected that an additional $40,000 could be received by increasing the charges to $135 per visit.

Mr. Wolf asked what percentage of Home Care patients are Medicare.  Mrs. Grush responded that 80% of the patients this year are Medicare as compared to 81% last year.  Insurance patients have increased steadily over the past five years

Mr. Wolf moved to approve the increase in Home Care fees, as presented, seconded by Mr. Heinisch. 

Mrs. Pecka questioned the higher rate for MSW services.  Mrs. Grush responded that a great deal of time is spent with these patients in making referrals, completing paperwork and linking the clients up with referrals.

Motion carried.  

Personnel/Compensation Adjustments 

Mrs. Grush reported that the beginning of the new budget year, December 1, is typically the time of year when agency salaries are reviewed and adjustments made, if necessary.  She pointed out that part-time temporary employees receive the cost-of-living increase each December, but are not eligible for the mid-year merit increase.  She is recommending that all part-time temporary employees receive the full 3% increase this year effective December 1, 2002.  She pointed out that staff begin to slide down the scale when they receive only one increase each year, and new staff that are hired are making more than current employees.  All adjustments will cost approximately $6,000 and have been built into the salary line item.

Mrs. Grush recommended salary adjustments prior to the December 1, 2002, increase for the following staff: 

Heidi Zanker, R.N., from $18.29 to $19.00 per hour in Home Care and $16.54 to $16.68 in Public Health Lorna Mackeben, R.N., from $16.14 to $16.68 per hour

Linda Gletty, R.N., from $16.41 to $16.68 per hour

Gary Judd, Communicable Disease Prevention Specialist, from $15.31 to $15.70 per hour

Peggy Newby, Pediatric Services Coordinator, from $20.51 to $21.00 per hour

Mrs. Grush is recommending a FY2002 bonus for Peg Carroll, Communicable Disease coordinator, of $1,500 because of the amount of overtime required in this position.  She also recommends an increase in salary for Mrs. Carroll from $24.87 to $25.87 per hour and an increase in the salary range from $17.03 - $26.40 to $18.93 - $29.34.

Mrs. Grush is also requesting a change in the Fiscal Coordinator position, which was approved by the Board approximately one year ago, from an hourly position to a salaried position, placing it in the same status as all other coordinator positions. 

Mr. Groark moved to approve the personnel compensations and adjustments, as presented, seconded by Mr. Heinisch.  Motion carried.

Purchase of Generator 

Mrs. Grush reported that a $78,000 Bioterrorism Grant was received from the State to upgrade the agency’s computer system for 24 hours per day, seven days per week, connectivity to the Internet.  The county’s Information Management Office (IMO) wrote the specifications and is completing all the actual work.  Five new computers have been purchased and the agency is now also connected to the Sheriff’s Department.  Mrs. Grush stated that these grant dollars are to be spent before December 31, 2002, and since approval was not received until October to spend the money, to get it all completed before December 31 is of concern.

In the Bioterrorism Grant, $11,000 for a backup generator was requested because the new Health Department facility has no backup at all in place.  The old Health Department building was hooked up to the Nursing Home’s generator.  The original plan was to have very minimal backup for two computers and the server by hooking up to the DeKalb County Rehabilitation and Nursing Center’s (DCRNC) new facility, thinking this could be accomplished for approximately $11,000.  However, an estimated cost is around $25,000.  In meeting with the County’s facility manager, he feels the entire Health Department and everything, including phone, lights, refrigeration, computers and air conditioning, could be maintained in a disaster situation.  Mrs. Grush stated she feels this should be considered in light of the minimal backup received for $25,000.  She added that there simply has not been enough time to obtain all necessary information; however, in light of the grant’s deadline, some decisions may need to be made soon and certainly before the next Board meeting.

At this time, Mrs. Grush asked the Board to consider authorizing a budget expenditure up to $100,000 for backup power.  It is estimated that the generator will cost around $40,000, writing of specs for hookup is around $10,000, and actual hookup would be around $30,000 to $40,000.  Mrs. Grush stated that once she receives the detailed information, she would communicate that to the Board via written correspondence whereby the Board would have the opportunity to approve or deny the request to proceed.  The generator would need to be placed out for bids.

Dr. Peltz asked if the Convocation Center, which would be used in the event of a disaster, has a backup generator.  He pointed out that this money could be used to purchase a generator for that facility if they do not currently have a system.  Mrs. Grush responded that she is positive the Convocation Center does have a generator.

Mr. Wolf asked if smallpox vaccine would be stored at the Convocation Center or at the Health Department when it was received.  Mrs. Grush stated that it would be at the Convocation Center if mass immunization of all residents was to be done.  It would be stored at the Health Department if pre-event vaccination were to be given. 

Mr. Heinisch asked if the question was the maintaining of the medication.  Mrs. Grush responded that it is more than just the medication issue, but also involves the phones, lights, refrigeration, and computer connectivity with the State and CDC.  She feels strongly that the Health Department should be on its own system and not be dependent on the DCRNC. 

Mr. Heinisch requested that the correspondence justify this expenditure should the public question this purchase.  Mrs. Grush assured him that this would be completed. 

Nominating Committee 

Nomination of Board Members

Mr. Groark, chairman of the Nominating Committee of the Board of Health, recommended the reappointment of Mr. Heinisch and Mr. Kuhn for three-year terms from 12/1/02 through 11/30/05.

The Committee also recommended the appointment of Dr. Rosemary Lane, retired community physician who was the Director of the University Health Service for many years, as a new member of the Board, with the first term from 12/1/02 through 11/30/05.

On a motion by Mr. Wolf, seconded by Mrs. Pecka, the nominations of DeKalb County Board of Health members were approved.  Motion carried.

Election of Officers for 2003

Mr. Groark presented the slate of officers for 2003 as Mrs. Pecka for President, Mr. Kuhn as Vice President and Mr. Heinisch as Secretary.

On a motion by Dr. Bishop, seconded by Mr. Wolf, the slate of officers for the Board of Health for 2003 were approved, as presented.  Motion carried. 

Recognition of Retiring Board Members 

Mrs. Grush presented a plaque to Dr. Wiley, who has not accepted a second term due to his impending retirement.  She thanked him for his years of service to the Board.  She also thanked Dr. Peltz for his service to the Board as president for the past two years and presented him with a gift certificate.   

CORRESPONDENCE AND ANNOUNCEMENTS 

Newspaper articles for the months of September and October 2002 included coverage of changes necessary in the field of public health, the need for rabies shots and tags for dogs, the reduction of danger from the West Nile virus until next spring, the infection of a DeKalb woman by West Nile, the death of a horse in Sycamore from West Nile, Breast Cancer Awareness Month in October, preparation for the flu shot season, smoke-free restaurants in DeKalb County, Great American Smoke-out on November 21, the residents of DeKalb County as leaders in recycling in the state, and November as Home Care Month.  

Correspondence included a thank you note from a WIC client thanking for service received. 

ADJOURNMENT 

On a motion by Mrs. Pecka, seconded by Mr. Groark, the Board of Health meeting adjourned at 8:55 p.m.  Motion carried.   

Steve Kuhn, P.A., Secretary
DeKalb County Board of Health