BOARD MEMBERS PRESENT:  Glenda Pecka, R.N., M.S., President; Steve Kuhn, P.A., Vice President; Carl Heinisch, Secretary; Russell Bishop, Psy.D.; Julia Fullerton; Rosemary Lane, M.D.; Fred Peltz, D.D.S.; Debra Schelkopf, D.V.M.; Steve Wolf, R.N. 

BOARD MEMBERS ABSENT: Mike Groark, J.D. 

MINUTES 

On a motion by Ms. Fullerton, seconded by Mr. Kuhn, the minutes of the Board of Health meeting of January 28, 2003, were approved.  Motion carried. 

DIVISION REPORTS 

Mrs. Grush announced that tomorrow is the 30^th anniversary of the employment of Mr. Drake, Director of Environmental Health.  She added that he was presented with a certificate at the County Board meeting last week.

Mrs. Grush stated that all counties in the state of Illinois have received Local Health Prevention Grant money for many years, which supports a statewide system of local health departments to assure the protection of the public through the provision of various health protection programs, such as communicable disease and environmental health programs.  This grant is based on a formula using population, per capita income and assessed valuation.  Minimum grant awards are $50,000.  Mrs. Grush explained that the Northern Illinois Public Health Consortia was successful in getting a Cook County legislator to sponsor a bill changing the distribution of the funding based solely on population.  This would result in 81 health departments in the state losing Local Health Protection Grant funding and would create significant damage to the local public health system serving counties outside of Chicago and the suburban area.  The Consortia also proposes that health districts be established across counties based on minimum population thresholds, recommending a threshold of 250,000 to 500,000.  Those health departments falling into this threshold would remain as they currently exist.  Others below that threshold would become districts, such as the joining of Boone, DeKalb, Ogle, Whiteside, Lee, JoDavies and Stephenson counties.  Administrators outside the collar counties have banded together to defeat this legislation arguing that this would create an extra costly layer of middle management, that communities have greater control over public health programs through a local board of health, and that it would create a significant division among the ranks at a time when they should be working together and strengthening public health in the state.  Mrs. Grush pointed out that this bill has passed out of both the House and the Senate on first reading.  Both Senator Burzynski and Representative Waite are opposed to the bill and indicated that this is an example of the effort that is on a fast track to redirect many downstate dollars to Chicago and the suburbs.

Mr. Heinisch stated that this argument has been ongoing in various levels of government and will continue to be an issue.  Mrs. Grush stated that this legislation was not discussed at the meeting of the Public Health Administrator’s Association.  Mrs. Pecka asked if Mrs. Grush had taken any action against the proposed changes, and she indicated she has responded to these issues.  She cited one of the concerns being that one-third of the legislators are from the City of Chicago, one-third from the suburbs and one-third from the rest of the state; consequently, the vote will direct money to Chicago and suburbs.

Mrs. Grush stated that another issue facing public health is funding to assist in addressing West Nile Virus (WNV) and other vector diseases.  The Public Health Administrators’ Association supports HB 2812, which increases the used tire fee to $2 per tire toward funding for West Nile.  She reported that our agency still has 10,000 briquettes on hand, and Mr. Drake has scheduled a meeting in April to distribute them and train individuals on how to drop them in catch basins.

The Health Department has experienced a number of building problems, including broken pipes, which happened twice in January.  The current problem is that there are two sets of controls on the heating system that do not communicate with each other.  To better manage this system, Invensys controls will be placed on this system and the Trane controls removed, and the system will be monitored by Central Plant staff in Sycamore rather than by the Nursing and Rehabilitation Center staff. 

Mrs. Grush thanked Karen Hills and Deb Rolf for the time they have invested in implementing the Health Insurance Portability and Accountability Act (HIPAA) at the Health Department and Home Care.  She added that this project is a huge undertaking for any health care provider.

Mrs. Grush reported that progress is being made with the smallpox program, with workers compensation remaining the biggest issue on a statewide level, resulting in less participation in the program than the State had hoped.  There are several bills at the State level that address this, making a smallpox reaction a coverable loss when the vaccine is given for work-related purposes.  The DeKalb County Board did pass a resolution at their meeting last week making this a coverable loss under the County’s Self-insured Workers Compensation Program. 

DeKalb County was a training site for the northern part of state for the administration of smallpox.  To date, three Health Department employees have received the vaccine: Peg Carroll, coordinator of Communicable Disease; Gary Judd, HIV Prevention Specialist; and Jane Lux, Director of Personal Health Services.  The main complaint of all three participants has been itching at the site.  March 27 is the first official clinic day scheduled for public health and hospital providers to come to our Health Department to receive the vaccine.  Mrs. Grush is scheduled for that day, as well as six staff from Rochelle Hospital.  She showed the 54-page consent to the Board, which must be received five days before being vaccinated.  CDC developed the majority of the consent, but part of the holdup with implementing it was supplements added by the state of Illinois.  Mrs. Grush stated she would like to say we are getting a team ready, but should Illinois or DeKalb County have a case, it would take more than five individuals to administer the vaccine. 

Dr. Peltz asked if the public should consider receiving the vaccine.  Mrs. Grush responded that she does not feel the general public should get it at this time.  Mr. Wolf stated that he was aware of a list of volunteers from Valley West Community Hospital and Kishwaukee Community Hospital (KCH) who said they wanted to receive the smallpox vaccine.  Mrs. Grush stated both facilities have submitted names to the state, but their concern is that staff could transmit the disease to a patient and the liabilities associated with that.  Mr. Kuhn indicated that he was told he would need to take three weeks of vacation if he was vaccinated.  Mrs. Grush believes that KCH has the same policy.  Dr. Bishop asked who would receive this consent form.  Mrs. Grush responded that this consent is for the Phase 1 volunteers and assumes the same form will be used for the Phase 2 individuals, which includes health care providers and clinics and other Health Department employees. 

Dr. Bishop asked Mrs. Grush if she had any idea what could be done to increase people’s willingness to participate in Phase 1 and Phase 2.  Mrs. Grush responded that individuals must be guaranteed that they will be covered under workers compensation for any related illness and can work with a dressing over the site or be paid if required to be off work for three weeks, as well as some kind of protection from the federal government for those who are not working.  If individuals, such as retired nurse are recruited to help, they will also need some protection.  She added that there is current legislation at the federal level that will place this vaccine under the Vaccines for Children (VFC) fund that would provide $50,000 (minimum) if you became ill from the vaccine and $266,000 if the individual died as a result of receiving the vaccine.   She added that there is a group of people that would have volunteered months ago if the federal government had had these assurances in place.  The workers compensation issue will be settled at the state level during the current legislative session.  The government hoped to have 10 million volunteers by this time and have only 12,000 to 15,000 nationwide. 

Mr. Heinisch asked what the Health Department is hearing about SARS (Severe Acute Respiratory Syndrome) at this point.  Mrs. Grush responded that information is being received several times a day and there is one suspect case in Chicago.  30 other cases are being investigated.  Mrs. Carroll, coordinator of Communicable Disease, explained the screening criteria as contact with someone who has recently traveled and a fever of greater than 104 degrees. 

Mr. Drake, director of Environmental Health, reported that he is receiving requests from service groups to speak on West Nile Virus.  Mr. Wolf asked if the fact that our area experienced a cold winter would have an effect on the mosquito larvae population.  Mr. Drake responded that it will help but pointed out that the virus is actually in the birds and carried by the mosquito.  He is coordinating mosquito control efforts with municipalities and all are interested, with some having budgeted for larviciding. 

Mrs. Grush reported that Mrs. Lux, director of Personal Health Services, has had a difficult few months with staffing.  A number of employees have left and Mrs. Lux has tried to replace them with bilingual staff, with no luck.  Mrs. Grush stated the agency was fortunate to recruit Bette Chilton, who is bilingual, back as WIC Coordinator, beginning June 2.  Ms. Chilton has worked for the agency in the WIC program in the past and also knows public health.  She added that one of the benefits that helped recruit Ms. Chilton was the cost and coverage of our health insurance.

Mr. Kuhn asked if charging for Family Planning contraceptives would help cover the increase in pharmaceutical costs.  Mrs. Grush responded that clients are charged based on a formula under the grant, with the majority of clients being lower-income and not paying much.  She pointed out that the cost of birth control pills to agencies has increased while the grant for next year serving the same number of clients is at the same dollar figure. 

Mrs. Baj, director of Home Care, reported a great deal of activity in her program with building and restructuring and the addition of cubicles, phones and computers.  Mr. Wolf asked if there was any competition in the home care market in this area.  Mrs. Baj responded that Carleton does have some patients in our area, as do the Visiting Nurses Association and Swedish American’s program from Rockford and Fox Valley serving the eastern portion of our area.  Mr. Wolf asked if it could be assumed that the Health Department receives at least 95 percent of referrals from the hospitals.  Mrs. Baj stated that she has been told this by nursing homes, but hospitals do not release that information. 

Mrs. Zanellato, director of Health Education, reported that she has not yet heard the grant awards for next year in her programs.  She continues to do a great deal of work with the Bioterrorism Grant in terms of creating a directory and planning. 

Mr. Wolf asked if an HIV Grant award had been received.  Mrs. Grush reported that she submitted a request of $45,000 and has been awarded $36,000, adding that she feels fortunate to receive that.  She pointed out that DeKalb County has a strong program for such a small county.  Mrs. Carroll stated that our agency works very hard to locate clients as they are not as readily identifiable as they are in a metropolitan area.   

FINANCIAL DATA 

Mrs. Grush pointed out that expenses for February were up because physical therapy services had not yet been billed for January and February, and there was a large supply order for Family Planning and employee wellness. 

On a motion by Dr. Bishop, seconded by Mr. Wolf, the Financial Statements for the months of January and February 2003 and the Claims for the months of February and March 2003 were approved.  Motion carried. 

NEW BUSINESS 

Board of Health Membership Vacancy 

Dr. Bishop, chair of the Nominating Committee, asked for recommendations to the Board of Health to replace Dr. Cole who has recently left the community.  Mrs. Grush asked members to contact either Dr. Bishop or her, adding that the physician vacancy is a very difficult one to fill.   

Home Care Administrative Review 

Home Health revenue for 2002 was $2,149,601, as compared to $1,943,739 in 2001.  A chart of cost, charge and limit per visit was presented from 1995 through 2002.  A chart showing the source of referrals and admissions, as well as reasons for discharge, was presented.  Total unduplicated patients for 2002 was 947 with a total of 17,900 home visits made, compared to 2001 with 861 patients and 15,470 visits. 

The Home Care Program is required to conduct chart audits on a quarterly basis on a percentage of charts.  This year, Mrs. Baj included some case mix profiles comparing 622 cases in our program to 3,259,009 cases in the reference mean nationally.  Results showed that our program faired quite well and actually did better in some areas.  Over the past year, feedback has begun to be received from a 25-page assessment that nurses are required to complete.  This feedback and data collected goes toward determining the payment to be received for a 60-day episode for Medicare patients and is also used for Outcome Based Quality Improvement (OBQI).   

Home Care Policies and Procedures – Recommended Changes 

Recommended changes to the DeKalb County Home Care Policies and Procedures were presented.  Mrs. Pecka questioned if the Social Worker Assistant was a new category being used.  Mrs. Baj responded that the agency only had Medical Social Workers up until the last six months, but assistants are now allowed in the rules and regulations, so an assistant from Family Service Agency was contracted.  This assistant is able to do everything the social worker can do, but all activities must be reviewed by the social worker.  The Rules require that the assistant have a Bachelors degree, while the one hired by the Home Care Program has a Masters and is a licensed professional counselor. 

Dr. Lane asked about implementation of the dress code in the Home Care Program.  Mrs. Grush stated that it was necessary to establish specific guidelines for a dress code, which is in compliance with that of Public Health. 

Home Care Classification/Staff Recommendations 

Classification and staffing recommendations in the Home Care Program were presented.  A classification of Home Care Program Development Coordinator is proposed, replacing that of Home Care Patient Care Coordinator.  The salary range decreases from $19.91 - $30.85 per hour to $18.55 - $28.75 per hour.  This is a 5 percent increase for the nurse currently in the Quality Improvement Nurse position. 

A reduction in the salary range of Home Care Office Coordinator was proposed from $14.81 - $21.10 per hour to $12.22 - $17.54 per hour.  This is a 10 percent increase for the individual currently in a Secretary B position who has accepted the position, should it receive Board approval.  The acceptance of this position will reduce Secretary B classifications by .6 FTE. 

It is being proposed that a new classification title, Home Care Billing Coordinator, be implemented and filled by the individual currently serving as Office Coordinator in the program.  Salary remains the same, and position title only changes.  Job descriptions for these three positions were presented. 

A revised job description for the Clinical Team Leader was also presented.  An organizational chart of the Home Care Division was presented. 

Health Department Personnel Policy Revisions 

“Failure to report to work or notify supervisor of reason for absence for three days” was presented as a change to “Infractions Warranting Discipline and Discharge.” 

A clarification was made to the On-call and Holiday Compensation chart compensating staff that work on the Christmas Eve holiday at double time.   

Health Insurance Portability and Accountability Act Policies 

Mrs. Baj distributed a handout to members that is used in training Home Care staff on the HIPAA policies.  The compliance date is April 14, 2003, and the policies deal with the protection of individually identifiable health information.  Health plans, health care clearinghouses and healthcare providers who transmit standard transactions electronically are covered under this Privacy Rule.  Strict penalties exist for agencies in non-compliance with the Act.  Mrs. Baj explained that Protected Health Information (PHI) is individually identifiable health information that is transmitted or maintained in an electronic media or any other form or media.  Health information is anything that is created or received by a healthcare provider that relates to the person’s health condition and is individually identifiable.  The Privacy Rule requirements cover the use and disclosure of PHI, which can only be disclosed for treatment, payment or health care operations or to the individual themselves.  Incidental disclosures and the minimum necessary requirements were also reviewed.  A Notice of Privacy Practices must be given to all patients and clients in covered programs at the time of first service delivery after April 14, 2003.  Mrs. Baj indicated that the Home Care Program was part of a consortia that contracted with John Gilliland, a lawyer who developed templates for the policies, Notice of Privacy Practices and forms.  Public Health was part of another consortium that contracted with Deanna Mool, a lawyer in Springfield.  This Act allows patients to request special protection of their health information, as well as restrictions on its use or disclosure.  Patients can also inspect their health record and request a copy.  They may also request to have their health information amended and may receiving an accounting of disclosures of their PHI.  Mrs. Baj stated that there are also a number of administrative requirements, with every agency required to designate a Privacy Officer, with our agency’s being Karen Hills at Public Health and Deb Rolf for Home Care.  All staff must be trained, including volunteers and contracted staff and an individual must be designated to receive complaints.  She added that the Security Rule would be coming out in the fall of 2003 addressing standard transactions and code sets.

Mrs. Pecka asked about the requirements relating to mental health care.  Mrs. Baj responded that those releases are more stringent and require a special authorization with a specific purpose.  Mrs. Hills added that the client is not allowed to access psychotherapy notes. 

No changes were recommended to the Board of Health Bylaws at this time.

On a motion by Mr. Heinisch, seconded by Dr. Peltz, all recommended changes were approved as presented.  Motion carried.

Vision and Hearing Screening Program

Mrs. Grush reported that several changes have occurred in the Vision and Hearing Screening Program to cause management staff to reevaluate the program.  This service has been provided to children in preschool, day cares and all public and parochial schools in DeKalb County since the origination of the Health Department.  Approximately 14,700 students are screened each year, with 29,400 tests conducted.  This includes children in grades 1, 2, 3, 4, 5, 6, 8, 9, all special education students, teacher referrals and children new to the district. 

Mrs. Grush indicated that screening is the responsibility of the school district, not the Health Department.  This service has been provided to the school districts at no cost to them.  Mr. Wolf asked if the schools required this by law.  Mrs. Grush responded that some grades are mandated to be provided with this service, either by the schools’ own staff or by someone with whom they contract.  Our Health Department has received $18,000 in grant money for this service.  Because the grants have been stagnant for years, many health departments have discontinued providing this service and/or began charging schools for the service.

Current costs of the program were presented, with direct costs at .6 FTE at $32,000 and overhead at $15,000, for a total of $47,000.  Revenue for the program is $36,100.  There are a number of issues that have developed with this program including the need to receive consent to screen all children and provide them with a Notice of Privacy Practices under HIPAA if the agency continues to bill IPA.  Another concern is that this particular IPA billing has always been a time-consuming task for agency staff, because they must match the names of students served from the school rosters with a listing from the IPA office of eligible children.  Another issue is that the state grant has been stagnant for years, and because of the State’s fiscal crisis, we have only received $100 or our 2003 grant that began July 1, 2002.  Our agency has always provided more screening than is required by the School Code.  A final reason is that both our technicians have health issues that make their continued employment uncertain, and training of new staff would be difficult as the Illinois Department of Public Health (IDPH) has gone from seven to two trainers statewide.

Mrs. Grush made the following recommendations: (1) reduce the children screened to the mandated grades, thereby reducing the number of test by approximately 50% and reducing the cost of the program; (2) do not bill Public Aid so the HIPAA requirement is eliminated; and, (3) reevaluate the ability to continue providing the service to the schools as warranted. 

Mr. Wolf moved to accept the proposed recommendations, seconded by Dr. Schelkopf.  Motion carried. 

CORRESPONDENCE AND ANNOUNCEMENTS 

Correspondence included a letter from Representative Hastert in response to Mrs. Grush’s letter expressing concerns about the availability of spectrum frequency for public safety needs. 

Newspaper articles for January and February focused on the preparation for smallpox

vaccination, the recovery of a 12-foot python by Animal Control staff, February as National Heart Month, the New American Plate campaign for healthy eating, and an Altrusa literacy project of presenting book bags. 

ADJOURNMENT 

On a motion by Mr. Heinisch, seconded by Dr. Lane, the Board of Health meeting adjourned at 9:07 p.m.  Motion carried.

                                                                                   
Carl Heinisch, Secretary
DeKalb County Board of Health