Karuk Tribe of California
Health Board Meeting Minutes
August 11, 2005
Happy Camp, California
Ayukii,
The meeting was called to order at 5:16 PM by Arch Super, Chairman.
Roll Call
Present
Arch Super, Chairman
Leaf Hillman, Vice-Chairman – late – 5:51 PM
Roy Arwood, Member
Florence Conrad, Member
Robert Goodwin, Member
Robert Grant, Member
Alvis Johnson, Member
Absent
Florrine Super, Secretary
Leeon Hillman, Treasurer
Quorum is established.
The Health Mission Statement was read aloud by Florence Conrad.
Approval of the Agenda for August 11, 2005
Robert Goodwin moved and Alvis Johnson seconded to approve the Agenda for August 11, 2005. 5 haa, 0 puuhara, 0 pupitihara.
1) Approval of the Minutes for July 14, 2005
Florence Conrad moved and Alvis Johnson seconded to approve the Minutes for July 14, 2005. 5 haa, 0 puuhara, 0 pupitihara.
2) Old Business
NIHB Membership: Larry distributed information regarding the National Indian Health Board and if the membership fee of $632 is justified. He states they lobby nationally for Indian Health issues. He named several different activities they are involved in and services they provide to Tribal Governments. He recommends that they pay the amount and be involved as they will benefit directly/indirectly from their work on a national level. They are the national equivalent of the California Rural Indian Health Board. Bud asked who their current Board Chair is – Larry states it is Sally Smith from Alaska. Bud states they used to attend and be involved but they stopped attending and participating. Bud states they started working closely with Dr. Grim and were receiving the information first hand not through them. Maria Tripp is the local representative for the Tribe. The activities are lobbying so it must be paid from discretionary.
Alvis Johnson moved and Florence Conrad seconded to pay $632 to re-join the National Indian Health Board. 5 haa, 0 puuhara, 0 pupitihara.
Turtle Health Plan: Arch updated the group on the Turtle Health Plan’s progress and purpose. Larry states that their goal is to become an HMO and begin administering Medi-Cal to Native Americans. The monies saved each year could be reimbursed to the Tribes. It would be a health plan for individuals eligible for Medi-Cal. Due to internal problems dealing with the State, they have moved toward becoming a Health Insurance provider for Tribal Programs, it would be a commercial product. Roy gave some additional information regarding their activities and progress. They ran into problems getting providers to sign on to the program and there were also legislative road-blocks encountered, they also ran into financial troubles. They have been approached by Blue Lake to establish a healthcare plan that would be commercial and save the Tribes dollars. They would also work toward Worker’s Compensation and other services that can save the programs dollars. Roy states they last he heard Turtle has decided to create a subsidiary of the Turtle Health Plan to work on this project.
HRSA Recommendations: Arch also spoke to Larry about the HRSA recommendation that the chairs for each health committee report directly to the Health Board monthly. Larry reviewed the report to determine if this item was a recommendation or a requirement. Larry states that there are items that must be done such as the Health Plan, Strategic/Operating Plan, and Business Plan. Those are items that must be completed and are being worked on. Another item is Senior Management/Board of Director training. They recommend the CPCA Annual Meeting in Burbank in September, and other similar meetings. Roy asked if they can bring someone on site rather than sending a large group on travel. The grant can fund this expense. They can use up to $12,000 of HRSA dollars for training/technical assistance. He has scheduled a meeting with Lessie to discuss strategic planning that can meet with HRSA requires rather than doing it twice.
There was extensive discussion regarding how they will adapt to the HRSA suggestions and educate them regarding how a Tribal organization works. They will let them know that they will do what is reasonable to adapt to the suggestions but will not be revamping everything.
3) Vickie Walden
Not present, written report included, no action items. Arch asked about the dental fee schedule, it should be ready next month.
Florence Conrad moved and Roy Arwood seconded to approve Vickie’s report. 5 haa, 0 puuhara, 0 pupitihara.
4) David Eisenberg
David requested approval of an amendment to the Partner Support Agreement with Northern Sierra Rural Health Network to extend their agreement through June 30, 2006 and obtain additional support for the tele-medicine services they are receiving. At this time they receive these services at no charge and this amendment will extend them one more year. He explained what these services are used for including; mental health visits and staff meetings between Happy Camp and Yreka. There are two approved Contracts, one for Yreka and one for Happy Camp. These are amendments to those contracts. The numbers are Contracts 05-C-018 and 05-C-019.
Robert Goodwin moved to approve amendments to Contracts 05-C-018 and 05-C-019 for Happy Camp and Yreka and Florence Conrad seconded. 5 haa, 0 puuhara, 0 pupitihara.
Leaf Hillman arrived at 5:51 PM.
David also gave a very short update on the current situation between HCHS and the Tribe. Currently the Tribe pays HCHS $2,000 per month for rent under a 5 year lease that has 2 years left. As a 501(c)3, HCHS can only transfer their assets to another 501(c)3. The Tribe is not a traditional 501(c)3 but in the past they have been treated as one. Larry recommends going back to this issue and looking into obtaining this status so that they can receive the land and building and renovate the building into the new clinic and they could also save $2,000 each month in rental fees. Bob states that there has been discussion regarding the Tribe purchasing the Fuileye property from Housing and then leasing it to the Fire Department to build their new building on, that would create additional revenue. David states that the County is 100% sure that the Tribe does not qualify as a 501(c)3 and he would be very interested in how they can obtain this status. Leaf states that in the grant-writing arena they run into this problem continually and they have asked the IRS to provide information that demonstrates how the Tribe is considered a non-profit under their codes. And they have the documentation that substantiates this in the finance office to satisfy the funders and it has worked several times. Leaf asked who they are trying to satisfy in this process.
David states the worst case scenario is that HCHS would be contacted down the road and told that they transferred it illegally and they would be responsible for the fair market value of the land. HCHS can easily transfer the land to the Fire Department but that has not happened yet. In David’s opinion they can only do it if 1) the Fire Department could not force the Tribe out, and 2) the rent revenue could only be used for maintenance of that building instead of general funds.
What they need is a tax attorney that is experienced with tax/corporate/Tribal issues to see what the legalities are. David continued with the options that are available and emphasized that nothing has changed as of this time despite community rumors. Another option is for the Tribe to buy it and use the $2,000 to make the bank loan payment.
The Council would like for the Administration to actively pursue resolution of the 501(c)3 issue and transfer of the building/land to the Tribe for renovations.
Leaf Hillman moved and Florence Conrad seconded to approve David’s report. 6 haa, 0 puuhara, 0 pupitihara.
5) Lessie Aubrey
Lessie was present to review her written report with the Board.
She requested approval of the Organizational Performance Improvement Plan and went over the changes. They changed the mission statement, updated the list of external customers, internal customers, and patient types. The communication flow sheet was updated and the Organization Performance Improvement Matrix for 2005. The remainder of the document detailed the committees and teams that work within the Health Program and their responsibilities and what they do for the Program. She reviewed the documents in detail with them.
Florence Conrad moved and Robert Goodwin seconded to approve the Organizational Performance Improvement Plan as revised. 6 haa, 0 puuhara, 0 pupitihara.
She requested approval of Policy 03-006-001, C and P Policy and Procedures. She went over the additions that were made to document procedures they use for credentialing and privileging.
Robert Goodwin moved and Florence Conrad seconded to approve the C and P Policy and Procedures as revised. 6 haa, 0 puuhara, 0 pupitihara.
She requested approval of Policy 03-008-010, Process for Handing Complaints against Licensed Independent Practitioner’s regarding their Provision of Medical Care. This establishes a process for complaints and how they will be handled.
Florence Conrad moved and Leaf Hillman seconded to approve the Process for Handling Complaints against Licensed Independent Practitioner’s regarding their Provision of Medical Care. 6 haa, 0 puuhara, 0 pupitihara.
Lessie requested out of state travel for herself and Barbara to attend the 10th Annual Joint Commission Ambulatory Care Conference in October in Chicago, Illinois. The funding will come from their travel budget in the next Fiscal Year.
Roy Arwood moved and Leaf Hillman seconded to approve out of state travel for Lessie Aubrey and Barbara Snider to Chicago, Illinois in October. 6 haa, 0 puuhara, 0 pupitihara.
There will be a meeting on Sunday, September 18, 2005 in Phoenix, Arizona of the National Association Medical Staff Services (NAMSS) Conference. It will be a policy forum designed for individuals who submit queries and reports to the National Practitioner Data Bank and the Healthcare Integrity and Protection Data Bank which she does. Larry feels it is too far for only three hours. She has been told it would be very beneficial for her to attend. She could fly down and back in the same day since there are direct flights to Phoenix. The Board took no action on this issue.
She reviewed the remainder of her report with them which were items not requiring action from the Board which included the previous month’s ACQI Meeting Minutes.
Florence Conrad moved and Robert Goodwin seconded to approve Lessie’s report. 6 haa, 0 puuhara, 0 pupitihara.
6) Patti White
Written report only, away on vacation. There were no action items included in her report.
Florence Conrad moved and Robert Goodwin seconded to approve Patti’s report. 6 haa, 0 puuhara, 0 pupitihara.
7) Joe Snapp
Written report only, away on leave. There were no action items included in his report. Arch asked if there is a plan for Oak Knoll at this time. Leaf states Housing has an architect to draw up the plans but it is unclear what will happen after that is done as there is no funding. At some point the Council will need to decide how they would like to proceed beyond that point. That would be best discussed with the Housing Authority.
Robert Goodwin moved and Leaf Hillman seconded to approve Joe’s report. 6 haa, 0 puuhara, 0 pupitihara.
8) Larry Jordan
He announced that the Tribe and the CA Department of Alcohol and Drug Programs will be hosting a meeting on 8/31 from 9:30 to 3:30 at the Miner’s Inn Convention Center in Yreka. The Tribe will be hosting the Lunch that day and there will be several clinics participating.
He states CRIHB is requesting a letter of support for their grant to the California Endowment through which they would subcontract with the Health Program for about $20,000 to do about one or two activities each month with the kids. It is called the Eagle Vision: An American Indian Youth Health Promotion Program. Flo Lopez asked who would be on a committee to ensure that it is equally distributed amongst the youth.
Robert Goodwin moved and Florence Conrad seconded for Larry to draft a letter of support for the CRIHB grant application for Arch to sign. 6 haa, 0 puuhara, 0 pupitihara.
He requested approval of Contract 05-C-062 with Pioneer Cleaning Service in the amount of $1,800 per month which can be funded from Indirect. There were complaints from the previous staff members that it was too much work for one person. It will save monies in supplies, carpet cleaning, floor/stripping waxing. Robert Grant pointed out that this is taking away a job from a Tribal Member. He suggests hiring two employees rather than contracting it out. Bob states that would cost twice as much as it did previously which was $23,000 for one employee. It could have been done as an RFP to see if any Tribal Members were interested in doing this as contractors. They are under a timeline as the current employee has not been working since August 8, 2005. They can always cancel it with 30 days notice if they choose to do so in the future.
Robert Goodwin moved and Alvis Johnson seconded to approve Contract 05-C-062. 6 haa, 0 puuhara, 0 pupitihara.
Larry distributed the summary of the meeting that he recently attending in Lincoln City, Oregon. He states the Warm Springs Tribe has been the test site for the past year for the Electronic Health Record package. The providers have indicated an interest in visiting that site to view the software as they will be required to implement this in the very near future. There were dates in September, October, and November available and the staff is working out the details of who will go and see the package. They do a hands-on demonstration of the package.
He states the Tribal Management Grant was submitted to IHS today electronically. It was one of the first submitted on www.grants.gov site and it will be used to improve their Billing/Accounts Receivable Department including training, upgrades, etc. to make that department function more smoothly. The overall purpose is to improve the Billing processes throughout the Tribe in Medical and Dental.
The HRSA Renewal application for Year Two was successfully submitted last week. The Year Two focus will be expansion of Social Services. They will hire an LCSW for the Happy Camp/Orleans area and two additional Substance Abuse Counselors, one in Happy Camp and one in Orleans. A second Dental Hygienist for Yreka will be hired in this year as well. He already has a lead on an individual that may be interested in coming to work here.
He was invited by Margo Kerrigan to participate in a conference call last month regarding Native American Issues with representatives from HUD, BIA, and IHS. They are interested in doing a community based project with the Tribe. The dam removal project may be something they could be interested in. Another could be putting land into Trust for a new Clinic site in Happy Camp and assisting them with that. There will be another conference call coming up and they feel that those are good potential projects to pursue assistance with.
He went on to discuss potential sites for the Happy Camp Clinic. He distributed a letter from the Internal Revenue Service regarding the 501(c)3 status of the Tribe as a tax exempt government entity. This may assist them in the pursuit of HCHS transferring the current clinic building and land to the Tribe so that they can renovate it into a new facility. Bob suggests contacting this individual at the IRS and giving him the specific situation with HCHS so that he can write a letter to their Board regarding the situation and what is possible under the IRS’ Codes. This may save them from hiring an attorney. They asked Larry to pursue this option vigorously.
He requested approval to attend the NIHB 22nd Annual Consumer Conference, October 16-19, 2005 in Phoenix, Arizona. Roy has expressed an interest in attending this conference as well.
Robert Goodwin moved and Leaf Hillman seconded to send Larry Jordan and Roy Arwood to Phoenix, October 16-19, 2005 in Phoenix, Arizona. 5 haa, 0 puuhara, 1 pupitihara (Roy Arwood).
Lessie states Arch should attend the NIHB Meeting as Council Representation is needed at those conferences. That way they can fight for their health issues.
He requested approval of the revised Pharmacy Charging Policy Summary. He also updated them on the status of the back-billing at the Pharmacy. Now that they are underway and the system is under control they are tearing through the back billing at a rapid pace and are set to meet the 30 day deadline. They also have a representative from the State working with them to receive batches weekly. He states Suzanna and her staff are addressing this very well.
The savings options to revise the Pharmacy Charging Policy are as follows:
Option One:
$2 Co-Pay to Karuk Tribal Members $26,400
$5 Co-Pay to Tribal Descendents $14,500
Charge Out of the Area Members $60,000
Total Savings Annually $100,900
Option Two:
$5 Co-Pay to Karuk Tribal Members $66,000
$10 Co-Pay to Tribal Descendents $29,000
Charge Out of the Area Members $60,000
Total Savings Annually $155,000
There was discussion regarding the out of the area prescription problem and why they are where they are and what they can do. Leaf states they created this problem when they opened the Pharmacy and they need to be responsible managers for their Health Program and address this issue that they created which is being taken advantage of. It always hurts when they take something away that is good, but they didn’t used to do it and they need to stop it before it gets too out of control. They MUST send letters to these individuals explaining what happened and a grace period before the change takes effect. Larry suggests implementing the new policy as of October 1, 2005 so they have time to announce it and make it known. Leaf asked what this will do for the overall situation of the Pharmacy. Larry states it is a step in the right direction. Laura states the remainder of the fix comes from the clean-up of the back-billing and future billing and working with the Eligibility Worker to get people signed up for programs and HRSA assistance. Laura states that this Fiscal Year they will still be behind but by next Fiscal Year they may be solvent if everything is address and done properly.
Leaf Hillman moved and Robert Goodwin seconded to approve Option One with the addition of a phase in period under which the policy will take effect on October 1, 2005 and an effort will be made to explain and advertise this change and explain it ahead of time. They will also charge a $1 dispensing fee to Medi-Cal Patients. 5 haa, 1 puuhara (Robert Grant), 0 pupitihara.
Laura states the entire country has this problem not only Tribes, it is a nation-wide problem with the cost of pharmaceuticals. Larry states UIHS is in much worse shape than this program so they are ahead by addressing the issues now.
His last item was to let them know the Pharmacist will be unavailable until at least the end of September. There has been discussion regarding bringing in a temporary Pharmacist to cover for him. They have been unable to locate one as of now so they will continue to rely on the Raley’s contract until he comes back.
Robert Goodwin moved and Florence Conrad seconded to approve Larry’s report. 6 haa, 0 puuhara, 0 pupitihara.
9) Sara Spence
Sara requested approval of revisions to ten position descriptions to be in compliance with JCAHO regulations for measurable terms. There were the Pharmacy Billing Clerk, Patient Referral Clerk, Family Nurse Practitioner, Executive Director of Health and Human Services, CHS Supervisor, CHS Clerk I, Pharmacy Receptionist, Medical Records Clerk-HCHS, Medical Assistant, and Medical Records Clerk-Yreka.
Roy Arwood moved and Florence Conrad seconded to approve the revisions to the position descriptions. 6 haa, 0 puuhara, 0 pupitihara.
10) Roy and Cecilia Arwood
Cecilia is attempting to apply for a grant to fund the War Dance and cover all of the items they have been purchasing on their own and can’t afford any longer. She is requesting a letter of support documenting the support that will be provided by the Tribe. The instructions indicate they must be a 501(c)3 or have proof of their Tribal Status included with the application. Bob suggests a letter of support from the Tribe indicating they are all Tribal Members. The best way to do it is for the Tribe to apply and then pass it through, if it is not done that way they are highly likely to not receive the funding. It can be approved through a phone vote tomorrow if she chooses to do it that way.
11) Thank you letters from Tribal Members
Two letters from Tribal Elders were included thanking the Tribe for their gifts that they were unable to receive at the Reunion as they could not travel.
12) Florence Conrad
She distributed the agenda from today’s government to government meeting and also the minutes from the last meeting. On August 31, 2005 at 10 AM there is a Summit Meeting with the Forest Supervisors and the Regional Forester.
The Planning Meeting will be changed to September 1, 2005 instead of August 31, 2005 at 10 AM.
13) Committee Reports
None at this time.
Closed Session from 9:14 PM to 10:35 PM
Leaf Hillman moved and Robert Goodwin seconded to pay $1,000 toward CHS Case #149 in the amount of $3,225.54. 6 haa, 0 puuhara, 0 pupitihara.
Leaf Hillman moved and Robert Goodwin seconded to pay $1,000 toward CHS Case #150 in the amount of $2,539.58 4 haa, 0 puuhara, 2 pupitihara (Florence Conrad and Roy Arwood).
Florence Conrad moved and Leaf Hillman seconded to approve the request for assistance at the rate of $120 per day for Tribal Member #41 to the Madrone Hospice House. 5 haa, 0 puuhara, 0 pupitihara. (Robert Goodwin not present for voting).
Robert Goodwin moved and Leaf Hillman seconded to allow Tribal Member #3778 to be eligible for hire within the Tribe again. 6 haa, 0 puuhara, 0 pupitihara.
Florence Conrad moved and Leaf Hillman seconded to approve the temporary appointment of four registered voters not immediately related to the candidates to fill the vacancies on the Election Committee through the 2005 Election. They will start on October 11, 2005. 4 haa, 0 puuhara, 2 pupitihara (Robert Goodwin and Roy Arwood).
Leaf Hillman moved and Roy Arwood seconded to approve a loan for $775 to Tribal Member #1066 to be repaid $50 every two weeks. 6 haa, 0 puuhara, 0 pupitihara.
Request for assistance from Employee #9253 tabled to the Wednesday meeting for more details.
Alvis Johnson excused himself at 10:03 PM.
Consensus: To cancel the IRMP Meeting tomorrow.
Robert Goodwin moved and Leaf Hillman seconded to adjourn at 10:40 PM.
Next Meeting Date: September 8, 2005 at 5 PM in Happy Camp.
Yootva,
______________________________
Arch Super, Chairman
Recording Secretary, Sara Spence