Karuk Tribe - Health Board Meeting
February 10, 2011 - Meeting Minutes
Meeting called to order at 3:03 pm by Vice-Chairman, Michael Thom
Present:
Michael Thom, Vice-Chairman
Florence Conrad, Member at Large
Wilverna Reece, Member at Large
Alvis Johnson, Member at Large
Dora Bernal, Member at Large
Charron Davis, Member at Large
Crispen McAllister, Member at Large
Absent:
Arch Super, Chairman (travel – excused)
Florrine Super, Secretary (travel – excused)
Quorum is established.
Prayer was done with the Council and audience.
The Health Mission Statement was read aloud by Dora Bernal, Member at Large.
Agenda:
Verna Reece motioned and Bud Johnson seconded to approve the agenda with changes, 6 haa, 0 puuhara, 0 pupitihara.
Minutes of January 13, 2011:
Dora Bernal motioned and Sonny Davis seconded to approve the minutes, 6 haa, 0 puuhara, 0 pupitihara.
Guests:
1.) Amy Coapman, Yreka CAC
Amy is present to provide a report on ARRA and funding that is available for provider incentives. There is a Medicare program and Medicaid program, with the Medicaid being a better option for the Karuk Tribe and their patient population. A maximum provider incentive payment is $20,000 for each provider for six years, and an additional allotment of funding for supplies to get the facilities to move toward electronic health record requirement. The Karuk Tribal Health Program has already begun to make the necessary improvements to their systems and continue to work toward full EHR; with the additional agreements in place she believes that the health program could advance EHR progress even further. There is funding for training, equipment and supplies. It appears that there is a lot of funding available and with the penalties for non compliance it seems appropriate to enter into the agreements that provide the resources for compliance. Each provider will sign up for this funding individually but sign that funding over to the Tribe. There has to be a certified EHR software which RPMS is not but will be soon. Temporarily what has to be shown to the State is that the health program has a system and has been using it; while RPMS is pending certification. In 2012 demonstration to the State must be that the Tribe is using it “meaningfully”. One way would be to demonstrate meaningful use is how the Tribal clinics refer and communicate with outside agencies that the Tribe refers patients to. The tracking of the patient care while working with outside agencies meets that requirement.
Amy then went on to discuss the funding opportunities that may continue once initial insolvent is approved. It will not cost the Tribe any funding to sign up for this but it may need to be reviewed and it requires the application to be completed and submitted.
The difference between Medicaid and Medicare is that Medicaid will pay more. The facility also has to meet patient volumes of Medicaid patients at 30% which they show 38%. For Medicare there has to be a higher percentage rate which the health program does not meet.
The Tribal Council tabled the agreements and provider application to their Thursday Planning Meeting. They would like to review the documents and also have the internal review policy followed.
2.) Robert Attebery, Tribal Member:
Robert is present tonight to seek insurance coverage at the High School in Happy Camp from now till May of 2011. He noted that there are teenagers that use the gym recreationally from time to time, and it’s a positive outreach for children and adults. The School District requires insurance. Robert understood that the Family Resource Center may have provided the insurance but their requirements are too strict including rules that don’t meet the “open gym” concept. Bob has the people that attend sign waiver forms that participate to assist in releasing liability in case there are any injuries during open gym.
Florence Conrad motioned and Crispen McAllister seconded to provide insurance coverage for the school, 6 haa, 0 puuhara, 0 pupitihara.
3.) Laura Mayton, CFO:
Laura is present to seek approval from the Tribal Council to cover the deductible for the damages to the Tribe’s boat. The deductible is $5,000 and will have to come from Council Discretionary. The incident report noted that the use was from ceremonies and an employee was driving and hit a rock. Not included in the official report was that the boat was not removed from the water and the motor was engulfed in water, causing more damage then what would have been done if it would have simply been removed from the water. The total cost of the repairs is a little over $11,000 with the insurance company paying an estimated $6,000. The place that is fixing it is the place that built the boat. Michael asked if the employee was reprimanded for the negligent use of the boat. Laura is unsure of the outcome. This will be tabled to closed session.
Laura then noted that there is a project that is being done at Seiad Creek. The insurance coverage for the project is $2million up $1million for the general projects. The increase in coverage raises the insurance cost to $608 yearly, which Laura is trying to code to the specific department however; she is unsure at this time if they have that amount. She will bring that information back if it is unallowable to get that funding but due to the project requirements she would like to get the Council to cover the cost from discretionary if it’s not budgeted in the program budget. The Council did not have an issue with this, due to the project needing completion but she is to check the program budget first.
Director Reports:
1.) Daniel Pratt, TANF
Daniel is present to review his written report with the Council. He has two action items. Daniel asked when the Council would be available to meet and review safety issues at the Orleans site. The Council will look at available dates and get back to Daniel on what they are available for to have a meeting. (Barbara – February 21, 2011).
CalWORKs is coming under fire, and effective of June 1st there will be a 13% cash deduction. For Tribal TANF programs there will be no difference and “probably” not next year either. If the State determines to demolish the CalWORKs program then the funding would go back to the Federal Government and that may be an option to seek direct funding, however the Federal Government may want to re-negotiate the numbers of clients that the programs have. There is a reduction in funding across the board and in the June the special election ballot containing social services programs will provide what California tax payer’s support and what options California has regarding reducing programs. If the ballot measure fails then there would be additional cuts in social services. For Tribal TANF is looking fine but he is monitoring this and reviewing the California budget because it will affect different programs that overlap with Tribal TANF.
Quartz Valley Tribe has submitted information for six cases and that will increase the Tribe’s program funding to cover those clients, however, this may take the Tribe to a higher case load but not comparable to the time and requirements that the staff in Yreka will have to handle. Daniel will be working with them to determine any increases to their caseload to at least fifteen for the negotiation process.
Next week there is a Tribal TANF Summit on reauthorization which is taking place for Tribal TANF programs nationwide to work on national legislation to access more funding through reauthorization. He continues to work on this and other options of increasing funding and securing current funding.
Currently, Daniel is reviewing discussions that will take place at the Tribal Consultation and there needs to be representatives present to discuss the cuts to TANF by ACF.
Daniels action item is to develop a policy for NICWA and TANF to provide coverage. There is no policy that currently covers each department and how they complete referrals to provide continuity for the agencies that cover the different programs. Daniel would like to send Alphonso to the annual NICWA Conference to Anchorage AK, April 17-20, 2011. And then to Denver for TANF training also in April. Daniel wants to send Alphonso to Denver to meet with Handel Technologies to ensure they can adequately pull reports as promised that the new software could do. It’s important to have staff with the capability of trouble shooting the software and a point of contact person who can work with the software company.
Florence Conrad motioned and Crispen McAllister seconded to approve Alphonso’s travel to Anchorage AK April 17-20, 2011, 6 haa, 0 puuhara, 0 pupitihara.
Florence Conrad motioned and Crispen McAllister seconded to approve Alphonso’s travel to Denver CO, April 2011, 6 haa, 0 puuhara, 0 pupitihara.
Crispen McAllister motioned and Florence Conrad seconded to approve out of state for Arch Super and Dora Bernal to Las Vegas, March 10, 2011 for consultation, 6 haa, 0 puuhara, 0 pupitihara.
Bud Johnson motioned and Sonny Davis seconded to approve Daniel Pratt’s report, 6 haa, 0 puuhara 0 pupitihara.
2.) Mike Edwards, Children and Family Services:
Mike has no action items but is present to review his written report with the Council. He included his monthly information on clients that are served under children and family services; including transportation services, counseling services, drug and alcohol classes, DUI classes and ICW cases.
He provided the gift from a recent travel that he went to the Council. He is unsure where to store it but he will find a location. There is an ICW meeting scheduled for February 22, 2011 in Happy Camp.
Verna Reece motioned and Bud Johnson seconded to approve Mike’s report, 6 haa, 0 puuhara, 0 pupitihara.
3.) Vickie Simmons, Clinical Operations:
Vickie is present to review her report and the meetings she has participated in and/or chaired over the last month. The second quarter GPRA report was sent in and it shows the Tribe’s increase in measures along with the clinics needs to improve meeting their national standards. The clinics met only three of the measure and have sixteen left to go.
She has attended trainings and those went well. She reviewed her budgets and noted that they are tracking them well.
Vickie noted that the Orleans clinic has had some issues with doors being left open. The waiting room and the community room are insecure as they are locked but someone is entering the building and when they leave they are leaving the facility unlocked. Vickie noted that DNR has a storage area that they need to access so they cannot be locked out; Florence is unsure of this, because DNR only accesses that storage space every couple of months. Locking the facility at night will secure the facility and then DNR can enter that facility during working hours.
Bud Johnson motioned and Crispen McAllister seconded to approve Vickie’s report, 6 haa, 0 puuhara, 0 pupitihara.
4.) Eric Cutright, IT Director:
Eric is present to review his written report. Eric first presented an action item to change procurement that was previously approved and use a cheaper vender that actually has the equipment in stock. The new vender is Vision Computers, Inc and is $2,179 for server replacement in Orleans.
Florence Conrad motioned and Crispen McAllister seconded to approve procurement and allow a different vender, Vision Computers INC in the amount of $2,179, 6 haa, 0 puuhara, 0 pupitihara.
Eric then presented procurement for storage equipment that will store medical records.
Florence Conrad motioned and Sonny Davis seconded to approve procurement and allow the purchase from the File Guy, 6 haa, 0 puuhara, 0 pupitihara.
Eric then presented a new policy for approval that includes a policy regarding use of electronic media that the Council and the Committee Members sign. Laura noted that technically the Council and Committee members are employees because they are given W2’s so they should be covered under the personnel policies. Eric spoke to Sara, HR and she said that they are not covered and with the new policy it will create a binding agreement on use and what will happen if the use is not within the Tribe’s business.
Verna Reece motioned and Florence Conrad seconded to approve the policy and issue notice to Council Members and Committee Members to sign the acknowledgment, 6 haa, 0 puuhara, 0 pupitihara.
Eric then went on to seek approval for a purchase order that stands open at Verizon Wireless for cell phones and changing plans. They were previously authorized $55,000 per year which is an open purchase order for him to adjust the plan as needed without going back and forth with additional PO’s. He would need to increase that amount now due to the high volume of cell phones in the organization.
Florence Conrad motioned and Crispen McAllister seconded to approve agreement 11-A-018 with Verizon Wireless along with the increased purchase order (for one year), 6 haa, 0 puuhara, 0 pupitihara.
He highlighted his written report noting that the construction for the Yreka clinic project will start next week or the week after. This will reduce parking but the staff is working on this to allow patient parking. Local businesses may allow some parking near the Yreka clinic, but the staff and Council want to ensure that the patients have adequate parking to enter the facility.
Dora Bernal motioned and Florence Conrad seconded to approve Eric’s report, 6 haa, 0 puuhara, 0 pupitihara.
Eric then noted that the Council has been invited to have a pre-meeting in Yreka regarding Broadband services in Yreka.12:00 to 2:00 pm TANF staff meeting will take place. These will be held at their new office in Yreka. 1107 South Main Street, Yreka CA. And then following that meeting, the Broadband meeting will be at the Council Chambers.
Dora asked Eric on the sound system for the Council Meetings. Eric noted that this is on his to do list but he has not had time to look into it.
5.) Vickie Walden, Dental Office Manager:
Vickie is not present but her written report was provided for the Council to review.
Verna Reece motioned and Dora Bernal seconded to approve Vickie’s report, 6 haa, 0 puuhara, 0 pupitihara.
6.) Lessie Aubrey, EDHHS:
Lessie is out on travel and Vickie Simmons is present to seek approval of her action items.
Florence Conrad motioned and Sonny Davis seconded to approve the revised organizational cart for the Yreka clinic, 6 haa, 0 puuhara, 0 pupitihara
Vickie then presented the MAA Specific Agreement.
Florence Conrad motioned and Sonny Davis seconded to approve the agreement 11-A-020 with CRIHB, 6 haa, 0 puuhara, 0 pupitihara.
11-A-022 will be brought to the Planning Meeting on the 17th because it did not have the name change from Karuk Tribe of California to Karuk Tribe.
Dora Bernal motioned and Crispen McAllister seconded to approve contract 11-C-032 with Inder Wadhwa, 6 haa, 0 puuhara, 0 pupitihara.
Lessie noted that Arch will need to be appointed the authority to vote for the Karuk Tribe at the Annual IHS meeting.
Florence Conrad motioned and Crispen McAllister seconded to approve Arch to have voting authority for the Karuk Tribe while at the consultation, 6 haa, 0 puuhara, 0 pupitihara.
Consensus: for Michael to send his schedule to the whole Council so they are aware of his travel.
Florence Conrad and Bud Johnson seconded to approve resolution 11-R-015 with Plumas County, 6 haa, 0 puuhara, 0 pupitihara.
Dora Bernal motioned and Crispen McAllister seconded to approve a credit card to be issued to Dr. Milton with a $1,500 credit limit, 6 haa, 0 puuhara, 0 pupitihara.
Verna Reece motioned and Sonny Davis seconded to approve signing the PACT Provider document, 6 haa, 0 puuhara, 0 pupitihara.
Vickie then provided an update on the billing income and revenue generated as attached to Lessie’s report from Suzanna Hardenburger, Business Office Manager.
Crispen McAllister motioned and Sonny Davis seconded to approve Lessie’s report, 6 haa, 0 puuhara, 0 pupitihara.
6.) Annie Smith, PHN:
Annie presented a position description for a registered dietician that is paid for from the diabetic grant. She developed this position description and is seeking Council approval. This position is funded yearly by the diabetic grant and although the diabetic grant is competitive it will be able to show the need and is ideal for a type of project that the diabetic grant wants to see. This staff person would work in all three communities and assist in diabetic education.
Bud Johnson motioned and Verna Reece seconded to approve the position description for a dietician, 6 haa, 0 puuhara, 0 pupitihara.
Dora asked how often someone is in the field checking on Elders. Annie noted that the area employees go out and check on Elders and they are seen once a month in each community. The ones in Yreka are being visited. Annie keeps tally of those Elders that are being seen and who hasn’t been seen. The staff monitors the workers and they have all worked on a plan to go through the entire Elder list, touching bases with all of them.
Verna Reece motioned and Crispen McAllister seconded to approve Annie’s report, 6 haa, 0 puuhara, 0 pupitihara.
7.) Chad Tiraterra, RPMS Site Manager:
Chad has three action items. His first action item is for Dentrix software for approval by the Council. All three action items will be tabled to Thursday to follow policy of allowing the Council time to review action items.
Michael asked about the RPMS national certification. Eric and Chad will check on the exact date and report that information back to the Council. Dr. Burns then noted that his main concern is the e-prescribing. Dr. Burns noted that this will take place in the next couple of months, but Chad noted that it will be taking place sooner than that and the certification should be very close as well but again he’ll check on that information and report back to the Council.
Florence Conrad motioned and Bud Johnson seconded to approve Chad’s report, 6 haa, 0 puuhara, 0 pupitihara.
Closed Session:
Employee: 5621 has credentialing and privileging for the Council to review and approve.
Dora Bernal motioned and Bud Johnson seconded to approve the $5,000 deductible for the boat insurance, from Council discretionary with a directive issued to Bob Goodwin, Leaf Hillman and Ron Reed that they are the only three authorized to drive or operate the boat and will follow policy, 6 haa, 0 puuhara, 0 pupitihara.
Informational: Need for a physician at the facility is a concern and becoming a bigger concern.
Consensus: to deny pay increase for employee #4811.
Consensus: for the Council Members to remember their appearance to audience and displaying respect to Directors and Tribal Members when they address the Council.
Michael Thom motioned and Bud Johnson seconded to approve being a Chamber of Commerce Member with fees of $50 annually from Council Discretionary, 6 haa, 0 puuhara, 0 pupitihara.
Dora Bernal motioned and Bud Johnson seconded to approve employee #7931 to attend one day supervisors training with mandatory attendance for employee #1653, 6 haa, 0 puuhara, 0 pupitihara.
Michael Thom motioned and Sonny Davis seconded to approve paying $500 for NCTCC Membership dues, 6 haa, 0 puuhara, 0 pupitihara.
Next Meeting Date: March 10, 2011 at 3pm in Happy Camp, CA.
Florence Conrad motioned and Dora Bernal seconded to adjourn meeting at 6:45 pm, 6 haa, 0 puuhara, 0 pupitihara.
Respectfully Submitted,
________________________________
Michael Thom, Vice-Chairman
Recording Secretary, Barbara Snider