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HomeMy WebLinkAboutMINUTES - 06272000 - D2 TO: BOARD OF SUPERVISORS FROM: William Walker, M.D., Health Services Director Contra HATE: ,lune 21, 2000r Costa County SUBJECT: Closure of Contra Costa Home Health Agency SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECC3( ME-NDATIONS: 1. OPEN and conduct a public hearing on the closure of the Contra Costa Home Health Agency in accordance with Health and Safety Code Section 1442.5 (Beilenson Act). 2. CONSIDER public testimony and the Staff report on the closure of the Home Health Agency. 3. DECLARE that the Board of Supervisors has also considered public testimony and the staff report on the closure of the Home Health Agency at the May 23, 2000, budget workshop. 4. RECOGNIZE that the Health Services Department is facing a $10.4 million shortfall for FY 00/01, and that closure of the Home Health Agency will result in $650,000 savings to the General Fund. 5. AUTHORIZE the Health Services Director to initiate the closure of the Contra Costa Home Health Agency, as recommended by the Health Services Director. 6. DIRECT the Health Services Director to arrange for appropriate placement for any patients being served by the Home Health Agency. 7. RECOGNIZE that the Health Services Director will ensure that all appropriate state and federal laws and regulations are complied with in closing the Agency. 8. AUTHORIZE the Health Services Director to transfer existing Home Health Agency staff to other programs within Health Services. 9. RECOGNIZE that work Specifically fitting the Horne Health Aide classification will no longer be available in Health Services, and authorize the Health Services Director to offer all the incumbent Home Health Aides work in other appropriate programs in Health Services, with no decrease in salary or Seniority. 10. AUTHORIZE the Human Resources Department to prepare a layoff notice for the Home Health Rehabilitation Therapy Coordinator, if an appropriate alternative assignment cannot be found for that incumbent. If a layoff is implemented, the incumbent will revert to an Occupational Therapist in Health Services. FISCAL IMPACT; Closure of the Contra Costa Home Health Agency will result in a savings of$650,000 to the General Fund, CONTINUED ON ATTACHMENT: YES x SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S)- ACTION OF BOARD ON June 27 - 2000 APPROVED AS RECOMMENDED _X X OTHER X X EE THE ATTACHED ADDENDUM FOR BOARD ACTION VOTE SUPERVISORS AND YHA�BY CERTIFY THAT THIS IS A TRUE UN (MOUS (ABSENT _ AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ��ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. Contact:Wendel Brun , D,HSD Public Health cc: Health S ces A Inlstration ATTESTED June 27 . 2000 PHIL BATCHELOR,CLERK OF THE BOARD OF 7'✓ SUPERVISORS AND CO NTY ADMINISTRATOR BY & 1ADEPUTY ADDENDUM TO IT'EM D,2 June 27, 2000 Agenda This is the date and time noticed by the Health Services Department for the Beilsenson Hearing,pursuant to Health and Safety Code, Section 1442.5, regarding the elimination or reduction in the level of medical services provided by the County, and/or closing of County Health facilities relative to the state-licensed Home Health Agency. Those present at the hearing included: Sara Hoffinan, Assistant County Administrator; Victor Westman, County Counsel; Dr. William Walker, Health Services Department Director; and Dr. Wendel Brunner, Health Services—Public Health. Dr. Walker presented the staff report. He stated that Contra Costa County was the only County in the State to still to run their own Home Health Agency. He further stated that closing the agency would save the County approximately$650,000 annually. It was noted that the present employees would be relocated with the Health Services Department, and they would arrange for appropriate placement for any patients being served by the Agency,if it is closed. The hearing was opened, and the following people appeared to speak: Date Schwertscharf, California Nurses Association, Home Health Agency; Patrice Coelho, RN, 1821 Glenhaven Avenue, Walnut Creek, Home Health Agency; Francisco Ugarte, California Nurses Association, 2000 Franklin, Oakland; Joseph Partansky, 1406 Barbis Way, Concord; Bill Schlant,Local One, 5034 Blum Road,Martinez. The Board discussed the issues. Supervisor Gioia inquired if there was a plan for County oversight for the patients during this transition period. Dr. Brunner noted that was an important issue and the Public and Environmental Health Advisory Board raised the same question. He stated it was very important that the Department develop a mechanism for following up on the impact of the closure, and ensuring that the patients do not fall through the cracks and are receiving adequate care. Dr. Walker noted that there is a case management unit in the Contra Costa Health Plan that will oversee those issues. Supervisor Gioia suggested it would be advisable to present a plan to the Board that specifically addresses how the County is going to be proactive in ensuring there are no service gaps during this time. Supervisor Gerber asked what was the effective date of the action being considered today. Dr. Walker responded it would take approximately 60 days to comply with the regulatory provisions of the State and Federal government to de-license the Agency. Supervisor Canciamilla inquired how much of the$650,000 savings is attributable to the extensive billing, financial and administrative services required for Medicare reimbursement, and how much is actually going to be saved from the service site. '::2-zo Dr. Walker stated it was costly to run a small agency,but the per capita overhead casts of providing that reporting is extraordinary. Unless you are able to spread the costs over a large agency,it doesn't work. He stated that he couldn't provide the numbers presently, but would attempt to get them for the Board. Supervisor DeSaulnier moved that the Health Services Department come back to the Board within the 60 day period.(prior to the effective date of the closure of the Agency), and the staffs recommendations. Supervisor Gioia seconded the motion. The vote was as follows: AYES. SUPERVISORS GIOIA,UILKEMA, DeSAULNIER, and CANCIAMILLA NOES: SUPERVISOR GERBER ABSENT: NONE ABSTAIN: NONE IT IS BY THE BOARD ORDERED that staffs recommendations are APPROVED; and the Health Services Department is DIRECTED to provide the Board with a plan, within 60 days,which addresses service provisions. BACKGROUND: The Health Services Department reported to the Board of Supervisors on March 23, 2000, that it was facing a $10.4 million gap between expenditures and revenues projected for FY 00-01. On May 23, 2000, the County Administrator presented a Third Quarter Report identifying the causes of the budget issues in the Health Services Department and recommending a number of actions, including closing the Contra Costa Home Health Agency. That Third Quarter Report noted that recent changes in Medicare reporting requirements and reimbursement rates have greatly increased the non-revenue offset costs of operating Medicare-licensed home health agencies. It has become clear over the last two years that small and medium-sized home health agencies operating with Medicare and Medi-Cal revenue are no longer financially viable. Only very large agencies with the ability to spread large fixed administrative and reporting costs requirements are able to continue to function in this current environment. The Health Services Department proposes to no longer seek Medicare reimbursement for home nursing visits and ancillary services in Public Health, and to conclude the restructuring by phasing out the Home Health Agency (HHA). Savings of $650,000 in County subsidy can be redirected to direct health care. However, Medi-Cal reimbursement would still be maintained through Targeted Case Management (TCM) for eligible home nursing services. This change will allow for the elimination of the extensive billing, financial and administrative services required for Medicare reimbursement. The permanent staff in HHA would be reassigned or offered jobs in other programs in Public Health or elsewhere in the Department, which are covered by existing revenue streams. Background on the Contra Costa Home Health Agency Contra Costa County Health Services has operated a Medicare-licensed Home Health Agency for over 20 years. In 1996 the Agency was at its greatest capacity, with 70 permanent employees (48.9 FTEs) and 21 per diem registered nurses. In 1996 the Agency made 3100 to 3200 visits per month. In response to the changing Medicare regulations, however, the Department began to restructure the Agency. In addition, the Contra Costa Health Plan asked the Department to ensure that every newborn baby and mother received a home nursing visit within 72 hours, if possible. At the same time, Medi-Cal opened a reimbursement stream for these home nursing visits which could be billed through Public Health at a rate of $320 per mother/baby visit. As a result of these administrative changes at the state and federal levels, as well as the interests of the Contra Costa Health Plan in ensuring that the newest Health Plan members receive early nursing services, the Department began transferring staff from the Home Health Agency into other parts of Public Health. In March 2000 the Home Health Agency had 14 permanent employees (11.9 FTEs) and one per diem registered nurse. The Agency made 746 visits in March. The patient impact from CC Medicare-reimbursed home nursing services has been carefully screened. Findings are that the patients can be served by other agencies in collaboration with the Health Services Department. The Contra Costa Health Plan has agreements with a number of home health agencies to provide services to Health Plan members and other Contra Costa Health Services patients. Those home health agencies will bill Medicare or Medi-Cal directly for services to patients referred by Contra Costa Health Services. For those patients not covered by Medi-Cal, Medicare, or private insurance, the agencies will accept Contra Costa Health Services referrals at fee-for-service Medi-Cal rates. The Contra Costa Health Plan has recently contracted the home health agencies, and they have responded that they are available to accept all the additional referrals. On May 23, 2000, the Board directed the Health Services Department to schedule a Beilenson Hearing and return on June 27, 2000. That hearing has been scheduled for June 27 at 2 p.m., and Beilenson Hearing Notices have been posted at all Health Services Department facilities as required. 2 ' CALIFORNIAVED NURSES — ' I ru�.NOR ASSOCIATIt�N Shaping Tbmorrow's Health Care www.calnurse.org ' CL it art? {F-,t,• ' AC mgarding cost-cutting measures during bu deficit, Staffing=hiring Hire more permanent nursing staff and reduce the number of overtime hours as well as reliance on a per/diem staff which is used as a regularly scheduled workforce. Hire more staff and improve staffing to reduce the amount of overtime and the potential for malpractice lawsuits. Per/Diem nursing 4 shiftimonth requirement wastes too much money.Per/diems leave if can't meet requirements,which causes higher turnover and increases number of orientations performed. This would limit the amount of overtime needed. Open up the opportunity for all health services employees to do job shares voluntarily reduced work days/weeks and/or months. Have at least 2 meetings a week to allow for nurses input about efficiency. Billing Aggressively bill Mrd party and governmental sources for services rendered. Improve documentation on billing Administrative overhead Many departments are staffed with too many administrators and not enough care-givers. Consultant work--$400,000 for two positions. These salaries are far too costly for the County to incur. Require all administrators to do direct line work. Misc. Hire a community organizer to take County Health Service providers and patients to go to the State and demand increased funding to the Counties. Improve education and training--establish computer training programs. El CNA OAKLAND O CNA SACRAMENTO CJ CNA SAN JOSE L@7 CNA FRESNO D CNA SANTA MONICA F1 CNA SAN DIEGO HEADQUARTERS 11.00 11th,Ste 205 101 Race Strut PO Sox 27317 3250 Ocean Park Blvd 3611 5th Ave Ste J 2000 Franklin St.Ste 300 Sacramento,CA 95814 San Jose,CA 95126 Fresno,CA 93729 Ste 385 San Diego,CA 92103 Oakland,CA 94612 (916)446-5021 (408)920-0290 (209)261-9571 Santa Monica,CA 90405 (619)299-3731 (510)273-2200 Fax(916)4466319 Fax(408)920-0362 Fax(209)261-9572 (310)664-6369 Fax(619)299-8543 Fax(510)663-1625 Fax(310)664-6.375 .4 Viµ.. v V June 12, 2000 NOTICE OF PUBLIC HEARING The Board of Supervisors of dee County of Contra Costa will conduct a PUBLIC HEARING pursuant to Health and Safety Code Section 1442.5, on the elirnlnation of and/or reductions In the level of medical services provided by the County, and/or the closing of County health facliftles. The hearing will be hold at the following time and place: Tuesday, June 27,2000, at 2:00 p.m. Board of Supervisors Chambers Room 107, Administration Building bat Pine:street Martinez, CA 94553 At the hearing. the Contra Costa County Board of Supervisors will consider the impact on the health cam needs of the CourtVs indlpents of the implementation of the changes set forth in the attached summary. The Board does not consider all of the program changes in the attached summary to to within the requked coverages of Health and Safety Code bion 1442.5. Its scheduling of shies Hearing, giving this Notice of Public Hearing, the holding of a Hearing, and the making of any findings. shaff not be construed as an adn*slon by the County of Centra Crista, or the Beard of Supervisors. that any of the actions included in the attached summery arra subject to the hearing provisions of Health and Safeety Code section 14+42.5.