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Local
Government Advisory Committee
Minutes - December 14, 2001
Room 473, Human Services Building, Salem
Minutes Not Final Until Approved By
LGAC
Contents:
Attending
Cindy Becke,r DHS–Chief Administrative Officer
Lennie Bjornsen, DHS–Continuous System
Improvement
Larry Cole, League of Oregon Cities
Jean Cowan, Lincoln County Commissioner
Ron Dodge, Polk County Commissioner
Vic Falgout, Douglas County Juvenile
Department
Bill Fink, DHS–Community Human Services
Gina Firman, Assoc of Oregon Community
Mental Health Programs
Irene Fischer, Davidson Clackamas County Human
Services
Linda Fleming, Conference of Local Health
Officials
Ramona Foley, DHS–Children, Adults & Families
David Foster, Oregon Housing and Community Services
Gordon Fultz, Association of Oregon Counties
Robert Furlow, Douglas County Health and Human
ServicesSharon Guidera, Assoc of Oregon
Community Mental Health ProgramsCathy Iles, DHS–Continuous
System Improvement
Chris Johnson, Yamhill County Health and
Human Services
Lisa Joyce, DHS–Legislative and Intergovernmental
Relations Manager
Linda Modrell, Benton County Board of Commissioners
Mike Morgan, Jefferson County Administrative
Officer
Anne Peltier, Conference of Local Health
Officials
Bill Wagner, Cascades West Council
of Governments
Minute-Taker: Dena Comer, DHS–Director’s Office
Administration and Staff to LGAC
Introductions/Opening
Meeting called to order by Jean Cowan, Co-Chair. Roundtable
introductions were made.
Minutes from the November 9, 2001 meeting were approved.
Membership
Cowan reported that the Association of Oregon Counties
(AOC) is undergoing a reorganization of its infrastructure, and is in
the process of developing its steering committees. Until the AOC develops
its Human Services steering committee, it will not formally suggest
appointments to LGAC.
Lisa Joyce reported that she has only received recommendations
from the Association of Oregon Community Mental Health Programs,
and the Oregon Association of Area Agencies on Aging and Disabilities.
Joyce further reported that work is underway to post LGAC
minutes and handouts to the DHS website. In the near future, LGAC information
will be web-based and not mailed, with the exception of those who do
not have Internet access. The purpose of these efforts is to both cut
down on mailing expenses and to provide an efficient way for members
to forward that information to interested parties. If needed, hard copies
will remain available by contacting Dena Comer at DHS.
Cowan suggested that prior to meetings, LGAC agendas,
minutes, and other documents be sent electronically and not followed
with paper copies via US regular mail, unless other arrangements are
made with Comer. Hard copies will remain available at the meetings.
Budget Update
Handout #1 DHS Budget Presentation
to the House Special Committee on Budget Prioritization &
Senate Budget Rebalance
Committee
Vic Todd began the update by distributing the handout
prepared for the House and Senate Committee hearings earlier this week.
DHS will be working with the Governor’s Office within the next
two weeks to refine the document to reflect what the actual budget
recommendations
will be.
Todd provided a brief overview of the handout, and explained
that the first two pages outline major DHS program revenues and expenditure
areas. The next three-to-four pages outline the substantial growth of
food stamp and TANF caseloads. DHS is achieving an estimated 75 percent
penetration rate into the eligible population for food stamps, up from
the projected low-60 percent range.
Bill Wagner referred to the food stamps chart within the
document, and commented that the actuals are aimed at higher than 75
percent.
Joyce asked if the eligible population figure had been
adjusted, given the downturn in the economy.
Todd replied that the figures are based on the number
of people at poverty level, and are national estimates.
Robert Furlow asked how recently the food stamp growth
trends have been recalculated.
Todd replied that the document reflects figures from September,
however the growth trends have actually grown since that time.
Fultz asked, in reference to the trend lines for the health
plan and food stamps, if there is a reason why the same hasn’t
been done for mental health caseloads and the demand on public health
services and senior services.
Chris Johnson replied that in the last session, Legislature
did make the number of committed individuals to Mental Health programs
a caseload growth issue, which has never been done before.
Joyce explained that, with the short time frame for preparing
the presentation document, DHS chose to outline food stamp growth in
order to indicate the Legislature’s under forecasting. With respect
to food stamps in particular, the work being done in caseload management
has been shifted to TANF eligibility, and the document indicates the
impact on staff. Additionally, another issue surrounded food stamp
outreach
as a driver to increased caseloads to the Health Plan, the single biggest
portion of the General Fund budget. The graphics used to present the
food stamp issue were presented as an effective illustration tool.
DHS
did discuss the unmet demand on mental health and other areas as the
presentation continued.
Fultz commented that in the future, it would be helpful
if trend lines and the overall demand for services could be presented
to the Legislature.
Cindy Becker acknowledged the gap and explained that,
typically, the document presented to Legislature is standard. The Legislature
understands the relationship between the financial and demand situations,
and the set of illustrations DHS typically presents are easy to analyze
and provide a "picture." Presenting other program areas than
are traditionally included is certainly an option.
Furlow suggested that it would be helpful to make an analysis
of the proposed cuts and the impact of caseload growth across the different
service elements, in relationship to what may happen at the county level
when state services are no longer provided and become an issue of service
and mandate. Delivery of services is the focus at county level.
Todd agreed on the importance of providing such an analysis,
and explained that DHS noted in the document that taking a particular
action would shift the caseload somewhere else.
Furlow further commented that when an option is picked
which may cut dollars and a certain number of individuals from the caseload,
an alternative might cost five or ten times the original amount. Those
projected costs need to be estimated and included, as well.
Cowan suggested, as DHS works to create this type of document,
it contact LGAC members who have expertise in particular areas. Such
collective work might be helpful in creating long-term information when
approaching the decision-makers.
Fultz suggested that, in preparation for the next Session,
DHS Administrative Services work with Mental Health, Juvenile, Senior,
and Public Health directors to design measurements which would assist
in collecting the data to present to the Legislature.
Becker agreed, and replied that working now on modeling
the reduction impacts with small, medium and large counties would be
helpful for the next Session.
As Vic continued his overview of the document, Joyce relayed
Bobby Mink’s comment that each of the cuts is contrary to the Department’s
mission. DHS would normally oppose the reduction proposals being made.
Sharon Guidera commented that the AOC and the Mental Health
Programs noted that, while not specifically referred to, there were
over 30 items which would adversely affect clients. DHS’ Children,
Adults and Families reductions affect contracts for on-sight services
in Mental Health, Alcohol and Drugs, foster care, as well as JOBS Plus.
Todd replied that DHS initially came out of session with
a tight budget, and these reductions do have a broad impact on services.
In response to David Foster’s request for clarification,
Todd explained that the presentation document takes DHS to the 10 percent
reduction requested by the Governor.
Cowan suggested that LGAC put ideas on the table as to
how to strategize on future service delivery within the next biennium.
Wagner asked for estimated dates that information would
be available regarding impact of the reductions. The information will
be helpful for his group in developing their budget.
Becker responded that the reductions referred to have
an assumed start date of April 2002, not including DHS’ rebalance
numbers.
Vic further explained that the Special Session would address
the bigger budget problem, as well as DHS’ budget problems. Special
Session will occur in February.
Becker explained that DHS would release the information
as soon as the Legislature allows it, as it is public information.
Gina Firman remarked that, in reference to some 10 percent
reductions in the document, smaller counties may have layoffs that will
eliminate service, causing the counties to reach out regionally.
Foster commented that while the situation may seem gloomy,
it is important to see that change can be an opportunity to develop
different strategies and solutions, which may include improvements.
Joyce explained that in addition to the House and Senate’s
heart-broken response to DHS’ reduction in services, there was
concern regarding the difficulty clients have in achieving job placement.
Cowan suggested that this group use resources developed
over the years to see that limited revenues flow as directly as possible
to serve our constituents.
Performance Measures
Handout #2 DHS Evaluation System
Performance Measurement, December 12, 2001 Edition
Handout #3 DHS Performance Measurement Report
Fall 2001
Handout #4 DHS High Level Outcomes
As of 12/14/01
Lennie Bjornsen began his presentation of Performance
Measure issues by providing a review of his DHS Evaluation System handout.
The document contains components, which are being developed across the
Department surrounding results, measurements, and evaluation. They range
from high-level outcomes to specific management information regarding
caseloads and forecasting. Continuous System Improvement (CSI) is working
in collaboration with an employee survey, and a possible consumer survey
for those people who come to DHS. There is speculation as to the creation
of a quarterly report on Departmental results, which would be available
to LGAC and others who would observe the Department as decision-makers.
Work is being done on an Integration Index, which would include 15 different
scales detailing integration, from working toward a single consumer
plan to coordination of communication among various organizations.
Bjornsen distributed copies of DHS’ first Performance
Measure Report and explained that this information is needed in order
to make decisions as to whether or not DHS has the right programs,
and
if they are being implemented as well as they could be. Bjornsen further
explained that the Legislature is excited about the performance measurements
and high-level outcomes. They are interested in the intermediary results
and how DHS is doing in one quarter as compared to another, over time.
Becker remarked that what the report does is outline return
on investment. Additionally, the document can be used as a communication
tool reflecting the priorities within the Human Service system, both
at the state and county level.
Bjornsen referred to the High-Level Outcomes document
and explained that the DHS Cabinet developed these 19 through the examination
of approximately 150 original outcomes. There are other ideas in development
surrounding other outcomes. The first is in regards to mental health,
and the other speaks to health disparity as an area the Department should
address.
Bjornsen explained that Bill Fink and DHS’ Community
Human Services (CHS) will be working with CSI on management information.
Detailed evaluations will be done on areas such as cost per case, timeliness,
and effectiveness, and how CHS’ managers can make a difference.
Cowan asked that Bjornsen attend LGAC meetings and incorporate
the Performance Measure information into the roundtable discussion.
HIPAA
Handout #5 HIPAA Partner/Provider Forum
Nov. 28, 01 (folder)
Handout #6 HIPAA Partner/Provider Forum
155 Cottage St. Conference Room A
November 28, 2001
Becker distributed a folder, which was prepared for a
Provider Forum held on November 28, along with the minutes of the event,
and provided a brief explanation of the Health Insurance Portability
and Accountability Act (HIPAA). It is a largest unfunded mandate in
Health and Human Services history. The financial implications are that
it will out-phase those of Y2K preparations. The DHS budget has estimated
an amount of $27 million to implement HIPAA. Passed a number of years
ago, HIPAA was originally intended to allow individuals to have their
health insurance portable as they move from one place to another. As
the final bill was passed, more was added. HIPAA now includes not only
the portability, but the disclosure, translation and transaction of
protected health information. Protected health information is more than
medical; it is behavioral, physical, and impacts anyone who provides
health services. HIPAA governs the electronic, oral, and written transfer
of information.
There are three major components of HIPAA, which include
transactions and codes, privacy, and security. Legislation standardizes
transactions and codes for billing and information exchange nationwide.
Civil and criminal penalties will apply for noncompliance. The date
for compliance is October 2002 for transactions and codes, although
an extension has been proposes until October 2003. The compliance date
for privacy is April of 2003, and while security does not have an implementation
date at this time, finalized regulations are expected within the next
30 days, plus 26 months until actual compliance.
Becker explained that DHS is not responsible for its partner’s
compliance with HIPAA. DHS is working closely with its attorneys in
this matter, and it is suggested that each organization do the same.
While DHS is happy to share information, it is unable to provide legal
advice. The County Data Managers Committee may be a resource, in addition
to traditional legal counsel.
Becker suggested two websites for HIPAA information, www.hipaagives.org,
which is a free public agency site, and hippagives (full
website address not provided). There are other websites listed in the
distributed folder. While DHS has created a website, it is still in
development at this time. North Carolina is a leader in the country
with regard to implementation, and has a wealth of information available.
Becker further explained that DHS will be presenting HIPAA
expensed in Special Session as part of its rebalance, with the understanding
that the original cost projection of $27 million will most likely not
be adequate.
Cowan asked what role LGAC will be playing with regard
to HIPAA, and if the issue is something that should be placed on future
agendas.
Becker replied that while HIPAA is a federal mandate and
not open for advice, it would be appreciated if this information could
be shared with local entities. DHS is available to visit respective
groups, as well.
At Cowan’s request, Becker agreed to inform LGAC
when HIPAA issues need to be included in the agenda.
Reorganization Update
Handout #7 Cabinet Action on Recommendations
of Task Group 3.2.1.4
Handout #8 Remaking DHS:
Advocate and Advisory Group Connections
Final Report of Task Group 3.2.1.4
Becker began her brief update by explaining that while
it was hoped that the Department of Administrative Services’ survey
would be available, it has not been completed.
Becker relayed that one of the biggest issues DHS is
currently facing is going from policy to practice, and ensuring that
the program and policy clusters are well connected to Community Human
Services.
Ramona Foley explained that by the next LGAC meeting,
the DHS Cabinet will be able to define what the interface looks like
with respect to the policy clusters, specifically Seniors and People
with Disabilities (SPD), Children, Adults and Families (CAF), and the
field. The goal is that no matter whom a question is posed to within
DHS, the same answer would be given. The connection must not be lost
between sound policy and the front line level.
Barry Kast joined the discussion by providing an overview
of his Task Group 3.2.1.4 handout. He explained that as the structure
of DHS changes, advice provided by statutory and other advisory groups
must be considered. Kast briefly explained the nine recommendations
included in the document.
Guidera asked if these recommendations go beyond DHS
to affect the counties’ statutes to establish regulations.
Kast responded by relaying Mink’s comments that
while DHS is reorganizing, it is not attempting to reorganize the local
environment. The Health Services cluster, however, has a variety of
liaison processes and requirements for public health, mental health,
etc., and has created a committee to examine community linkages.
Organizational Updates
Fultz reported that the AOC has approached the Special
Session with a proposal with the hope of reducing the impact of reductions
to critical services. Additionally, the AOC has requested of the Legislature
and the Governors Office that the group will be able to review the impact
on a county-by-county basis. The purpose of the request is to allow
flexibility to move funds around to address problems critical to specific
counties.
Vic Falgout reported on the anxiety within Juvenile
Justice with respect to their own set of reductions, in addition to
the DHS reductions having an impact on Juvenile services.
Foley responded that Senator Hannon referred to the
Juvenile Justice situation this week, indicating a public awareness
of the potential problem.
Other Items
Handout #9 LGAC 2002 Meeting Schedule
Cowan asked the group to consider the February 8 meeting
date, and whether it should be firm due to the Special Session. At this
time the meeting will occur as scheduled.
Future Agenda Items*
DAS Survey
Policy-to-Practice
*Actual agenda is dependent upon a meeting with the
LGAC Executive Committee.
Next Meeting
Date: January 11, 2002
Time: 9:00AM - Noon
Location: HSB 473
Note: 2:00PM-4:00PM Stakeholders/Partners
Meeting
Location: HSB 137 A-D
If you would like copies of the handouts, contact:
Dena Comer
DHS Director’s Office, 4th Floor
500 Summer Street NE, E-15
Salem, OR 97301-1097
Telephone: (503) 945-6843
Americans with Disabilities Act Notice: Do you
have a physical or mental impairment that makes it hard for you to
communicate? If so, you can get this document in Braille, computer
disk, large print
or oral presentation by contacting Jessica Ferge, Department of Human
Services, Director’s Office, (503) 945-6609, TTY (503) 945-6214.
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