Local Government Advisory Committee
Minutes - December 14, 2001
Room 473, Human Services Building, Salem
Minutes Not Final Until Approved By LGAC
Cindy Becke,r DHSChief Administrative Officer
Lennie Bjornsen, DHSContinuous 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, DHSCommunity 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, DHSChildren, 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, DHSContinuous System Improvement
Chris Johnson, Yamhill County Health and Human Services
Lisa Joyce, DHSLegislative 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, DHSDirectors Office Administration and Staff to LGAC
Meeting called to order by Jean Cowan, Co-Chair. Roundtable introductions were made.
Minutes from the November 9, 2001 meeting were approved.
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.
Handout #1DHS 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 Governors 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 hasnt 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 Legislatures 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 Minks comment that each of the cuts is contrary to the Departments 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 Fosters 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 Senates 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.
Handout #2 DHS Evaluation System
Performance Measurement, December 12, 2001 Edition
Handout #3 DHS Performance Measurement Report
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.
Handout #5HIPAA Partner/Provider Forum
Nov. 28, 01 (folder)
Handout #6HIPAA 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 partners 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 Cowans request, Becker agreed to inform LGAC when HIPAA issues need to be included in the agenda.
Handout #7Cabinet Action on Recommendations of Task Group 184.108.40.206
Handout #8Remaking DHS:
Advocate and Advisory Group Connections
Final Report of Task Group 220.127.116.11
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 18.104.22.168 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 Minks 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.
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.
Handout #9LGAC 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*
*Actual agenda is dependent upon a meeting with the LGAC Executive Committee.
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:
DHS Directors 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, Directors Office, (503) 945-6609, TTY (503) 945-6214.