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Minutes Not Final Until Approved By LGAC

Local Government Advisory Committee Meeting Minutes

February 13, 2004
Room 473, Human Services Building, Salem



Attending

Jerry Burns, DHS — Deputy Assistant Director, Children, Adults and Families, Field
Larry Cole, League of Oregon Cities
Jean Cowan, Lincoln County Board of Commissioners
Ron Dodge, Polk County Board of Commissioners
Wendy VanElverdinghe, Community Action Directors of Oregon
Gina Firman, Association of Oregon County Mental Health Programs
Irene Fischer-Davidson, Clackamas County Human Services
David Foster, Oregon Housing and Community Services
Gordon Fultz, Association of Oregon Counties
Robert Furlow, Douglas County Health & Social Services
Bobby Greene, Lane County Board of Commissioners
John Hartner, Oregon Association of Community Corrections Directors
Lisa Joyce, DHS — Director’s Office
Barry Kast, DHS — Assistant Director, Health Services
Linda Modrell, Benton County Board of Commissioners
Jim Neely, DHS — Deputy Director
Dan Postrel, DHS — Administrative Services
John Swanson, DHS — Finance and Policy Analysis
Jean Thorne, DHS — Director James Toews DHS — Assistant Director, Seniors & People with Disabilities
Gillian Wesenberg, Douglas County Commission on Children and Families

Minutes: Dena Comer,
DHS — Director’s Office Administration and staff to LGAC

Welcome and introductions/approval of minutes

Jean Cowan called the meeting to order, and rountable introductions were made. The minutes from the December 12, 2003, meeting were approved.

Elections

ACTION: Moved, seconded, passed: The slate of Linda Modrell as Chair, and Cowan as Vice-Chair

Director’s report

Thorne announced that Vic Todd has been named Assistant Director for Finance and Policy Analysis (FPA). Todd has managed agency budgets for 14 years, including serving as FPA’s Assistant Deputy Director, and as acting Assistant Director since August 2003. In Todd’s absence, John Swanson will provide today’s budget report.

Thorne announced Stephaine Parrish-Taylor as the new Administrator of DHS’ Office of Vocational Rehabilitation Services (OVRS). Taylor brings more than 18 years experience to this position, including 11 years in management. Most recently, she was manager of the OVRS North Portland field office, and was selected for her extensive experience and in-depth knowledge of issues affecting the disability community. She will begin her new role April 1.

Measure 30 planning

Thorne explained this is a work in progress, and provided an overview of the appropriation, the loss of tobacco funding, and the reduction impacts to each DHS cluster. Beginning last month, DHS analyzed the types of costs or savings it anticipates thus far into the biennium, including considering all federal guideline options. The bulk of the reductions are due to be taken out of the Oregon Health Plan (OHP). Planning options at this point include transferring remaining Senior and People with Disabilities (SPD) savings to OHP, an additional $8 million Emergency Board (E-Board) special purpose appropriation for a hospital Standard benefit, and not restoring levels 12 and 13 in SPD. Any of these options require E-Board approval. A consideration is that any reductions taken in OHP would result in costs to other program areas.

The Governor outlined his priorities following the Measure 30 election, including his wish that DHS hold onto the OHP Plus population and services. Toward this and the reduction requirements, DHS has undertaken many steps to refine its estimates, including a pseudo-rebalance. Still, it’s difficult to know how DHS will accomplish its reduction requirements.

Led by the Governor’s Office, discussions have occurred with the Medicaid Managed Care plans and the Hospital Association. The issues include provider taxes (assuming they are ultimately approved by the federal government) and any excess that might be applied after rate adjustments and aggregate returns are made.

Thorne explained that while the Governor would like to keep benefits for mental health, chemical dependency, and children and pregnant women, his lower priorities include adult dental and vision. In question is whether or not DHS will be able to keep its waivers, and whether or not it will be allowed to keep its prioritized list. Initial discussions have started with the federal government, but it’s difficult to predict success at this point.

As DHS strives to protect as much of the OHP Plus package and clients as possible, August 1 is the projected reduction implementation date, with reductions in other budget areas projected for May 1.

Q. If we’re not successful in holding on to the waiver, can we still do managed care, particularly in the arena of mental health?
A. Yes

Q. Is DHS planning to go to the E-Board to ask for the transfer of SPD funds? If so, there are many stakeholders who would be willing to write letters; would that be helpful?
A. DHS needs to finalize its plan. Also, there is resistance to not restoring SPD levels 12 and 13; it’s hard to know for sure if this will be part of the plan. When it's finalized, the letters would be helpful.

Gina Firman committed the Association of Oregon Counties, Mental Health Programs (AOCMHP) to writing such letters once DHS has completed its plan.

Q. If authority won’t be forthcoming until the April E-Board, then how soon would we be getting contract changes and notices to clients on those changes?
A. The legal requirement is that notices be sent to clients 30 days prior. If DHS is allowed to keep its waivers, then the necessary rate changes must be calculated. DHS will be putting together a communication plan for conveying changes to clients, and possible written suggestions for alternative resources.

Q. Restoration cannot be done without going to the E-Board, correct?
A. Any time something is transferred from one place to another, the E-Board must approve.

Q. Does the provider tax have to be included as part of the discussion in order to cover the priorities the Governor outlined?
A. Probably Q. Has the Governor’s Office or the Legislature informed DHS of its intent to implement the approximately $100 million in the gap of remaining reductions now, or to hold it for use later in the biennium?
A. There is $780 million in actual lost revenues. The dissappropriation bill identifies $545 million in specific reductions, which creates a gap. To address the gap, the Governor first goes to the ending balance, which is approximately $135 million at this point, leaving approximately $100 million in the gap. According to the bill, the Governor would then take across-the-board reductions to address this, of which $20+ million would come from DHS. This is not being done at this point, because if such reductions were taken and the revenue forecast jumps back up, the additional amount would also have to be added back across-the-board. The Department of Administrative Services (DAS) will wait until the March and (possibly) June forecasts, but has put everyone on notice of the potential reductions beyond what’s already been identified.

Q. If we lose the demonstration waiver, would we lose the Family Health Insurance Assistance Program (FHIAP)?
A. We would lose the federal match for FHIAP.

Q. Between now and April, are there any ways LGAC members can assist DHS?
A. By the end of March, DHS should know what can be squeezed out of its budget, and what the federal government will say about the provider tax. If by then DHS knows about the managed care tax, it will help in the planning. If not, the Governor’s office will outline what they are willing to attach to certain sources of revenue.

Q. Of the $89 million, how will LGAC and other partners be involved in identifying reductions?
A. If additional reductions are needed, discussion can occur at LGAC.

Q. To clarify, regarding the $95 million in projected savings of caseload reduction, is this something already applied?
A. Yes. It has already been used.

Lisa Joyce informed the group, if it hears something strange, and if any issues need clarification, they can contact either Vic Todd or her in order to get the correct answers.

Q. The AOC voted recently to send a letter to the Governor requesting that the $17.8 million be restored to Community Corrections and caseloads. In that discussion, was there any recognition of the importance of chemical dependency and mental health to Community Corrections? In terms of public safety, this is just as important as caseload issues.
A. The AOC advanced both to the Governor’s Office. This is an excellent point, and one that will be carried forward to the AOC’s Human Services Committee and to AOC leadership.

Q. From the local perspective, it would be very helpful to get budget information as soon as possible. What is DHS’ drop date?
A. By mid-March, DHS should have an idea of what will have to be done. If having to use provider taxes is included, that is beyond the agency’s control. The E-Board is April 8 & 9, but if there are federal requirements, it could be longer.

Firman reported that the AOCMHP has been conducting visits around the state, and the feedback is that if Plus is gone, there are counties who are not sure if their infrastructure can be held together.

05-07 budget development

Handout #1:DHS Advisory Groups

Handout #2:DHS Groups consulted in budget development

Handout #3:Timeline for LGAC participation in DHS 05-07 budget development

Handout #4:State of Oregon Budget Process Overview

Handout #5:DHS 2003-05 Agency Request

Joyce briefly outlined handouts #1-3, explaining the very short timeline to develop a set of policy packages, and that DHS has not yet received its budget instructions from DAS.

Referring to handouts #4 and 5, Swanson outlined the budget development process, explaining the public piece will begin in April and continue through June. Handout #5 is the agency request from the last process. The next biennium’s policy packages must be prepared by July in order to be included in DHS’ budget document, which must be prepared by the end of August.

Q. How many of the 188 items listed on the agency request were referred to the Governor’s Office?
A. All were part of the agency’s request. The shaded items went forward from the Governor’s Office.

Q. How will restorations of lost programs be addressed? How do we avoid having the old programs compete with new programs?
A. DHS could somehow prioritize a mixture of restorations with the new, but it’s hard to do that without first knowing what DAS will do.

Comments from the group included the need for LGAC to be in partnership with the state to prioritize the items, and the need to meet the changing times and be on the offensive rather than the defensive in the process.

Thorne suggested that the June LGAC meeting include input from the group on policy packages and reduction options. Referring to handout #5, Joyce explained that if anyone would like the policy packages, DHS would make them available.

LGAC purpose

Handout #6:LGAC’s work?

Handout #7:Making Government Work for Oregonians: A Plan for Achieving Results-Based Government (Advisory Committee on Government Performance and Accountability) January, 2004

Possible roles

Modrell opened the discussion by utilizing handout #6 as a guide, and referred to her roles presentation at the November meeting. She explained that ultimately she would like to know whether or not LGAC members would be interested in working on items 1-4 as outlined in the handout, and to identify the scope of that work.

Modrell explained the four ideas listed in the handout, and available tools for each:

  • Item 1: This is actually about what should be done by the community, the individual, the state, and the local government.
  • Item 2: This is a complex idea that would cost a significant amount of money, but could be an effective way to balance services with community values and costs.
  • Item 3: This involves seeking the most efficient and effective means of operating a social support system.
  • Item 4: This addresses how to build upon strengths to foster resilience.
Gordon Fultz suggested a category for basic minimums, as well as a category for optional items, adding there may be litigation out there affecting those minimums.

Cowan commented that Lincoln county has gone through a process similar to item #2, and while it’s good, it’s also difficult. The outcome for Lincoln County was a prioritized list. The other factor that should be considered is whether or not there are cost savings to the general fund budget. She suggested moving to a management-level discussion to frame issues prior to asking for community input. She added there is value in establishing for voters the connectivity between taxes and services, which is critically lacking at this time.

Firman suggested that before a discussion can take place, it would be helpful to have a list of all the things DHS does, including options and requirements. This list could then be taken to the communities.

Additional group comments included support for defining LGAC’s roles, and the value in outlining what services are required, and who provides them. Additionally, the suggestion was made that if actions such as these aren’t taken, we will remain vulnerable to such directions as benchmarks, outcomes, etc., none of which have been effectively utilized. Joyce suggested that handout #7 could be an effective tool, explaining the Governor referred to it many times the day after the election.

Joyce further reported that during the initial phases of reorganization DHS catalogued the different things it does, however mandates were not included. Group response included a suggestion for a foundational piece such as a spreadsheet, where different areas could be presented at different venues, depending on the audience. Identifying unfunded mandates could be useful in budgeting and other work. DHS is often asked about such unfunded mandates including the Health Insurance Portability and Accountability Act (HIPAA), staffing studies, etc.

Foster expressed his willingness to work on items 1 and 4, and Furlow suggested that whatever process LGAC pursues, it not create work but create a system for dialogue so that LGAC can be effective for DHS. Modrell commented that it’s the job of County Commissioners to look toward the future. She added that the ideas outlined here are not necessarily ready to present to anyone in a meaningful way.

Cowan suggested that the group revisit the four ideas, and a logical next step is to ask DHS staff to develop one piece of work from which to have a discussion and generate additional interest.

ACTION: Joyce will prepare an inventory of DHS programs

Linking back to organizations represented at LGAC

Group members described the various ways information is conveyed to and from the organizations they represent. One method included taking the information gained at LGAC, particularly that which requires feedback, and discussing it in relation to the operation of the program(s). While every organization is different, it is evident the role of information conduit is primary, and the advice brought to LGAC is the result of collected ideas from various local sources.

With respect to whether or not LGAC members have a relationship with DHS advisory groups, Thorne referred to handouts #1 and 2 and explained that the most helpful thing would be a higher-level look at how the pieces fit together. Joyce added the other purpose of the advisory group list is to communicate how much input DHS receives, and to dispel the myth that government makes its decisions in a vacuum.

Fultz commented that DHS’ LGAC is one of the most effective he has seen. He suggested an additional, community-development type forum, where state agency directors sit at the table with local officials to discuss issues. Thorne replied that such a forum has been considered in the past, but it is dependent upon the issues.

Modrell suggested that the March meeting include looking at the inventory Joyce will prepare, and the scope of LGAC’s work as a continuation of today’s discussion.

Other items

Handout #8:DHS News Release: State names new head of the Governor’s Advocacy Office

Thorne announced Gin Denison’s retirement from the Governor’s Advocacy Office, and Naomi Steenson as her successor. Steenson will begin her new role on March 1.

Future agenda items

The actual agenda is dependent upon the LGAC Executive Committee meeting.

Next meeting

Date: March 12, 2004
Time: 9:00 AM — Noon
Location: Room 473, Human Services Building

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
e-mail: dena.comer@state.or.us

Americans with Disabilities Act Notice: This document is available 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) 947-5330.