Apr 26 Chairman’s Meeting: March 20, 2019
Indian River County Hospital District
March 20, 2019
TRUSTEES: Marybeth Cunningham Karen Deigl (via telephone)
Ann Marie McCrystal Barbara Bodnar
Allen Jones Michael Weiss
STAFF: Jennifer Frederick Kate Voss
OTHER ATTENDEES: Pat Knipper Kathy Hendrix
Ashley Baum Marie Andress
Michael Kint Matt Reiser
Lundy Fields Nick Coppola
Victor Basil Carol Kanerak
Michelle Genz Vicki Soule
Convene Meeting – Marybeth Cunningham, Chairwoman
Mrs. Cunningham convened the Chairman’s meeting of the IRCHD at 10:00 AM by welcoming those in attendance.
Update on VNA Community Health Education Campaign Report- Pat Knipper, Director, Community Wellness and Mobile Health
Ms. Knipper provided the Trustees with an update concerning the VNA mobile health unit and the community health education campaign which kicked off October, 2018. As part of the campaign, the mobile unit was placed at new locations in Gifford and Wabasso, along with broadening Mental Health Collaborative services in all communities through relationship building with churches, food pantries, and community partners. Further, they have expanded the data collections platform through enhanced survey and health screening tools. To date, the mobile unit has received data tracked from 734 surveys and 922 MHC visits between October, 2018 and February, 2019. Additionally, the mobile unit has provided 298 health screenings for patients. Currently the mobile unit operates 6 days a week until 7:00 PM which is helpful to provide after-hour care to those who are unable to obtain an appointment with a doctor or would otherwise have utilized the emergency department. Ms. Knipper explained that patient volumes have increased but there still needs to be further community outreach and education, with the main goal being to assist the patients in establishing a primary care provider, to provide a continuum of care.
Ms. Knipper then discussed the VNA’s community collaborative group which is made up of approximately 25 local health agencies who meet every two weeks. The mission of the collaborative is to understand and serve the health and wellness needs of the medically underserved and their families who lack access to quality medical, dental and mental health care. Some of the key observations they have learned through this process are that access to medication and lab work are barriers for most patients, and a majority of patients are not established with a primary care provider. She reviewed data concerning site visits, demographics, and health outcomes. Additionally, she discussed in detail the ‘Positive Change’ program which was developed to target 30 patients, who expressed desire to make positive health lifestyle change. The program tracks the patients progress for one year and develops a plan to address their health goals and medical conditions. Currently, 22 patients are enrolled but only 6 have returned for their 30 day follow up appointment. Ms. Knipper stated that the VNA will continue to work with these patients and their compliance with the program. Lastly, Ms. Knipper stated that she would be requesting an additional six months of funding for the mobile unit and the community health education campaign, at tomorrow night’s regular monthly meeting.
United Way ALICE Population Report – Michael Kint, CEO United Way
Mr. Kint provided the Trustees with a brief review of the ALICE population report for Indian River county, which was published February, 2019. He stated that ALICE is an acronym for asset, limited, income, constrained, employed households, that earn more than the Federal Poverty level but less than the basic cost of living for the county. In Indian River County, 40% of households are considered to fall under the ALICE population, which is higher than the state average of 32%. Additionally, 11% of households in the county are considered to be in poverty. Mr. Kint stated that between 2010 to 2016 conditions have improved for some families, but with rising cost of living, many are still struggling. He further reviewed the household survival budget which reflects the bare minimum that a household needs to live and work. It showed that in 2016, costs were well above the Federal Poverty level of $11,880 for a single adult and $24,300 for a family of four. Additionally, family costs have increased by 15% statewide, compared to 9% inflation nationally. Mr. Kint informed the Trustees that the entire report could be viewed on the United Way’s website, should they wish to review it.
Update on United Against Poverty Medical Services- Annabell Robertson
Mrs. Cunningham asked Ms. Robertson to provide a brief update concerning the medical services that will be offered at the new UP Center. She stated that the center has partnered with TCCH to provide same day medical services to adults and children. There will also be mental health services available for adults by appointment. Additionally, there are plans to have a health navigator to help with applying for District eligibility, along with assisting them with referrals for other health services. The center also has 5 new education rooms where they will offer classes on health and nutrition. They anticipate these services to begin in September.
Discussion of District Qualification Requirements and Guidelines – Marybeth Cunningham, Chairwoman
Mrs. Cunningham stated that the District will soon begin their funding application process for fiscal year 2019-2020. She explained that over the last several years, the board has had multiple conversations concerning the District’s qualification guidelines. It has been suggested that the District increase the Federal Poverty level to capture additional residents who fall outside the current level of 150%. She would like the board to discuss and approve any changes before the funding application deadline of April 26, so that any agency applying will have the appropriate guidelines to complete their requests. She asked each Trustee to share their thoughts and recommendations on the same. After further Trustee discussion, the board agreed to the following changes:
1. Identification: Applicant must provide one photo ID or one form of acceptable identification. A list of acceptable documentation can be found in the Policy & Procedure Manual – Determination for Eligibility Criteria.
2. Residency: Applicant must be an Indian River County resident. Proof of residency is satisfied by providing two current documents in applicant’s name that confirms address on application or is an address in Indian River County.
3. Income: The annual household income must be less than 200% of the Federal Poverty Level Guideline. Gross income is the amount of income received as of the date of the application for the time period of 4 weeks prior. If income is self-declared and is less than $900 per month, a Letter of Financial Support is required.
4. Insurance: The District Healthcare Financial Assistance Program is available for applicant’s whose insurance benefits have been exhausted and who are seeking service for a medically necessary condition. Applicants who are otherwise eligible for Medicaid must first comply with Medicaid and include a reason for their denial. If denied due to non-compliance, applicant is not eligible for District financial assistance. A copy of the denial letter must be included with the application. These changes will begin with the 2019-2020 fiscal year effective October 1, 2019.
Mrs. Cunningham stated that these proposed changes will be voted on by the board at tomorrow night’s regular monthly meeting.
Program Liaison Update- Jennifer Frederick, Program Liaison
Mrs. Frederick stated that the District funding applications were sent out to 18 agencies and are due back April 26, 2019. Additionally, the application has been posted on the District website for any other interested parties to access. She has prepared the tentative budget schedule and the Trustees will need to decide if they want to hear presentations from all agencies applying for funding, or just new agencies that are applying for the first time. Mrs. Cunningham indicated that this would be an item for discussion at next months Chairman’s meeting.
Discussion with HRSA Project Officer Regarding NAP Funding- Vicki Soule, CEO TCCH & Marie Andress, CEO Whole Family Health
Ms. Soule stated that as a follow up to last months discussion surrounding Whole Family Health seeking to become a fully Federal Qualified Health Center (FQHC), she wanted to inform the Trustees of new information she received from Ms. Andress. Mrs. Soule had been told that if Whole Family Health Center (WFHC) received two years of initial funding from a New Access Point (NAP) grant award, WFHC would then need to compete for TCCH’s funds in order for their Health Resources & Service Administration (HRSA) funding to continue. This could result in all the HRSA funding going to one organization and none towards the other, but this information was not accurate.
Ms. Andress stated that she spoke to WHFC project officer at HRSA and they provided a different description of how the NAP funding works for a FQHC look-alike. She indicated that if Whole Family Health Center is awarded the NAP grant funds, they will become a full access FQHC. Then the NAP would provide grant funds to WFH for the next two years in an amount not to exceed the maximum award of $650,000 each year. At the end of the two-year period, they would be required to submit a Service Area Compete (SAC) application just as all other FQHC’s must do, every three years to retain their funding. The project officer also confirmed, during any FQHC’s SAC year, any other FQHC can “compete” for the same funds by submitting an application which requires them to provide, at a minimum, all the same services available to all the patients being served by the FQHC currently providing the services. Further, most FQHC’s do not compete for each other’s grant funds, rather they each submit their SAC application every three years, to retain the funds they already receive. Lastly, if Whole Family Health Center is awarded the NAP funds for the two-year initial funding period, those same funds will continue when they submit their SAC application in year three and would not detract from or diminish in any way TCCH’s grant funds. TCCH should have every reason to expect their HRSA funding to continue without interruption while Whole Family Health Center receives new funding through the New Access Point grant opportunity.
Public Comment- There was no public comment.
Adjourn- The meeting was adjourned at 12:45 PM