Chairman’s Meeting: March 20, 2019

Chairman’s Meeting: March 20, 2019

Indian River County Hospital District
February 20, 2019
10:00 AM

TRUSTEES: Marybeth Cunningham Karen Deigl
Ann Marie McCrystal Barbara Bodnar
Allen Jones Michael Weiss

ABSENT: Tracey Zudans

STAFF: Ann Marie Suriano Jennifer Frederick
Kate Voss Jennifer Peshke, Esq.

OTHER ATTENDEES: Michael Felix Michelle Genz
Kip Jacoby Nate Bruckner
Vicki Soule Miranda Hawker
Mayur Rao Carol Kanerak
Marie Andress Janet Begley
Nick Coppola Trip Snelson
Annabel Robertson Deana Shatley

Convene Meeting – Marybeth Cunningham, Chairwoman

Mrs. Cunningham convened the Chairman’s meeting of the IRCHD at 10:00 AM by welcoming those in attendance. Mrs. Cunningham stated that there is an addition to the meeting agenda. Mrs. Peshke will provide an update concerning the health department and the lease and funding agreement for the Gifford Health Center, between agenda items number 5 and 6.

Agreed Upon Procedures Report – Kip Jacoby, CPA MJTB

Mr. Jacoby explained that this report was prepared following a review of all funded agencies, to ensure that the agencies are following the District’s agreed upon procedures guidelines for indigent qualification during FY 16-17. Mr. Jacoby reviewed the report in detail and stated that overall most applications were complete and are in compliance with District guidelines, however they did discover a few discrepancies with residency qualifications. Mr. Jacoby believes that most patients who applied for indigent care were eligible but some were unable to provide the proper documentation. He further reviewed the financial data concerning patients billed to the District but were unable to be qualified. The Trustees agreed that since these cases were billed during the transition period of the care card, the board would not be requesting the agencies to payback the unqualified cases. Moving forward, the board agreed to conduct an audit on each funded agency annually. Mrs. Peshke indicated that she would add language relative to that matter into the funded agency agreements, which are signed at the beginning of each fiscal year. Those agreements outline all requirements of the entity receiving funding from the District. Lastly, Mr. Jacoby stated that this process took much longer than anticipated, due to the volume of data they had to review, some of which was in paper form. Now that the District has transitioned fully to the electronic database, the process will take much less time.

United Way Funding Evaluation Process and Outcome Indicators – Nate Bruckner, Director of Community Impact

Mr. Bruckner provided a review of the United Way’s grant funding application process, which is open to any nonprofit that serves Indian River County. Every two years the United Way conducts the grant funding application process and has a specific cause that it focuses on during that funding cycle. Agencies who are granted funding, receive those funds over a two-year period. Currently during this funding cycle, the focus is on children’s services. In past years they have focused on senior services and mental health. He explained that historically appointed community members have been the individuals who reviewed the submitted applications for grant funding. Now, the United Way has transitioned to a completely electronic version which is done online, and the results from this transition have proven to be successful. Mr. Bruckner further explained that to evaluate outcome indicators for the grant recipients, they look to leaders in the community who serve on their citizens review panel. Additionally, programs that receive funding are required to submit progress reports every 6 months.

United Against Poverty Eligibility Criteria- Annabel Robertson, Executive Director

Mrs. Robertson explained that United Against Poverty (“UP”) is a non-profit organization with its main objective being to inspire and empower people living in poverty to lift themselves and their families to economic sufficiency. She provided a review of UP’s requirements for member share grocery program, which is a food and household assistance program where low income-qualified members can select items for their family needs. Included in her presentation was a map of Indian River County that outlined data concerning areas of the county and the number of residents in that area who participate in the member share grocery program. Currently the program serves 800 people a day and they expect that to number to increase to approximately 1000. Mrs. Robertson further review the qualification guidelines for the member share program. She explained that members must be at 200% or below the Federal Poverty Level to qualify. They also collect subsequent data such as proof of residency, but this is not a requirement to participate in the program. Additionally, UP offers many other services such as life enrichment programs, employment training, and case management, which are all free of charge.

Presentation on FQHC’s- Marie Andress, CEO Whole Family Health

Ms. Andress provided a historical review of Whole Family Health (“WFH”). She explained that in October 2017, WFH became a Federal Qualified Health Center (“FQHC”) look-alike, which is a community-based health care provider that meets the requirements of HRSA, but does not receive federal grant funding. However, WFH is currently completeing the application process to become a fully qualified FQHC and their first visit from HRSA will take place in March. Ms. Andress reviewed the medical services that are offered through WFH, along with the sliding fee discount program which help patients with their cost of care. There was board discussion surrounding the District qualification requirements verses the HRSA requirements. The Trustees questioned whether WFH obtaining full FQHC status would affect TCCH’s funding, which is also an FQHC. It was explained that if WFH was to obtain full FQHC status, that there would be a review by HRSA after two years of both agencies. If TCCH is not offering the same level of services or more, funding could be pulled from TCCH. However, this is not likely to occur as currently TCCH offers more medical services than WFH and has received multiple rating of excellence from HRSA. The Trustees agreed that they would like more information on this matter and asked that Ms. Andress keep the District informed of this process.

Updated Concerning Indian River County Health Department Agreements Regarding the GHC and RFP Update Jennifer Peshke, Esq.

Mrs. Peshke indicated that on February 8, the Health Departments provided notice to the District that they would no longer be providing dental and primary care services at the GHC and that they also would be vacating the building beginning March 1, 2019. Subsequent to that announcement, Mrs. Peshke review all legal documents between the District and the Health Department. Currently, the Health Department has two active agreements with the District which include an agency funding agreement, and a lease agreement for the Gifford Health Center. Mrs. Peshke has reviewed both agreements and advised that board that the Health Department’s announcement to discontinue services and vacate the building is a violation of both the lease agreement and the agency funding agreement. She recommended to the board that the considering requesting Health Department to consolidate primary care services at GHC until the end of the current funding cycle, to avoid a lapse in access to care for the community. There was Trustee discussion concerning the Health Departments announcement and most board members felt that the District should hold the Health Department accountable to the terms of the funding agreement and lease, and it was requested that the Health Department respond to the concept of consolidating services at the GHC.

Mrs. Hawker addressed the board and stated that after the Districts initial RFI process, the Health Department reviewed their revenues sources and discovered that primary care and dental services are unsustainable financially. She explained that this trend is happening across the state and very few Health Departments provide primary care services. Additionally, a provider from the Health Department has taken an extended leave of absence and will not be providing primary care services for an extending period of time, leaving one less doctor on staff. She indicated that primary care services could be consolidated at the Gifford Health Center, per the Districts request. She also indicated that the Health Department’s legal counsel does not feel that they have violated the terms of the lease agreement with the District. Mrs. Cunningham stated that the District has organized a meeting of funded agency providers this coming Friday, to discuss sustainable options moving forward and the next steps of supporting the Gifford community.

Mrs. Peshke provided a review of the RFP process timeline with the Board. She indicated that on February 27, the District will hold a public meeting to review and receive feedback concerning the RFP. Mrs. Suriano will take those recommendations and update the document accordingly. The RFP will then be posted for distribution and response. Additionally, the District will hold a pre-submission conference in March, which is a required step in the process that allows potential responders and the public to ask any questions concerning the RFP. On the chosen date, the District will receive the sealed proposals in compliance with Florida Statutes. Once the proposals are received the evaluation committee will review the same and provide a recommendation to the board and the board will vote on a final proposal.

Program Liaison Update- Jennifer Frederick, Program Liaison

Mrs. Frederick provided her program liaison update and stated that she is working to select metrics relative to the initiatives set forth in the Districts strategic plan for FY 2019-2021. Additionally, she stated that the she has asked Michael Kint from the United Way, to present their new report on the ALICE population at next month’s Chairman’s meeting.

Public Comment-

Mr. Felix indicated that FQHC‘s are now the main entities to provide sustainable primary care in public health however, the cost to deliver primary care services to those without a payor source will usually require additional financial subsidy.

Adjourn- The meeting was adjourned at 12:45 PM