PROCEEDINGS OF THE BOARD OF HEALTH

Transcription

1 The Board of Health met in regular session held at the County Administrative Office Board Room at 10:30am. Those present: Ronald Henderson, Chairman; David White, Vice-Chairman; Gary Ellis, Commissioner; Robert Hill, County Attorney; Rick Eckert, County Manager; Marie Simons, Deputy Clerk to the Board. A. WELCOME None 1. PLEDGE OF ALLEGIANCE 2. ROLL CALL: Ronald Henderson, District 1 Present Gary Ellis, District 2 Present David White, District 3 Present 3. CALL TO THE PUBLIC: The Call to the Public agenda item was a time when the citizenry brought forth items of interest or concern. Please note that no formal action was taken on these items during this time due to the open meeting law provision; however, they may be placed on future posted agenda if action was required. Note: The remainder of the meeting commenced immediately after the Call to the Public. B. COUNTY MANAGER, Rick Eckert, consideration for removal or change in any items on this Agenda: None C. CONSENT AGENDA: NONE D. GENERAL BUSINESS & ADMINISTRATIVE ITEMS: 1. Proposed Revision to the Montrose County Board of Health Resolution, (Septic Regulations) Proposal: To amend the currently effective Board of Health Resolution previously adopted by Montrose County and adopting a revised Montrose County Board of Health Resolution, which governs the review and design of septic systems. (This item was continued from the January 22, 2013 meeting.) PROJECT DESCRIPTION: This item was continued from the January 22, 2013 meeting to allow additional issues to be addressed prior to adoption. The Montrose County Board of Health Resolution governs the review and design of septic systems. From time to time, this Resolution is updated to address new technology, land use changes and impacts on economic development. The last update was adopted on March 3,

2 ANALYSIS: The proposed amendment to the Resolution will include revisions to the definitions and tables including modifications to the required leach field setbacks from property lines and clarifications to the required geological ground water table information. The Montrose County Subdivision Regulations are also being amended to allow staff to verify that each lot will have a location for a septic system that will be designed per the County Health Resolution. A draft copy of the Board of Health amendment was sent to the local engineer firms to provide input on the proposal. Comments were received and changes were made to the draft to reflect appropriate comments. The proposed amendment was also sent to the State of Colorado for review and comment. A representative of the State has provided comments that may need to be incorporated into the document prior to adoption. RECOMMENDATION: The Montrose County Planning and Development Department recommends that this item be continued to a future meeting to allow additional changes to be made to the draft and that a final version be created and published prior to scheduled public hearing. Discussion Planning & Development Director Steve White referenced the discussion that took place in the March 18, 2013 BOCC meeting. An excerpt of that discussion was as follows: "Planning & Development Director Steve White noted that this item (Item F1) was connected with Item F2, which pertained to the Zoning Resolution and lot size minimums. He also explained that Item D1 of the Board of Health Agenda (which was scheduled that day for 10:30am) pertained to septic design regulations. These three items were heard at the January 22, 2013 BOCC meeting. The Planning & Development Department wished these three items to be run together concurrently; however, the Board of Health item had several issues that needed resolved; therefore, Planning & Development Director White requested continuing Items F1 and F2 until May 20, This would allow staff adequate time to resolve the issues." Planning & Development Director White explained that one of the reasons for the request for a continuation was that an addition of a variance procedure was being created and required approval by the State. COMMISSIONER WHITE MOVED TO CONTINUE ITEM D1 TO THE BOARD OF HEALTH MEETING ON MAY 20, 2013 AT 10:30AM. COMMISSIONER ELLIS SECONDED. MOTION CARRIED UNANIMOUSLY. 2. Environmental Health & Education Manager a. Introduction Jim Austin, Environmental Health & Education Manager Health & Human Services Director Peg Mewes introduced Jim Austin, the new County Environmental Health & Education Manager. She explained that he had extensive experience and education in environmental health in the Denver Public Health Department, and most recently, was a consultant in the food service industry. b. Update on Food Service program Environmental Health & Education Manager Austin reported that the new State rules that pertained to retail food (restaurants and groceries) went into effect on March 1,

3 Changes in the food service industry would need to contend with issues such as refrigeration temperatures, as well as focus on the obligation of sick employees to report their conditions. Those in charge of retail food establishments would also be obligated to take appropriate actions regarding sick employees. Gunnison County enrolled in the FDA National Voluntary Retail Program Standards, which was a tenpoint effort to improve retail food inspection and enforcement programs around the country. It applied to State programs that are found in health and State agriculture departments as well as local health departments. He noted there were approximately twenty local Colorado agencies enrolled. The Montrose County HHS Department had enrolled the previous week. The first step was to perform a selfassessment, which is a formalized process to evaluate the different components of the food inspection program. The FDA allows one year for this process. One of the requirements of HHS's annual contract with the State Health Department was for a HHS staff member to complete a standardization process. This takes approximately three days and involves the staff member (Food Inspector Vera Stauffer) working with a State Health Department Standardization Officer to assure that HHS is appropriately applying and interpreting the rules. That staff member would then standardize the remaining HHS staff in their respective local agencies. The State is requiring local agencies to make inspections based on a risk assessment model. The old model required restaurant inspections twice a year. Some restaurants pose a greater risk of food-borne disease transmission and require more attention; that risk is based upon a formula, which identifies those restaurants and includes the type of menu and the ways food is prepared. HHS's contract with the State included classification of the restaurants located in Montrose, Ouray, and Gunnison Counties. The process was not time consuming and would set the frequency for inspections of the various restaurants. The Cottage Foods Act 1 that was passed in 2012 allowed a limited list of foods such as baked goods or dry spices to be produced in home or non-regulated kitchens. That list did not include dairy foods. The person in charge of food safety must meet a level of food safety training. The Cottage Foods Act requires a sales limit of $5000 revenue on each type of food produced, labeling requirements, and the foods cannot be sold at wholesale and can be sold directly to the consumer; the consumer cannot resell the products. There was a pending bill before the General Assembly to broaden training options. Options for posting food inspection reports: o Denver and Tri Counties Health Departments post food establishment violations and inspector comments on their websites. o Montrose and Summit Counties Health Departments post a scanned pdf image of each food establishment's inspection on their websites. o Larimer County gives limited information on the violation, but contains no comments regarding food inspections. Commissioner Henderson expressed appreciation for the update and noted that the health of food workers needed to be closely observed due to the possibility of contamination. He informed Environmental Health & Education Manager Austin that the Commissioners were always willing to hear his concerns or comments. Commissioner Ellis inquired whether the new method for determining the frequency of facility inspections allowed the County to post food inspection results on its website. Environmental Health & Education Manager Austin responded that the regulations did not address posting food inspection results and would not prohibit posting results of food inspection. 1 For more information regarding the Cottage Foods Act, go to 3

4 3. Sequestration update Peg Mewes, Director HHS Director Mewes reported that certain funds in Public Health allocations are not "safe", which meant they could be used in other areas in the State that are experiencing funding problems. It had been reported that funding reductions would not occur prior to June 30, 2013, which coincides with the State's funding year. The Department of Public Health & Environment (CDPHE) was considering these funding reductions; however, it was not yet known which programs would be reduced or how much the funding reductions would be. The Department of Public Health & Environment hoped to address the funding reductions at the State level and that the reductions would not affect local Public Health Departments. HHS Director Mewes acknowledged the County had received no guarantee it would not experience funding reductions. Although there would be an 8% reduction to the Cities Readiness Initiative, HHS Director Mewes pointed out that the County was not involved in the program and would not experience a reduction in revenue. Although HHS Director Mewes noted there would most likely be a small reduction in the County's Public Emergency Preparedness contract by July 1, 2013, she expressed hope that the County's scope of work would be adjusted accordingly. HHS Director Mewes also reported that it had been rumored that immunizations funding would also be reduced, as well as VFC (a free vaccine). She noted however, that she received information that morning that the three immunization grants HHS applied for with CDPHE had been approved. At Commissioner White's inquiry, HHS Director Mewes explained that CDPHE did not know what the reductions in funding would be and that it was unclear when this information would be forthcoming. 4

5 Commissioner Henderson inquired if there would come a time when Montrose County would cease to work with the Hospital, due to the privatization of the Hospital. HHS Director Mewes responded that the County and Hospital were required to continue working with each other because the Hospital remained the local hospital no matter its status (private or county). Financial Director Cindy Bennet inquired whether there were any proactive strategies regarding how to address budgetary reductions to the County. HHS Director Mewes responded that no strategies had yet been created; however, the immunization grants that HHS recently received were in part being used to supplement any funding reductions. HHS Director Mewes agreed with Financial Director Bennet's assertion that it would be best to be proactive and create a strategy to overcome funding reductions; however, she pointed out that she did not know what those reductions would be. At Commissioner Henderson's inquiry, HHS Director Mewes asserted that there could be no prior planning because she did not know what the reductions would be; however, she reported that she had been informed that the information regarding reductions should be available in approximately one month. Once she received that information, HHS would be able to address budgetary reductions. 4. Navigator update - Peg Mewes, Director HHS Director Mewes informed the Board that HHS was looking into applying for a Navigator program to address the Affordable Care Act that would take effect October 1, HHS Director Mewes reported that she and Human Services Manager Carol Friedrich attended a weeklong seminar in Denver where proposals were given by several State departments that outlined how the Affordable Care Act would affect Colorado. HHS Director Mewes explained that Connect for Health Colorado would create a new internet system, which involved CBMS 2 Colorado Benefits Management System and PEAK Program Eligibility and Application Kit. Individuals may go to the PEAK website and apply for Medicaid and food stamps. 2 For more information regarding CBMS and PEAK, go to 5

6 Connect for Health Colorado is creating a third program called COHBE, which would interface with PEAK and CBMS and as of October 1, 2013, would determine the eligibility of individuals who wish to be covered by Medicaid. HHS Director Mewes asserted that the following list indicated individuals in Montrose County that could be eligible for Medicaid coverage. HHS Director Mewes outlined the following guidelines for those who would be eligible for Medicaid, and noted that a couple could be a mother and child. She reported that approximately half of the population of Montrose County was eligible for Medicaid. Commissioner White pointed out that many doctors did not accept Medicare or Medicaid. HHS Director Mewes responded that the question had been raised (and remained unanswered) as to how this would affect doctors who did not accept Medicare or Medicaid. She indicated there were bills pending that were meant to address how to make Medicare or Medicaid more profitable for physicians and hospitals. Commissioner Ellis noted that some years ago, regulations became so prohibitive in Colorado that many Colorado health providers left the State, which created a deficiency of health providers. At his inquiry, HHS Director Mewes asserted that she did not know whether more physicians would return to Colorado to accommodate the Exchange Act. 6

7 Regarding the grant for the Navigator program, HHS Director Mewes explained her belief that no Human Services Departments in Colorado wished to apply for the grant. It was believed that another entity would apply for the grant, which HHS would support. That entity would be responsible for any applications coming in for Medicaid. The applications would be divided into those who qualify for Medicaid and those who would be eligible for the Benefit Exchange, which meant they would be required to choose between different types of insurance coverage. This would be based upon what type of supplement they would receive to pay for the insurance. Montrose County would only be required to administer coverage to those eligible for Medicaid. HHS Director Mewes also noted that HHS was obligated to receive and accommodate any applicant who calls or visits their office without appointment. County Manager Rick Eckert inquired what the term "Churn" meant and what would happen once the 12-month coverage ended. HHS Director Mewes explained that currently, when Medicaid covers an individual, a redetermination is made after six months of coverage; however, under the Affordable Care Act, redetermination will take place after twelve months. This means that individuals would be required to enroll and re-qualify once a year. At Financial Director Bennet's inquiry, HHS Director Mewes explained that the Federal Government established the poverty level for those eligible for Medicaid. HHS Director Mewes explained that the term "Churn" was devised by the Department of Human Services. Churn occurred when a child's eligibility status for Medicaid changed to CHP Plus due to a parent obtaining employment. A great deal of confusion takes place ("churning") when the child is being shifted from Medicaid to CHP Plus. Many times, the situation with the family changes again when a parent loses employment, which makes the child eligible for Medicaid again. To reduce the amount of "churning", the Affordable Care Act implemented the 12- month coverage eligibility. Public Works Director Brian Wilson noted that individuals making $22 per hour were considered to be in the poverty level. At his inquiry, HHS Director Mewes explained that rental property income and other supplemental income would be considered part of an individual's income level. Commissioner Henderson reported that he recently learned that Colorado was now providing Navigator for individuals that needed assistance going through the legal process of the Court system. 5. Legislation update Peg Mewes, Director HHS Director Mewes noted that the following update concerned legislation that was the most pertinent to Health & Human Services; however, the amount of pending legislation that would affect the Department of Health that was ongoing was double that amount. She reported that she kept a record of all bills affecting HHS, which were available to the Commissioners at any time. 7

8 HHS Director Mewes reported that one school in Montrose County makes available free or reduced-cost lunches to approximately 87 percent of its students. Another school was close to 70 percent. At Commissioner Ellis' inquiry, HHS Director Mewes affirmed that the School District would be required to provide the Breakfast After the Bell Nutrition Program to each of its schools. At Commissioner White's inquiry, HHS Director Mewes explained the Federal Government did not submit an economic impact statement regarding this bill; however, she reported there would be an economic impact to the schools required to provide the program. The focus of this bill was the detrimental effect that missing a meal was having on a child rather than the economic impact the program would have on schools. At Commissioner White's inquiry, HHS Director Mewes asserted the breakfast would most likely not be a Continental breakfast. At Commissioner Ellis' inquiry, HHS Director Mewes explained that the bill originated at the State level and not the Federal level. HHS Director Mewes explained the State of Colorado was concerned that now that the use of marijuana was legal in Colorado, vendors would put marijuana in food or drink items; therefore, the bill was being proposed to limit what items marijuana could be put into. This would reduce incidents where children would ingest marijuana by mistake. At Commissioner White's inquiry, HHS Director Mewes asserted that this bill was not connected to the Cottage Foods Industry Act. However, Environmental Health & Education Manager Austin explained that the Division of Environmental Health (that oversees food) was involved in creating the language for HB County Manager Eckert asserted that the language ("require a minimum of components") of the bill made no sense. HHS Director Mewes noted that there were three legislative bills regarding marijuana in 2012 and there was only one legislative bill in 2013 concerning marijuana. HHS Director Mewes explained that this bill was introduced in January and was laid over in March; therefore, it was her belief the bill would not be passed. At Commissioner Ellis' inquiry, HHS Director Mewes explained that the Montrose County HHS Department would not be responsible for the program; it involved the Colorado 8

9 Department of Health & Environment. CDPHE has a grant program that allows schools to apply for funding to incorporate the Comprehensive Human Sexuality K-12 Education program. HHS Director Mewes explained that in 2012, a bill failed that attempted to move all child health programs under one office in the Department of Human Services. Governor Hickenlooper however has the ability to establish and develop offices; therefore, he established an Office of Early Childhood and transferred several child health programs to the Office of Early Childhood. HB would require programs that were not yet under the Office of Early Childhood to be transferred to that office. HHS Director Mewes asserted that there was not a great deal of opposition to the bill and would most likely pass. HHS Director Mewes noted that HB would extend the exemption date of cigarettes from the State sales and use tax. 9

10 HHS Director Mewes noted that HB failed to pass in 2012; a minor change was made to the bill and was reintroduced in HHS Director Mewes explained that SB would expand how HHS could use grant funds. 10

11 Commissioner Ellis noted that SB was discussed at a session of CCI (Colorado Counties, Inc.) and the discussion became quite contentious. Questions regarding fiscal impacts of the bill were not answered. The State projected that the Medicaid Expansion bill would cost approximately $2100 per FTE (Full Time Employee) per year; Commissioner Ellis asserted that this was not probable. Colorado commissioners were asked to vote on whether CCI should monitor, oppose, or support the bill. Several individuals suggested that the bill be monitored; however, Commissioner Ellis made a motion to oppose the bill because it was his belief that a strong message that the bill was not acceptable needed to be sent the Legislature. After Dick Hodges of Park County seconded the motion, discussion took place where several HHS directors expressed their belief that Colorado counties needed to support the bill. Commissioner Ellis' motion failed (27 to 8), which he acknowledged was surprising due to the many unanswered questions that remained. Another individual from a mountain community made a motion to monitor the bill, which passed (26 to 2). HHS Director Mewes noted it was estimated there would be an additional 191 individuals entering data for the eligibility process for COHBE. An additional staff of fourteen supervisors and fourteen clerical would be necessary to implement the program. She acknowledged that these individuals would be paid a very low income. County Manager Eckert noted that just because Medicaid would be expanded did not mean that doctors would be available to accept Medicaid and serve those covered by Medicaid. He inquired whether this was discussed at CCI. Commissioner Ellis responded that this was not discussed; discussion focused on what it would cost counties to insure people in the program. He acknowledged that he was bewildered as to why the majority of Colorado commissioners chose not to oppose the bill. HHS Director Mewes pointed out that although the bill was named the Medicaid Expansion bill, individuals could not qualify for the Exchange until they applied for and were declined Medicaid coverage. Commissioner Henderson inquired whether HHS Director Mewes and/or Human Services Manager Friedrich would be willing to make a presentation regarding these matters to the Montrose ACT (Association of Commerce & Tourism) organization. HHS Director Mewes accepted the invitation. E. UNFINISHED BUSINESS: NONE F. PLANNING & DEVELOPMENT: NONE G. EXECUTIVE SESSION: NONE 11

12 With no further business coming before the Board, the Board of County Commissioners adjourned at 11:31am. ATTEST: BOARD OF MONTROSE COUNTY COMMISSIONERS Francine Tipton-Long, County Clerk & Recorder By: Marie Simons Deputy Clerk of the Board Ronald D. Henderson, Chairman David S. White, Vice Chairman Gary Ellis, Commissioner 12