Agenda

Call to Order

Approval of the May 3, 1999 Human Services and Executive Session Minutes

Additions to the Agenda

Limited Public Comment

1 Board of Commissioners - Capital Area District Library Appointment

2. PHP - Communication from Olga Dazzo, President

3. Health Department

a. Presentation Regarding Health Department Dental Clinic

b. Resolution to Establish a Fee for Administering Certain Vaccines

c. Resolution to Amend the Lease Agreement with the Black Child and Family Institute

d. Resolution to Authorize an Amendment to the Agreement with the Michigan Department of Community Health to Accept Assignment of a Mobile Clinical Unit

e. Resolution to Authorize a Fourth Equip Special Project Grant

f. Resolution to Authorize a Prescription Drug Purchase Assistance Agreement

g. Resolution to Authorize Agreements and Contracts, Adjust the Status of a Position and Amend the Health Department's 2000 Budget to Coordinate the Breast and Cervical Cancer Control Program in Washtenaw and Livingston Counties

h. First Quarter Travel Report

i. Informational Item - Ongoing Tuberculosis

j. Informational Item - Physician Contract with Michigan State University

k. Resolution to Authorize an Amendment to the 1998-99 Agreement with the City of Lansing

l. Informational Item - Dental Clinic Presentation

4. Board Referrals

a. Letter from the Mid-South Substance Abuse Commission Requesting the Commission's Portion of the 1999 Ingham County "Cobo Hall Convention Facility Tax"

b. Resolution from Iron County Regarding the Use of Tobacco Settlement Funds

Announcements

Public Comment

Adjournment

The County of Ingham will provide necessary reasonable auxiliary aids and services, such as interpreters for the hearing impaired and audio tapes of printed materials being considered at the meeting for the visually impaired, for individuals with disabilities at the meeting upon five (5) working days notice to the County of Ingham. Individuals with disabilities requiring auxiliary aids or services should contact the County of Ingham in writing or by calling the following: Ingham County Board of Commissioners, P.O. Box 319, Mason, MI 48854 Phone: (517) 676-7200. A quorum of the Board of Commissioners may be in attendance at this meeting.

Return to Top of Document

The following items have attachments available in the Board of Commissioners Office:

1 Board of Commissioners - Capital Area District Library Appointment

2. PHP - Communication from Olga Dazzo, President

3. Health Department

a. Presentation Regarding Health Department Dental Clinic

4. Board Referrals

a. Letter from the Mid-South Substance Abuse Commission Requesting the Commission's Portion of the 1999 Ingham County "Cobo Hall Convention Facility Tax"

b. Resolution from Iron County Regarding the Use of Tobacco Settlement Funds

HUMAN SERVICES COMMITTEE

May 3, 1999

Minutes

Members Present: Anne Smiley, John Czarnecki, Mary Stid, Michael Severino and

Alfreda Schmidt

Members Absent: None

Others Present: John Neilsen, Jerry Ambrose, Bob Glandon, Bruce Bragg and Paul Pratt

The meeting was called to order by Chairperson Smiley at 7:02 p.m. in Conference Room B of the Human Services Building, 5303 South Cedar, Lansing.

Approval of the April 19, 1999 Minutes

MOVED BY COMM. STID, SUPPORTED BY COMM. SEVERINO, TO APPROVE THE APRIL 19, 1999 MINUTES. MOTION CARRIED UNANIMOUSLY. Absent: Comm. Schmidt

Additions to the Agenda: None

Limited Public Comment: None

1. Health Department

a. Resolution to Amend the Project Respect Contract with the City of Lansing

MOVED BY COMM. STID, SUPPORTED BY COMM. SEVERINO, TO APPROVE THE RESOLUTION TO AMEND THE PROJECT RESPECT CONTRACT WITH THE CITY OF LANSING. MOTION CARRIED UNANIMOUSLY. Absent: Comm. Schmidt

b. Resolution to Authorize a Contract to Conduct a Population Based Community Survey

Mr. Bragg explained that the Resolution will authorize a contract with Information Transfer Systems, Inc. (ITS) to conduct a population based community survey of health related behaviors. The survey is part of the Health Department's work to document the health related behaviors of County residents and to track changes over time. The survey results will assist with the evaluations required for Johnson Foundation and the W.K. Kellogg Foundation grants.

Half the cost of the survey will be funded by the County and half by the two grants. The ITS proposal was for $48,778. The funds to complete the survey are included in the Department's 1999 budget.

In response to Mr. Neilsen, Mr. Bragg stated that this survey will be conducted periodically.

MOVED BY COMM. STID, SUPPORTED BY COMM. SEVERINO, TO APPROVE THE RESOLUTION TO AUTHORIZE A CONTRACT TO CONDUCT A POPULATION BASED COMMUNITY SURVEY. MOTION CARRIED UNANIMOUSLY. Absent: Comm. Schmidt

Chairperson Smiley stated that she attended a Ready to Learn community forum along with Mr. Bragg and Chairperson Pratt. She believes it would be good for this Committee to discuss the different prevention programs throughout the County. The County should focus on prevention.

Mr. Bragg explained that the forum attempted to share new information which scientifically documents the importance of the first year of life. Many of the initiatives identified are programs and services of the County Health Department. He stated that Chairpersons Pratt and Smiley thought it would be beneficial to share information regarding the services with the community again. Chairperson Smiley stated the media could be used for a community-wide effort. This issue will be discussed further in the future.

(Comm. Schmidt and Chairperson Pratt arrived at 7:09 p.m.)

2. Controller's Office - Legal Remedies Regarding IRMC Indigent Care Compliance - Attorney Bill Perrone

Mr. Ambrose stated that Mr. Perrone is present to address this Committee's concerns regarding IRMC.

THE COMMITTEE WENT INTO EXECUTIVE SESSION WITH THE FOLLOWING ROLL CALL VOTE: YEAS, COMMS. SMILEY, CZARNECKI, STID, SEVERINO AND SCHMIDT.

THE COMMITTEE RETURNED TO REGULAR SESSION WITH THE FOLLOWING ROLL CALL VOTE: YEAS, COMMS. SMILEY, CZARNECKI, STID, SEVERINO AND SCHMIDT.

Announcements

Mr. Neilsen informed the Committee that the next meeting will be June 7. The Human Services departments were advised to have any pressing issues included on tonight's agenda.

Public Comment: None

The meeting adjourned at 8:06 p.m.

Respectfully submitted,

Debra Neff

2

MEMORANDUM

TO: Human Services Committee

Finance Committee

FROM: Bruce Bragg

DATE: May 14, 1999

SUBJECT: Recommendation to establish a $7 vaccine administration fee and a revision in the fee for influenza immunization

This is a recommendation to establish a $7 fee for the administration of certain vaccines. Generally, the Department currently does not charge for the administration of vaccines. Many of the vaccines are administered free of any charge, such as vaccines for children that are required by state law. However, the Department does recover the cost of certain vaccine products, such as vaccines for international travel and vaccines to protect against occupational risk of exposure to disease. The customer is charged only the cost of the vaccine; there is no calculation for the cost of administering the vaccine.

The Board has authorized a $5 fee for influenza immunization. The fee was intended to pay for the cost of the vaccine product and support a portion of the cost of administering the vaccine. This is the only instance where a vaccine administration fee is charged. The typical charge for influenza immunization in the community is $10. I am recommending that the influenza immunization charge be increased to $7. The cost of the vaccine product is about $2. The additional $5 will help pay for the cost of administering the vaccine.

These changes will increase revenue in the Immunization Clinic by about $65,000 in 2000. About $28,000 will be used to offset loss of grant revenue. The remainder will provide general support to the immunization program, helping to pay for the increase in the cost of doing business.

These changes will not affect the access to free vaccine for children. Nor will they prevent the Department from waiving fees in situations of exposure to disease. The Department also waives fees for influenza immunization when it is clear that the patient cannot pay. These practices will continue.

I recommend that the Board of Commissioners adopt the attached resolution and authorize these changes in the Health Department's fee schedule.

Attachment

cc: John Jacobs w/attachment

Judy Williams w/attachment

Introduced by the Human Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO ESTABLISH A FEE FOR ADMINISTERING CERTAIN VACCINES

WHEREAS, the Board of Commissioners has the authority to establish fees for services provided by the Health Department, ("The fees charged shall not be more than the reasonable cost of performing the service." 333.2444); and

WHEREAS, the Health Department administers a number of vaccines to adults; and

WHEREAS, in most cases the Department does not charge anything for administering the vaccine, but only charges the estimated cost of the vaccine product being administered; and

WHEREAS, it is important financially for the Department to raise funds to support its immunization activity; and

WHEREAS, the Health Officer has recommended that the Board of Commissioners establish a $7 (seven dollar) administration fee for vaccines when they are administered for purposes other than childhood immunization and disease outbreak control.

THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners establishes a $7 (seven dollar) fee for the administration of vaccines for purposes such as international travel, routine influenza immunization and for protection against occupational risk of exposure.

BE IT FURTHER RESOLVED, that the fee for influenza immunization shall be increased from $5 to $7.

BE IT FURTHER RESOLVED, that it is the intent of the Board of Commissioners to assure that all Ingham County children have free access to vaccines for childhood diseases that are required for school entry and that the Health Department shall assure that vaccines are available to protect persons against documented and evaluated exposures to communicable diseases, including rabies and Hepatitis B.

BE IT FURTHER RESOLVED, that the $7 vaccine administration fee and the revised fee for influenza shall be effective October 1, 1999.

MEMORANDUM

TO: Human Services Committee

Finance Committee

FROM: Bruce Bragg

DATE: May 14, 1999

SUBJECT: Authorization to Amend the Lease Agreement with the Black Child and Family Institute

This is a recommendation to authorize an amendment to the existing lease agreement with the Black Child and Family Institute to increase the compensation paid by the County.

Since January, 1995 the County's WIC Program has occupied space in the Black Child and Family Institute under the terms of a lease agreement. One of the provisions of the agreement is that the County shall pay a proportionate share of the cost of operating the BCFI facility. In the lease agreement that value was set at $1,800 per year. The WIC Program occupies approximately 2.8% of the total space in the building (780 square feet) and utilizes a 400 square foot classroom one pay per week.

The Black Child and Family Institute has calculated the current value of the County occupancy at about $6,000. It would like to adjust the County's contribution to the facility cost to about $6,000 and has suggested that it be accomplished gradually over a three year period. The proposal would increase the annual rent to $3,600 effective January 1, 1999 to $4,800, effective January 1, 2000 and to $6,000 effective January 1, 2001.

I recommend that the Board of Commissioners authorize the amendment by adapting the attached resolution.

Attachment

cc: John Jacobs w/attachment

Doris Goodman w/attachment

Bob Glandon w/attachment

Introduced by the Human Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO AMEND THE LEASE AGREEMENT WITH THE BLACK CHILD AND FAMILY INSTITUTE

WHEREAS, the Women, Infant and Children's Special Supplemental Food and Nutrition (WIC) utilizes space at the Black Child and Family Institute, 835 W. Genesee Street, Lansing, to deliver services to low-income women, infants and children who are nutritionally and medically at risk; and

WHEREAS, since January 1, 1995, the WIC Program has occupied space at the Black Child and Family Institute under the terms of a lease agreement whereby the County contributes to the cost of utilities, custodial, maintenance and other services in the building based on the proportional space it occupies; and

WHEREAS, the Ingham County cost was determined to be $1,800 per year during 1995 and has remained at that level to the present, with the WIC Program occupying approximately 2.8% of the space in the BCFI facility; and

WHEREAS, the Black Child and Family Institute has advised the County that the cost of utilities, maintenance, and custodial has increased and that the Ingham County proportional share effective January 1, 1999, will increase to $3,600 per year; effective January 1, 2000, the rent would increase to $4,800 per year; and January 1, 2001, the rent would increase to $6,000 per year; and

WHEREAS, the Health Officer has recommended that the Board authorize the proposed changes by authorizing an amendment to the lease agreement with the Black Child and Family Institute.

THEREFORE BE IT RESOLVED, the Ingham County Board of Commissioners authorizes an amendment to the lease agreement with the Black Child and Family Institute, 835 W. Genesee Street, Lansing, originally authorized in Resolution No. 95-24.

BE IT FURTHER RESOLVED, that the lease agreement shall be amended to adjust the annual payment by Ingham County for occupancy of 780 square feet of space by the WIC Program from $1,800 per year to $3,600 per year effective January 1, 1999, and to $4,800 per year effective January 1, 2000, and to $6,000 per year effective January 1, 2001.

BE IT FURTHER RESOLVED, that the amendment shall also authorize the WIC Program to utilize a 400 square foot classroom one day per week throughout the period of the lease agreement.

BE IT FURTHER RESOLVED, that the Board Chairperson is authorized to sign the amendment after review by the County Attorney.

MEMORANDUM

TO: Human Services Committee

Finance Committee

FROM: Bruce Bragg

DATE: May 21, 1999

SUBJECT: State Assigned Mobile Immunization and Screening Unit - Amendment

The Michigan Department of Community Health assigned to Ingham County one of six mobile immunization and screening units as part of the Statewide Immunization Initiative. The units are mobile clinics built on Ford truck chassis by a motor home manufacturer in Indiana. The County and the State executed an agreement to implement the assignment. The MDCH proposes to amend the agreement to extend the assignment for the period October 1, 1998 through September 30, 1999.

The Ingham County Health Department uses the mobile unit to help serve hard-to-reach population groups. For example: people in shelters, those in senior citizen housing, and in certain schools where the Health Department cannot provide services due to lack of space. This unit did not result in the development of new services, but it did improve the department's ability to deliver several of the services already provided, such as: immunizations, WIC, EPSDT, Medicaid applications, lead screening, and breast and cervical cancer screenings. Shelters visited included: CATA, Economic Crisis Center, Volunteers of America, shelter for homeless people, and shelters that rotate from church to church (Lansing Area Rotating Shelters). The Breast and Cervical Cancer Control Program has also used the unit to provide screening services to be provided in locations without permanent facilities in Clinton and Jackson Counties. Several Health Department staff in the programs that utilize the unit have been trained by the manufacture to operate the vehicle.

CATA has agreed to provide covered storage for the vehicle at the Tranter Street facility. CATA and the County have entered into a Letter of Understanding regarding the storage. The agreement with CATA renews automatically on a year to year basis unless it is canceled by either party. Central Ford Truck provides the maintenance to keep the warranty in effect, including oil changes and lubrication. The Board of Commissioners authorized the establishment of a special part-time Bus Overseer position to provide housekeeping arrangements and maintenance.

I recommend that the Board of Commissioners adopt the attached resolution and authorize an amendment to the agreement and to accept assignment of the vehicle from the State for the period October 1, 1998 through September 30, 1999. I anticipate that this agreement will be extended from year to year.

Attachment

Return to Top of Document

Introduced by the Human Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO AUTHORIZE AN AMENDMENT TO THE AGREEMENT WITH THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH TO ACCEPT ASSIGNMENT

OF A MOBILE CLINICAL UNIT

WHEREAS, the State of Michigan has purchased six mobile clinical units and has proposed to assign one unit to Ingham County for the period October 1, 1994 through September 30, 1995; and

WHEREAS, the Ingham County Health Department staff has developed plans to utilize the mobile unit to improve access to services including: immunizations, WIC, EPSDT, lead screenings, breast and cervical cancer screenings, and physical assessment at shelter sites; and

WHEREAS, the State and Ingham County have entered into an agreement, authorized in Resolution No. 94-317, amended it in Resolution No. 95-221 for the period of October 1, 1995 through September 30, 1996, amended it again in Resolution No. 96-191 for the period of October 1, 1996 through September 30, 1997, amended it again in Resolution No. 98-33 for the period of October 1, 1997 through September 30, 1998, and the State proposes to amend the agreement again to extend the assignment for the period October 1, 1998 through September 30, 1999; and

WHEREAS, the Capital Area Transit Authority has agreed to provide covered storage for the Unit, and has entered into a Memorandum of Understanding with Ingham County which automatically extends on a year to year basis unless terminated by either party; and

WHEREAS, the Health Officer recommends that the Board of Commissioners authorize the proposed amendment to the agreement and continue the assignment of the mobile clinical unit.

THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners authorizes an amendment to the agreement, originally authorized in Resolution No. 94-317, with the Michigan Department of Community Health to extend the assignment of a mobile clinical unit for the period October 1, 1998 through September 30, 1999.

BE IF FURTHER RESOLVED, that the mobile unit will be utilized to improve citizen access to immunizations, health screenings, and other public health services.

BE IT FURTHER RESOLVED, that Ingham County shall maintain the equipment in a clean, safe and sound manner, that maintenance shall be performed to conform with the manufacturer's specifications, that the County shall pay for all vehicle operating expenses such as gas and oil, and that the State shall provide insurance on the mobile unit in accordance with state policy.

BE IT FURTHER RESOLVED, that Ingham County may loan the unit to other local health departments with the concurrence of the MDCH.

BE IT FURTHER RESOLVED, that the Board Chairperson is authorized to sign the amendment after review by the County Attorney.

MEMORANDUM

TO: Human Services Committee

Finance Committee

FROM: Bruce Bragg

DATE: May 24, 1999

SUBJECT: Recommendation to Authorize a Fourth EQUIP Grant Agreement

This is a recommendation to authorize a fourth EQUIP Special Project Grant. This special project grant will provide the OYC with $10,200 to support the development of a Creation Station that will collect re-usable materials from area manufacturers and retailers; and sort and store the materials for distribution to area child care providers and parents. The materials collected will be the types that commercially are regarded as discards, but child care provider staff can use as education materials for science and art projects. Surplus, discards, remnants and leftovers will be "changed" into educational materials and supplies through the Creation Station.

The Creation Station is a non-profit corporation, and its Board of Directors is composed of community representatives from the schools, environmental groups, the US Postal Service, the City of Lansing and other community agencies. The Creation Station has authorized the services agreement with the County to implement the EQUIP grant agreement.

The attached resolution will authorize the Controller to amend the Health Department's 1999 budget to accept the fourth EQUIP grant and will authorize a $9,200 service contract with the Creation Station.

I recommend that the Board of Commissioners adopt the attached resolution and authorize the fourth EQUIP grant and service contract.

Attachment

cc: Ken Sperber w/attachment

John Jacobs w/attachment

Introduced by the Human Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO AUTHORIZE A FOURTH EQUIP SPECIAL PROJECT GRANT

WHEREAS, Ingham County's Office for Young Children (OYC) provides child care information and referral services to the general public and through contractual relationships to certain employer groups; and

WHEREAS, the OYC also carries out activities and provides services to support the development of new child care resources in the community and to support the existing child care providers; and

WHEREAS, the State of Michigan has contracted with the Michigan Community Coordinated Child Care Association (Michigan 4C Association) to implement a grant program to improve child care services, and the Michigan 4C Association has issued requests for proposals to organizations to expand the number of child care providers and to improve the quality of child care services in communities; and

WHEREAS, the OYC has submitted a proposal, in conjunction with the non-profit corporation, The Creation Station, to develop a re-use center for recycling materials to be used for children's creative art and science activities in child care; and

WHEREAS, the Michigan 4C Association has advised that it is funding a $10,200 grant award to Ingham County to implement the proposal, and the Health Officer has recommended that the Board of Commissioners accept the grant.

THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners accepts the fourth EQUIP grant from the Michigan 4C Association, with the purpose of implementing The Creation Station Project.

BE IT FURTHER RESOLVED, that the Controller is authorized to adjust the Health Department's 1999 budget, increasing the total by $10,200 and adjusting various line items, including adding $9,200 in contractual services.

BE IT FURTHER RESOLVED, that the Board of Commissioners authorizes a service contract with the non-profit corporation, The Creation Station for up to $9,200.

BE IT FURTHER RESOLVED, that the Board Chairperson is authorized to sign a service contract with The Creation Station after review by the County Attorney.

MEMORANDUM

TO: Human Services Committee

Finance Committee

FROM: Bruce Bragg

DATE: May 24, 1999

SUBJECT: Recommendation to Authorize a Prescription Drug Assistance Grant Agreement

This is a recommendation to authorize a grant agreement with the National Association of Community Health Centers, Inc. The NACHC proposes to grant up to $11,950 to Ingham County to help pay for prescription drug costs of clients of the homeless health center which operates as part of the Sparrow Community Health Center. The attached resolution will authorize the agreement which will be in place for one year after the date of execution.

I recommend that the Board of Commissioners adopt the attached resolution and authorize the grant agreement.

Attachment

cc: Bruce Miller w/attachment

Kay Kujula w/attachment

John Jacobs w/attachment

Introduced by the Human Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO AUTHORIZE A PRESCRIPTION DRUG PURCHASE ASSISTANCE AGREEMENT

WHEREAS, the National Association of Community Health Centers, Inc. has offered an $11,950 grant to assist with the purchase of prescription drugs for clients of the Homeless Health Center (Sparrow Community Health Center); and

WHEREAS, the Health Officer has recommended that the Board of Commissioners authorize the grant agreement.

THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners authorizes a grant agreement with the National Association of Community Health Centers, Inc. to implement a prescription drug assistance program for clients of the County's homeless health center project which operates out of the Sparrow Community Health Center.

BE IT FURTHER RESOLVED, the National Association of Community Health Centers, Inc. will provide Ingham County up to $11,950 to pay for a portion of, or all of, the patient out-of pocket share of the total prescription drug charges.

BE IT FURTHER RESOLVED, that the period of the agreement shall commence on the date of full execution and continue for one year thereafter.

BE IT FURTHER RESOLVED, that the Controller is authorized to amend the Health Department's 1999 and 2000 budgets to implement this resolution.

BE IT FURTHER RESOLVED, that the County is authorized to execute a contract with a pharmacy in the area of the Sparrow Community Health Center in order to facilitate the prescription drug assistance provided for in the grant agreement.

BE IT FURTHER RESOLVED, that the Board Chairperson is authorized to sign the grant agreement and the pharmacy contract after review by the County Attorney.

Return to Top of Document

MEMORANDUM

TO: Human Services Committee

Administrative Services/Personnel Committee

Finance Committee

FROM: Bruce Bragg

DATE: May 23, 1999

SUBJECT: Recommendation to Authorize the Ingham County Breast and Cervical Cancer Control Program to Assume Responsibility for the Program Coordination in Washtenaw and Livingston Counties

This is a recommendation to authorize the Health Department's Breast and Cervical Cancer Control Program (BCCCP) to assume program coordination responsibilities in Washtenaw and Livingston Counties. The Breast and Cervical Cancer Control Program (BCCCP) is a statewide program. Currently, the Ingham BCCCP program administers the service in Clinton, Eaton, Gratiot, Ingham and Jackson Counties. The County first contracted with the state in 1992-93 to implement the service in Ingham County. The state is working to make the program administrative regions bigger and bigger as opportunities are identified. The Federal funding for the administration of BCCCP program has declined, which make it important to develop the most cost effective model for administering the service delivery system. The Washtenaw/Livingston program is experiencing staff turnover which presents such an opportunity.

The goal of the BCCCP program is to save lives and improve quality of life for low-income women by the early identification and treatment of cases of breast and cervical cancer. The objective of the current Ingham County project is to screen about 1,600 low-income women over 40 years of age each year for breast and cervical cancer. Each woman receives a breast examination, including mammogram, and a pelvic examination, including a pap smear. Women identified as at-risk are referred for diagnosis and possible treatment. The program includes follow up to assure that diagnosis and treatment have occurred.

The BCCCP program contracts with providers throughout the service area to facilitate screening, diagnosis and treatment. Providers are compensated for screening and diagnosis services according to an established fee schedule. There are no funds for treatment. Physicians and other providers participating in the program, including hospitals, agree to provide the necessary treatment services.

The expansion of services into the Washtenaw and Livingston County area will require additional service contracts with providers in those communities. Additionally, we propose to contract with the Washtenaw County Health Department to conduct program outreach services, and to provide follow-up on women identified for diagnosis and possible treatment.

The Michigan Department of Community Health will incorporate the funding for the Washtenaw/Livingston expansion into the 1999-2000 Comprehensive Plan, Budget and Contract which will be presented to the Board of Commissioners in July or August. However, if the program is to be operational on October 1, 1999, we need to get authorization to contract with providers and to execute the appropriate intergovernmental agreements with Washtenaw and Livingston Counties. The attached resolution will authorize the Department to move forward with the program expansion, authorize service contracts with providers, authorize the Controller to include the expansion program revenue and expenditures in the Health Department's 2000 budget and authorize a change in status of a Health Educator II position from part-time to full-time. The resolution will also instruct the County Attorney to draft the resolutions and contracts necessary to implement the intergovernmental agreements.

I recommend that the Board adopt the resolution and authorize the program expansion.

Attachment

cc: Bruce Miller w/attachment

Laura Peterson w/attachment

John Jacobs w/attachment

Robin Lewis w/attachment

Introduced by the Human Services, Administrative Services/Personnel and Finance Committee of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO AUTHORIZE AGREEMENTS AND CONTRACTS, ADJUST THE STATUS OF A POSITION AND AMEND THE HEALTH DEPARTMENT'S 2000 BUDGET TO COORDINATE THE BREAST AND CERVICAL CANCER CONTROL PROGRAM IN

WASHTENAW AND LIVINGSTON COUNTIES

WHEREAS, the Ingham County Health Department has been approached by representatives of the Michigan Department of Community Health and the Washtenaw County Health Department to consider assuming the duties of coordinating the Breast and Cervical Cancer Control Program in Washtenaw and Livingston Counties; and

WHEREAS, changes are occurring in the national BCCCP program which make this proposal advisable for all three counties; and

WHEREAS, Ingham County's BCCCP program already coordinates the BCCCP services in Clinton, Eaton, Gratiot, Ingham and Jackson Counties; and

WHEREAS, Intergovernmental agreements with Washtenaw and Livingston Counties will be necessary to implement this proposal, as will service contracts with health care providers in Washtenaw and Livingston Counties, including contracts with the Washtenaw County Health Department; and

WHEREAS, it will be necessary to increase a part-time Health Educator position to full-time status in order to accommodate the additional work; and

WHEREAS, the Health Officer recommends that the Board of Commissioners adopt the attached resolution and instruct the County Attorney to prepare a resolution to implement the Intergovernmental Agreements necessary to implement the proposed service expansion into Washtenaw and Livingston Counties.

THEREFORE BE IT RESOLVED, that Ingham County Board of Commissioners authorizes the Breast and Cervical Cancer Control Program (BCCCP) operated by the Ingham County Health Department to extend its program coordination to include Washtenaw and Livingston Counties.

BE IT FURTHER RESOLVED, that the Board of Commissioners instructs the County Attorney to prepare the necessary intergovernmental agreements and resolutions to implement the program expansion authorized in this resolution.

BE IT FURTHER RESOLVED, that the Board of Commissioners authorizes the execution of all contracts to screen, diagnosis, treat breast and cervical cancer with health care providers in Washtenaw and Livingston Counties and authorizes a contract with the Washtenaw County Health Department to provide outreach to eligible persons and to follow-up on BCCCP program clients.

BE IT FURTHER RESOLVED, that the Controller is authorized to incorporate the expenditures and revenues for the expanded BCCCP program, which will be included in the 1999-2000 Comprehensive Plan, Budget and Contract with the Michigan Department of Community Health, into the Health Department's 2000 budget.

BE IT FURTHER RESOLVED, that the part-time Health Educator II position (HLHCAN007) shall be changed to full-time status effective October 1, 1999.

BE IT FURTHER RESOLVED, that the Board Chairperson is authorized to sign the agreements and service contracts authorized by this resolution, after they have been reviewed by the County Attorney.

May 18, 1999

To: Human Services Committee

From: Dean G. Sienko, M.D.

Medical Director

Re: Informational Item - Ongoing tuberculosis case

Through this memorandum I wish to inform you of an ongoing, difficult to manage, tuberculosis case that we are involved with at the Health Department. I will avoid using the patient's name in accordance with medical confidentiality protocol.

Sparrow Hospital Emergency Room staff first suspected that the man had a tuberculosis-related problem in late February. In early March, he did not return for follow-up visits, and based on his clinical presentation and uncooperativeness, Health Department staff felt that he was a threat to the public health. Accordingly, we successfully petitioned the Probate Court to detain him at Ingham Regional Medical Center so that we could isolate him and provide treatment for his tuberculosis.

On March 3^rd, IRMC doctors placed the man on a four-drug anti-tuberculosis regimen. On March 5^th, the court ordered that he be detained at the hospital for an additional 14 days.

He continued to have sputum samples that turned-up positive for Mycobacterium tuberculosis. In addition to his TB problem, he suffers from substance abuse and is homeless. Accordingly, the court issued another 14-day stay at the hospital.

In late March, the court asked an independent physician review panel to provide guidance on the case. This three-physician panel recommended that the court continue to isolate him and treat him for tuberculosis. As the patient began getting restless and threatened to escape from the hospital; hospital staff allowed him to walk in the hallways as long as he wore a mask.

In April, the patient continued to have sputum smears and cultures that were positive for TB. The physician panel, again per request of the court, recommended that he not be discharged given the persistent communicability of his tuberculosis infection. On April 26^th, Judge Economy continued his detention at the hospital for an additional 45 days; this order will expire on June 10^th.

Through early May his sputum smears continue to be positive. Additionally, his chest x-ray reveals a deterioration in his condition. The attending physician at IRMC called some colleagues from Detroit to discuss the case; they did not recommend any changes to the current plan. The laboratory reports that all of the drugs being prescribed should be effective against this strain of tuberculosis. In summary, we have a person who has been hospitalized with tuberculosis for over two months and who is not responding to therapy. Generally, most people show clinical improvement and negative sputum smears within 2-3 weeks of the initiation of treatment; this is clearly not the case for this man. Both internal and external reviews of this situation conclude that the man is still infectious and remains a threat to the public health.

In addition to the personal hardship on this patient and his family, this matter is an expensive endeavor for the County. Not only are we spending extensive staff time to attend to this situation, but the funds to pay for his hospital care are charged against the obligation the IRMC has through the In-Kind Contribution Agreement that was part of the County's divestiture of the Ingham Medical Center. Given these facts, we felt it was appropriate to appraise you of this situation and respond to any questions you may have.

MEMORANDUM

TO: Human Services Committee

FROM: Bruce Bragg

DATE: May 24, 1999

SUBJECT: Informational Item: Physician Contract with Michigan State University

This will advise you that the contract between Ingham County and the College of Osteopathic Medicine for physician coverage is scheduled to expire at the end of 1999. The option to extend the agreement is part of the current agreement.

The contract with the College of Osteopathic Medicine includes a comprehensive scope of services and involves providers from three separate Departments within the College of Osteopathic Medicine. All together, the services represent direct service hours equal to approximately 2.5 FTE physicians. The physicians provide patient care as well as other services to patients in the Adult and Child Health Clinics at the main Health Department, at Willow Plaza Services, at Health Centers located on the campus' of Sparrow and St. Lawrence Hospitals and at the Ingham County Youth Center. The contract also provides for after hour telephone coverage so that patients can communicate with a physician 24 hours a day 365 days per year.

This is an important contract to the Department. It would be impossible to replace the providers under this contract on short notice. That is why when the current contract was last negotiated the University and the County adopted language that gave the County an option to renew the contract for a three year period (commencing January 2000 through December 2002). Also, when the contract was negotiated in 1996 the County and the University agreed to a plan whereby the University would be paid an amount based on 70 percent of its cost per physician FTE. The 1999 rate paid to the University - $135,848 per FTE - reflects that understanding.

The renewal language continues the compensation plan agreed to in 1996. It says the University will be compensated for services performed at either seventy percent of the cost per physician FTE, or at an increase of three percent, whichever is less. A three percent increase would make the rate $139,924.35 in the year 2000. The rate for 2001 would be $144,122.08. The rate for 2002 would be $148,445.75. A separate payment schedule exists for the portion of the contract provided by staff from the Department of Internal Medicine. The payment schedule reflects an altered scope of services and is less than the schedule for the other Departments in the College of Osteopathic Medicine. This schedule would also be adjusted by three percent per year.

I am bringing this contract to your attention now because once we hear back from the University I expect to bring to you a resolution requesting authorization to extend the agreement with a three percent increase.

cc: Bruce Miller

Dean Sienko

Memorandum

TO: Human Services Committee

Finance Committee

FROM: Bruce Bragg

DATE: May 25, 1999

SUBJECT: 1998-99 Agreement with the City of Lansing - Proposed Amendment

The City of Lansing is proposing to amend the agreement with Ingham County to provide an additional $10,000 in funding to support services provided through the Health Department and MSU Extension. The original agreement was authorized by the Board of Commissioners in Resolution No. 98-210. The services supported are:

1. The City of Lansing provides $36,000 to support the operation of the Adult Health/VD Clinic. This is the level of support that the City has provided for several years.

2. The City of Lansing provides $10,000 to support the operation of the Food Bank Project. This is the level of support that the City has provided for this project for several years.

3. The City of Lansing would increase the funding from $79,000 to $89,000 to support the operation of a Day Care Scholarship Program within the Office for Young Children. The amount supported for scholarships for low-income, City of Lansing residents to provide for day care for their children is $80,000. The amount supported for the operation of the Office for Young Children is $9,000. Approximately 175 low-income families benefit from this service.

4. The City of Lansing began supporting psychological treatment for families involved with sexual abuse of children in 1987-88. Families are identified by Health Department programs, the Family Independence Agency, Probate Court, and other community agencies. If there is no other source of assistance, they are referred to the High Risk Adolescent Program at Willow Plaza Services. The High Risk Program makes a referral to psychologists in private practice that have agreed to provide treatment services at a reduced rate. The City has allocated $15,000 per year for this service for each year since 1987-88. The City of Lansing will also contribute $10,000 to help support the cost of operating the High Risk Adolescent Program.

5. The City of Lansing provided $10,000 to support the transfer of the Medical Access Program from the Red Cross to the Ingham County Health Department in 1997-98. It proposes to continue that support in 1998-99. This has been a very successful transfer.

6. The City of Lansing has provided $6,900 to support the activities of the Ingham County/City of Lansing Youth Violence Coalition for the last two years. This funding is incorporated into the agreement for public health services. The funds actually flow through to the MSU Extension budget, where that activity is supported. The City proposes to continue that funding in 1998-99.

The amend will allow the number of families served by the Child Care Scholarship Program to increase from 150 to about 175. Additionally the amend set out that $170,000 of the total $176,900 is to be used by the Health Department and that $6,900 is to be used by the Ingham County MSU Extension. I recommend that the Board authorize the amendment.

Attachment

cc: Ken Sperber w/attachment

John Jacobs w/attachment

Darnell Earley w/attachment

Introduced by the Human Services and Finance Committees of the:

INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO AUTHORIZE AN AMENDMENT TO THE 1998-99 AGREEMENT WITH THE CITY OF LANSING

WHEREAS, the City of Lansing has for many years provided funding to Ingham County to help support public health services for City of Lansing residents; and

WHEREAS, the City of Lansing executed a 1998-99 agreement authorized by Resolution No. 98-210; and

WHEREAS, the City of Lansing has proposed to amend the agreement to add $10,000 of revenue to expand the child care scholarship program operated by the Office For Young Children; and

WHEREAS, the Health Officer has recommended that the Board of Commissioners authorize the amendment.

THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners authorizes an amendment to the agreement with the City of Lansing to provide financial support to certain services provided by or through the Ingham County Health Department and MSU Extension.

BE IT FURTHER RESOLVED, that the period of the agreement shall be July 1, 1998 through June 30, 1999.

BE IT FURTHER RESOLVED, that the City of Lansing shall provide $176,900, and increase of $10,000 from the original amount, to support the following services:

1. Adult Health/V.D. Clinic

2. Food Bank Project Operation 3. Child Care Scholarship Program/OYC

4. High Risk Adolescent Program

5. Medical Access Program

6. Ingham County/City of Lansing Youth Violence Prevention Coalition

BE IT FURTHER RESOLVED, that the additional funding shall be used to expand the child care scholarship program operated by the Office for Young Children, and that the amendment shall specifically set out that $170,000 of the funding will support the services provided through the Ingham County Health Department and the $6,900 that will be used by Ingham County MSU Extension to provide support to the City/County Juvenile Violence Prevention Coalition.

BE IT FURTHER RESOLVED, that the Controller is authorized to amend the Health Department's 1999 budget to implement this resolution.

BE IT FURTHER RESOLVED, that the Board Chairperson be authorized to sign the amendment after review by the County Attorney.

Return to Top of Document