HomeMy WebLinkAbout09092019 City Council Laydown - SCHC Recommendations City of Seward,Alaska
Resolution 2019-076 (Attachment 1)
Seward Community Health Center,SCHC would like to have the following Section 2 of resolution 2019-076 removed
or changed on our budget resolution:
"Section 2.The attached budget includes the one existing provider.of behavioral health services which was hired
before the City was informed that the CHC intended to enter that line of service.The City has made clear to the CHC that
any future direct hiring of staff related to behavioral health or substance use disorder services is considered in direct
conflict with the CoApplicant Agreement's prohibition against competition and is therefore disallowed by the
CoAppl.i.cant Agreement."
SCHC's reasons for removal or change:
1. Section 2 is not directly related to our budget and should be addressed in.our co-applicant agreement,currently
being revised, and not our budget resolution
2. The SCHC 2020 budget was recommended for approval by the Coordinating Committee as per section 5 of the
agreement. Section 2 was not reviewed or recommended by the Coordination Committee. (Agenda
Statement Attachment 2)
3. Section 2 makes a false claim by stating that the provider was hired before the City was informed that the SCHC
intended to enter into that line of service. SCHC notified the City,through the Coordinating Committee,of our
intent to deliver behavioral health services on two documented occasions, The Provider was hired in June of
2018.
a. Excerpt from July 121h Coordinating Committee minutes (7/12/17 Minutes attachment 3)
Expanded Services Grant Opportunity:Mental Health and Substance Abuse
There's anew grant opportunity available thru HRSA aimed at integrating behavioral health with primary care;the deadline
is July 26. Mental health service expansion has been identified as a community need and a strategic objective for SCHC.
The grant allows for$75k for ongoing personnel(half for men tol health,half far substance abuse)and$75k for one-time
technology and training. Craig said SeaView Community Services maybe able to provide part-time staffing and possibly
training for our staff. However, he hasn't heard back from SeaView yet. We.may also look into telemedicine equipment
whether we collaborate with SeaView or not.
b. Excerpt from 10/18/17 Coordinating committee minutes (10/18/17 Minutes attachment 4)
AIMS grant--We received funding to start integrating behavioral health with primary care. Our original plan was to hire a
case manager to help with mental health referrals. However, discussions since then have been pointing to a need for more
mental health support for kids in the schools. Craig is still in discussions with SeaView about what might work best.
c. Behavioral Health Integration meeting on 11/27/17(Minutes Attachment 5)
The attached minutes shows collaboration and discussion about the use of SCHC behavioral health services
primarily in the schools,where the need for behavioral health assessment and brief intervention in all Seward
schools especially elementary was discussed. SCHC started to provide.this service in December of 2018, after
being accused of competing with Seaview,even though Seaview was unable to obtain funding or provide this
this service. The City intervened and stopped us from providing services in the schools. After further review the
City allowed us to provide these services. In May of 2019 though collaboration and the receipt of an additional
Federal grant, a contract was secured for Seaview to provide this service for the community and schools.
4. Section 2 will lead to further disciplinary action from HRSA and possibly loss of grant. Pat Fairchild is the HRSA
consultant that was jointly hired by the City and SCHC to assist with the revised co-applicant agreement.
Her comment is below from an email on 8/28/19(Attachment 6)
) I definitelythink HRSAwou I dobject to Section 2(taIkingabout be haviora I hea I thstaff)on the basis
that it limits the governing board's ability to exercise its required authority to determine services.The
way I read the resolution,the City Cound I is te I I ingth:e health ce niter governing board what they can and
can't do-which is precisely what HRSA doesn't allow. If the City continues with this position,I believe
you will not have the current Condition lifted(oryou will geta new one)and you will go into progressive
action.As you know,if the City doesn't reconsider and you move through progressive action without
resolution/compromise,the grant maybe terminated and the service area re-competed,
S. Collaboration over competition comment.
Pat had a comment on this clause: "I know the City believes that, because the co-applicant agreement says you
will collaborate not compete, it's OK to have the requirement in the resolution. But, in my opinion the clause in
the co-applicant agreement should not enable the City to define what services you provide or who you doldo not
hire."
From SCHCs perspective,the way this should work, is that if any organization believes that the SCHC is
competing or attempting to compete and they inform the City, instead of working directly with the SCHC.The
City should require collaboration between the two organizations with the result focused on the best outcome
for our community, before getting involved.
6. Safety net provider:
SCHC is our community's safety net provider. We are supposed to make sure that all people in our community
get the care they need and do not fall through the gaps. By limiting what the SCHC can do for the community
we are widening the gap and allowing more people to fall through,and go untreaited.This is especially dangerous
with behavioral health.
7. Federal Funding
After reviewing HRSA's documentation it does appear that Seaview could receive federal funding by becoming a
HRSA sub-recipient. This is noted in chapter 12,Contract and Sub-awards, of the HRSA compliance manual.
8. Integrated Behavioral Healthcare refers to the State Behavioral Health Director's comment, (letter in council
packet pg. 29) about Behavioral Healthcare readily available in primary care settings.SCHS utilizes a behavioral
health consultant model that uses assessment, brief intervention and referral to behavioral health specialty
care. (Attachment 7)This type of service is critical to our community's care and!should not be removed from
the SCHC.
9. Intentions: SCHC does not intend or have any plans to displace any local providers. Our intention is to make
sure everyone gets the care they need,with the help of all of our community's healthcare providers.
Since SCHC started to integrate behavioral health we have seen behavioral health referrals double, (Attachment
8)and based on the attached comments from the August clinical collaborative meeting minutes, Seaview
appears to be doing well financially.
a. Tommy Clanton, Behavioral Health Director—SeaMew is working with 180 individuals in the
community, the highest volume SeaView, has ever had! They've added an additional
provider, Steve Hess, present, Looking at strategies for managing the wait list this fall. 'They
have funds to offer additional chnicians. They don't know what the BH grant will look like
from the State. They're not concerned about the healthi of the agency, but the grant helps
with staffing. People in this room have helped to decrease the stigma, and not to wait until
there are significant crises. There have been more seasonal individuals experiencing more
stressors, worked closely with Providence as well.
10. Current contract with Seaview:Seaview and SCHC currently has a contract for Seaview to access the SUD/MH
Federal grant through SCHC,which was started on May 1, 2019. The contract requires Seaview to comply with
the grant conditions of providing assessments, brief interventions, referral for treatment and community
education.Seaview is required to utilize 1.25 full time equivalents (FTE's) for the provision of assessment
services to a minimum of 67 adults and youth in our community before December 31,2019. Ail encounters are
to be recorded in the health center's electronic health record,via data transfer from:Seaview's'records.
At the end of July 2019,three months into the contract and payments of$26,000 Seaview has not recorded any
assessments.We Have also not received any documentation of assessments for the month of August. Seaview is
supposed to give SCHC a written update report on September 6,2019 and we will be forwarding their report to
comply with HRSA's reporting requirement.by September 161n
11. If the Council wants to have a comment about collaboration over competition in our budget resolution,then
SCHC would prefer something like the following:
Another Proposer!Section 2. The Seward Community Health Centel-is the safety net provider for the Seward
community. Regarding Substance use and mental health services,SCHS and Seaview community services must
collaborate to ensure that anyone who requests or needs substance use or mental health services will receive
appropriate services regardless of ability to pay or service provider preference, and that no-one will fall through
the cracks and not receive needed services. If needed or requested services are not available,then appropriate
services will be arranged through referral and transportation procedures. All referrals will be managed and
followed up by the referring organization.
Sponsored by: Meszaros.
Reconsideration: September 9, 2019
CITY OF SEWARD,ALASKA
RESOLUTION 2019-076
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SEWARD,
ALASKA, APPROVING THE 2020 GRANT YEAR BUDGET FOR THE
SEWARD COMMUNITY HEALTH CENTER AS REQUIRED BY THE
CO-APPLICANT AGREEMENT BETWEEN THE CITY OFSEWARD AND
THE SEWARD COMMUNITY HEALTHCENTER(CHC)
WHEREAS, on December 13, 2010, the Seward City Council enacted Ordinance 2010-
008 establishing the powers and duties of the Governing Board of Directors ("Governing
Board") charged with oversight of the Seward Community Health Center, as amended by
Ordinance 2013- 01.3 on December 16, 2013; and
WHEREAS, the City of Seward ("City") and the Seward Community Health Center
("CHC.").are ao-applicants as a federally qualified health center in accordance with Section 330
of the.Public Health Service Act(42 U.S.C. §254b); and
WHEREAS, the City and the CHC entered into a Co-Applicant Agreement dated
February 20, 2014, and the City Council authorized submission of the previous Service Area
Competition Grant application via Resolution 2015-080 approved on September 2, 2015,
wherein the parties agreed that the CHC budget would be submitted to the City Council after
approval by the Governing Board and providing that "the City Council may not unilaterally
revise a budget approved by the Governing Board or approve an alternate budget for the Health
Center without review and final approval by the Governing Board, with subsequent follow-up by
the City Council";.and
WHEREAS, the Governing Board of the. CHC approved the 2020 Seward Community
Health Center Section 330 (Year 6) grant budget at a board meeting held on July 25, 2019, and
the Coordinating Committee ("Committee") of the CHC met to review the grant budget on
August 5, 2019, and both the Governing Board and the Committee recommend approval by the
Seward City Council.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF SEWARD,ALASKA that:
Section 1. The Seward City Council hereby approves the 2020 budget of the Seward
Community Health Center ("CHC"), representing the Year 6 grant budget for Section 330
funding through the Health Resources and Services Administration.
Section 2. The attached budget includes the one existing provider of behavioral health
services which was hired before the City was informed that the CHC intended to enter that line
of service. The City has made clear to the CHC that any future direct hiring of staff related to
behavioral health or substance use disorder services is considered in direct conflict with the Co
PG ti
CITY OF SEWARD, ALASKA
RESOLUTION 20I9-076
Applicant Agreement's prohibition against competition and is therefore disallowed by the Co-
Applicant Agreement.
Section 3. The.CHC is requesting a financial contribution from the City of Seward in the
amount of$100,000 for the 2020 grant year which will be subject to approval by the Seward City
Council during its upcoming budget deliberations.
Section 4.This resolution shall take effect immediately upon adoption.
PASSED AND APPROVED by the City Council of the City of Seward, Alaska, this
26th day of August, 2019.
THE CITY OF SEWARD,ALASKA
David Squires, Mayor
AYES:
NOES:
ABSENT-
ABSTAIN:
ATTEST:
Brenda J. Ballou, MMC
City Clerk
(City Seal)
24 �G 2
Agenda Statement
Meeting Date: August 26,2019
Through: Scott Meszaros, City Manager
From: Kristin.Erchinger, Finance Director
Agenda Item: City Council Co-Applicant Approval of Section 330 Seward Community
Health Center 2020 Budget
BACKGROUND &JUSTIFICATION:
The Seward City Council authorized the creation of the.Seward Community Health Center(SC.HC)
and governing Board when it enacted Ordinance 2010-008 in December 2010, formalizing the
powers and duties of the board of directors charged with overseeing the Seward Community Health
Center.
The City of Seward and SCHC are co-applicants for Section 330 federal funding to operate a
federally qualified health center in Seward;together, the entities comprise the Health Center. The
parties entered into.a Co-Applicant Agreement(Agreement)on February 20,2014 approved by City
Council Resolution 2014-018, and. subsequently amended in Resolution 2018-067 approved on
August 13,2018.This Agreement requires that the SCHC budget be approved first by the governing
Board and then by the City Council, and includes the following language:
§3.2.4"The Governing Board shall approve the annual operating and capital budget in accordance
with Section 330 requirements and City policies. The overall plan and budget shall be
prepared under the Governing Board's direction by the Health Center's management team
and the Finance Committee ofthe Governing Board,
§3.2.S "The Governing Board shall submit an annual budget far the health center to the City
Council far approval,as a co-applicant requirement of Section 330. The Board shall
submit the budget no later than October!of each year,for the following year.lfthe
Board unreasonably fails to approve an annual budget,the City may still submit the
annual funding request under Section 330 of the Federal Public Health Service Act.No
budget shall become effective without City Council approval. "
§4.2. a "The City Council shall be responsible for adopting the Health Center's annual operating
and capital budgets as finally approved by the Governing Board,the City Council may
not unilaterally revise a budget approved by the Governing Board or approve an
alternate budget for the Health Center without review and final approval by the
Governing Board,with subsequent follow-up by the Council in accordance with Seward
City Code 2.40.030(a).
In accordance with Section.S of the Agreement,the parties also agree to participate in a Coordinating
Committee comprised of one member each of the Governing Board, the City Council, the Health
Center executive director, and the City Manager or his designee. This group met to review the
proposed 2020 Seward Community Health Center budget and has recommended its approval.
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Crai Ambrosiani
From: Craig Ambrosiani
Sent: Wednesday,August 28, 2019 7:47 AM
To: smeszaros@cityofseward.net, Kris Erchinger
Cc: David Squires, sseese@cityofseward.net
Subject: FW:Comments on City's Budget Resolution
Hi Scott.
I asked Panto review the recent budget resolution and let me know what HRSA will do if this is enacted. Her answer is
below.
As you know, Pat Fairchild is a HRSA reviewer for public entity grantees.The City and the CHC have contracted her to
assist with bringing our co-applicant agreement into compliance.
Her answer is consistent with what HRSA has been telling us and City administration for months.
From: Pat Fairchild <pfairchild@jsi.com>
Sent:Tuesday,August 27,2019 6.02 PM
To! Craig Ambrosiani<CAmbrosiani@sewardhealthcenter.org>
Subject:Comments on City's Budget Resolution
Hi Craig. In response to your question about the City Council's recent budget resolution, I definitely think HRSA would
object to Section 2 (talking about behavioral health staff) on the basis that it limits the governing board's ability to
exercise its required authority to determine services.The way I read the resolution,the City Council is telling the health
center governing board what they can and can't do-which is precisely what HRSA doesn't allow. If the City continues
with this position, I believe you will not have the current Condition lifted (or you will get anew one)and you will go into
progressive action.As you know, if the City doesn't reconsider and you move through progressive action without
resolution/compromise,the grant may be terminated and the service area re-competed. I know the City believes that,
because the co-applicant agreement says you will collaborate not compete, it's OK to have the requirement in the
resolution. But,in my opinion the clause in the co-applicant agreement should not enable the City to define what
services you.proviide or who you do/do not hire. I am not sure what advice to give you about next steps-other than
what you've already done-which is let the City know the resolution probably won't fly with HRSA and figure out a way
to compromise. Let me know if you want to discuss more.
Pat
1
Behavioral HealthConsultant/Case Manager
Job Description
I i
OCodYMUNITY"
H ALTH'
NCENTER
Name Issue Date
Job l itle Behavioral Health Consultant/Case Manager Review Date 12/8/201
Reports to Clinic supervisor Department Clinic
Supervises N/A FLSA status Non-Exempt
Job purpose
Provide behavioral health and substance abuse consultation to children,adolescents,adults,and
families to improve psychosocial functioning.Serves as a point of contact for referring providers,
patients,and caregivers to provide resources and assistance with accessing clinical and supportive
care services as part of the Care Coordination Team offered at Seward Community Health Center
(SCHC)and in the Seward area community.
Duties and responsibilities
• Provide comprehensive assessment and diagnosis of behavioral health&substance abuse clients.
• Provide effective treatment planning and assisting clients in successfully achieving goals.
• Evaluate crisis situations and apply appropriate interventions.
• Provide assessment,consultation,and brief intervention for substance abuse problems or
psychological/psychiatric problems and/or disorders.
• Assist in the detection of"at risk"patients and development of plans to prevent further
psychological or physical deterioration.
• 'Work with Care Coordinator,Health Educator,and primary care team in developing care
management processes such as the use of guidelines,disease management techniques,case
management,and patient education to improve self-management of chronic disease.
• Monitor the site's behavioral health program,identifying problems related to patient services and
making recommendations for improvement.
• Help coordinate care with other mental health care providers;monitor patient stability and
independent living.
• 'Visit homes and schools to determine patient and family needs,develop plan to meet needs.
• Assist patients in setting up referral appointment and ensuring the patients keep appointments.
• Advocate for the patient with special needs.
• Help patients obtain necessary resources.
• Assist community members and health field personnel to assess,plan for,and provide needed
health and related services..
• Refer patients with social and emotional problems to other,community agencies for assistance.
• Document patient cases,including assessment and patient's consent to obtain assistance.
• Maintain safe,secure,and healthy work environment by following,and enforcing standards and
procedures; complying with legal regulations.
• Prepare reports as required by various federal,state,and local programs.
• Document patient notes,referrals,and related information in EHR in a timely fashion.
• Document findings to track trends and changes in the health of the community.
• Participate in Quality Improvement(QI),and Quality Assurance(QA,)activities as appropriate.
•. Maintain patient confidence and protect operations by keeping patient care information
confidential..
• Update job knowledge by participating in educational opportunities.
• Enhance health care practice reputation by accepting ownership for accomplishing new and
different requests; exploring opportunities to add value to job accomplishments.
• Perform other related duties as assigned.
C_
Behavioral Health Consultant job description FINAL 120917 �� � h
Page 1 of V&
;.Qualifications
• Education/Experience: Master's Degree in Social Work or PhD in Clinical Psychology. 1-2 years
of previous experience in linking consumers with various community resources preferred.
• Computer Skills:To perform this job successfully,an individual should have knowledge of
Microsoft Office applications.Prior experience with Epic EHR preferred.
• Certificates and Licenses: Licensed in the State of Alaska as a Licensed Clinical Social.Worker
(LCSW)or a Licensed Psychologist. Must also maintain a valid BLS certification.
• Must possess the ability to communicate verbally and non-verbally with clients,coworkers and
members of management. Excellent professional customer service skills required.
• Excellent working knowledge of behavioral medicine and evidence-based treatments for medical
and mental health conditions.
• Ability to work through brief patient contacts as well as to make quick and accurate clinical
assessments of mental and behavioral conditions.
• Should be comfortable with the pace of primary care,working with an interdisciplinary team, and
have strong communication skills.
• Ability to design and implement clinical pathways and protocols for treatment of selected chronic
conditions.
+Vormirtg Conditions
While performing the duties of this job,the employee generally works within the interior of a healthcare
clinic/office environment.The general work environment is clean with a moderate temperature and noise
level.Employee will be required to use a computer and other office equipment and participate in
communication through typing,reading,writing and telephones,etc.The employee may be in contact
with patients under all conditions and circumstances,e.g.,illness,emotional duress and hostility. Daily
work activities also involve contact with the general public,students,staff members,and government
representatives under all conditions and circumstances. The employee may be exposed to infectious
waste,blood,body fluids,communicable/infectious diseases,air contaminants and hazardous chemicals.
All SCHC facilities are non-smoking. SCHC will provide the employee instructions on how to prevent and
control such exposures. The employee may be exposed to the Hepatitis B Virus. SCHC will snake the
Hepatitis B vaccination available to all employees.free of charge.
Physical'Requirernents
The physical demands described here are representative of those that must be met by an employee to
successfully perform the essential functions of this job.Reasonable accommodations may be made to
enable individuals with disabilities to perform the essential functions.While performing the duties of this
job,the employee is regularly required to sit and talk,or hear.The employee is frequently required to walk
and use hands to finger,handle,or feel.The employee is occasionally required to stand;reach with hands
and arms;stoop;kneel;crouch;or crawl.The employee must occasionally lift and/or move up to 20 lbs.
Specific vision abilities required by this job include:close vision,distance vision,peripheral vision,depth
perception,,and ability to adjust focus.
Direct Reports
.None,but works closely with providers,clinical support staff,and Care Coordinator.
Employee:Confirmation
I confirm I have read the above job description,fully understand the requirements of the job,and agree to
perform my duties accordingly.
Printed Name-
Signature- Date:
Behavioral Health Consultant job description FINAL 120917
Page 2 of 2 `SY
)&
Seward Community Health Center
Behavioral Health, Psychiatry and Psychology Referrals
Seaview Other Total 6mo total
Jain-17 1 1 2
Feb-17 0 0 0
Mair-17 1 1 2
Apr-17 1 0 1
May-17 1 1 2
Juan-17 1 1 2 9
Jul-17 0 1 1
Aug-17 0 0 0
Sep-17 1 1 2
Oct-17 1 0 1
Nov-17 0 1 1
Dec-17 0 0 0 5
Total 2017 7 7 14
Ave/mo. 0.5 0,581,17
Jan-18 2 0 2
Feb-18 1 1 2
Mar-18 1 0 1
Apr-18 1 2 3
May-18 0 2 2
Jun-18 0 1 1 11
Jul-18 1 1 2
Aug-18 1 3 4
Sep-18 3 2 5
Oct-18 1 2 3 1 non spec, I Neuro psych
Nov-18 2 2 4
Dec-18 2 2 4 22
Total 2018 15 18 33
Ave/mo. 1.25, 1.50 2.75
Jan-19 0 1 1 Psychology
Feb-19 4 0 4
Mar-1 9 2 0 2
Apr-19 1 0 1
�May-19 1 2 3 1 non spec, I Neuro psych
Jun-19 1 1 2 13
Jul-19 1 1 2 Psychology
Aug-19 3 0 3
Total 2019 13 5 18
Ave/MO. 1.63 0.63 2.25
SCHC LCSW started work in July 2018
Source Data: EPIC E.H.R.
Patients who have fallen through the cracks
• A patient in her early 20s was referred to services with SeaView far anxiety and
depression. The patient returned to our clinic in August 2019 to meet with her PCP to
discuss the above issues.The patient stated that she "does not feel comfortable" with
the providers at SeaView, including Dr Mack, and she has discontinued services with
them.The patient reported still struggling with depression in her appointment with her
PCP. However, she refused any other referrals for behavioral health treatment.
• In May 2019, a pediatric patient was referred to SeaView because they have a provider
that specifically provides play therapy. It was in the best interest of the patient to
receive this type of therapy. An appointment for an assessment was made but.later
cancelled. The patient's mother stated that financially they couldn't afford it. She did
not state what the cost would be.The family does have one of the more common
insurances found in Seward.
• Around the end of July 2019, a patient in her mid-30s cancelled an appointment to
discuss MH concerns with a medical provider. It was suggested that the BHC still call her
to follow up. The patient had self-referred to SeaView knowing she would benefit from
services.The patient was told at the time that SeaView was not consider in-network
with her insurance. She did not proceed with services due to the cost. She said that the.
assessment would cost her around $600.She was offered a payment plan. The patient
stated that she, "felt very frustrated by the lack of options in Seward."
• SeaView has stated that a person CANNOT use the sliding scale if they have insurance.
They can do a payment plan option.The concern is that someone who is already
struggling with severe mental illness will not seek service due to the added financial
stress. The World Health Organization issued a report that compared the disability
impact of mental illnesses and medical illnesses. The disability for a person with
moderate depression is similar to the impact from severe asthma or relapsing ms. The
disability from severe depression is comparable to quadriplegia.
P i"�-17 e—-,M S 9