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INGHAM COUNTY BOARD OF COMMISSIONERS

VIEWS: 55 PAGES: 38

									CHAIRPERSON                                                                          HUMAN SERVICES COMMITTEE
MARK GREBNER                                                                            JOHN CZARNECKI , CHAIR
                                                                                            LISA DEDDEN
CHAIRPERSON PRO TEM                                                                        MICHAEL SEVERINO
CHRIS SWOPE                                                                              CURTIS HERTEL JR.
                                                                                          VICTOR CELENTINO
VICE-CHAIRPERSON PRO-TEM
MIKE SEVERINO

             INGHAM COUNTY BOARD OF COMMISSIONERS

                      P.O. Box 319. Mason, Michigan 48854          Telephone (517) 676-7200 Fax (517) 676-7264


THE HUMAN SERVICES COMMITTEE WILL MEET ON MONDAY, JULY 23, 2001, AT 7:00
P.M., IN CONFERENCE ROOM B OF THE HUMAN SERVICES BUILDING, 5303 S. CEDAR,
LANSING.
                                   Agenda
Call to Order
Additions to the Agenda
Limited Public Comment

1.        Community Mental Health - Public Hearing on the Amendment to the Agreement for the Community
          Mental Health Board of Clinton-Eaton-Ingham Counties

2.        Ingham County MSU Extension
          a.     Resolution to Authorize Ingham County MSU Extension 4-H Youth Programs to Enter into a
                 $10,475 Professional Service Contract with the Lansing School District to Expand 4-H After-
                 school Programs Targeting Lansing Elementary School Students
          b.     Resolution to Accept a Grant and to Authorize Sole Source Contracts to Provide Services
                 Required to Meet the Goals and Objectives of the Minority Over-representation Grant
                 Awarded to Ingham County by the Michigan Family Independence Agency, Juvenile Justice
                 Grant Unit

3.        Health Department
          a.     Presentation on Jump Start Program (no material )
          b.     Resolution to Adjust the Fees for On-site Sewage Disposal and Water Well Applications and
                 Permits
          c.     Resolution to Authorize a New Clinical Services Fee Schedule
          d.     Resolution to Enhance the Staffing Levels and Services in the Children’s Special Health Care
                 Services Program
          e.     Resolution to Authorize Administrative Services Agreements with Nonprofit Health Care
                 Corporations in Other Counties

4.        Discussion - Status of Environmental Tobacco Smoke Task Force

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.
                                                                                           Agenda Item 1




To:            Ingham County Human Services Committee

From:          John L. Neilsen, Deputy Controller

Subject:       Amendment of the Agreement for the Community Mental Health Board of Clinton-Eaton-
               Ingham Counties

Date:          July 17, 2001

Commissioners:

Attached you will find the original staff review and Resolution Number 01-148 “Resolution to Amend the
Agreement for the Community Mental Health Board of Clinton-Eaton-Ingham Counties” that authorizes an
amendment to the Agreement for the Community Mental Health Board of Clinton-Eaton-Ingham Counties by
amending the formula by which the participating counties are represented on the Community Mental Health
Board according to Census data.

The Board of Commissioners approved this resolution in May of this year and the agreements implementing this
amendment have been prepared for signature; however, according to the authorizing legislation (Mental Health
Code and Urban Cooperation Act of 1967) each participating entity must hold a public hearing prior to the
amendment taking effect.

The July 23 Human Services meeting will serve as Ingham County’s public hearing and Clinton and Eaton
Counties will establish their own public hearings in order to implement the amendment.

If you should have any questions, please contact me.


c:      Bob Sheehan, Director of Community Mental Health
        Ryan Wood, Clinton County Administrator
        Jim Stewart, Eaton County Administrator
                                                                                          Agenda Item 1

RESOLUTION STAFF REVIEW                     DATE      April 23, 2001


Agenda Item Title        Resolution to Amend the Agreement for the Community Mental Health Board of
                         Clinton-Eaton-Ingham Counties




Submitted by             Community Mental Health


Committees:              Ad.Ser/Per. , H.S. * , Law & Cts. , Finance


Summary of Proposed Action (see attached letter of explanation)
This resolution authorizes an amendment to the Agreement for the Community Mental Health Board of Clinton-
Eaton-Ingham Counties by amending the formula by which the participating counties are represented on the
Community Mental Health Board according to Census data.

This will change the representation from the current CMH Board from:

County                   Current #                    New Number
Clinton County              2                              2
Eaton County                2                              3
Ingham County               8                              7
TOTAL                      12                              12

These changes will take place January of 2002.

Financial Implications
None




Other Implications




Staff Recommendation: JA        JN *      HH
This resolution should be approved.
                                                                                           Agenda Item 1
SUBSTITUTE                                                               ADOPTED - MAY 8, 2001
                                                                             Agenda Item No. 16
Introduced by the Human Services Committees of the:

                         INGHAM COUNTY BOARD OF COMMISSIONERS

     RESOLUTION TO AMEND THE AGREEMENT FOR THE COMMUNITY MENTAL
            HEALTH BOARD OF CLINTON-EATON-INGHAM COUNTIES

                                         RESOLUTION #01-148

WHEREAS, the Agreement for the Community Mental Health Board of Clinton-Eaton-Ingham Counties, as
amended in 1996, contains the formula by which the participating counties are represented on the Community
Mental Health Board; and

WHEREAS, the Community Mental Health Board of Clinton-Eaton-Ingham Counties, made up of appointed
representatives and commissioners from each county has developed a revised representation formula
implementation method for use in Fiscal Year 2002 and in subsequent new census years; and

WHEREAS, the revised representation formula implementation method agreed upon by the Community Mental
Health Board of Clinton-Eaton-Ingham Counties represents a change from that contained in the Agreement.

THEREFORE BE IT RESOLVED, that the Agreement be amended by the third amendment to the Agreement
for the Community Mental Health Board of Clinton-Eaton-Ingham Counties, adding to Section V of the
Agreement with the following, effective May 1, 2001.

                                         Establishment of the Board

Evaluation of the Census data for the purpose of determining county representation should occur every ten years
soon after the receipt of the new census data. This evaluation should be made by the staff of the Community
Mental Health Board, approved by the CMH Board of Directors and be reported to the county administrator
of each county. This review should occur in a timely fashion once the data is available. The evaluation should
determine the number of appointees to the CMH Board from each county. The number of appointees from each
county for the subsequent year will be determined based on that analysis.

The new plan for County representation should become effective on January first of the next year when
appointments are regularly made by the respective counties.

BE IT FURTHER RESOLVED, that the Board Chairperson and County Clerk are authorizedto sign
the agreement upon approval as to form by the County Attorney.

HUMAN SERVICES COMMITTEE: Yeas: Czarnecki, Dedden, Severino, Celentino
 Nays: None Absent: Hertel Approved 4/30/01
                                                                                         Agenda Item 2b


RESOLUTION STAFF REVIEW                      DATE     June 26, 2001


Agenda Item Title      Resolution to Authorize Ingham County MSU Extension 4-H Youth Programs to Enter
                       into a $10,475 Professional Service Contract with the Lansing School District to
                       Expand 4-H After-school Programs Targeting Lansing Elementary School Students

Submitted by           Cooperative Extension Office


Committees:            Ad.Ser/Per. , H.S. * , Law & Cts. , Finance *


Summary of Proposed Action
This resolution authorizes Ingham County Michigan State University Extension to enter into a $10,475
professional service contract with the Lansing School District to support after-school and summer 4-H youth
programming.




Financial Implications: The Lansing School District is proposing to fund the following budget:

       Program Interns                                        $6,075
       Garden Start-Up Costs                                  $1,500
       Activity/Snack Supplies                                $1,100
       Travel Expenses/Training for Program Coordinator       $1,000
       Transportation (Field Trips/Community Service)         $ 800

       Total                                                 $10,475




Other Implications




Staff Recommendation: JA        JN *      HH
This resolution should be approved.
                                                                                          Agenda Item 2b

Introduced by the Human Services and Finance Committees of the:

                        INGHAM COUNTY BOARD OF COMMISSIONERS

   RESOLUTION TO AUTHORIZE INGHAM COUNTY MSU EXTENSION 4-H YOUTH
 PROGRAMS TO ENTER INTO A $10,475 PROFESSIONAL SERVICE CONTRACT WITH
  THE LANSING SCHOOL DISTRICT TO EXPAND 4-H AFTER-SCHOOL PROGRAMS
          TARGETING LANSING ELEMENTARY SCHOOL STUDENTS.

WHEREAS, the Ingham County Board of Commissioners allocates funds to support Michigan State
University (MSU) Extension 4-H Youth Programs for temporary employment resources to conduct summer
and after-school programming; and

WHEREAS, Ingham County MSU Extension 4-H Youth Programs has provided Ingham County youth with
safe, structured activities during non-school hours; and

WHEREAS, the Lansing School District has made additional funding available for Ingham County MSU
Extension 4-H Youth Programs to continue to facilitate after-school and summer Garden Club programming
to five elementary schools; and

WHEREAS, 4-H After-School Garden Clubs will continue to provide opportunity to engage youth in
learning projects that connect them to a public garden and MSU and involve them in longer-term positive
relationships with adults as teachers; and

WHEREAS, the Lansing School District and Ingham County MSU Extension have agreed to contract for
professional services to support an ongoing after-school and summer program to be completed by June,
2002, according to the following budget:

       Program Interns                                         $6,075
       Garden Start-Up Costs                                   $1,500
       Activity/Snack Supplies                                 $1,100
       Travel Expenses/Training for Program Coordinator        $1,000
       Transportation (Field Trips/Community Service)          $ 800

       Total                                                  $10,475

THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners authorizes Ingham
County Michigan State University Extension to enter into a $10,475 professional service contract with the
Lansing School District to support after-school and summer 4-H youth programming according to the
budget above.

BE IT FURTHER RESOLVED, that the County Controller be authorized to amend the 2001 Ingham
County MSU Extension budget to add $10,475 in accordance with this resolution.
                                                                                           Agenda Item 2b


BE IT FURTHER RESOLVED, that Ingham County MSU Extension is authorized to hire temporary
County employees in accordance with the contract.

BE IT FURTHER RESOLVED, that the Chairperson of the Ingham County Board of Commissioners and
the County Clerk are authorized to sign any necessary contract documents consistent with this resolution and
approved as to form by the County Attorney.
                                                                                         Agenda Item 2c
RESOLUTION STAFF REVIEW                       DATE      June 26, 2001


Agenda Item Title        Resolution to Accept a Grant and to Authorize Sole Source Contracts to Provide
                         Services Required to Meet the Goals and Objectives of the Minority Over-
                         representation Grant Awarded to Ingham County by the Michigan Family
                         Independence Agency, Juvenile Justice Grant Unit


Submitted by             Cooperative Extension Office/YVPC


Committees:              Ad.Ser/Per. , H.S. * , Law & Cts. , Finance *

Summary of Proposed Action
This resolution authorizes amendments to Resolution #00-252 which authorized Ingham County on behalf of
the City of Lansing/Ingham County Youth Violence Prevention Coalition to accept a grant to address issues
of minority over-representation in the local juvenile justice system.

Financial Implications

Revenues
Lansing Community College (LCC)                        $7,500 in cash
                                                        7,493 in kind contribution
Michigan Council on Crime and Delinquency               5,040 in-kind contribution
MFIA                                                   20,000 grant
Total                                                 $40,003

Expenses
McCoy Company -Violence Interruption Experience
Training and Train the Trainer services            $26,000
-Follow-up consultant fees to support as necessary
implementation of the training curriculum             1,500
-in-kind services expenses                           12,533
                                                    $40,003

Other Implications Resolution #00-252 authorized an acceptance of a $20,000 grant from the Juvenile
Justice and Delinquency Prevention Unit of the Michigan Family Independence Agency to continue
implementation of the three year strategic plan to reduce Minority Over-Representation in the Ingham
County juvenile justice system. The resolution also authorized sole source contracting with Lansing
Community College, the McCoy Company and the Michigan Council on Crime and Delinquency to carry
out the objectives of this project.

Staff Recommendation: JA       JN *       HH
This resolution should be approved.
                                                                                               Agenda Item 2b
Introduced by the Human Services and Finance Committees of the:

                          INGHAM COUNTY BOARD OF COMMISSIONERS

RESOLUTION TO ACCEPT A GRANT AND TO AUTHORIZE SOLE SOURCE CONTRACTS
TO PROVIDE SERVICES REQUIRED TO MEET THE GOALS AND OBJECTIVES OF THE
 MINORITY OVER-REPRESENTATION GRANT AWARDED TO INGHAM COUNTY BY
THE MICHIGAN FAMILY INDEPENDENCE AGENCY, JUVENILE JUSTICE GRANT UNIT


WHEREAS, the Ingham County Board of Commissioners and the City of Lansing have jointly formed the
Ingham County/City of Lansing Youth Violence Prevention Coalition (YVPC) to implement violence
prevention strategies in Ingham County; and

WHEREAS, the Coalition through one of its task forces, has developed a strategic three-year plan to
reduce Minority Over-Representation in the Ingham County juvenile justice system and successfully
completed objectives of the said strategic plan through earlier projects utilizing Federal Juvenile Justice Act,
Minority Over Representation/Disproportionate Minority Confinement intervention funds; and

WHEREAS, Ingham County on behalf of the City of Lansing/Ingham County Youth Violence Prevention
Coalition has submitted an application to the Juvenile Justice and Delinquency Prevention Unit of the
Michigan Family Independence Agency for a $20,000 grant to continue implementation of the
aforementioned strategic plan, responding appropriately to issues of minority over-representation in the local
juvenile justice system; and

WHEREAS, Resolution #00-252 authorized the acceptance of this grant should it be awarded and further
authorized sole source contracting with Lansing Community College, the McCoy Company and the
Michigan Council on Crime and Delinquency in accordance with the services delineated in the grant
application; and

WHEREAS, due to significant modifications in how the services will be delivered and subsequent need to
restructure the application budget, the earlier application has been withdrawn and replaced with a new
application to the Michigan Family Independence Agency, Juvenile Justice Grant Unit; and

WHEREAS, if this grant is awarded, it will secure $40,033 grant from MFIA ($20,000 from MFIA
requiring a local in-kind match of at least $20,033) for a contract period that starts August 1, 2001 and will
terminate July 31, 2002; and

WHEREAS, the required local in-kind match which is specifically shown in the application budget will be
provided in the following manner: up to $7,500 in cash from Lansing Community College (LCC), $7,493 in-
kind contribution from LCC and $5,040 in-kind contribution from the Michigan Council on Crime and
Delinquency; and
                                                                                           Agenda Item 2b

WHEREAS, this project will continue data acquisition and analysis activities and institutionalize self
awareness, cultural competency, conflict de-escalation and community alliance building training components
in the Mid-Michigan Police Academy at Lansing Community College toward the primary goal of reducing
the number of minority youth entering the Ingham County Juvenile Justice System; and

WHEREAS, the YVPC requests authorization for sole source contracting for services for contract periods
starting no earlier than August 1, 2001 and ending no later than July 31, 2001:

a:      $26,000 for McCoy Company Violence Interruption Experience (VIE) and a follow-up four day
        Training of the Trainers.

b:      Up to $1,500 consultant fees to McCoy Company for follow-up consultant to support as necessary
        implementation of the training curriculum.

WHEREAS, the YVPC further requests authorization to establish authorizing agreements between the
County and the following agencies for respective cash or in-kind contributions to meet the local match
requirements of the grant:

1)      Up to $7,500 grant of funds from LCC to Ingham County to cover follow-up consultant
services provided by Mc Coy Company.

2)      $7,493 in-kind contribution from LCC for personnel and supplies in accordance with
the grant application budget.

3)     $5,040 in-kind contribution from MCCD for data collection, data analysis and report
development.

THEREFORE BE IT RESOLVED, that contingent upon the above referenced grant application being
awarded, the Ingham County Board of Commissioners authorizes that this $40,033 grant be accepted by
Ingham County from MFIA to contract for the services and establish the associated agreements as outlined
above.

BE IT FURTHER RESOLVED, that the Ingham County Board of Commissioners authorizes for a contract
period starting no earlier than August 1, 2001 and ending no later than July 31, 2002:

1)      A sole source contract with the McCoy Company to provide Violence Interruption Experience
        Training and Train the Trainer services at a cost not to exceed $26,000 and follow-up consultant
        services at a cost not to exceed $1,500.

2)      An agreement with LCC to accept a $7,500 grant from LCC to support the consultant services

3)      An agreement with LCC for an in-kind contribution of at least $7,493 for personnel and supplies.
                                                                                           Agenda Item 2b

4)     An agreement with MCCD for an in-kind contribution of at least $5,040 for data collection, analysis
       and developing a report.

BE IT FURTHER RESOLVED, that the County Controller is authorized to amend the Ingham County
MSU Extension 2001 budget in accordance with this resolution.

BE IT FURTHER RESOLVED, that the Chairperson of the Ingham County Board of Commissioners and
the County Clerk are authorized to sign any necessary contract documents consistent with this resolution and
approved as to form by the County Attorney.
                                                                                              Agenda Item 3b


RESOLUTION STAFF REVIEW                        DATE       July 9, 2001


Agenda Item Title       Resolution to Adjust the Fees for On-site Sewage Disposal and Water Well
                        Applications and Permits


Submitted by            Health Department


Committees:             Ad.Ser/Per. , H.S. * , Law & Cts. , Finance *


Summary of Proposed Action (see attached letter of explanation)
This resolution will authorize effective October 1, 2001 adjustments in the Environmental Health Fee
Schedule to set the application fee for a permit to install an on-site sewage disposal system, the application
fee for a permit to install a water well and the fee for land evaluation services such that the County recovers
the full cost of regulating these activities, less any revenues from other sources. Currently, the fees charged
for these services result in the recovery of about 16% of the cost of services in these two program areas.
This recommendation would recover about 68% of the total costs through the fees with the remaining 32%
to be recovered by the state grants and formula revenue.




Financial Implications (see attached breakdown of individual fees, 2002 budgeted revenue and
additional revenue estimated, nearly an additional $233,000 as projected)




Other Implications - This policy decision is based on the premise that the County should recover the full
costs of their services in these areas.




Staff Recommendation: JA        JN *        HH
This resolution should be approved.
                                                                                               Agenda Item 3b
                                          MEMORANDUM


To:             Human Services Committee
                Finance Committee

From:           Bruce Bragg

Date:           July 17, 2001

Subject:        Recommendation to Adjust the On-Site Sewage System, Water Well Application Fees and
                Fees for Land Evaluation for On-Site Sewage Applicability

This is a recommendation to adjust the Environmental Health Fee Schedule to set the application fee for a
permit to install an on-site sewage disposal system, the application fee for a permit to install a water well and
the fee for land evaluation services such that the County recovers the full cost of regulating these activities,
less any revenues from other sources.

Currently, the fees charged for these services result in the recovery of about 16% of the cost of services in
these two program areas. This results in a substantial subsidy to those persons proposing to build homes in
areas of the County not served by municipal water and sewage systems. The adjustment in the fee schedule
is intended to end that subsidy. After October 1, 2001, the homeowner or builder will be required to pay
the County approximately 68% of the full cost of implementing the On-Site Sewage Disposal and the Water
Well Programs, with approximately 32% to come through grant or formula revenue. I recommend that the
Board adopt the attached resolution and authorize the adjustment to the Environmental Health Fee Schedule.

c:      Bob Godbold w/attachment
        Garry Rowe w/attachment
        John Jacobs w/attachment
                                                                                               Agenda Item 3b

Introduced by the Human Services and Finance Committees of the:

                          INGHAM COUNTY BOARD OF COMMISSIONERS

 RESOLUTION TO ADJUST THE FEES FOR ON-SITE SEWAGE DISPOSAL AND WATER
                   WELL APPLICATIONS AND PERMITS

WHEREAS, the Health Department has a statutory responsibility to prevent human exposure to
environmental hazards, and has authority from the Michigan Public Health Code to adopt regulations to
implement these responsibilities, and the authority to establish fees to recover the cost of such services; and

WHEREAS, the Ingham County Board of Commissioners has promulgated the Ingham County Sanitary
Code which provides the Ingham County Health Department with the authority to regulate the installation of
on-site sewage systems and water wells for family homes and other small quantity users and generators; and

WHEREAS, the Sanitary Code requires that any person intending to install a water well or an on-site
sewage system must file an application with the Health Department and meet criteria set out in the Sanitary
Code and in other guidance; and

WHEREAS, the existing Environmental Fee Schedule results in the County being paid about 16% of the
cost of providing the services to regulate the on-site sewage and water well programs; and

WHEREAS, the Health Officer has proposed an adjustment to the Environmental Health Fee Schedule, for
on-site sewage system applications and permits and water well applications and permits, which would allow
the County to recover the full cost of providing the services, less any state financial support for these
services.

THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners effective October 1,
2001, amends the Environmental Health Fee Schedule with the intent to recover from fees approximately
68% of the cost of regulating the construction of on-site sewage disposal system and water wells and for
land evaluation services related to on-site sewage systems and water wells, with the remaining 32% of cost
to be recovered from grants and formula revenue.

BE IT FURTHER RESOLVED, that effective October 1, 2001, the on-site sewage disposal application fee
shall be established at $385 for new systems and at $100 for the repair or replacement of an existing system.

BE IT FURTHER RESOLVED, that effective October 1, 2001, the application fee for a water well shall be
established at $385 for a new water well and $100 for the repair or replacement of an existing water well.
                                                                                    Agenda Item 3b

BE IT FURTHER RESOLVED, that effective October 1, 2001 the fee for land evaluation for on-site
sewage or water well suitability shall be established at $385.

BE IT FURTHER RESOLVED, that the Controller is authorized to adjust the Health Department’s 2001
and 2002 budgets in order to implement this resolution.
                                                                                             Agenda Item 3c

RESOLUTION STAFF REVIEW                        DATE      July 9, 2001


Agenda Item Title       Resolution to Authorize a New Clinical Services Fee Schedule


Submitted by            Health Department


Committees:             Ad.Ser/Per. , H.S. * , Law & Cts. , Finance


Summary of Proposed Action (see attached letter of explanation)
This resolution will authorize a new fee schedule for the clinical services delivered by the Health Department
effective August 1, 2001. The State of Michigan Medicaid Program is implementing a Uniform Billing
Project, to become effective on August 1, 2001, with the purpose of being compliant with the Federal
Health Insurance Portability and Accountability Act of 1996 (HIPPA). Ingham County will have to change
its fee schedule in order to comply with the Uniform billing Project, by adding and deleting some categories
of services.




Financial Implications (see attached proposed fee schedule)
When the Department recommends fees to the Board of Commissioners, the schedules take into
consideration the cost of providing services, the usual and customary charge for the service in the community
and the Medicaid screen for such services.

The new fee schedule should not place any additional barriers to service for our low-income clients. The
new schedule will represent the Health Department’s charges for its clinical services. It is the amount to be
billed to individuals or third parties. The third party payers (Medicaid, Medicare or private insurers) will
always pay our charge or their screen, whichever is lower. The individual’s bill will be adjusted, based on
family income and the sliding fee schedule.


Other Implications
It may be necessary to make additional changes in the fee schedules as more HIPPA rules are released.


Staff Recommendation: JA        JN *        HH
This resolution should be approved.
                                                                                             Agenda Item 3c


                                         MEMORANDUM


To:             Human Services Committee
                Finance Committee

From:           Bruce Bragg

Date:           July 17, 2001

Subject:        Resolution to Adopt a New Clinical Services Fee Schedule

This is a recommendation to authorize a new fee schedule for the clinical services delivered by the Health
Department. The Health Department maintains fee schedules for many of the services it provides. For
personal health services, most fees are subject to a sliding fee schedule, which adjusts (reduces) the
established fee for low income persons. Most third party payers will pay their established rate for a service,
or the amount billed, whichever is lower.

The Michigan Public Health Code provided the Board of Commissioners with the authority to establish fees
for services provided by the Health Department. Such fees may not exceed the reasonable cost of providing
the services. The Department periodically recommends to the Board adjustments to its fee schedules.
When the Department recommends fees to the Board of Commissioners, the schedules take into
consideration the cost of providing services, the usual and customary charge for the service in the community
and the Medicaid screen for such services.

The State of Michigan Medicaid Program is implementing a Uniform Billing Project, to become effective on
August 1, 2001, with the purpose of being compliant with the Federal Health Insurance Portability and
Accountability Act of 1996 (HIPPA). It may be necessary to make additional changes in the fee schedules
as more HIPPA rules are released. The new fee schedule adds some new fees for services and deletes
some fees from the existing schedule. All other fees are unchanged by this action.

The new fee schedule should not place any additional barriers to service for our low-income clients. The
new schedule will represent the Health Department’s charges for its clinical services. It is the amount to be
billed to individuals or third parties. The third party payers (Medicaid, Medicare or private insurers) will
always pay our charge or their screen, whichever is lower. The individual’s bill will be adjusted, based on
family income and the sliding fee schedule.

Attached is a proposed new Ingham County Health Department Clinical Services Fee Schedule. I will
distribute in the committee meetings a copy of a QuatroPro schedule setting out all the added service
categories and those deleted.
                                                                                       Agenda Item 3c

I recommend that the Board of Commissioners adopt the attached resolution and establish the new Fee
Schedule for Clinical Services effective August 1, 2001.

Attachments:   1)      Ingham County Health Department Clinical Services Fee Schedule (August 1, 2001)
               2)      Resolution


cc:    John Jacobs w/attachment
       Eric Thelen w/attachment
       Bruce Miller w/attachment
                                                                                         Agenda Item 3c

Introduced by the Human Services and Finance Committees of the:

                        INGHAM COUNTY BOARD OF COMMISSIONERS

      RESOLUTION TO AUTHORIZE A NEW CLINICAL SERVICES FEE SCHEDULE

WHEREAS, the Michigan Public Health Code provides the Board of Commissioners with the authority to
establish fees for services provided by the Health Department; and

WHEREAS, the Board of Commissioners periodically adjusts the fee schedule for clinical services provided
by the Health Department; and

WHEREAS, the State of Michigan Medical Services Administration (Medicaid Agency) is implementing a
Uniform Billing Project effective August 1, 2001 which is intended to bring the Michigan Medicaid Program
into compliance with the Federal Health Insurance Portability and Accountability Act of 1996; and

WHEREAS, Ingham County will have to change its fee schedule in order to comply with the Uniform billing
Project, by adding and deleting some categories of services; and

WHEREAS, the Health Officer has recommended that the Board of Commissioners adopt a new Clinical
Services Fee Schedule, leaving in place the existing sliding fee schedule based on ability to pay.

THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners hereby adopts the
attached Clinical Services Fee Schedule for services provided by the Ingham County Health Department, to
be effective August 1, 2001.
                                                                     Agenda Item 3c

INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE

                                   Effective August 1, 2001
Procedure
  Code        Explanation of Services                                   FEE

              Office Visits - New Patients
      99205   New - Level 5-Comprehensive-High Complexity               $110.00
      99204   New - Level 4-Comprehensive-Moderate Complexity            $90.00
      99203   New - Level 3-Detailed-Low Complexity                      $65.00
      99202   New - Level 2-Expanded Focus                               $45.00
      99201   New - Level 1-Problem Focused - Straight Forward           $40.00
      99387   New - 65 years and over                                    $90.00
      99386   New - 40 through 64 years                                  $80.00
      99385   New - Well Child - 18 through 39 years                     $70.00
      99384   New - Well Child - 12 through 17 years                     $70.00
      99383   New - Well Child - 5 through 11 years                      $70.00
      99382   New - Well Child - 1 through 4 years                       $70.00
      99381   New - Well Child - under 1 year                            $70.00

              Office Visits - Extablished Patients
      99215   Revisit - Level 5-Comprehensive-High Complexity            $75.00
      99214   Revisit - Level 4-Detailed-Moderate Complexity             $50.00
      99213   Revisit - Level 3-Expanded-Low Complexity                  $35.00
      99212   Revisit - Level 2-Problem Focused - Straight Forward       $25.00
      99211   Revisit - Level 1-Straight Forward                         $25.00
      99397   Revisit - 65 years and over                                $70.00
      99396   Revisit - 40 through 64 years                              $65.00
      99395   Revisit - Well Child - 18 through 39 years                 $60.00
      99394   Revisit - Well Child - 12 through 17 years                 $60.00
      99393   Revisit - Well Child - 5 through 11 years                  $60.00
      99392   Revisit - Well Child - 1 through 4 years                   $60.00
      99391   Revisit - Well Child - under 1 year                        $60.00
      99402   Preventative Medicine Counseling - 30 min.                      **
      99401   Preventative Medicine Counseling - 15 min.                      **

              Other Office Visits
              Agency PEs/County Pre-Employ PE's                          $30.00
              Insurance PEs                                              $45.00
              Immigration PE's                                           $70.00
              Employment/School PE's                                     $40.00
              Travel Consultation                                        $25.00
              Lab/Injection Only                                          $5.00

              Laboratory
      82947   Blood sugar                                                 $5.00
      87210   Hanging drop                                                $5.00
      83655   Lead                                                       $15.00
      85018   Hemoglobin                                                  $5.00
      82270   Occult Blood                                                $5.00
      86403   Strep Screen                                                $6.00
      84703   UCG                                                         $6.00
      81002   Urinalysis                                                  $3.00
      81000   UA with Micro                                               $3.00
                                                                                        Agenda Item 3c

INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE

Procedure
  Code        Explanation of Services                                                      FEE

              Procedures
      92551   Audiogram -Screening                                                          $20.00
      92552   Audiogram -Threshold                                                          $20.00
      11100   Biopsy, skin - single lesion                                                  $55.00
      11101   Biopsy, skin - each additional lesion                                         $25.00
      57510   Cautery (Electro/Thermal) - Cervix                                           $115.00
      54050   Destruction (lesion(s) penis (Condyloma) simple; chemical
      54055   Cautery Destruction lesion(s) Penis (Electrodesiccation)                     $165.00
      57061   Destruction vaginal lesion(s) simple; any method                              $80.00
      54065   Destruction lesion(s), penis, extensive; any method                          $170.00
      56515   Destruction lesion(s) vulva, extensive; any method                           $105.00
      57452   Colposcopy                                                                    $60.00
      57454   Colposcopy with biopsy and/or endocervical curettage                          $70.00
      11720   Debridement of Nail(s) by any method; one to five                             $20.00
      56501   Destruction of lesion(s), vulva, simple, any method                           $90.00
      96110   Denver Development Test                                                       $35.00
      69210   Ear Irrigation                                                                $10.00
      93000   EKG                                                                           $30.00
      11740   Evacuation of subungual hematoma                                              $25.00
      11400   Excision, benign lesion, except skin tag, on trunk, arms                      $80.00
              or legs: lesion diameter 0.5 cm or less
      11420   Excision, benign lesion, except skin tag, on scalp,                           $70.00
              neck, hands, feet, genitalia; lesion dia. .5 cm or less
      11421   lesion diameter .6 to 1.0 cm                                                  $90.00
      11422   lesion diameter 1.1 to 2.0 cm                                                $100.00
      11423   lesion diameter 2.1 to 3.0 cm                                                $115.00
      11424   lesion diameter 3.1 to 4.0 cm                                                $130.00
      11426   lesion diameter over 4.0 cm                                                  $175.00
      11450   Excision for hidradenitis; axillary; with simple or intermediate repair       $95.00
      11470   Excision for hidradenitis; perianal, perineal, or umbilical;                 $110.00
              with simple or intermediate repair
      57500   Excision, cervix, biopsy or local excision, single or multiple                $55.00
      57505   Excision, endocervical cutterage                                              $70.00
      58100   Excision, endometrial sampling                                                $45.00
      57100   Excision, biopsy of vaginal mucosa, simple                                    $55.00
      56605   Excision, biopsy of vulva or perineum, one lesion                             $65.00
      56606      each separate additional lesion                                            $50.00
      57160   Fitting and insertion of pessary support device                               $50.00
      10060   Incision and drainage of abcess, simple, or single                            $60.00
      56420   Incision and drainage of Bartholin's gland abcess                             $60.00
      92567   Impedance Tympanometry                                                        $20.00
      98925   OMT - quantity 1-2 Body regions                                               $20.00
      98926   OMT - quantity 3-4 Body regions                                               $25.00
      98927   OMT - quantity 5-6 Body regions                                               $35.00
      78596   Pulmonary Function Study                                                     $205.00
      94640   Pulmo-Aid Nebulizer                                                           $25.00
      11200   Removal of skin tags, any area, up to and including 15 lesions                $45.00
      X0055   Suture Removal                                                                $15.00
      17000   Wart Removal/Destruction of Lesions = 1                                       $40.00
      17003   Wart Removal/Destruction of Lesions = 2-14                                    $10.00
                                                                                      Agenda Item 3c

INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE


Procedure
  Code         Explanation of Services                                                   FEE

      17004    Wart Removal/Destruction of Lesions = 15 plus                             $120.00
      17110    Destruct flat warts, molluscum contagiosumor milia, up to 14 lesions       $40.00
      17111    Destruct flat warts, molluscum contagiosumor milia, 15 plus lesions        $50.00
      86580    TB Skin Test                                                                $7.00
      16020    Dressing, burn                                                             $10.00
      76830    Ultrasound, diagnostic; echography, transvaginal                           $60.00
      36415    Venipucture, routine or finger/heel/ear stick for                           $5.00
               collection of specimen(s)

               Injections
      J1100    Decadron                                                                    $6.00
      J3301    Kanalog -10, -40                                                            $8.00
      J0696    Rocephin Injection 250 mg (each 250 mg. dosage)                            $13.00
      J2920    Solu-Medrol                                                                $10.00
      J3420    Vitamin B-12                                                                $7.00

               LEAD POISONING INVESTIGATION FEES
     300025    Initial Environment Assessment                                            $100.00
     300026    Follow-Up Environmental Visit                                             $100.00
     300027    Nursing Assessment/Education                                               $85.00

               MATERNAL AND INFANT SUPPORT SERVICES
       Z0001     Clinic                                                                   $80.00
 Z0004/Z0020     Home                                                                    $105.00
 Z0002/Z0022     Clinic                                                                   $75.00
 Z0003/Z0021     Home                                                                     $95.00
       Z0005   Education                                                                  $40.00

               PRENATAL FEES
      X4855    First Visit                                                                $75.00
      X4855    Revisit                                                                    $75.00
      X4854    Package Price                                                             $700.00
      59025    Fetal non-stress test                                                      $25.00
      76818    Fetal biophysical profile, with non-stress testing                         $65.00
      76815    Diagnostic Ultrasound, OB, limited                                         $55.00
      59430    Postpartum care only                                                       $85.00

               FAMILY PLANNING

               Office Visits
      89005    New Physical Exam (See preventative med. codes 99383-99387)                $50.00
      89027    Annual Physical  (See preventative med. codes 99393-99397                  $35.00
      89025    Medical Revisit  (See office procedure codes 99211-99213)                  $15.00
      89020    Counseling Visit (See preventative med. codes 99401-99402                  $10.00
      89049    Lab Only                                                                    $6.00
                                                  Agenda Item 3c


INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE


Procedure
  Code         Explanation of Services                             FEE
               Procedures
      57170    Diaphragm Fit                                        $14.00
      58300    IUD Insertion                                        $60.00
      58301    IUD Removal                                          $14.00
      11975    Norplant Insertion                                  $150.00
      11976    Norplant Removal                                    $150.00

               Laboratory
    85018QW    Hemoglobin                                            $5.00
               VDRL                                                  $5.00
       81002   Urinalysis                                            $3.00
       81000   Urine Micro                                           $3.00
    84703QW    Pregnancy Test                                        $6.00
       87210   Hanging drop/Micro                                    $5.00
               Cytology/Pap                                          $8.00

               Contraceptive Supplies
      Z8500    Birth Control Pills                                   $6.50
      Z8506    Plan B (Emergency Contraceptive)                          **
      Z8510    Diaphragm                                            $10.00
      Z8511    Condoms (Male)                                        $0.60
      Z8512    Condoms (Female)                                          **
      Z8513    Foam/Jelly/Cream/Film                                 $4.50
      Z8585    Lunelle Injection                                         **
      J7300    IUD                                                 $125.00
      A4260    Norplant                                            $400.00
               Vaginal Contraceptive Film                            $1.80
       J1055   Depo Provera                                         $30.00
               Sponge                                               $10.00

               Pharmaceutical Supplies
      Z8051    Amoxicillin, 250 mg.                                  $5.00
      Z8052    Amoxicillin, 500 mg.                                  $5.00
      89851    Ampicillin, 250 mg.                                   $5.00
      89852    Ampicillin, 500 mg.                                   $5.00
      89858    Bactrim                                               $5.00
      Z8060    Diflucan, 150 mg. 1 tab                                   **
      Z8061    Erythromycin, 250 mg.                                 $5.00
      Z8062    Erythromycin, 500 mg.                                 $7.00
      Z8092    Floxin 400 mg. (single dose)                          $5.00
               Floxin (14 day)                                      $45.00
      Z8090    Flagyl, 4 tabs                                            **
      Z8091    Flagyl (Metronidzaole) 14 tabs                        $7.00
               Gantricin                                            $10.00
               Gynazole                                             $20.00
      89862    Mycelex G Cream                                      $15.00
      Z8063    Keflex 250 mg                                         $7.00
      Z8064    Keflex 500 mg                                         $7.00
                                                                                                        Agenda Item 3c

INGHAM COUNTY HEALTH DEPARTMENT CLINICAL SERVICES FEE SCHEDULE


 Procedure
   Code                 Explanation of Services                                                              FEE

            Z8082       Monistat 7 inserts                                                                        $21.00
                        Macrodantin                                                                               $40.00
            Z8059       Probenecid 500 mg                                                                          $5.00
            J0696       Rocephin Injection 250 mg                                                                 $11.00
            Z8066       Suprax 400 mg. 1 cap                                                                           **
            Z8067       Suprax 400 mg. 10 caps                                                                         **
            Z8005       Terazol Cream                                                                             $14.00
            89850       Tetracycline 250 mg                                                                        $3.00
            89854       Tetracycline 500 mg                                                                        $3.00
            Z8070       TMP-SMZ-DS 28 tabs                                                                             **
            Z8076       Zithromax, 250 mg 6 caps                                                                       **
            Z8077       Zithromax, 1 gm    Suspension                                                                  **
            Z8074       Vibramycin (Doxycline)                                                                     $5.00



** No Medicaid Fee published yet, set fees to the next highest $5.00 increment when Medicaid fees are published




Update 6/28/01;7/02/01;7/05/01
                                                                                          Agenda Item 3d


RESOLUTION STAFF REVIEW                      DATE       July 9, 2001


Agenda Item Title      Resolution to Enhance the Staffing Levels and Services in the Children’s Special
                       Health Care Services Program


Submitted by           Health Department


Committees:            Ad.Ser/Per. * , H.S. * , Law & Cts. , Finance *


Summary of Proposed Action (see attached letter of explanation)
This resolution will authorize an expansion of services provided through the Health Department’s Children’s
Special Health Care Services Unit. The State of Michigan is proposing that the Unit expand services in two
areas: by providing nursing case management for families and professional oversight to staff giving care to
fragile ventilator dependent children and others who require hourly nursing care in the home, and by
completing assessments and developing Individualized Health Care Plans for children to be enrolled in one of
the two Special Health Plans contracted to serve the CSHCS population.

In order to provide the enhanced services, the County will have to establish a new full-time Public Health
Nurse I position and a new 3/4 time Community Health Representative II position. Program related
computer equipment and office furniture and equipment will also have to be purchased through these funds.




Financial Implications
The State of Michigan will compensate the County directly for the intensive case management services
through the existing CPBC Agreement. The two Special Health Plans (Children’s Choice of Michigan and
Kid’s Care of Michigan) will compensate the County for the development of Individual Health Care Plans
through the existing contracts with the County.

The total projected annual revenue from these two sources is $115,000 and the anticipated annual
expenditures are between $95,000 and $100,000.


Other Implications


Staff Recommendation: JA        JN *       HH
This resolution should be approved.
                                                                                              Agenda Item 3d

                                          MEMORANDUM


To:             Human Services Committee
                Administrative Services/Personnel Committee
                Finance Committee

From:           Bruce Bragg

Date:           July 17, 2001

Subject:        Recommendation to Authorize Expanded Children’s Special Health Care Services

This is a recommendation to expand services provided through the Health Department’s Children’s Special
Health Care Services Unit. The CSHCS unit has provided outreach and enrollment services for many years.
The State of Michigan is proposing that the Unit expand services in two areas: by providing nursing case
management for families and professional oversight to staff giving care to fragile ventilator dependent children
and others who require hourly nursing care in the home, and by completing assessments and developing
Individualized Health Care Plans for children to be enrolled in one of the two Special Health Plans
contracted to serve the CSHCS population.

The State of Michigan will compensate the County directly for the intensive case management services to the
very vulnerable children through the existing CPBC Agreement. The two Special Health Plans (Children’s
Choice of Michigan and Kid’s Care of Michigan) will compensate the County for the development of
Individual Health Care Plans through the existing contracts with the County.

The total projected annual revenue from these two sources is $115,000 and the anticipated annual
expenditures are between $95,000 and $100,000.

In order to provide the enhanced services, the County will have to establish a new full-time Public Health
Nurse I position and a new 3/4 time Community Health Representative II position. Computer equipment
and office furniture and equipment will also have to be purchased.

I am recommending that the Board of Commissioners adopt the attached resolution and authorize the
expansion in the Children’s Special Health Care Services Program.

Attachment

cc:     Anita Turner w/attachment
        John Jacobs w/attachment
        Bruce Miller w/attachment
                                                                                             Agenda Item 3d

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

                         INGHAM COUNTY BOARD OF COMMISSIONERS

       RESOLUTION TO ENHANCE THE STAFFING LEVELS AND SERVICES IN THE
            CHILDREN’S SPECIAL HEALTH CARE SERVICES PROGRAM

WHEREAS, the State of Michigan operated the Children’s Special Health Care Services Program to assure
access, coordinate the care of and to pay for the care of Michigan children with special health care needs;
and

WHEREAS, the State contracts with local health departments to provide outreach and coordination and
case management services for eligible and enrolled children and families; and

WHEREAS, the State is proposing that local health departments assume responsibilities for assessing each
child enrolled in one of the two Special Health Plans under contract with the State and developing an
Individual Health Care Plan; and

WHEREAS, the State is proposing that local health departments assume responsibility for the coordination
of care for a set of fragile children (e.g. children on ventilators); and

WHEREAS, the State of Michigan, and the two Special Health Plans (Children’s Choice of Michigan and
Kid’s Care of Michigan) will pay Ingham County through existing contracts for the cost of the enhanced
services; and

WHEREAS, the Health Officer has recommended that the Board of Commissioners authorize the Health
Department to initiate the enhanced services to families of children with special health care needs, and has
advised that the revenue generated from services will fully pay for the additional resources required to
provide the enhanced services.

THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners authorizes the Health
Department to enhance the services provided through the Children’s Special Health Care Services Program
to provide case management services to families and professional oversight to staff giving care to fragile
ventilator dependent children and others who require certain hourly nursing care in the home.

BE IT FURTHER RESOLVED, that the Board of Commissioners authorizes the Health Department to
accept referrals from Children’s Choice of Michigan and Kid’s Care of Michigan to assess children and to
develop an Individual Health Care plan upon enrollment and then annually thereafter, with such care plan to
serve as a tool for referral and authorization of appropriate health/medical care.

BE IT FURTHER RESOLVED, that a full-time Public Health Nurse I position (ICEA Nursing N2) be
established effective September 1, 2001.
                                                                                        Agenda Item 3d

BE IT FURTHER RESOLVED, that a three-quarter time Community Health Representative II position
(UAW TOPS D) be established effective September 1, 2001.

BE IT FURTHER RESOLVED, that the MIS Director is authorized to expend up to $4,000 to purchase
computer equipment and software to support the implementation of the enhanced services for children with
special health care needs.

BE IT FURTHER RESOLVED, that the Controller is authorized to adjust the Health Department’s 2001
and 2002 budgets in order to implement this resolution.
                                                                                            Agenda Item 3d
RESOLUTION STAFF REVIEW                       DATE      July 9, 2001


Agenda Item Title       Resolution to Authorize Administrative Services Agreements with Nonprofit Health
                        Care Corporations in Other Counties

Submitted by            Health Department

Committees:             Ad.Ser/Per. * , H.S. * , Law & Cts. , Finance *


Summary of Proposed Action (see attached letter of explanation)
This resolution will authorize agreements with nonprofit corporations in other communities in Michigan to
provide assistance to them in the operation of health benefit plans for low-income, uninsured persons. As
previously discussed with the Human Services Committee, the Ingham County Health Department has
provided administrative support services to the Ingham Health Plan Corporation since its formation in 1998,
these unique skills and experiences are in demand in other communities. The specific set of services to be
provided to each new corporation will probably be unique, but each set of services will be a subset of those
services described in “The General Scope of Services for Agreements” statement attached to this
memorandum.

The Department proposes to create a Division of Health Plan Management within the Bureau of Community
Health Services. The role and function of two existing positions will be changed and three new positions will
be established.

Financial Implications
The Midland Health Plan Corporation and the Kalamazoo Health Plan Corporation have already offered to
purchase services from Ingham County. We expect other counties to extend such offers within a few
months.

The contracts with Kalamazoo and Midland will include one-time payments of $15,000 and additional
payments based on the enrollment in their respective health plans. This up-front $30,000 revenue will
support the cost of purchasing computers and the salary and fringes for those employees who start
employment prior to October 1, 2001. The capitated payments, which will begin in October 2001, will be
approximately $5 per month for each person enrolled in one of the health plans. We expect enrollment to
build slowly. During FY 2002, we anticipate revenue of approximately $275,000 against expenditures of
about $175,000. By FY 2003 we expect that these contracts will result in $200,000 to $300,000 of
revenue in excess of related expenses.

Other Implications
The Human Resources Department has reviewed the positions undergoing change and has recommended
job titles and salary grades, which are reflected in the attached resolution.

Staff Recommendation: JA        JN *        HH
This resolution should be approved.
                                                                                               Agenda Item 3e
                                          MEMORANDUM


To:             Human Services Committee
                Administrative Services/Personnel Committee
                Finance Committee

From:           Bruce Bragg

Date:           July 17, 2001

Subject:        Recommendation to Authorize Administrative Support Services Agreements with Michigan
                Nonprofit Corporations Planning or Operating Health Benefit Programs For Low-Income,
                Uninsured Persons

This is a recommendation to authorize agreements with nonprofit corporations in other communities in
Michigan to provide assistance to them in the operation of health benefit plans for low-income, uninsured
persons. The Ingham County Health Department has provided administrative support services to the
Ingham Health Plan Corporation since its formation in 1998. The specific set of services to be provided to
each new corporation will probably be unique, but each set of services will be a subset of those services
described in “The General Scope of Services for Agreements” statement attached to this memorandum.

The Midland Health Plan Corporation and the Kalamazoo Health Plan Corporation have already offered to
purchase services from Ingham County. We expect other counties to extend such offers within a few
months.

This service will represent a new source of revenue in the future. Initially, the revenue will be necessary to
support the development of new resources, staff, computers, furniture, etc. However, by FY 2003 we
expect that these contracts will result in $200,000 to $300,000 of revenue in excess of related expenses.
This will be important as we struggle to find financial support to the many services provided through the
Department for low-income, uninsured persons, at the same time that we maintain responsible disease
control and environmental services and work with the community to identify the causes of health problems
and the development of strategies to improve the overall health of the community.

It will be necessary to implement a reorganization and to add some additional resources in order to provide
these services to other communities. The Department proposes to create a Division of Health Plan
Management within the Bureau of Community Health Services. The role and function of two existing
positions will be changed and three new positions will be established. The Human Resources Department
has reviewed the positions undergoing change and has recommended job titles and salary grades, which are
reflected in the attached resolution.

The contracts with Kalamazoo and Midland will include one-time payments of $15,000 and additional
payments based on the enrollment in their respective health plans. This up-front $30,000
                                                                                         Agenda Item 3e


revenue will support the cost of purchasing computers and the salary and fringes for those employees who
start employment prior to October 1, 2001. The capitated payments, which will begin in October 2001, will
be approximately $5 per month for each person enrolled in one of the health plans. We expect enrollment to
build slowly. During FY 2002, we anticipate revenue of approximately $275,000 against expenditures of
about $175,000.

Attached is a copy of a communication I presented to the Human Services and Finance Committees in May
2001 and the generic scope of services statement. Also attached is a resolution which will authorize the
contracts with non-profit corporations, the reorganization, budget adjustment, etc. I recommend that the
Board adopt the resolution and authorize the actions necessary to establish these services to other
communities.

Attachment

cc:    Bruce Miller w/attachments
       Laura Peterson w/attachments
       John Jacobs w/attachments
       Terri Younger w/attachments
       Jim Hudgins w/attachments
                                                                                           Agenda Item 3e



                                         MEMORANDUM


To:             Human Services Committee
                Finance Committee

From:           Bruce Bragg

Date:           April 4, 2001

Subject:        Contracts to Provide Administrative Support to Other Communities

This is a notification that Ingham County has been approached about the provision of administrative support
to other communities attempting to develop an organized system of health care to their uninsured population.

The Ingham Health Plan program now provides health plan coverage to 11,500 people in Ingham County
and plans are in development to add three new coverage options that will increase enrollment. Within the
next 18 months there will be sufficient options available so that the community can say no uninsured person
need go without access to an organized system of health care.

Other communities are beginning to work on plans to address the needs of their uninsured populations. Six
to eight communities are working on Ingham Health Plan-like programs and are at various stages of
development. The state of Michigan set aside $10 million in the FY 2001 budget from tobacco settlement
money to stimulate communities interested in implementing programs to cover uninsured people. There is
interest to increase that by $7 million in FY 2002. This will enable more communities to begin developmental
work. All of the communities will use mechanisms similar to Ingham County’s to finance and administer
basic health systems for low-income uninsured people, including those who are eligible for the State Medical
Plan.

Jay Rosen from Health Management Associates, Inc. (HMA), projects that within a few years between
100,000 - 200,000 people will be in programs like the Ingham Health Plan. HMA is working with six
communities to help them understand what is needed to develop programs like the Ingham Health Plan.
HMA is suggesting that these communities talk to Ingham County about the way in which the Ingham Health
Plan is administered. Representatives from three communities have met with staff from the Health
Department recently to learn how Ingham County supports the Ingham Health Plan Board by providing
outreach, enrollment and member services, and how we develop and/or maintain provider networks, carry
out case management services, adjudicate and pay claims and assist in formulary management. The
representatives from these communities have been very impressed with the operation of the Ingham Health
Plan. They have been very impressed with the automated systems that Ingham County has developed to
assist in program operation.
                                                                                                Agenda Item 3e


Representatives from Washtenaw County have asked us to develop a proposal to provide certain
administrative services under a contract with them. Midland County is also close to initiating services and is
interested in contracting with Ingham County for supportive services. We have also met with representatives
from Kalamazoo County; they also seem interested in contracting with Ingham County for these services.
We have been advised that Genesee County will approach us in the near future.

The Department already operates the Breast and Cervical Cancer Program in eight counties, so there is a
model to look at in contemplating how it would operate IHP-like programs for uninsured people in other
communities.

The Health Department already has some infrastructure in place and will be adding important pieces as it
implements the federally funded Community Access Program grant in 2001-2002. It should be cost-
effective to build on the foundation already laid. The revenue potential is significant and could be important
to the Health Department in future years. Revenue projections from the four counties that have expressed
interest could reach $1 million per year. The County would incur some additional costs to add capacity to
serve the additional communities, but it will be only a portion of the anticipated revenue.

In order to undertake these initiatives it will be necessary to add some staff, to invest in certain technological
enhancements and to reorganize some of the activities and staff in the Department. I expect to present a
specific proposal to the Board of Commissioners within the next two months. This communication is an
advance notice of the development of this work. Attached is a list of the set of services that the Health
Department will be prepared to provide to other communities. The exact relationship will likely differ
community by community.

Attachment

Bruce Miller w/attachment
John Jacobs w/attachment
                                                                                                 Agenda Item 3e

                         PROPOSED SCOPE OF SERVICES STATEMENT
                   Administrative Support Services to Community Health Plan Operations

1.   Program Support
     a. Provide quarterly enrollment and reports of certain services and costs

2.   Outreach and Enrollment
     a. Develop materials/manual for enrollees
     b. Enter enrollment data and maintain an enrollment roster
     c. Order and issue ID cards
     d. Transmit monthly rosters to local enrollment staff
     e. Coordinate the re-eligibility process with local enrollment staff
     f. Train local staff in performing enrollment, dis-enrollment and re-enrollment functions
     g. Provide consultation and advice to local staff in performing outreach
     h. Facilitate monthly roster updates for State Medical Plan enrollees

3.   Member Services
     a. Answer questions that come from members
     b. Refer complaints, concerns and grievances to appropriate staff
     c. Clarify coverages and member fees
     d. Start the process of making changes in member information in system

4.   Develop and/or maintain a provider network
     a. Facilitate development contracts for primary care, specialty care, lab, x-ray and pharmacy services
     b. Develop provider manual, and keep it up-to-date with coverages authorized by the Board.
     c. Conduct training sessions with primary care providers
     d. Manage provider contracts and relationships
     e. Answer questions that come from providers
     f. Respond to complaints and concerns
     g. Clarify coverages and member eligibility
     h. Provide intervention when needed
     i. Provide monthly enrollment rosters to primary care providers/other providers
     j. Process monthly payment to providers and other vendors

5.   Case management services
     a. Coordinate Medicaid eligibility issues with members and F.I.A.
     b. Assign authorization numbers for specialty referrals
     c. Process exceptions for drugs not on formulary
     d. Respond to complaints, concerns and grievances
     e. Assist patients in transitional relationships
     f. Transfer members to new PCP’s at providers’ request
     g. Update the drug formulary at routine intervals
     h. Research requests for additions to the drug formulary
     i. Handle claims resolution disputes
                                                                                        Agenda Item 3e


6.   Other program management services
      a. Adjudicate and pay claims
      b. Assist HMA in formulary management
      c. Maintain a toll-free 1-800 number for providers and members
      d. Maintain physician and provider site information for P.B.M. purposes
      e. Follow up on P.M. problems and issues
      f. Maintain and update the case management and enrollment databases
      g. Perform data backups
      h. Generate utilization reports
      i. Update and maintain Medicaid fee screens used to reimburse certain providers
      j. Train staff on use of data system
      k. Develop and maintain website including on-line enrollment and verification
          of patient eligibility
                                                                                            Agenda Item 3e


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

                         INGHAM COUNTY BOARD OF COMMISSIONERS

   RESOLUTION TO AUTHORIZE ADMINISTRATIVE SERVICES AGREEMENTS WITH
        NONPROFIT HEALTH CARE CORPORATIONS IN OTHER COUNTIES

WHEREAS, the Ingham County Health Department has provided administrative support services to the
Ingham Health Plan Corporation since its creation in May 1998; and

WHEREAS, those services include general staff support to the operation of the Board of Directors,
outreach and enrollment, member services, provider network development and maintenance, claims
adjudication and payment, case management and other program management services; and

WHEREAS, other counties in Michigan are developing health benefit programs for low-income, uninsured
persons, modeled on the Ingham Health Plan; and

WHEREAS, some other communities have approached Ingham County to provide administrative support to
their health plan corporations; and

WHEREAS, the Health Officer has recommended that the Board of Commissioners authorize agreements
with nonprofit corporations planning or operating health benefit programs similar to the Ingham Health Plan,
through which the Ingham County Health Department will provide administrative support services.

THEREFORE BE IT RESOLVED, that the Ingham County Board of Commissioners authorizes
administrative supportive services agreements with Michigan nonprofit corporations planning or operating
health benefit programs for low-income, uninsured persons.

BE IT FURTHER RESOLVED, that Ingham County shall make available through the Ingham County
Health Department the following types of services: Outreach and Enrollment, Member Services,
Development and Maintenance of a Provider Network, Adjudication and Payment of Provider Claims,
Case Management Services and Program Management Services.

BE IT FURTHER RESOLVED, that the compensation from the nonprofit corporations shall fully
compensate Ingham County for the cost of the services to be provided.

BE IT FURTHER RESOLVED, that a reorganization is authorized within the Health Department to create a
Division of Health Plan Management within the Bureau of Community Health Services.

BE IT FURTHER RESOLVED, that a full-time Account Clerk-Health Department position (UAW TOPS
D) be established, effective October 1, 2001.
                                                                                           Agenda Item 3e


BE IT FURTHER RESOLVED, that a full-time Secretary-Health Department position (UAW TOPS D) be
established, effective August 1, 2001.

BE IT FURTHER RESOLVED, that a Senior Public Health Nurse position (ICEA Nursing N4) be
established, effective September 1, 2001.

BE IT FURTHER RESOLVED, that position number HLHCAN001, Health Programs Manager (MCF-
11) shall be reclassified to Director of Health Plan Management Services, (MCF-12).

BE IT FURTHER RESOLVED, that position number HLHADM018, Systems Analyst/Health has been
evaluated by the Human Resources Department and while additional duties are assigned, the position, which
was established at the ICEA Prof 10 level because of market through the Rye Study, shall remain at the
ICEA Prof 10 salary level.

BE IT FURTHER RESOLVED, that the MIS Director is authorized to purchase computer equipment and
software not to exceed $5,000 to support activities related to this resolution.

BE IT FURTHER RESOLVED, that the Purchasing Director is authorized to expend up to $10,000 to
purchase office equipment and furniture to implement this resolution.

BE IT FURTHER RESOLVED, that the Controller is authorized to adjust the Health Department’s 2001
budget by increasing revenues and expenditures by $30,000 and making adjustments to individual line items
necessary to implement this resolution and initiate services to the Midland Health Plan Corporation and the
Kalamazoo Health Plan Corporation.

BE IT FURTHER RESOLVED, that the Board Chairperson is authorized to sign agreements with nonprofit
corporations after review by the County Attorney.
                                                                                            Agenda Item 4
                                 INGHAM COUNTY CONTROLLER

Gerald W. Ambrose                                                                             John L. Neilsen
Controller                                                                                  Deputy Controller
Phone (517) 676-7206                                                                      Phone (517) 676-7211
FAX (517) 676-7306



County Courthouse
P.O. Box 319
Mason, Michigan 48854




TO:       Board of Commissioners

FROM: John L. Neilsen

DATE: June 20, 2001

Attached you will find some additional information regarding the proposed Regulation Eliminating Smoking in
Public and Private Workplaces and amendment to the Ingham County Clean Air Regulation to Restrict
Smoking in Restaurants and Bars.

1.    Technical Amendments as proposed by John Veenstra;

2.    Smoking Bans in Restaurant & Bars and in Workplaces & Public Places in Michigan: The Marquette
      Decision; this is a Smoke-Free Environments Law Project from The Center for Social Gerontology, Inc.

3.    Regulation to Control Air Contamination by Tobacco Use in Restaurants and Bars - Draft #2 as proposed
      by Mark Grebner (6-10-01).

The Chairperson, John Czarnecki wanted you to have this information. In addition, the Human Services
Committee at their 6-18-01 meeting proposed the establishment of a task force to review all three versions of
the proposed ETS regulations with respect to the legal status, practicality, public health impacts, impact on
business community, time frames for implementation, etc.

Proposed representatives on the task force include:
Mark Grebner, Lisa Dedden, Victor Celentino
2 members of the County Hospitality Industry
1 member - Board of Health
1 member - Health Department
Corporation Counsel
1 additional citizen

If you should have any questions, please feel free to contact me.

c:    Bruce Bragg, Health Department
      Bob Glandon, Health Department

								
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