MINUTES OF THE
DUKES COUNTY HEALTH COUNCIL
Regular Meeting of October 24, 2002
I certify that to the best of my ability to record and recall, these are the Minutes of the Regular Meeting of the Dukes County Health Council held on October 24, 2002.
Meeting began at 8:05 a.m.
Members Present:
*Ex Officio
Jo Ann Murphy Jacque Cage
Tad Crawford Sandra Lothrop
Marni Lipke Charles Silberstein
Melinda Loberg Ned Robinson-Lynch
Chris Knowles Kathy Logue
Peter Strock (8:15 AM) Carol Borer*
Cathy Brennan Lorna Andrade
Kathleen Fitzgibbon Joyce Steward
Fred Rundlet Robert Sawyer
Kathleen Rose William Elbow
Jane Cleare Ilene Klein
Also Present: Marsha Smolev, Noreen Flanders (County Treasurer), Dan
Greenberg, Woody Williams, Mary Leddy, Diane Becker (9:05 AM)
Absent: Michele Lazerow Else Membreno Marguerite Bergstrom Dan Seklecki
Michelliny Faust Tim Walsh
Sarah Isenberg Dennis Hoak
Sarah Kuh *
The next meetings will be held on November 21, and December 19, 2002. Kathy Logue Moved that the Minutes of September 26, 2002 be Approved as written. Charlie Silberstein Seconded the Motion. The Vote to Approve the Minutes was Unanimous.
Tad Crawford reported that there were almost two years of Draft Minutes needing approval. Kathy Logue Moved that all the Draft Minutes of 2001 and 2002 be Approved as Written. Joyce Steward Seconded the Motion. The outstanding Draft Minutes were as a unit Approved. Ned Robinson-Lynch Abstained from the Vote.
Tad Crawford proposed a list of people to serve on the Interim Coordinating Committee:
Tad Crawford – Chair
Ilene Klein – Vice Chair
Jacque Cage – Secretary
Kathy Logue – Treasurer
Jane Cleare Moved that this list of people be Approved to serve on the Interim Coordinating Committee until such time that new members are appointed and the Coordinating Committee can be elected. Bob Sawyer Seconded the Motion. The Vote to Pass the Motion was Unanimous.
Charlie Silberstein Moved that the Health Council voice its gratitude to the people willing to put in time on this Interim Coordinating Committee. Bob Sawyer Seconded the Motion that Passed Unanimously.
Tad Crawford said he would be meeting with County Treasurer Noreen Flanders to do a formal accounting Grant by Grant. Fred Rundlet asked that future Treasurer’s Reports indicated the deadline that Grants terminate. Lorna Andrade Moved to Accept the Treasurer’s Report. Kathy Logue Seconded the Motion that Passed Unanimously.
Noreen Flanders reported to the Council on the County’s Budget process, and accounting procedures and policies (see attached report.) The Council members expressed gratitude for the clear and informative presentation.
Fred Rundlet asked the County Treasurer to provide Council members with a Budget timetable, so they could plan better and ‘feed into the process.’ He also asked whether anyone had ever analyzed the total funds that the State of Massachusetts derives from the Vineyard compared to funds that come back to the Vineyard. Treasurer Flanders agreed that could be done. There was some discussion about moving money between line items. Ned Robinson-Lynch reminded Council members that movement depended on funding source agreements and restrictions. Noreen Flanders completed her presentation and left at 8:44 AM.
Ned Robinson-Lynch reported on the Retreat planned to begin in the afternoon of November 20, 4 – 8 PM and to continue the following morning at the Health Council meeting November 21, 8 - noon. Pot luck supper would be included on the 20th. Fred Rundlet was hoping that Tom Wolfe would agree to facilitate the Retreat. At the Retreat, Chris Knowles would review the history of the Health Council. Tad Crawford was collecting historical Health Council documents to be distributed.
Ned Robinson-Lynch said there were 3 categories discussed with the facilitator:
· Identity, mission, values
· Relationships with others (Foundation for Island Health, Island Health Plan, County, Lighthouse Alliance, community, practitioners…)
· Objectives (concrete projects, activities, partnerships)
Discussion followed about input for the Retreat, collecting documents, asking agencies, etc., for mission statements. Jane Cleare asked that the original document from John Knight be included. Fred Rundlet Moved that the dates proposed, the facilitator, and the outline of subjects, be pursued. Kathy Logue Seconded the Motion. The Vote to Pass the Motion was Unanimous.
Ned Robinson-Lynch asked that appreciation for Tad Crawford’s commitment to the Health Council be mentioned in the Minutes. The fee for Tom Wolfe is $1500. Ned Robinson-Lynch thanked Tad Crawford for making $1000 available through the Mobile Foundation.
Diane Becker, Director of Health Promotion at Johns’ Hopkins, and Coordinator of the Island-wide Needs Analysis, arrived at 9:05 AM.
Kathy Logue mentioned that the Data and Funding Committee needed help and should perhaps be separated into two Committees. Fred Rundlet said that Health and Human Services Coordinators in Boston were looking at what was going on Martha’s Vineyard. He said he believed the different groups seeking funding needed coordination.
Mary Leddy spoke for the Access Program and asked how a Brazilian childbirth educator could be brought onboard. Ilene Klein suggested that she speak with the nurse manager of Obstetrics at the Hospital.
Peter Strock reported that the Dental Program was still looking for a dentist. Jacque Cage reported that the Geriatric and Substance Abuse Committee was connecting with the Lighthouse Alliance regarding Mental Health and that the Geriatric Care Committee was working on its survey about accessing the system. Kathy Logue Moved that the Health Council support moving ahead with the Geriatric Care Access Survey. Jane Cleare Seconded the Motion. The Vote to Pass the Motion was Unanimous.
Marni Lipke reported that the Chronic Illness Network was partnering with Island Parents for a phone line and moving ahead seeking Grants. Charlie Silberstein reported that the Prevention and Wellness Committee was working on its Health Matrix, planning Grand Rounds, and meeting regarding Youth Health Initiatives. A Retreat was being planned on Youth Health Initiatives, so people could find out what others were doing and coordinate efforts. Peter Strock noted that churches were active on these issues in the South. It was not clear if they were included in the group working on Youth Health Initiatives.
Charlie Silberstein reported that the Foundation for Island Health had a Retreat 3 weeks ago at which the Mission was reworked. The goal was to promote the health care movement and find a common union, to find health care for ALL on the Island, but to be ‘transparent’ to other groups in the process. Currently, the FIH was focusing on sending a Mission statement to the Health Council so they could impact its direction and finding a replacement for Carol Cohen and Pam Putney.
Ilene Klein described the Scientific Program, now called the Program Committee. She explained the need for information technology to facilitate communication in the health network. She stressed the focus was getting things done, not who did them. There are several projects in the Program Committee:
· Health network – Dr. Becker’s model for the framework for how to work together (Fred Rundlet is also working on this.)
· Youth Initiative – focus on alcoholism and substance abuse, have a summit meeting, find champions
· Coordination of care – need portable medical records, coordinating year-round and season residents on and off Island, include Wellness, Geriatric, Chronic Care Committees
· Institutional Review Board – necessary for Federal funding
· Vision for an advisory group – to look at proposals and give feedback
· Symposium Committee – to have year-round symposia
Dr. Becker, Subcommittee Chair of the Program Committee, was introduced. Dr. Becker said her work was to define the status of health on Martha’s Vineyard, from a scientific point of view, thus, statistically. Dr. Becker explained that while many studies were in existence, many important pieces were missing. Two important notes: Vineyard residents are extremely healthy, and the leading cause of death on the Island was, surprisingly, lung cancer. Dr. Becker was taking this project on pro bono. Tad Crawford thanked Dr. Becker for giving the Island this extraordinary opportunity. He mentioned that contributors would be needed to get the job done, that despite Dr. Becker’s personal contribution, the real cost of a project like this would be between $25,000 and $50,000.
Mental Health is to be included in the project.
Kathy Logue Moved to adjourn. Bob Sawyer Seconded the Motion.
The meeting adjourned at 10:02 AM.
Notes for Health Council Meeting
West Tisbury Fire Station
Thursday, October 24, 2002
8:00 am
The Health Council’s activities encompass many sources of revenue for its programs. It is important to understand that only authorized expenses can be deducted from a particular source of revenue. In that regard, we have set up a County Grant Policy with the assistance of our auditors.
Sources of Revenue
County appropriations are part of the budget or supplemental budget. The access program’s administrator’s salary is by county appropriation as was the funding for JSI. Therefore, the only expenses that are paid from Dept. 1500, are Sarah’s salary and benefits. Even if there is excess appropriation, it cannot be used for anything other than what it was appropriated for. This is carried forward into the next fiscal year only if a contract has not been completed in the current fiscal year.
Annual Budget- County Manager distributes forms that I have prepared. Sometime in January a department head meeting is called where the guidelines for the next fiscal year are discussed (i.e. no capital expense, no COLA’s) and the deadline for preliminary budget submission is given. Once all departments have submitted their budgets, the county manager and I put together the first round of numbers. We look at anticipated revenue and requested expense to see where it stands. Always, requested expense exceeds revenue. The manager starts to meet with department heads to see where they feel they can reduce expenses. After those meetings, another round of numbers are put together. If the budget is not balanced at that time, the manager begins to review revenue and reduce budgets. This
continues until a balance is reached. At that time the County Commissioners get a copy of the budget to review at a public meeting. When the Commissioners agree with the budget, it is published for the public hearing before the County Advisory Board ( one selectman from each town). After the public has input the Advisory Board decides on the final budget. They have the final word before it goes to the Department of Revenue before the County Finance Review Board. Usually, the DOR will call me and review each budget for changes and/or inconsistencies with other counties before the County Finance Review Board meets. Until the budget is approved, no salaries can be increased or capital expenses made. We are on what we call a 1/12th budget. We can spend in any month, only what we spent in the year previous, minus any capital expenses. When the budget is approved usually sometime after July 1, it is business as usual.
Supplemental budget- Once or twice during the year after the audit has been completed and we know what the Unreserved Fund Balance (free cash) is, the county manger will inform department heads that we are anticipating a supplemental budget meeting on a particular day. Recently this has been when a cost of living adjustment for employees is approved, when capital expenses can be reviewed and the funding of special projects. . A deadline for requests is given. When the deadline has come, all requests are put together and prioritized. Discussion with department heads begins again and when the manager is satisfied with the amount of free cash to be spent (always leaving a balance for the next fiscal year and emergencies) the County Commissioners receive a copy for review at their meeting.
The Advisory Board calls a meeting, reviews the requests and votes. (NOTE: These meetings are not frequent!! Usually one in the fall and one in June at the close of the fiscal year.) Again they have the final word about what to send to the DOR. The process is the same as the annual budget with the DOR calling and reviewing the supplemental requests, and the County Finance Review Board having final approval.
Grants, as you know, are a process. Anyone can fill out the forms for a grant, but as it states in the County Charter and Grant Policy, as the Chief Executive Office of the County the County Manager must sign all grant applications. This will make the County the lead agency and checks will be payable to the County so that they may be deposited to the County’s account. We do not set up separate bank accounts for each department, agency or grant. We keep it separate in the general ledger by setting up different "Funds" depending on source of revenue. It also gives us the information we need to ensure that only the expenses that the grantor intended to cover are deducted from the funds when they arrive.~
Expenses
Expenses are paid twice monthly on a predetermined schedule. The entire county submits their bills on forms called warrants.
Whoever puts the warrant together for each department must understand (and keep track of) the source of revenue. They must give the fund or department number that the expense is coming from as well as the expense account number (telephone, office supplies, postage, etc.).
Another reason why all grant documents must be kept in the administration building is so I have the information to be sure that the money is being spent as the grantor intended. Also, when the auditors arrive, they "test" the expenses to be sure that we have complied with the terms of the grant application.
There are some expenses that are charged to departments on warrants that my office prepares. They include workers’ compensation, unemployment, liability and health insurances and overhead. Overhead is calculated according to the Cost Allocation Plan which was adopted by the County Commissioners in 2001. The basic premise is that funds other than 010 (County General Fund) have their revenue and expenses segregated. Therefore, although these funds receive the benefit of the county administration, they do not contribute to it unless it is allocated according to a fair plan and charged to those funds. The expenses included in the allocation are portions of the County manager’s assistant, the treasurer’s office, legal, audit and administration building expense. This overhead is allocated by # of
employees, "inches’ of invoices, time for general ledger and special reporting. If a department is the focus of a special audit, as the airport in FY01 and health council grants in FY02, they are charged with a share of the special audit costs.
In this regard, any departments that are funded by the county appropriations are not charged with overhead as they "share" in the reduction of unreserved fund balance by virtue of being part of that fund. Conversely, funds that only have specific income and expense charged to them, must share in the cost of administration.
I can provide copies of the Cost Allocation plan to anyone who would like one.
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