Advisory Sub Committee
Archived Minutes
Meeting Minutes - March 1, 2002
Helena,MT
Members Present: Mary Anne Guggenheim , Chairperson, Cyndi Leaphart RN, Dr. Marian Kummer, Michele Thibodeaux, Sylvia Danforth, Dr. Jack Haling, Dr. John O'Conner, Dr. Jim Reynolds
Members Excused: Debbie Christian, Dr. Annette Grefe, Kathleen Masis, Dr. Mark Wilgus
(Note that Dr. Jack Haling has replaced Dr. Mike Garver who resigned for personal reasons.)
The meeting was called to order at 10:05 AM by Chairperson Guggenheim
It was noted that minutes of the last meeting (October, 2001) were not received by some committee members. Those minutes and the minutes for this meeting will be sent and reviewed for committee acceptance at the next meeting.
A draft document (prepared by Mary Noel) relating to the purpose and composition of this committee was distributed and briefly discussed. The document is included with these minutes. Although this committee has been meeting for several years, its purpose and membership has never been formally defined. We plan to finalize this document at the next meeting. How and who decides on committee membership needs to be established so that the committee can optimally represent primary care and specialty providers, community representatives, families and patients (i.e.teenage) and other appropriate perspectives. The issue of selection and terms of leadership should also be defined. Comments on the draft document should be submitted to Mary Noel before May 1, 2002. (email: manoel@state.mt.us; fax: 444-2750; mail: PO box 202951, Helena, MT 59620)
Reports:
1. Sharon Wagner reported that legal review of the rules revisions resulted in the opinion that the list of covered conditions must be included in the actual published rules (not just in the working papers of CSHS). The rules are about ready for public notice.
2. Mary Noel reported on the administrative reorganization that has occurred. CSHS as an administrative unit will be physically moving to the 6th avenue building on March 4. All phone #'s, etc remain the same.
3. Mary Noel presented a financial statement for the first 4 months of FY 2002 (which began Oct 1, 2001). The committee asked to review actual expenditures at the completion of the fiscal year in order to consider recommendations for future budget plans and prioritization of expenditures as they relate to direct patient services.
4. Mary Noel gave an update on the CHIP program. It is currently full at its current allowable capacity of 9350 children. There are 203 children on the waiting list. The average time from application to being accepted into the CHIP program (an opening becoming available) is 6-8 weeks. Blue Cross/Blue Shield continues to carry the insurance for the program at a cost of $107.61 per child per month. Dental services are carried separately from the medical insurance program. Currently 219 dentists in the state are participating.
CSHCN performance measures were presented by Sharon Wagner. The document comparing Title V Grant performance measures and the proposed CSHS and Healthy People 2010 objectives were compared. The working document is attached to these minutes. The committee made several suggestions as each of the 6 draft proposals were discussed and will be incorporated as the document is developed further. Send comments on the performance measures to Sharon before May 1, 2002.
The CSHS Data base system (aka the "gold system") was presented over the lunch break by MaryLynn Donnelly who has been the lead person in its development. It has been 3 years in development. The presentation demonstrated a number of very useful aspects of the program: (1) client confidentiality is preserved, (2) extensive data about each client contact is available and can be assessed in a variety of interactive ways, (3) the regional clinics interface with the central program and all of the client data from those clinics is incorporated into the database, (4) it appears to be quite user-friendly. Data from 18,000 children who have had contact with the CSHS program since 1988 are currently in the database. Day by day contacts by staff are being entered. The committee was positively impressed with the database and thank all who worked to make it a reality.
The specific issue of qualifications of specialty providers was discussed. Current rules indicate that a specialty provider "must be either board eligible or board certified in the area of the specialty provided". After discussion the committee voted to add to the rules the following:
'be board-eligible or board-certified in the specialty for the condition being treated or working in cooperation with a physician who is. A health care provider who does not meet these qualifications may submit a curriculum vitae and request that the Advisory Committee approve him or her as a specialty provider.
'(section 37.57.117)
Maggie Bullock, Administrator of Health Policy Division, shared with the committee the current status of department work relative to the Executive planning process in preparation for the 2003 legislative session. Financial constraints are considerable and entitlement programs such as Medicaid are substantially over budget this fiscal year. The combination is challenging, to say the least. Several health care planning efforts either have occurred or will in the near future. The administrative goals of "increasing coverage for the nearly 20% of people in Montana currently without coverage for health care" and "reducing, or at least not increasing, state expenditures for health care" seem to the committee a bit contradictory. We appreciate the hard work being done by Maggie and her colleagues.
The final committee discussion was a continuation of the general issue of specialty care clinics and CSHS-sponsored services that was initiated at the prior meeting. The general goal is to provide/facilitate appropriate medical services to all children with special health care needs, regardless of where they live in the state. Four general ways to increase current services were identified:
1. Increase covered medical conditions and/or increase financial limits for eligibility. (ie., to 225% of poverty level)
2. Facilitate the availability of specialty providers, both those who practice in state and those who come from other states. In addition to sponsoring travel and clinic sites for providers, CSHS could also help subsidize travel for clients, if that was a barrier to access. Explore the use of telemedicine in helping bring together a specialty provider, the primary health care professional (medical home) and the children/families who need services.
3. Diversify/increase the location of specialty clinics.
4. Develop ways to collect fees for client services (when deemed financially appropriate and feasible) so as to extend CSHS budgetary capabilities.
Dr. Haling discussed the specialty services currently available in Great Falls, none of which are well integrated into the CSHS menu or database. He will discuss this with his colleagues and look for ways to improve the situation. A 1999 list of specialty providers/clinics available to Montana families was distributed. We want to update this list. This discussion will be continued and is seen as one of the core ways that this committee can help the CSHS program.
Meeting adjourned at 2:45 PM.
Next meeting sometime in October 2002 - give us your input as to preferences.
