Advisory Sub Committee
Archived Minutes
Meeting Minutes - October 8, 2004
(via Met-Net)
Attendees: Mary Anne Guggenheim, Jerry Eichner, Maureen Leo, Betsy Erickson, Sylvia Danforth, Marian Kummer, Lori Byron, Laura Nicholson, Theresa Gruby, Mary Noel, Marylynn Donnelly, BJ Archambault
Introductions
Meeting called to order by Mary Anne Guggenheim, Chairperson, from the Helena METNET Site. Introductions from Great Falls, Miles City, Missoula, Billings, and Helena were accomplished. Minutes for the 4-16-04 meeting were approved as written.
Program Updates
1. Regional Clinics
a. Ellen Carey-Missoula
Pulmonary Clinic increased from one clinic to 2
JRA Clinic started Feb 04
Rest of the clinics stable
Endocrine Clinic is the exception; see16-20 children per day with Dr Swinyard , 8 a.m. to 7 p.m. during a 6-day period three times a year.
Diabetics are triaged out to other providers. But the endocrine need still exceeds current endocrine clinic capacity. Dr. Swinyard's billing is done by CMC billing dept. (CMC had to go to pager to handle the numbers). Endocrine clinics break even-1/3rd of cost borne by CSHS and CMC provides the rest.
New supervisor starts in March, Deb Weatherwelt will be the Director of Women and Children's, and Jan Perry Vice President.
Grants were denied.
PLUK has requested space to expand services in the Western part of the state.
Need peds gastroenterology, and developmental peds clinics
b. Cyndi Leaphart-Billings
Reported Stephanie Majerus was her new supervisor. According to St. Vincent's their specialty clinics had a deficit of $300,000.
They have retained 13 of their 15 clinics; lost muscular dystrophy, the adults are being seen at Deaconess and also lost 2 times per year diabetes clinics.
Dr Kappy added one clinic, as did Dr Narkowicz, and he has telemedicine available
NICU clinic, and feeding clinic are awaiting administrative approval.
Dr. Laura Nicholson plans to bill for her clinic, as does Dr. Schleshinger currently with JRA clinic, Dr Eichner with pulmonary, and Shodair with genetics do currently. However, in neural tube defects clinics the providers each bill their time seperately.
A question was asked how doctors are paid to which Ellen volunteered they received per diem, lodging and costs.
Cyndi stated the doctors are paid a set fee, per diem, airline costs, mileage from Denver airport , parking and lodging.
2. CHIP-Mary Noel
Capped enrollment at 10,900 and approximately 251 on the waiting list.
BCBS contract in process, hope to sign it next Fri. Quite sure there will be no increased premium. Asking BCBS to cover mental health visit for child and parent(s). CHIP has initiated its new computer system- lots of bugs.
The Medicaid Redesign is talking now about raising Medicaid eligibility rather than expanding CHIP eligibility.
3. Financial report-Mary Noel
CSHS Budget- slightly overspent: $14,000 from Federal Fiscal Year (Oct. 1, 2003-Sept. 30, 2004); anticipate no more than 2% shown on budget sheet.
Budget notes: (see included budget sheet) top half of budget sheet is the infrastructure costs, bottom is service costs, including the free clinics served by staff Michele O'Donnell, Marylynn Donnelly and BJ Archambault.
4. CSHS program director status-Mary Noel
Barb Smith resigned in August to accept a position of fiscal analyst with the legislature.
Her has position not been filled in order to take advantage of vacancy savings and will wait until some time after the legislative session.
5. CATCH grant update-Marian Kummer
Wolf Point-Dr Zilkoski will work with staff, then results will be compared with Billings site
Focus Group Meetings: Peggy Eggen states she attended the Billings area parent focus group. Parents discussed frustration with difficulty identifying all the resources out there, even in Billings.
Laura Nicholson noted there is a website for resources in Yellowstone Co., probably a link with PLUK, also.
Another parent-identified problem was coordination of school and health services, parents say schools not doing their part.
Focus Group meetings planned for November 4 & 5th in Wolf Point-one for nurses, one with community providers: Medicaid, occupational, physical and speech therapy, Hi-Line Homes (Part C), and one with parents. Christine Pydo is the facilitator.
6. Electronic interface project-Marylynn Donnelly.
Cost $80,000 with a portion due to be reimbursed through SSDI and SSI.
A portion is 2003 cost over-run.
Budget is $56,000 for both years.
Link with SSI is being worked on, have three other links on board.
Montana School for the Deaf and Blind paid for and was provided with a link to the CHRIS database allow federally required client tracking
Newborn Hearing Screening Program needs an updated tracking mechanism for follow up of newborns failing their hearing screening at birth. Currently the hospitals send their information by disk to be downloaded into Hi-Trac. It is apparent follow up hearing screening results are not being submitted to Hi-Trac
Mental Health is interested in tracking also. Mental Health reports referrals down. However, in reviewing the SSI referrals, a large percentage of the child applicants need mental health services
Cost allocation is to the various programs/agencies to support the linkage development.
7. Website development-Mary Noel
Michele O'Donnell has developed the information for the website, but there has been a problem getting the needed technical support since the most recent reorganization.
8. Metabolic services
Mary Musil does not wish to renew her contract, needs full-time work. Cyndi Leaphart thinks she has located a registered dietitian interested in learning to provide the metabolic nutrition management. Scoshy Allen, R.D. continues to provide services for the western part of the state.
Report of the sub-committee re: Guidelines for Specialty Providers
Lori Byron reviewed the proposed guidelines and criteria to be met as it relates to direct CSHS support of PSP.
Generally the peds specialty physician does not supplant the primary care provider. Fred Gunville is probably an exception in Billings area; family may stay with him and not go back to PCP in the local area
Lori Byron will take the proposal, tweak it a bit, then the proposal will be sent out to the Advisory Council for final vote.
Review of overall clinical program- Mary Noel/Mary Anne Guggenheim
Marylynn presented information about the number of children attending the various clinic types and receiving services. For the next Advisory Council meeting data regarding the following elements has been requested:
Number of children served by statewide clinics and those who receive direct services (payment for services, meds, etc., enrolled in CSHS)
MAG would like to see a breakdown by geographic location of family and type of medical problem
Discussion of future directions:
Billing at clinics: Currently cleft and metabolic are the only two state staffed clinics not billing at this time.
Question: Are there gaps in specialty services. Orthopedic/musculo-skeletal may be an area, though we are aware of only 6 children served by CSHS going to Shriners clinic.
Question: Are kids living in the Great Falls catchment area underserved. Jerry Eichner thought not underserved but would be helpful to have a CSHS pediatric specialty site located in Great Fall. Compared to Helena and Havre, his pulmonary clinics are better organized and have a place for clinics to occur. Space in Helena and Havre dependent upon a provider being gone to find a space for clinic.
Patient satisfaction survey suggested.
National Cleft lip/ Palate Association has been working on developing a billing code for multidisciplinary clinics.
Ellen Carey and Cyndi Leaphart provide case management services to families coming to clinics by assuring families have payment for services, and transportation to clinic as well as other coordination and management services, which may billable to Medicaid.
Question: Is CSHS providing services of low priority. Mo Leo offered some of the CL/P services for her youngster were duplicative or not needed in her eyes.
Committee business
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Resignation of Marian Kummer, M.D. from Vice-Chair of the Advisory Council. She is the current chairperson of the Montana Academy of Pediatrics.
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Nomination and election of new Vice-Chair. Peggy Schlesinger nominated Laura Nicholson as the new Vice Chair. She was unanimously confirmed.
New business/information/ discussion
Addition of newborn hearing screening and follow up to CSHS program. Barb Smith signed an MOA with Jo Ann Dotson's Bureau to do follow up on the newborns failing their initial screening to assure a return for re-screening. Ellen and Marian stated the onus is with the hospital to see the infant returns. The main problem is the reporting done in the HI TRAC system does not have the newborn's name or the physician listed or complete enough information to do follow up.
Both newborn screening follow up and newborn hearing screening are unfunded mandates.
Betsy Erickson reminded staff she needs hard copy of the minutes and notification of the meetings.
Meeting adjourned.
Next meeting: May 6, 2005
METNET or travel to Billings?
