Minutes. Melanie Talbot, MIHS, Executive Director of Board Operations Cynthia Cornejo, MIHS, Assistant Clerk of the Board

Transcription

1 Minutes Maricopa County Special Health Care District Board of Directors Formal Meeting Maricopa Medical Center Auditoriums 1 and 2 February 26, :00 p.m. Present: Mary A. Harden, R.N., Chairman, District 1 Mark Dewane, Vice Chairman, District 2 Susan Gerard, Director District 3 arrived at 1:05 p.m. Elbert Bicknell, Director, District 4 Terence McMahon, Director, District 5 Others Present: Steve Purves, MIHS, President & Chief Executive Officer Bill Vanaskie, MIHS, Chief Operating Officer arrived at 1:55 p.m. Michael Ayres, MIHS, Chief Financial Officer Warren Whitney, MIHS, Chief External Affairs Officer Louis B. Gorman, MIHS, District Counsel Sherry Stotler, MIHS, Chief Nursing Officer Michael Peck, M.D., MIHS, Chief of Staff arrived at 1:02 p.m. Marshall Jones, MIHS, Vice President of Human Resources Susan Doria, MIHS, Vice President of Strategic Planning Guest Presenters: Bill Post, Bond Advisory Committee Chairman Mary Lee DeCoster, MIHS, Vice President of Revenue Cycle Cheri Tomlinson, MIHS, Vice President of Grants Michael Fronske, MIHS, Legislative and Governmental Affairs Director Dan Hobohm, M.D., MIHS, Vice President of Quality and Patient Outcomes Brian Maness, MIHS, Director of Contracts/Procurement Paul Dereadt, MIHS, Director of Purchasing and Supply Chain Management Kelly Summers, MIHS, Chief Information Officer Laurie Wood, MIHS, Vice President of Ambulatory and Physician Services Wilma Acosta, MIHS, Interim Chief Compliance Officer Recorded by: Melanie Talbot, MIHS, Executive Director of Board Operations Cynthia Cornejo, MIHS, Assistant Clerk of the Board Call to Order Chairman Harden called the meeting to order at 1:00 p.m. Roll Call Ms. Talbot called roll. Following roll call, it was noted that four of the five voting members of the Maricopa County were present, which represents a quorum. Director Gerard arrived shortly after roll call. Pledge of Allegiance The Pledge of Allegiance was led by staff from the Health Sciences Library department.

2 Call to the Public Chairman Harden called for public comment. There were no comments from the public. General Session, Presentation, Discussion and Action: 1. Department Spotlight Chairman Harden asked the representatives from the featured department, Health Sciences - Library, to introduce themselves, describe what they do and how long they have been at Maricopa Integrated Health System (MIHS). o o o o Rebecca Birr, Manager of the Library and Family Learning Centers, has worked for MIHS for nearly 14 years. April Aguinaga, Medical Librarian, has worked for MIHS for seven years. Deborah Richards, Library Assistant, has worked for MIHS for five years. Shirley Velazquez, Family Learning Center Coordinator, has worked for MIHS for a year and a half. Chairman Harden thanked the staff for their time and dedication to MIHS. 2. Discussion and Possible Action on Recommendations from the Bond Advisory Committee Mr. Post thanked the Board for the opportunity to present the results of the work completed by the Bond Advisory Committee (Committee). The Committee members focused their efforts on the needs of the community from a new perspective. He explained that over the past year, the Committee met in open, public meetings on a monthly basis, shared all the information presented on its website, held five additional public forums and met with numerous community and industry leaders on an individual basis. The conclusion of that effort is contained in the report recommended by the Committee. The report contains seven recommendations for the organization; including the growth of Graduate Medical Education (GME), expansion of the outpatient health clinics, increasing behavioral health capacity, building a right-size modern hospital, conducting an economic impact study, developing a bond proposal and communication plan, and creating collaborative community partnerships. The final recommendation from the Committee is for the Board to pursue bonding authority, not to exceed $935 million. It is also recommended that the Board perform due diligence in respect to specific projects and value engineering to uncover further cost refinements that can be achieved. Chairman Harden thanked Mr. Post for his leadership on the Committee, as well as Dr. Coor and the other members of the Committee. Director Gerard shared her appreciation for the quality of work completed by the Committee; the results exceeded the expectations set. Director Bicknell moved to formally acknowledge the receipt of and recognize the work of the Bond Advisory Committee written report. Vice Chairman Dewane seconded. Director Gerard clarified that the Board was accepting the report. This is the beginning of the process. The Board will review, discuss and make decisions prior to submitting ballot language. VOTE: Motion passed by voice vote. 2

3 3. Approval of Consent Agenda: a. Minutes: Approve Meeting Minutes dated: i. January 29, 2014 Formal ii. February 6, 2014 Special b. Contracts: i. Approve a new contract ( ) to the Intergovernmental Agreement with Maricopa County by and through the Ryan White Part A Program to continue to receive grant funding to provide the following services to patients eligible under Ryan White Part A: Outpatient Primary Medical Care, Mental Health Services, Substance Abuse Services, Medical Case Management/Early Intervention Services, and Oral Health Services. ii. Approve Amendment #1 to the agreement ( ) between United Audit Systems, Inc. (UASI) for outpatient medical coding services. iii. Approve Amendment #6 to the Provider Services Agreement ( ) between Maricopa County Special Health Cared District and District Medical Group to revise Exhibit B, Sections II, III, V, and VIII of the agreement c. Board Governance: i. Approve Amended and Restated Sub-operating Agreement between Southwest Center for HIV/AIDS, Inc. and Maricopa County Special Health Care District d. Medical Staff: i. Approve MIHS Medical Staff Appointments, FPPEs, Reappointments, Change of Privileges/Status, and Resignations for February 2014 ii. Approve MIHS Allied Health Professional Staff Appointments, FPPEs, Reappointments, and Resignations for February 2014 Vice Chairman Dewane moved to approve the consent agenda. Director McMahon seconded. Motion passed by voice vote. 4. Presentation on the Affordable Care Act (ACA) Project Ms. DeCoster said that because of the Affordable Care Act (ACA), uninsured individuals now have two options available for health insurance. The first option is to apply and be qualified for the expansion of the Medicaid program; the other option is to purchase health insurance through the federal marketplace. There is a particular interest for Arizona to have a successful open enrollment, as it is the only state in Medicare Region 9 with a federal marketplace. She stated MIHS has partnered with various vendors to reach out to the community, including Integrated Health Management Service (IHMS) to assist with the eligibility screening, Integrated Web Strategy (IWS) to create the website CoverMeAz.org, and other vendors to assist with marketing and outreach. 3

4 4. Presentation on the Affordable Care Act (ACA) Project, cont. Ms. DeCoster said that MIHS has also contracted with Meritus, a non-profit cooperative health plan, and with the University of Arizona health plan. Meritus has enrolled over 900 new members; compared to number of enrollees in the health plan for Pima, that is a quite an accomplishment. MIHS is proud to be a trendsetter and leader. She noted that Ms. Tomlinson was contacted by the Center for Medicare and Medicaid Services (CMS) and was asked to assist in the creation of a coalition focusing on open enrollment. As a result, Ms. Tomlinson is one of the founders of the Cover Arizona Coalition. She reviewed the governance structure, the in-reach and out-reach efforts, and the goals and objectives. A key objective was to not only capture the uninsured individuals and enroll them in an appropriate health plan, but to maintain the enrollment after the initial year. Ms. Tomlinson stated that there are several committees in place, all of which have a specific focus. The special populations committee focuses on five special populations and has successfully enrolled over 1,200 individuals in an appropriate health plan. The marketing and communication committee has done an outstanding job in getting the information out to the community; including the CoverMeAZ.org website; which was recognized by America s Essential Hospitals for the innovative and created strategy in reaching out to the community and showing that this service is available. As a result, MIHS is expecting to achieve the goal of enrolling 10,000 individuals by early April Also, according to the information received from CMS and Arizona Health Care Cost Containment System (AHCCCS), Arizona is ranked 15 out of 36 states that have the federal facilitated market place in the number of enrollments. Arizona is also one of the two states focused on expanding Medicaid and the marketplace simultaneously. She stated the success is due to the support from the Board and senior administration and the community is benefiting. 5. Discussion and Possible Action on Kronos Implementation, Change Order Requests, and Project Expansion Mr. Jones said that the Enterprise Application Suite (EAS) will implement a solution that will integrate financial management, analytics, supply chain, and human resources and payroll. He reviewed the timeline and milestones and noted that there are change orders being proposed. He stated that there is a need to extend the timeline by sixty days due to some challenges causing a delay. Mr. Jones stated that the original budget was $2.4 million; however, the organization change management component for $143,000 was omitted. There are four additional change orders, which require additional resources to continue the implementation, a total of $601,800. He noted that there were funds placed in the contingency budget for the project; however, not enough for the additional expense, so the project will utilize part of the MIHS capital contingency fund. He reviewed the return on investment, which is projected to result in an annual savings of $2.7 to $4.8 million. Director Gerard questioned the challenges encountered that caused the delay. Mr. Jones said that the interface for both Kronos and MIHS was not scaled properly. Vice Chairman Dewane asked if future issues should be anticipated due to the complexity of the project. Mr. Jones said that it was not anticipated. Chairman Harden referred to the projected annual savings and asked when those savings would be realized. Mr. Jones said some savings will be realized in early fiscal year The real substantive savings will be realized further down the road. 4

5 5. Discussion and Possible Action on Kronos Implementation, Change Order Requests, and Project Expansion, cont. Director McMahon asked if there was a reporting mechanism in place to demonstrate the actual savings and compare with the projected savings. Mr. Ayres said that there is a system in place and the information is provided to the Board upon request or at the completion of a project. Chairman Harden asked if the Board was being asked to approve the additional funds to further implement the EAS project. Mr. Purves said that the totality of the change order is over the approval authority of senior administration. He stated that senior administration is seeking authority to extend the contract and approval for the change orders. Director McMahon said should the Board not approve the extension, would the funds already spent be squandered. Mr. Jones said that would be the case. Mr. Purves directed Mr. Jones and Mr. Gorman to clarify what is requested from the Board and present at the end of the meeting. 6. Discussion and Possible Action on Maricopa Integrated Health System s 2014 Legislative Agenda and/or the District s Position Regarding Current or Proposed State and Federal Legislative Items Mr. Fronske reviewed the current statistics of the legislative session. He stated that with regard to the budget status, the major agency budgets, including the AHCCCS budget, had been heard in committee. There are also small working groups of legislators working on budget issues. He said that MIHS was in the process of exploring options to access additional Disproportionate Share Hospital (DSH) funding while working with AHCCCS to determine if there were funds not being utilized. He reviewed the bills that were being tracked by MIHS; SB 1035; the bill that would remove the mandated $5 million from Maricopa County for service delivery, has been amended since first presented. He noted that HB2234, which would have revoked the funding for the Medicaid expansion, appears to be dead. 7. Fiscal Year 2015 Budget Process Mr. Ayres stated that senior administration is recommending a significant change in the historical budgeting process; which would begin to forecast the projections for the next fifteen months now and create an annual budget. Due to the rate and magnitude of change in the healthcare industry, that becomes long range planning in the best of terms. Senior administration is planning on establishing a budget for the next fiscal year based on the strategic planning conducted with Navvis and amend the budget assumptions for areas that have a high order of magnitude and implications. Following this process, a detailed narrative of the operating plan will be provided and used as the budget for the year. Senior administration is proposing to budget every quarter, to monitor activities and adjust immediately to the changes in the environment, and amend the budget to address those changes. The Board will be presented with quarterly reviews, the variances from original assumptions and an explanation of actual performance over the period. He explained that the proposed process is very different from the process previously used; however, the final product will be the same. This process will provide senior administration better control of the operations. Director Gerard asked if the budget received in June 2014 will include detailed information. 5

6 7. Fiscal Year 2015 Budget Process, cont. Mr. Ayres said the budget for each quarter will be based off the actual performance from the previous quarter. 8. Discuss, Review and Possible Action on the Monthly Chief Financial Officer Report; Discuss and Review January 2014 MIHS Key Indicator Dashboards Dr. Hobohm reviewed the January quality dashboards. He stated that the System achieved the goal for falls with injury with zero harm. He noted there was one medication error with adverse event resulting in a higher level of care needed. The target for pressure ulcer was also missed in January along with the threshold for restraint episodes. He noted that the mortality rate was slightly over the threshold and the data is being analyzed to determine the reason for the increase. The readmission rate continues to run over the established target and there are extensive programs in place to correct and bring within target. He reviewed the process of care measures and noted the acute myocardial infarction (AMI) did not reach the goal of 95% due to missing one stemming within ninety minutes of arrival. The other targets met the thresholds. Chairman Harden questioned the underlying factors for readmissions. Ms. Stotler stated the matter was more psychosocial and there is a new transition clinic at the Comprehensive Health Center (CHC) to address the problem. Director Gerard stated that the number of restraint episodes exceeds the established target on a monthly basis. She asked if the goal was unrealistic. Ms. Stotler said that it is difficult to predict how the patients will react to treatment until they arrive. In lieu of traditional restraints; she noted the implementation of a bed enclosure for patients; however, the patient is confined to their bed and is considered a restraint episode. Director Gerard asked if the cases were reviewed to determine if they were handled correctly. Ms. Stotler said that there are several steps taken prior to restraints, including the utilization of cameras and sitters to monitor the patients. Dr. Hobohm said that it was important to note that there have been no injuries due to the restraints. There is also a new program in place and requires documentation for all restraint episodes and the internal audit program reviews that information. Director McMahon questioned the significance of the thresholds and the impact of the organization if they were not met. Dr. Hobohm said that hospitals that achieve 100% of all of the core measures would be ranked in the top 10% of hospitals nationwide. He said MIHS measures itself with hospitals statewide and nationwide and is better than average, locally and nationally, in most areas. Director McMahon asked if there were financial implications for not meeting the thresholds. Dr. Hobohm said that there are many reasons for tracking the data; however, there are financial reasons as well. Should the thresholds be achieved, there are additional funds; however, funds can be lost if not reached. Vice Chairman Dewane said the core measures are used to measure quality of care. 6

7 8. Discuss, Review and Possible Action on the Monthly Chief Financial Officer Report; Discuss and Review January 2014 MIHS Key Indicator Dashboards, cont. Mr. Vanaskie reviewed the January operational dashboard. Acute admissions continue to fall short of budget; however, the length of stay remained on budget and that resulted in the shortfall in patient days. The admissions in behavioral health remain strong as well as the length of stay. Ambulatory services volumes were better than budget in all areas with the exception of the dental clinics. The utilization in the operating room was on budget, and the number of deliveries was better than budget. The volume in the pediatric emergency room was less than anticipated. The length of stay for psych patients in the adult emergency department was 917 minutes. Chairman Harden questioned the psych length of stay in the emergency room. Mr. Vanaskie explained that the length of stay was for the adult patients in the emergency room (ER) waiting for a psych bed. He noted the time to treatment in the ER was 34 minutes. Mr. Purves stated that psych patients may be in the ER for an extended time; however, they are not receiving ER treatment; just waiting for placement. Mr. Ayres noted the covered lives information that is listed on the operational dashboard. He stated the Maricopa Health Plan (MHP) had the highest percentage of enrollees for the month in the valley and the Maricopa Care Advantage Plan is exceeding projections. He referred to the Chief Financial Officer (CFO) report and noted the challenges faced in January were the various changes effective at the beginning of the 2014 calendar year. He said there was a shift from self-pay into the Medicaid financial class; however, the rates for transition and reimbursement are unknown. Once the information is known, the information will be updated. He stated the MHP had an increase in volume and utilization due to the number of respiratory illnesses in January. He reviewed the cash liquidity and the days of cash on hand, which is being monitored closely. Break from 2:46 p.m. to 2:56 p.m. 9. Update on Savings Achieved from OMSolutions (O&M) Supply Chain Consulting Services; Approve Amendment #1 ( ) to the Consulting Services Contract between Maricopa Integrated Health System and OMSolutions Mr. Dereadt said that in February 2013, MIHS engaged with Owens & Minor Solutions (O&M) to implement a value analysis program. There were two goals at the time; one was to create a program that would be sustainable and successful upon the termination of the agreement, the second goal was to interject quality and value into the System while allowing for the reduction of expenses, supply chain activities and purchased services. To accomplish the first goal, seven value analysis teams (VAT) were created with representatives throughout the organization. There was also a steering committee established with participation from executives. The teams worked to identify and produce savings through a comprehensive review over the past twelve months. As a result, by January 2014, the organization exceeded the original goal of $12 million in savings over three years. The implemented savings are a culmination of contract negotiations, leveraging volumes to certain vendors, and utilization. Mr. Maness stated that there have been some challenges and competing priorities. With the start of the program, the purchasing and contract staff assumed added responsibility for the VATs over their current responsibilities. Another challenge faced was the concurrent implementation of the EAS system; which placed an additional strain on existing resources. In addition, there was a significant turnover of key staff members, which resulted in additional training for replacement staff and a delay in the project. 7

8 9. Update on Savings Achieved from OMSolutions (O&M) Supply Chain Consulting Services; Approve Amendment #1 ( ) to the Consulting Services Contract between Maricopa Integrated Health System and OMSolutions, cont. He said that there are more initiatives to be implemented over the next nine months which would result in added savings over the next three years. One option would be to utilize MIHS staff for the implementation, which would result in an additional $1 million in savings over the three-year period. However, should the O&M staff continue its engagement and focus on the implementation; the anticipated savings would be an additional $6 million over the same period. He recommended that the O&M contract be extended through the current fiscal year, with an option to extend on a month-to-month basis until the end of September 2014 to achieve the projected $6 million in savings. The combined savings would result in $18 million over a three-year period. Vice Chairman Dewane asked if the work performed by the consultants was outside the scope of ability for MIHS employees or if it was beyond the scope of the resources available. Mr. Maness stated that the activities performed were initially outside the scope of ability; however, the anticipated knowledge transfer has not been completed as quick due to the staffing challenges. At the conclusion of the contract, staff will be able to perform all activities previously performed by the consultants. Director McMahon asked if additional resources would be needed at the conclusion of the contract. Mr. Maness said that there may be some constrains on the MIHS staff; however, a solution will be needed for MIHS staff to absorb the responsibilities. Vice Chairman Dewane moved to approve amendment #1 to the supply chain consulting contract between MIHS and OMSoultions to extend the contract from February 1, 2014 through June 30, 2014 with the option to extend on a month-to-month basis from July 1, 2014 through September 30, Director Bicknell seconded. Motion passed by voice vote. 10. Status Update on ICD 10 Implementation Ms. DeCoster stated that the federal government has mandated that all healthcare providers in the United States transition the coding from ICD-9 to ICD-10, with the transition date of October 1, She noted that the current revision includes the largest increase in the codes to date. The primary use of ICD codes supports the classification of epidemiology, health management and for clinical purposes; with the United States being the only country to use ICD for reimbursement purposes, which will affect the payment stream for healthcare providers. The majority of the employees within the organization will be affected by the implementation. The keys to a successful implementation include training and testing. Mr. Summers said the implementation is interwoven throughout the health system. There are a number of ancillary systems integrated in EPIC and every application component or system component that is going to be affected by ICD-10, will be tested, modified and uploaded with codes. He noted that there has been significant progress. He pointed out that there was originally a computer assisted coding (CAC) tool budgeted for; however, there was some difficulty with the vendor and that item will not be implemented at this time. He anticipated the need to plan for that component in the next fiscal year. Ms. DeCoster stated the CAC tool is expensive and it will shorten the length of time for a coder to code the information by prompting the coder with coding suggestions. The tool will improve productivity, as it is anticipated that productivity will be negatively affected by the implementation of ICD-10. She stated that all participants of the Medicare programs will be transitioning to ICD-10, including payers; which may impact the cash flow. There is currently a testing schematic in place to prepare for this potential issue. 8

9 10. Status Update on ICD 10 Implementation, cont. Chairman Harden asked if the implementation was within budget. Ms. DeCoster said the project was measured every two weeks in respect to budget, scope and target date. The project is on target and on budget. Mr. Purves said over time, the productivity will improve and the specificity of the codes will allow the data to be analyzed and used to facilitate research. If MIHS does not comply with transition, claims to Medicare and Medicaid cannot be submitted. 11. Discussion, Consideration, and Possible Action on the Maricopa Integrated Health System s President & Chief Executive Officer s Performance Goals for Fiscal Year 2014 Director Bicknell moved to approve the Maricopa Integrated Health System s President and Chief Executive Officer s performance goals for fiscal year Vice Chairman Dewane seconded. Director McMahon asked if the change in the budget format will have an impact on the performance goals that were established. Mr. Purves said that there will still be an annual budget for the Board to approve and the performance goals will be built based off of that budget. Ms. Talbot clarified that the performance goals are for the current fiscal year. The proposed changes to the budget process will take place in the next fiscal year. Motion passed by voice vote. 12. Discuss, Review and Approve the Maricopa Integrated Health System President and Chief Executive Officer Job Description Referring to the items listed under Essential Functions, Director Gerard questioned if the importance of quality should be elaborated. She also asked if there should be a reference to the executive leadership succession plan incorporated in to the description. Mr. Purves stated that the importance of quality is referenced; however, if it pleased the Board, those statements could be strengthened to ensure the focus on quality is highly visible. In terms of leadership development and succession planning, that is what a leader does. Should the Board request that level of detail in the job description, the language can be added. Director Gerard said that was not necessary. Director McMahon moved to approve the Maricopa Integrated Health System President and Chief Executive Officer job description. Director Gerard seconded. Motion passed by voice vote. 9

10 13. Discuss Maricopa County Special Health Care District Procurement Code; Maricopa Integrated Health System Authorization and Responsibility Matrix; and Board Policy Statement 99104, Intergovernmental Agreements: Execution, Amendment and Termination Director Gerard said that after reviewing the legal opinion received, which states that all approvals, amendments, and terminations to an Intergovernmental Agreements (IGA) require Board action; her previous questions have been answered. She requested that the Maricopa County Special Health Care District (MCSHCD) Procurement Code and MIHS Authorization and Responsibility Matrix be reviewed periodically. Chairman Harden stated that the two documents are currently reviewed on an annual basis, or on an as needed basis. Mr. Purves said that there are systems currently being implemented to ensure that all items on the Authority and Responsibility Matrix are being properly monitored. Director McMahon asked what types of systems were being implemented. Mr. Purves stated that new software systems. 14. Discuss, Review and Approve and/or Rescind the Following Board Policy Statements: a. Financial Assistance Rescind policy b. Financial Assistance Discount Policy for Uninsured/Underinsured New policy Mr. Ayres stated the current Board policy statement directs the organization to evaluate a patient for their ability to pay accounts and creates a system to recognize the write-off. The system wide policy outlined the specific processes, procedures and guidelines for awarding different levels of discounts. In the current form, the existing policies do not meet the requirements established by the Health Resources and Services Administration (HRSA), which governs the operation of the Federally Qualified Health Center (FQHC) look-alike clinics. The three significant areas addressed include; the System cannot require payment prior to seeing a patient in a clinic; there can be no discounts for patients with income above 200% of the federal poverty level (FPL), and the policy must be approved by the Board of Directors and reviewed on an annual basis. He noted that there was one item in contention; the discount sliding fee scale. In particular, the fee schedule in category 3 of dental services. The intent of the guidelines is to avoid charging patients less than HRSA patients would be discounted. He believes the policy meets the intent of the guidelines. Director Gerard asked if the policy was consistent with what has been or will be approved by the Maricopa Health Centers Governing Council (Council). Mr. Ayres said that the policy has been presented to the Council and will be discussed at the next scheduled meeting. The Council may recommend amendments; if so, the policy will be presented to the Board for approval. There is a sense of urgency in that HRSA can survey the organization and there would not be a policy approved by the Board. Director McMahon stated that the term unable to pay was not defined in the policy. He asked what that definition would be. Mr. Ayres said that when a patient completes the financial assessment, it would be determined if they are unable to pay. Director McMahon asked how each financial counselor makes the determination. 10

11 14. Discuss, Review and Approve and/or Rescind the Following Board Policy Statements, cont. Ms. DeCoster stated that the organization has a standardized procedure and uses the FPL guidelines. All patients are asked the same questions to determine the category which they would qualify. The policy dictates that the guidelines need to be reviewed and updated every year what the current FPL. For the patients under 200% of the FPL, that is classified as unable to pay. For those patients over 200% of the FPL, they should be able to pay. Director McMahon questioned why it was not defined in the policy. Mr. Ayres said that the phrase can be removed from the policy. The policy is a guideline for the organization to manage the program and to provide guidance to a number of financial counselors to equitably apply the process and meeting HRSA guidelines. Ms. Wood stated that the two primary changes that the policy includes are; requiring a co-payment at the time of the visit and requiring patients to complete the Medicaid eligibility process. The second element is a profound change; the patients can be provided the opportunity to complete the eligibility process. She stated that the Council s Policy, Services and Compliance Committee will be reviewing the policy at the next scheduled meeting. The only concern is the item previously discussed by Mr. Ayres. Director Gerard asked if unable to pay was federal language and a HRSA requirement, therefore, could not be removed from the policy. Ms. Wood stated that to the best of her understanding, that particular phrase is not required by HRSA. Mr. Purves said that his primary concern is having a policy approved by the Board. Should it not meet the specificities of HRSA, the policy can be reviewed and amended. Ms. Wood stated that HRSA has 19 core requirements; one of which states that no discounts may be provided those patients with incomes over 200% FPL. It would appear the sliding fee scale in the policy would provide a discount in dental services for that particular category. Should the organization be surveyed, that would be questioned. Vice Chairman Dewane asked how that could be corrected. Mr. Ayres said the standard applied for those in category 3 is the same standard applied for all patients. The System is not applying a different standard for the discount for non-hrsa patients. Ms. Wood stated that the Council does not agree with the item. Mr. Gorman said that per the Cooperative Agreement between the Board and the Council, the Council is to follow the Board policies. The proposed policy is a Board policy and does follow the law and HRSA guidelines, as written. Mr. Purves said that the Board and the Council need to be comfortable with the language in the policy. Mr. Vanaskie reiterated that the Cooperative Agreement states that the Council will abide by the policies approved by the Board. The policy has not been reviewed by the interim Chief Compliance Officer to confirm that it complies with Center for Medicare and Medicaid Services (CMS). Chairman Harden stated her concerns with the policy as it has not been reviewed by the Chief Compliance Officer. Director Gerard agreed. 11

12 14. Discuss, Review and Approve and/or Rescind the Following Board Policy Statements, cont. Ms. Acosta stated that there would be no reason that the policy could not be approved pending further evaluation. She said it would be more damaging for the System if there were not a policy approved by the Board at the time of a HRSA survey. Hopefully in the future, there can be an organized and methodical process in place to address items such as this. Ms. Wood asked that the Board work collaboratively with the Council. Vice Chairman Dewane moved to rescind the Financial Assistance board policy statement and approve Financial Assistance Discount Policy for Uninsured/Underinsured board policy statement with the intent that the document come back after review by the Maricopa Health Center Governing Council so we are consistent with the language. Director Gerard seconded. Motion passed by voice vote. 15. Reports to the Board of Directors; Discussion and Possible Action: a. Patient Satisfaction Survey Results Report b. Whole Systems Measure Dashboard (Quality Report) c. Compliance Officer s Activities d. Internal Auditor s Activities e. Revenue Integrity Report f. Maricopa Health Foundation Report g. Semi-Annual Maricopa Health Centers Governing Council Report h. Semi-Annual Special Health Care District Risk Management Report i. Maricopa Integrated Health System s Monthly Employee Turnover Reports j. Unbudgeted New Positions/FTEs There were no questions or discussion. 16. iprotean Online Course Finance: Making Difficult Decisions About Services And Programs: A Portfolio Approach, Part One This item was not watched or discussed. 5. Discussion and Possible Action on Kronos Implementation, Change Order Requests, and Project Expansion Vice Chairman Dewane moved to extend the contract timeline and add an additional cost in the amount of not to exceed $602,000. Director Bicknell seconded. Motion passed by voice vote. 17. Concluding Items a. Future Agenda Items b. Board Member Requests for Future Agenda Items or Reports c. Comments i. Chairman and Member Closing Comment ii. President & Chief Executive Officer Summary of Current Events 12

13 17. Concluding Items, cont. Director McMahon requested an update on the Treasurer s Advisory Board, specifically, the charter and membership. Director Gerard requested a review of the Claims Committee charter in April Mr. Purves reviewed the news coverage over the past month. Of those was the news conference surrounding the unfortunate incident of a child being mauled by a family dog. The child is being treated at Maricopa Medical Center and the dog is receiving an influx of support from pet-lovers from across the country. There was also a feature story on the evening news surrounding the care that is being provided to a prospective pitcher for the Chicago Cubs. The patient was airlifted from a hospital in the Dominican Republic to the Arizona Burn Center for treatment. He is progressing well. NOTE: Director Gerard excused herself at 4:14 p.m. Adjourn Director McMahon moved to adjourn the February 26, 2014 Special Health Care District Board of Directors Formal Meeting. Chairman Harden seconded. Motion passed by voice vote. Meeting adjourned at 4:20 p.m. Mary A. Harden, R.N., Chairman Special Health Care District Board of Directors 13