DHFAC Meeting Minutes
September 26, 2000
Present:
- Patricia Blevins
- Deborah Capano
- Joseph DiPinto
- Thomas Grabowski
- Joseph Lieberman
- Charles F. Reinhardt
- Dennis Rochford
Absent:
- Vivan Longo
- 1David McBride
- Gregg C. Sylvester (Chair)
- Calvin Wilson
Welcome & Introductions
Gregg Sylvester was called out of town. Patricia Blevins chaired the meeting. She welcomed the committee and the public, and introductions followed.
HFAC Accomplishments
Patricia Blevins reviewed HFAC's recommendations and the amounts appropriated by the General Assembly. Joseph DiPinto explained that several items were funded that were not included in HFAC recommendations because they were not raised before the committee, but came to the attention of the General Assembly after recommendations were made. Specific questions about these items revealed the following information:
- Easter Seals proposed the survey of the disabled to the Joint Finance Committee. It is a follow-up to a previous survey of organizations that serve people with disabilities. This initiative will survey the people with disabilities directly. This is a one-time expenditure.
- The State Budget Office proposed spending minor capital improvement funds for public long term care facilities. SBO sought $10 million, and JFC appropriated $1.9 million. SBO will likely request more funding in future years. JFC was reluctant to appropriate settlement funds without a HFAC recommendation, but felt the improvements were needed. It was suggested that HFAC review this need.
Update on Implementation of HFAC Recommendations
Delaware Prescription Assistance Program (DPAP)- Philip Soulé
Philip Soulé distributed the DPAP Annual Report, which summarizes the first 5 ½ months of the program. Mr. Soulé provided the following highlights:
- 2,130 people were enrolled as of June 30.
- More women than men are enrolled.
- 70% of applicants were approved. Many that were not approved appeared to be eligible for the Nemours Pharmacy Program.
- More people with disabilities are enrolled than the elderly. The program was widely anticipated by people with disabilities. This mix of clients is expected to change as the program grows.
- DPAP is anticipating new enrollees in December as a result of Cigna discontinuing its Medicare HMO. DPAP is working to reach out to Cigna members.
- The Nemours program has begun to enforce a benefit limit of $500 spending on each client. This is an area for further discussion.
Questions from the group elicited the following information:
- DPAP will not likely spend the entire appropriation, which was to cover 18 months. However, the group agreed that the original estimates for the program were solid, and that more would be known in the spring.
- DPAP includes a drug utilization management system that checks prescriptions for adverse interactions. The DPAP system is built into the Medicaid system.
Tobacco Control & Prevention
Division of Public Health-Ulder Tillman
DPH has accomplished the following:
- Submitted paperwork to State Personnel to reclassify positions for a Chronic Disease Program Manager and a Cancer Program Manager.
- Developed a contracting strategy in partnership with community agencies.
- Released five RFPs for tobacco control: Media, Cessation, Evaluation, Community, and Coordination.
- Will release two more RFPs for cardiovascular screening and cancer/nutrition physical activity.
DPH is working on:
- Selecting bidders and issuing contracts for the five RFPs
- Hiring into reallocated potions
- Obligating miscellaneous funds for chronic disease, totaling $190,000.
Department of Public Safety-John Giles
John Giles reported on 23 action items planned for their appropriation. Highlights included:
- One of three Division of Alcoholic Beverage Control & Tobacco Enforcement agent positions is filled. Interviews for the other positions will begin on October 16. An administrative assistant has also been hired.
- Various equipment for the agents has been ordered or is awaiting hiring.
- Funds for Cooperating Underage Witnesses are being used for tobacco enforcement activities.
- Funds for public education and awareness will be used for pubic service announcements and tools for clerks to use to prevent sales to minors.
Department of Justice
Debra Lightsey spoke to Malcolm Cobin prior to the meeting. Mr. Cobin reported that DoJ has created a position and it will be filled shortly.
Medical Coverage-Persons who lose SSI benefits- Philip Soulé
This program will provide medical coverage for up to 24 months for former Supplemental Security Income (SSI) recipients losing Medicaid due to unearned income from government benefits like Social Security Disability Insurance and Veteran's Administration benefits. Services are planned to begin in January 2001, and this is on schedule. Medicaid is continuing to work with the federal government to get federal matching funds for this initiative. This is a challenge, because federal regulations do not allow increased eligibility for a single group of Medicaid recipients. Medicaid is exploring funding for this program as a Medicaid demonstration. For now, the program will move forward with state funding only.
Uninsured Action Plan-Paula Roy
The funding enabled the Delaware Health Care Commission (DHCC) to leverage two federal grants.
- The Community Access Program will make the safety net for the uninsured more user friendly. The program will help the uninsured find medical homes, providing appropriate and timely care. The program is a collaboration among safety net providers.
- The State Planning Grant will build on the CAP program and help to expand access.
DHCC defined strategic areas for expanding access:
- Children, including outreach and enrollment in the Delaware Healthy Children's Program.
- The working uninsured. DHSS is meeting with the Delaware State Chamber of Commerce on this issue.
- DHCC funded services at Delmarva Rural Ministries, a community health center, to promote access to appropriate primary care services.
Automatic External Defibrillators (AEDs)-Bill Stevenson
DPH has formed a partnership to lead the program with the American Red Cross, American Hearth Association, Christiana Care Health System, and the Delaware Chamber of Commerce. Christiana Care is conducting a study of public AEDs. The committee expressed concern about the design of the study, which compares survival rates for those who have access to AEDs with a similar group who does not. The committee suggested a presentation from the study director at a future meeting.
Bill Stevenson reported the following progress:
- DPH was able to purchase more AED units than estimated (366 vs. 247) because the per unit price was lower than anticipated. This means more devices can be placed, with fewer people trained at each site (7-8 instead of 10).
- DPH is using national placement parameters developed based on a national study. However, alterations may be made based on Delaware's data. Maintenance and inspection costs are born by the facility.
- The partners plan to ask facilities who get AEDs to consider donations to a fund that would purchase more units for Delaware.
Diabetes Pilot Project-Paula Roy
These funds were intended to implement recommendations of the Diabetes Task Force. DHCC has focused on two key recommendations for pilots-education and standards of care and benefits.
- DHCC issued a proposal for education for the general public, diabetics and families, workplace and schools. The focus is on vulnerable populations with higher death rates. The RFP encourages collaboration. Responses are due on November 3.
- DHCC is working with the Medical Society of Delaware on standards of care and standard health insurance benefits for diabetes. The Medical Society will be submitting a proposal to DHCC to get support for this project. Diabetes is the first in a series of chronic diseases that the Medical Society plans to work on with the insurance industry.
Substance Abuse Transitional Housing-Susan Gumbs
Susan Gumbs reported that the Division of Alcoholism, Drug Abuse and Mental Health (DADAMH) has collected information from visits to existing transitional housing programs. This design research lead to a draft RFP, which will be distributed on October 31, with a vendor selected by December 31. Program highlights include:
All residents will be required to meet one of the following conditions:
- Awaiting admission to a residential treatment program
- Recently discharged form a detoxification center or residential treatment program AND enrolled in an outpatient treatment program
- Actively participating in an outpatient treatment program and in need of a safe and drug free place to live while seeking safe and suitable housing.
All providers will be required to meet all of the following conditions:
- Ability to maintain a safe, sober and drug free environment in the facility 24 hours a day, seven days a week
- Employ managers who are knowledgeable about alcohol/drug addiction and who have a demonstrated commitment to sobriety
- Provide on-site self help resources
- Administer random breathalyzer and urine screenings to residents (and staff as appropriate)
The committee expressed concern about mixing those awaiting residential treatment with those who had graduated from residential treatment. Ms. Gumbs shared that the research at existing programs shows that this model can be successful when all of the services above are provided. The committee expected the RFP responses to shed light on this issue.
Lesser-known illnesses-Ulder Tillman
An RFP has been developed with the following scope of services:
- Define "lesser-known" and "devastating and costly"
- Obtain data on prevalence
- Identify clinical and supporting evidence
- Identify available testing regimens for each and costs of each regimen
- Describe support system currently in place
The RFP has been approved, with an anticipated award date of January 1, 2001.
Update on National Settlement Activities
Next payments-Debra Lightsey
Debra Lightsey reported that there is still debate about the base amount of the settlement. The figures on tobacco consumption from the federal government and the tobacco industry are at odds. The Attorney General's office anticipates further adjustments to the payments when this disagreement is resolved. This adjustment would be in addition to the regular volume and inflation adjustments.
Ms. Lightsey reviewed the payment schedule and amounts. The 2001 unadjusted payments due to Delaware are as follows:
- Initial payment on January 10, 2001-$10,069,286.22-This payment will likely be made prior to 1/1/01 and retroactively adjusted.
- Annual payment on April 15, 2001-$17,311,677.36M
American Legacy Foundation-Lynne Howard
The American Legacy Foundation will be holding a meeting in Delaware on October 5. The meeting is a "First Look" at the findings of the Foundation's Special Populations Forums, which have been held around the country to develop strategies for tobacco control in minority populations. Meeting attendees were invited to the Legacy meeting.
The committee noted that Delaware's grant request to the Legacy Foundation was not funded. The committee requested information about the next grant cycle and the grants that were awarded.
Items for future meetings
The following items were suggested:
- Review of HFAC process (building on committee member questionnaires)
- HFAC expectations and work plan for the coming year
- Nemours Pharmacy Assistance Program
- Smoking in public places, including schools
- More information on the AED study
- Information on the minor capital improvements to state long-term care facilities and broader issues for these public institutions
Meeting schedule
The next meetings were tentatively scheduled for October 26 and November 30 from noon to 2 in New Castle County.
Public Comment
Chris Manning of the American Heart Association clarified that the control group in the AED study receives training in CPR.
