APR-16-2010 15:32 TRAVIS COUNTY ATTORNEY P.001 1+1 ... · APR-16-2010 15:32 TRAVIS COUNTY ATTORNEY P.002 3. Discuss and take appropriate action on the approval and implementation

APR-16-2010 15:32 TRAVIS COUNTY ATTORNEY

1+1 ..., , CENTRAL HEALTH

CENTRAL HEAL TH** BOARD OF MANAGERS

AGENDA

Thursday, April 22, 2010 5:30 p.m.

1111 E. Cesar Chavez Street Austin, Texas 78702

Cesar Chavez Board Conference Room

CITIZENS' COMMUNICATION

CONSENT AGENDA

Notice to Public

P.001

All matters listed under the CONSENT AGENDA will be considered by the Board of Managers to be routine and will be enacted by one motion. There will be no separate discussion of these items unless members of the Board or persons In the audience request specific items be moved from the CONSENT AGENDA to the REGULAR AGENDA for discussion prior to the time the Board of Managers votes on the motion to adopt the CONSENT AGENDA.

C1. Approve minutes for the following meetings of the Central Health Board of Managers:

a. January 14, 201 O; and b. January 28, 201 O.

C2. Receive the April 201 O Investment Report and ratify Central Health investments for April 2010.

C3. Receive the March 31, Z009 Second Quarter Investment Report.

C4. Approve a contract for appropriate referral and funding for support services related to women's health services contracts.

REGULAR AGENDA ..

1. Receive and discuss a report on current actiVities related to Graduate Medical Education (GME).

2. ReceiVe and discuss a report of the March 2010 ffnandal statements for Central Health.

APR-16-2010 15:32 TRAVIS COUNTY ATTORNEY P.002

3. Discuss and take appropriate action on the approval and implementation of a service payment policy for contracted safety net providers.

4. Participate in and discuss a healthcare visioning exercise related to focus group feedback.

5. Receive and discuss an update to the Community Planning Initiative.

6. Receive and discuss a report on changing demographics in Travis County.

7. Receive and discuss a matrix of service delivery and financing mechanisms.

8. Receive and discuss reports from the Board committees: Audit and Compliance Committee; Budget and finance Committee; and ad hoc Legislative Committee.

9. Receive and discuss the CEO's report on the following Central Health activities; (a) procurement actMty; (b) current communications/outreach statistics; (c) a status report on North Central Health Center Project; (d) the MAP Program, including April enrollment and activities; and {e) the March Psychiatric Stakeholders meeting minutes.

1 o. Confirm the next regular Board meeting date, time, and location.

• The Board of Managers may take items in an order that differs from the posted order.

•• Central Health is the assumed name of the Travis County Healthcare District.

The Board of Managers may consider any matter posted on the agenda in a closed meeting if there are issues that require consideration in a closed meeting and the Board announces that the item will be

considered during a closed meeting.

TOTAL P.002

Board of Managers Meeting

April 22, 2010

Agenda Item C1 Approve minutes for the following meetings of the Central Health Board of Managers: (a) January 14,

2010 and (b) January 28, 2010.

(Back-Up – Draft Board Minutes)

Unapproved MINUTES OF MEETING – JANUARY 14, 2010

TRAVIS COUNTY HEALTHCARE DISTRICT

BOARD OF MANAGERS MEETING On Thursday, January 14, 2010, a regular meeting of the Travis County Healthcare District Board of Managers convened in open session at 5:38 p.m. in the Cesar Chavez Board Conference Room, 1111 East Cesar Chavez, Austin, Texas 78702. A quorum of the Board was present. Chairperson Coopwood was present, and Treasurer Rodriguez served as the Secretary for the meeting in Secretary Barker’s absence. The clerk for the meeting was Margo Davis.

CITIZENS’ COMMUNICATION

Clerk’s Notes: None.

CONSENT AGENDA

C1. Approve a regular meeting schedule for Fiscal Year 2010 for the Travis County Healthcare District Board of Managers.

Clerk’s Notes: This item was taken out of order. Manager Coleman-Beattie moved that the Board approve Consent Agenda item C1.

Manager Heidrick seconded the motion. The motion was adopted on the following vote:

Chairperson Tom Coopwood For Vice-Chairperson Rosie Mendoza Absent

Treasurer Frank Rodriguez For Secretary Bobbie Barker Absent Manager Anthony Haley For Manager Clarke Heidrick For Manager Donald Patrick For Manager Brenda Coleman-Beattie For Katrina Daniel For

REGULAR AGENDA

1. Receive and discuss a report on work using historically underutilized

businesses (HUBs).

Clerk’s Notes: This item was taken out of order. Managers Heidrick, Patrick, and Coleman-Beattie joined the meeting proceedings during this agenda item.

1.14.2010 – Meeting Minutes - 1

Unapproved John Stephens, District Acting Chief Financial Officer, and Barbara Kuhl, District Procurement Manager, explained the HUB report and the parameters that define the District’s HUB program. The District’s definition of a HUB is exacting and it is not merely women or minority-owned businesses. It is a for-profit, business with at least 51 percent ownership by one or more persons who have been historically underutilized (socially disadvantaged) because of their identification as being African Americans, Hispanic Americans, Asian-Pacific Americans, Native Americans, or women. District defined HUBs are also certified by one or more governmental certification programs (e.g. State of Texas, City of Austin, Texas Unified Certification Program). The District has few discretionary dollars to spend. The majority of its operating expenditure budgets are payments for health care delivery services through outside agencies or providers such as the City of Austin (now CommUnityCare), Seton, People’s Community Clinic and others or to governmental agencies such as Travis County for services but these agencies do not meet the definition of a HUB. In 2009, of the total $94.4 million budget, approximately 5.3 percent ($4.97 million budgeted funds) was available for possible procurement to HUBs, primarily in computer services/support ($1.88 million), legal services ($810,000), and professional consulting services ($788,000). These categories reflect the expenditures required to facilitate the transition of CommUnityCare from the City of Austin. The District has taken several steps to encourage HUB participation. The Board approved the District’s HUB policy, which stresses that a “good faith effort” must be made to assist certified HUB vendors and contractors in its award of contracts and subcontracts; procedures for small dollar procurements are to solicit HUBs whenever practical and available; and District solicitations require vendors to make a “good faith effort” to include HUBs. The District funds HUBs in three ways: indirectly through agencies that contract with HUBs (e.g. City, Travis County, Office Depot, Seton); indirectly through District contracts (e.g. HUB sub-contractors); and directly to HUB vendors. The District’s HUB expenditures are evolving from non-capital services associated with the transition of CommUnityCare to capital project expenditures, resulting in fewer operating dollars spent with HUBs and more spent on capital projects. From Fiscal Year 2008 to Fiscal Year 2009, the total HUB dollars decreased $40,897 and total expended dollars increased $41,681. For the time period from Fiscal Year 2006 to Fiscal Year 2009, non-capital HUB expenditures increased 52 percent, from $86,962 in 2006 to $132,264 in 2009. In Fiscal Year 2009, HUB expenditures were more than twice those of non-capital expenditures ($267,991 compared to $132,264). Construction project-related expenditures comprised 51.2 percent of the total expenditures. There was substantial HUB participation in all but the equipment category. The majority of the equipment expenditures related to the acquisition and implementation of the District/CommUnityCare IT and telecommunications infrastructure (White Glove Technologies).

2. Receive and accept the September 30, 2009, year-end financial statements

and the accompanying external auditors’ report.


Unapproved Clerk’s Notes: This item was taken out of order. Mr. Stephens and Ashlee Martin, Maxwell Locke & Ritter Audit Manager, reported on the

audit of the District’s financial activity for fiscal year 2009. No deficiencies in internal controls that are considered a material weakness were noted, and no notable items were reported on the financial statements.

Treasurer Rodriguez moved that the Board accept the September 30, 2009, year-end financial statements and the accompanying external auditors’ report as presented by staff and the District’s external auditors. Manager Patrick seconded the motion. The motion was adopted on the following vote:



3. Discuss District strategic planning activities. Clerk’s Notes: Christie Garbe, District Chief Communications and Planning Officer,

gave an overview of the District’s strategic planning activities. The District’s initiatives are guided by the Strategic Plan which outlines bold strategies for the District in achieving its vision and to enhance the health status of all Travis County residents. District staff and the Board are working collaboratively to implement a shared vision to continue improving access to quality health care services in Travis County. In an effort to finalize the Strategic Plan, the Board has agreed to revise its meeting schedule to include two Saturdays for calendar year 2010 (April 24, 2010 and October 9, 2010). These meetings will be used to address focus areas and strategies for on-going planning topics that are significant to the District.

4. Receive and discuss a presentation regarding the key concepts of health

maintenance organizations and managed care. Clerk’s Notes: Mr. Stephens, Trish Young Brown, District President and CEO, and

Dennis Edmonds, President/HMO Consultant of Dennis Edmonds & Associates, LLC, explained the key concepts of health maintenance organizations and managed care. The District engaged Dennis Edmonds & Associates, LLC (Edmonds) to assist the District in assessing the feasibility of forming a health maintenance organization (HMO). Under the agreement, Edmonds would first conduct a preliminary assessment, which would provide a broad overview of what would be required for the District to set up an HMO. The next part of Edmonds’ engagement is to conduct a feasibility study, which is


Unapproved more detailed than the preliminary assessment and focuses on defining the organizational structure, confirming the revenue source, creating financial assumptions, and determining the financial breakeven. At the end of the feasibility study, the District should have enough information to decide whether or not to proceed with the development of an HMO. Should the District decide to form an HMO, Edmonds will produce a development and implementation work plan and consult with the District throughout the process. As the first step in this discussion, Edmonds and District staff will present some key managed care concepts and discussion of why the District would want to set up an HMO, and the threats and opportunities that may accompany such an undertaking. If created, the HMO would help the District achieve managed care savings for targeted populations; create infrastructure to better serve patients with different types of coverage; utilize enhanced Federally Qualified Health Center (FQHC) Medicaid and CHIP reimbursement to help fund service shortage areas in specialty care and uninsured patients; and adequately position the District for health care reform. A comprehensive report was conducted in the form of a SWOT (strengths, weaknesses, opportunities, and threats) analysis. The analysis determined the major internal factors that could affect the success of the HMO, including size, strength, costs, revenues, and strategy, as well as external factors such as competitive positioning and industry trends. Nonetheless, the HMO coincides with the District’s Strategic Plan and is an opportunity to offer coordinated health care coverage that is affordable and reliable for individuals who would otherwise have to go without health care services.

5. Discuss the re-purposing of the Integrated Care Collaboration (ICC) and

Centex Systems Support Services (CSSS) and take appropriate action: (a) a request from ICC for a letter supporting a grant application under the Beacon Community Cooperative Agreement Program; (b) a request from CSSS for a letter supporting a grant application under the Health Information Technology Implementation for Health Center Controlled Networks Funding Opportunity; and (c) a request to increase the amount o the contract between the ICC and the District by up to $29,000 from service expansion funds.

Clerk’s Notes: Ms. Young Brown explained why the ICC needed to be re-purposed.

ICC and CSSS are separate organizations but their success depends on collaboration and connectivity. ICC has created and maintains a Health Information Exchange (HIE) and CSSS implements electronic health record systems in participating safety net provider practices who are also members of ICC. Electronic health record (EHR) data from ICC individual members/organizations (clinical and claims/billing data) feed into the health information exchange (HIE). When the District entered into the last renewal and amendment of its contract with ICC, the ICC was in process of being re-purposed. The ICC initially was created to address access and financing issues and obstacles to the efficient delivery of care for low-income and uninsured residents of Central Texas. The ICC develops joint projects among members to increase access, improve quality, and lower the costs of providing care to the region’s unfunded population. Recently reorganized, the ICC is a member-based collaborative governed by major financially contributing stakeholders (Travis County Healthcare District, Seton, St. David’s, Lone


Unapproved Star Circle of Care, Austin Travis County Integral Care). The ICC staff currently focuses on the collection and maintenance of health information exchange data and analytics, specifically analyzing data for community-wide reports that can be used by members to improve health in the community. An ICare technology platform upgrade is needed to ensure compliance with future meaningful use standards. CSSS is also undergoing a reorganization CSSS was initially formed with significant funding from St. David’s Foundation and the Michael and Susan Dell Foundation to implement electronic health records (EHR) in safety net provider practices and provide necessary ongoing support services to maintain system/help desk functions. CSSS is in the process of reorganizing to be governed by a board of stakeholders who are recipients and financial supporters of its efforts (CommUnityCare/Travis County Healthcare District, Lone Star Circle of Care, Community Health Clinics of South Central Texas, Seton, and St. David’s Foundation). Although CSSS can implement any EHR, it is focused on NextGen and E-clinicalworks software given these are selected systems by major health care providers in Central Texas. CSSS will serve as a Health Center Controlled Network (HCCN) for purposes of obtaining federal health information technology (HIT) grant funding which will augment local funding needed to support these efforts. ICC will submit a grant application under the Beacon Community Program for funding to support the ICare technology upgrade and systemic application of ICC care coordination and healthcare quality improvement demonstration projects. Both grants require a sustainability plan and the applications will look more competitive if early adoption of HIT and a strong commitment across multiple stakeholders to support these efforts is demonstrated.

Treasurer Rodriguez moved that the Board authorize the President and CEO to submit a

letter in support of the ICC’s grant application under the Beacon Community Cooperative Agreement Program and further moved that the Board authorize the President and CEO to submit a letter in support of a grant application for the Health Center Controlled Networks funding opportunity as presented by staff and finally moved that the Board approve an increase in the amount of the contract between the ICC and the District in an amount not to exceed $29,000 from service expansion funds as presented by staff and authorize the District President and CEO to negotiate and execute a final agreement on terms similar to those presented or on terms more favorable to the District. Manager Heidrick seconded the motion. The motion was adopted on the following vote:

Chairperson Tom Coopwood For

Vice-Chairperson Rosie Mendoza Absent Treasurer Frank Rodriguez For

Secretary Bobbie Barker Absent Manager Anthony Haley For Manager Clarke Heidrick For Manager Donald Patrick For Manager Brenda Coleman-Beattie For Katrina Daniel For

6. Receive and discuss the President and CEO’s self evaluation.


Unapproved


Clerk’s Notes: Chairperson Coopwood announced that the Board convene in

executive session to discuss agenda item 6 under Section 551.074 of the Texas Government Code, Personnel Matters.

The Board convened in a closed meeting at 8:49 p.m. and re-convened in open session at 9:04 p.m. and did not take action.

7. Confirm the next regular Board meeting date, time, and location. Clerk’s Notes: This item was taken out of order.

Chairperson Coopwood announced that the next regular Board meeting is scheduled to be held on Thursday, January 28, 2010, at 5:30 p.m., in the Granger Building, Commissioners Courtroom, 314 West 11th Street, Austin, Texas.

There being no further discussion or agenda items, Manager Patrick moved that the meeting adjourn. Manager Daniel seconded the motion. The motion was adopted on the following vote:



The meeting adjourned at 9:04 p.m. ____________________________________ Tom Coopwood, Chairperson Travis County Healthcare District Board of Managers ATTESTED TO BY: ____________________________________ Bobbie Barker, Secretary Travis County Healthcare District Board of Managers

Unapproved MINUTES OF MEETING – JANUARY 28, 2010


BOARD OF MANAGERS MEETING On Thursday, January 28, 2010, a regular meeting of the Travis County Healthcare District Board of Managers convened in open session at 5:31 p.m. in the Ned Granger Building Commissioners Courtroom, 314 West 11th Street, Austin, Texas 78702. A quorum of the Board was present. Chairperson Coopwood and Secretary Barker were present. The clerk for the meeting was Margo Davis.

CITIZENS’ COMMUNICATION

Clerk’s Notes: None.

CONSENT AGENDA

C1. Approve minutes for the following meetings of the Travis County Healthcare District Board of Managers: (a) September 10, 2009; (b) September 24, 2009; and (c) October 8, 2009.

C2. Receive the January 2010 Investment Report and ratify Healthcare District

investments for January 2010. C3. Receive the Travis County Healthcare District Investment Report for the First

Quarter Ending December 31, 2009. C4. Approve a recommendation for the process for the required annual

broker/dealer review and selection of approved broker/dealers under the District’s Investment and Collateral Policies and Procedures for the coming year.

C5. Discuss and take appropriate action on a proposed amendment to the

contract between the Travis County Healthcare District, CTMF, Inc. d/b/a Austin Medical Education Program and Seton Healthcare d/b/a University Medical Center at Brackenridge for the purchase of behavioral health care services.

Clerk’s Notes: Consent Agenda Item C5 was not considered as part of the consent

agenda on the Board’s recommendation.

Vice-Chairperson Mendoza moved that the Board approve Consent Agenda items C1, C2, C3, and C4, except for item C5 which the Board should vote on separately to allow for an abstention. Manager Coleman-Beattie seconded the motion. The motion was adopted on the following vote:


Unapproved

Chairperson Tom Coopwood For Vice-Chairperson Rosie Mendoza For

Treasurer Frank Rodriguez Absent Secretary Bobbie Barker For Manager Anthony Haley For Manager Clarke Heidrick Absent Manager Donald Patrick Absent Manager Brenda Coleman-Beattie For Katrina Daniel For

REGULAR AGENDA

C5. Discuss and take appropriate action on a proposed amendment to the

contract between the Travis County Healthcare District, CTMF, Inc. d/b/a Austin Medical Education Program and Seton Healthcare d/b/a University Medical Center at Brackenridge for the purchase of behavioral health care services.

Clerk’s Notes: Chairperson Coopwood turned the Chairperson’s role over to Vice-Chairperson Mendoza for this item and filed a conflict-of-interest affidavit as required by Chapter 171 of the Texas Government Code and did not participate in the deliberation or vote on this motion. Manager Coleman-Beattie moved that the Board approve Consent Agenda item C5. Manager Daniel seconded the motion. The motion was adopted on the following vote:

Chairperson Tom Coopwood Abstain Vice-Chairperson Rosie Mendoza For

Treasurer Frank Rodriguez Absent Secretary Bobbie Barker For Manager Anthony Haley For Manager Clarke Heidrick Absent Manager Donald Patrick For Manager Brenda Coleman-Beattie For Katrina Daniel For

Manager Patrick joined the meeting proceedings during this agenda item. 1. Discuss and take appropriate action on a contract with United Healthcare for

employee medical benefits for the plan year March 1, 2010 through February 28, 2011.

Clerk’s Notes: John Stephens, District Acting Chief Financial Officer, explained the

terms of the contract with United Healthcare. The contract with United Healthcare is for employee medical benefits for the new plan year of March 1, 2010 through


Unapproved February 28, 2011. Blue Cross Blue Shield of Texas (BCBS) provides the current medical plan for employees which will expire February 28, 2010. BCBS submitted their initial renewal proposal for the new plan year in December 2009 which indicated a 33.5 percent increase to the rates of the District’s insurance. The District’s benefits administration consultants, Holmes Murphy & Associates, Inc., and District staff quickly developed a solicitation to obtain competitive medical plan offerings based on the current plan structure. Three responses were received from BCBS, Humana, and United Healthcare (UHC). Four companies declined to quote stating that their rates were not competitive with the renewal rates quoted by BCBS. Holmes Murphy & Associates, Inc. contacted the three responsive insurers to request that they submit alternatives to the current plan structure that would manage the District’s rate increase to not exceed 10 percent and re-quote for those alternative plans. UHC sent two Choice Plus plan alternatives to the current plan and BCBS responded with one alternative to the current plan. District staff recommends UHC based on the alternative plan structures with associated pricing submitted by both BCBS and UHC. This option will mean an 8.12 percent increase to both the District (the District pays the employee only cost for each employee enrolled in the plan) and to those employees who choose to cover dependents. The current benefit plan with BCBS reduced from a 33.5 percent initial increase to a 19.5 percent increase after reviewing additional claims data. Even with this reduction after the review of additional claims data, the 19.5 percent increase was still higher than budget and not acceptable from a financial standpoint which resulted in the decision to seek alternative plan structures. CommUnityCare and District staff evaluated proposals using several guiding principles: the employee’s ability to access the benefit (provider availability); benefit structure; customer service/account management; and affordability. There is a significant overlap in providers under both plans and it is expected that very few employees will have to change providers. The benefit structure is the best overall with a per participant deductible of $750 (which UHC also includes in the out-of-pocket maximum), a lifetime maximum of $5 million, generic prescriptions at $10 each, and similar co-pays. The proposed benefit plan is affordable. The overall cost of the benefit offering to the District as well as the out-of-pocket costs to the employees is reasonable. The selected benefit plan will be available to both District and CommUnityCare employees for the upcoming plan year which begins March 1, 2010. The planned dates for open enrollment are February 2, 2010 through February 14, 2010.

Manager Coleman-Beattie moved that the Board approve a contract with United

Healthcare for employee medical benefits for the plan year March 1, 2010 through February 28, 2011 as presented by staff and authorize the District President and CEO to negotiate and execute a final agreement on terms similar to those presented or on terms more favorable to the District. Manager Heidrick seconded the motion. The motion was adopted on the following vote:

Chairperson Tom Coopwood For

Vice-Chairperson Rosie Mendoza For Treasurer Frank Rodriguez Absent

Secretary Bobbie Barker For


Unapproved Manager Anthony Haley For Manager Clarke Heidrick For Manager Donald Patrick For Manager Brenda Coleman-Beattie For Katrina Daniel Abstain

Manager Heidrick joined the meeting proceedings during this agenda item. 2. Receive and discuss an update from HillCo Partners, the District’s legislative

consultant, and District staff on proposed federal and state health law reforms.

Clerk’s Notes: Secretary Barker, Chair of the Legislative Committee, reported that the

Committee met the afternoon of January 28, 2010 to discuss recent legislative and executive branch activities.

Stacy Wilson, District Government Relations Director, and Marsha Jones, Legislative Consultant for the District, provided an update on the proposed federal and state health care law reforms and recent legislative and executive branch activities and the potential impact they could have on the District’s strategic plan.

3. Receive and discuss a report of the December 2009 financial statements for

the Travis County Healthcare District. Clerk’s Notes: Mr. Stephens gave an overview of the District’s financial statements for

December, including a discussion of the Statement of Revenues, Expenses and Changes in Net Assets, and the Balance Sheet. No notable items were reported.

4. Receive and discuss an update on the creation and implementation of a

community planning initiative. Clerk’s Notes: Ellen Richards, District Healthcare Planner, and Christie Garbe, District

Chief Communications and Planning Officer, provided an update on the recent community planning initiative activities. The District is continuing its work in networking with individuals and partner organizations to help develop strategies and comprehensive solutions to quality health care.

5. Receive and discuss reports from the Board committees: Budget and Finance

Committee; ad hoc Personnel Committee; ad hoc Legislative Committee; and the Brackenridge Lease Team.

Clerk’s Notes: The Board members present reported on the discussions and activities

of the committee meetings that had occurred since the previous Board meeting. 6. Receive and discuss the CEO’s report on the following District activities: (a)

procurement activity; (b) communications/outreach statistics for December


Unapproved


2009; (c) a status report on North Central Health Center Project; (d) the MAP Program, including December enrollment and activities; and (e) an update on the E-merge program.

Clerk’s Notes: Trish Young Brown, District President and CEO, briefly reported on the

ongoing District activities, including the procurement activity, communications/outreach statistics for December 2009, a status update on the North Central Health Center Project, the MAP Program, including December enrollment and activities, and an update on the E-merge program.

7. Confirm the next regular Board meeting date, time, and location. Clerk’s Notes: Chairperson Coopwood announced that the next regularly-scheduled

meeting is on Thursday, February 11, 2010, at 5:30 p.m., in the Cesar Chavez Board Conference Room, 1111 East Cesar Chavez Street, Austin, Texas 78702.

There being no further discussion or agenda items, Manager Patrick moved that the meeting adjourn. Manager Heidrick seconded the motion. The motion was adopted on the following vote:

Chairperson Tom Coopwood For Vice-Chairperson Rosie Mendoza For

Treasurer Frank Rodriguez Absent Secretary Bobbie Barker For Manager Anthony Haley For Manager Clarke Heidrick For Manager Donald Patrick For Manager Brenda Coleman-Beattie For Katrina Daniel For

The meeting adjourned at 6:43 p.m. ____________________________________ Tom Coopwood, Chairperson Travis County Healthcare District Board of Managers ATTESTED TO BY: ____________________________________ Bobbie Barker, Secretary Travis County Healthcare District Board of Managers


April 22, 2010

Agenda Item C2 Receive the April 2010 Investment Report and

ratify Central Health investments for April 2010.

(Back-Up – Investment Report)

AGENDA ITEM# __ _

STATE OF TEXAS

COUNTY OF TRAVIS


Whereas, it appears to the Board of Managers of the Travis County Healthcare District, Travis County, Texas that there are sufficient funds on hand over and above those of :immediate need for operating demand,

Now, Therefore, the Board of Managers hereby orders

1.) that the County Treasurer of Travis County, Texas, acting on behalf of the Healthcare District, execute the investment of these funds in the total amount of $9,112,000.00 in legally authorized securities as stipulated in the Travis County Hospital District Investment and Collateral Policy for the periods as indicated in Attachment A, which consists of 13 pages.

2 . ) that the County Treasurer, acting on behalf of the Healthcare District, take and hold in safekeeping all individual security investment instruments, relinquishing same only by order of the Board of Managers or for surrender at maturity.

Date: April 22, 2010

CHAIR, BOARD OF MANAGERS

VICE CHAIR, BOARD OF MANAGERS MANAGER

MANAGER MANAGER

MANAGER MANAGER

MANAGER MANAGER

ATTACHMENT A TRAVIS COUl\JTY HEALTHCARE DISTRICT

INVESTMENT DEPARTMENT

SECURITY TRANSACT!ON FORM

DATE: 03/26/2010

Ti ME: 10:30

The following transaction was executed on behalf of Travis County Healtncare District:

DESCRIPTION: TEXSTAR FUND NAME: HEALTHCARE DISTRICT

PAR VALUE: 20,000.00 SAFEKEEPING NO: N/A

CPN/DISC RATE: NIA PRICE: 100%

MATURITY DATE NIA BOND EQ. YIELD: 0:1675%

PRINCIPAL: 20,000.00 PURCHASED THRU: TEXSTAR

--------ACCRUED INT:

TOTAL DUE:

TRADE DATE·

NIA BROKER: NIA

20,UOO.OO CUS!P #: NIA

03i26i2010 S:::TTLEM=:NT DATE: 0312612010

AUTHORIZED BY_:_& )}A CA.SH/INVESTMENT MANJ\&E'""R---

TRAV!S COUNTY HEALTHCARE DiSTRICT


SECURITY TRANSACTION FOf~M

DATE::

TIME:

ATTACHMENT A

03/24/2010

10:30

·------ -The following transaction was executed on behalf of Trav is County Healthcare District:

DESCRIPTION: Texas Daily FUND NAME: Hf::AL THCARE DISTRICT

PAR VALUE: 20,000.00 SAFEKEEPING NO: N/A

CPN/DISC RATE: N/A PRICF.: 'i00%

MATURITY DATE N/A BOND EGL YIELD: 0.1698%

PRINCIPAL: 20,000.00 PURCHASED THRU: Texas Daily

ACCRUED !NT: N/A BROKER: NIA

TOTAL DUE: 20,000.00 CUSIP #: N/A

TRADE DATE: 03/24/2010 SETTLEMENT DATE: 03/24/2010

ATTACHMENT A TRAVIS COUNTY HEALTHCARE DISTr~ICT


SECUHITY TRANSACTION FORM

DATE: 0312212010

T!ME: 10:30

The followi ng transaction was executed on behalf of Travis County Healthcare District:

DESCRIPTION:

PAR VALUE:

CPNIDISC RATE:

MATURITY DATE

PRINCIPAL:

ACCRUED INT:

TOTAL DUE:

TRADE DATE:

Texas Daily FUND NAME: HF.AL THGARE DISTRICT

---------.. ~----

20,000.00 SAFEf<EEP!NG NO: N/A

---·----- ---··· ... ·----N/A PRICE: 100%

------------·-- --------NIA BOND EQ. YIELD: 0.1808%

20,000.00 PURCHASED THRU: Texas Daily

---NIA BHOKER: NIA

--------·· --·--·--20,000.00 CUSIP #: NIA

0312212010 SETTLEMENT DATE: 0312212010

.A.UTHORIZEDBY: J~ CASH/INVESTMENT MANAGER

ATTACHMENT A TRAVIS COUNTY HEALTHCARE DISTRICT

INVESTMENT DEPr\RTMENr

SECURITY TR/\N~>ACT!ON FORM

D/\TE: 03/19/2010

TIME: 10:30

T he following transaction was executed on behalf of Travis County Healthcare District:

DESCRIPTION:

PAR VALUE:

CPN/DISC RATE:

MATURITY DATE

PRINCIPAL:

ACCRUED INT:

TOTAL DUE:

TRADE DATE:

Texas Daily FUND NAME: HEAi.THC.A.RE DIST RICT

'! 78,000.00 S.A.FEKEEPING NO: N/A

N/A PRICE: 100%

N/A BOND EQ. YIELD: 0.1898%

'178,000.00 PURCHASED THRU: T1~xas Daily

NIA BROKER N/A

178,000.00 CUSIP #: l'l/A

SETTLEMENT DATE 03/19/2010

AUTHOf~iZED BY-~--_b__~ CASH/INVESTMENT MANAGER



SECURITY TRANSACTION FORM

DATE: 03/ 16/2010

Tll'v1E: 10:30

The following transaction was executed on behalt of Travis County Healthcare District:

DESCRIPTION: TEXPOOL FliND NAME: HEALTHCARE DISTRICT

---· -~-----

PAR VALUE: 20,000.00 SAFEKEEPING NO: NIA

----CPNIDISC RATE: NIA PRICE: 100%

MATURITY DATE NI.I\ BOND EQ. YIELD: 0.1822%

PRINCIPAL: 20,000.00 PURCHASED THRU: TEXPOOL

---------ACCRUED lNT: NIA BROKER: NIA

---------TOTAL DUE:

TRADE DATE:

20,000.00 CUSIP #: NIA

03116/2010 SETTLEMENT DATE: 0~116/2010

AUTHORIZED BY_J~ CASH/INVESTMENT MP1NAGER


!NVESTMENT DEPARTMENT


DATE:

TIME:

ATTACHMENT A

0311512010

10:30

The following transaction was executed on behalf of Travis Cl>Unty Healthcare District:

DESCRIPTION: Tex as Daiiy FUNu NAME: HEALTHCARE DISTRICf

PAR VALUE: 206,250.00 SAFEKfEP!NG NO: NIA

-----------·

CPNIDISC RATE: NIA PRICE: 100%

MATURITY DATE NIA BOND EQ. YIELD: 0. 1908%


ACCRUED INT: N/A BROKER: NIA

-------TOTAL DUE: 206,250.00 CUSIP #: N/A

TRADE DATE: 03/15/2010 SETTLEMENT DATE: 03115/2010

---------

AUTHORIZED BY:

ATTACHMENT A


INVESTMENT Df.PARTMENT

SECURITY TRANSACT!ON FORM

DATE: 03/12/2010

T!ME: 10:30

The following transaction was executed on behalf of Travi~ County Healthca;e District:

DESCRIPTION: Texas Daily FUND NAME: HEALTHCARE DISTRICT

PAR VALUE: 2,000,000.00 SAFEKEEPING NO: NIA

CPN/DISC RATE: N/A PRICE: 100%

MATURITY DATE N/A BOND EQ. YIELD: 0.1781%

PRINCIPAL: 2,000,000.00 PURCHASED THRU: Texas Daily

ACCRUED INT: N/A BROKER: N/A

TOTAL DUE: 2,000,000.00 CUSIP #: t-J/A


AUTHORIZED BY:

-CASH/INVESTMENT MANAGER

ATTACHMENT A

TRAVIS COUNTY HEALTHCARE DISTRiCT



DATE: 03/12/2010

------

TIME: 10:30

The following transaction was executed on behalf of Travis County He::ilthcare District:

DESCRIPTION: TEXPOOL FUND NAME: HEALTHCARE DISTRICT

PAR VALUE: 1, 109,000.00 SAFEKEEPING NO: N/A

CPN/DISC RATE: NIA PRICE: 100%

MATURITY DATE NIA BOND EQ. YIELD: 0.1 594%

PRINCIPAL: 1, 109,000.00 PURCHASED THRU: TEXPOOL

ACCRUED INT: N/A BROKER: N/A

TOTAL DUE: 1, 109,000.00 CUSlP #: N/A


AUTHORIZED B~A _____ , CASH/INVESTMENT MANAGER


!NVESl.MENT DEPARTME.NT


DATE: 03/11/2010

TIME: 10:30

The following transaction was execu!ed on hehalf of Tr<:vis County Healthcare District:

DESCRIPTION: Texas Daily FUND NAME: HEALTHCARE DISTRICT

----.-------- --------PAR VALUE: 174,000.00 SAFEKEEPING NO: N/A

CPN/D!SC RATE: N/A PRICE: 100%

-··-·---- ·-----MATURITY DA T E NIA BOND EQ. YlELD: 0.1751%

PRINCIPAL: 174,000.00 PURCHASED THHU: Texas Dai!y

ACCRUED INT: NII,,_ BROKER: N/A

-----TOTAL DUE: 174,000.00 CUSIP #: N/A

-----TRADE DATE: 03/11/2010 SETTLEMENT DATE: 03/11/2010

AUTHORIZED BY: I ~ ~----·------ ----CASrl/ INVESTMENT MANAGER


INVESTMENT DEPAR1 MENT

SECURlrY TRC\NS,A.CrlON FORM

DATE:

Tl ME:

ATTACHMENT A

0:1111120·10

10:30

The following transaction was executed on behalf of T!·avis County Haalthcc:ire District:

DESCRIPTION: Texas Daily FUND l'JAl'lt.E: HE?.L THCARE DISTRICT

----------PAR VALUE: 113,lSO.OO SAFEKEEPING NO: NIA

- .... ____________ ., CPN/DISC RATE: NIA PHICE: 100%

- - ·-·--.... -·-· ·~ ... --.

MATURITY DATE NIA BONO EQ. YIELD: 0.1751%

------------ --·- -------PRINCIPAL: 113,750.00 PURCHASED THRU: Texas Daiiy _________ ...,_,, _______

ACCRUED iNT: N/A BROKER: NII\

·-·-·-- --- -----·· TOTAL DUE: 113,750.00 CUSIP#: N/A

TRADE DATE: 03/'1 1/2010 SETTLEMENT DATE: 03/1 1/201 0

AUTHORIZED BY:

TRAVIS COUNTY HEALTHCARE DIS"iR!CT



DATE:

TIMF.:

ATTACHMENT A

03/09/2(;10

10:30

The following transaction was executed on behalf of Travis County Healthcare District:

DESCR!PTION: Texc.s Gaily FUND NAME: HE/\l THCARE DISTRICT

PAR VALUE: 13,000.00 SAFEKEEPING NO: NIA

CPN/DISC RATE: N/A PRICE: 100%1

----------.~1.4.TURITY DATE NIA BOND EQ. YIELD: 0:1871%


-------ACCRUED !Nl": N/A BROKH~:

TOTAL DUE: 13,000.GO CIJS!P #: N/A





DATE:

TIME:

ATTACHMENT A

3/1/2010

10:30

----·--


OESCRI PTION: Texas Daily FUND NAME: HcAL THCARE DISTRICT

PAR VALUE: 2,238,000.00 SAFEKEEPING NO: NIA

CPN/DISC RATE: N/A PRICE: 100%

MATURITY DATE N/A BOND EQ. YIELD: 0.1720%

PRINCIPAL: 2,238,000.00 PURCHASED THRU: Texas Daily

-·----------~-- ·-··---------·-ACCRUED INT: N/A BROKER: NIA

--- ------·--

TOTAL DUE: 2,238,000.00 CUSIP #: N/A


AUTHORIZED BY:

TRAVIS COUNTY HEAL THCAHE DISTRICT



DATE:

TIME·

ATTACHMENT A

3/1/2010

10:30


DESCRIPTION: Tex Pool FUND NAME: HEALTHCARE DISTRICT

PAR VALUE: 3,000,000.00 SAFE.KEEPING NO: N/A

-·--------------.. ----------CPN/DISC RA TE: N/A PRICE: 100%

---------------MATURITY DATE NIA BONO EQ. YIELD: 0.1526%

------------- --·--PRINCIPAL: 3,000,000.00 PURCHASED THRU: Tex Pool

--·--------ACCRUED INT: N/A BROKER: N/A

.. -.- ·---------·-·

TOTAL DUE: 3,000,000.00 CUSIP#: NIA


AUTHORIZED BY:

TRAVIS COUNTY HEALTHCARE DISTRICT MONTHLY INVESTMENT REPORT

PORTFOLIO STATISTICS

DATE: March 31, 2010

Operating-TexasDAILY 42,345,456.73 TexPool 39,752,325.96 TexSTAR 3,094,823.78 Treasury Securities 7,433,359.38 Government Agencies 54, 135,899.60 Commercial Paper 0.00

Total $ 146,761,865.45

Com~ared to Polic~ Limits Operating-

TexasDAILY 42,345,456.73 TexPool 39, 752,325.96 TexSTAR 3,094,823.78

Total LGIPS 85, 192,606.47

Treasury Securities 7,433,359.38

Government Agencies 54, 135,899.60 Commercial Paper 0.00

$ 146,761,865.45

Investment Revenue & Accrued Interest March 2010 Operating-

TexasDAILY 6,753.35 TexPool 5,566.13 TexSTAR 466.03 Treasury Securities 0.00 Government Agencies 320,000.00 Commercial Paper 0.00

332,785.51

Discount Accretion & Accrued Interest Treasury Securities 4,764.11

-less previous accruals 0.00 Government Agencies 60,386.05

-less previous accruals (297,638.89) Commercial Paper 0.00

-less previous accruals 0.00

(232,488. 73)

Total Investment Revenue & Accrued Interest $ 100,296.78

28.85% 27.09% 2.11% 5.06%

36.89% 0.00%

100.00%

Actual% Guidelines

28.85% 30.00% 27.09% 50.00%

2.11% 30.00% 58.05% 70.00%

5.06% 100.00%

36.89% 75.00% 0.00% 20.00%

100.00%

Fiscal YTD

36,497.95 25,260.78

9,060.61 0.00

1,082,600.00 0.00

1,153,419.34

14,138.65 0.00

433,822.65 (1,000,168.88)

0.00 0.00

(552,207.58)

$ 601,211.76


April 22, 2010

Agenda Item C3 Receive the March 31, 2009 Second Quarter

Investment Report.

(Back-Up – Second Quarter Investment Report)

CASH/INVESTMENT MANAGEMENT DEPARTMENT TRAVIS COUNTY, TEXAS

Travis County Administration Building

3 14 W. 11th Street, Suite 540 P.O. Box 1748

Phone: (5 12) 854-9085

Fax: {5 12) 854-42 10 Email: [email protected]

Austin, Texas 78767

DATE: April 22, 2010

TO: Thomas B. Coopwood, M.D., Chairperson Rosie Mendoza, C.P.A., Vice-Chairperson Frank Rodriguez, Treasurer Bobbie Barker, Secretary Clarke Heidrick, J.D., Manager Donald Patrick, M.D., J.D., Manager Brenda Coleman-Beattie, M.A., Manager Anthony Haley, J.D., Manager Katrina Daniel, R.N., Manager

FROM: Mary E. Mayes, Travis County Investment Manager

RE: Central Health Second Quarter March 31, 2010 Investment Report

INVESTMENT EARNINGS

Total portfolio earnings for this quarter:

Total portfolio earnings for this fiscal year:

$

$

286,097.77

601,211. 76

These earnings are determined on an accrual basis. Investment balances are in the Portfolio Statistics section of this report.

CASH AVAILABILITY

Operating Account for the Quarter Ended March 31, 2010:

The cash availability in the bank operating account is monitored daily. Typically, cash balances are invested as soon as they are known and available . The cash availability (includes the controlled disbursement) for the quarter ended March 31, 2010:

January

February

March

2010 Average Daily Collected Balance

$ 34,174.78

$ 30,335.16

$ 43,631.33

2009 Average Daily Collected Balance

$22,387.06

$25,236.30

$36,762.82

FOMC meeting on 4/28/10. The Bl oomberg po l l of 24 economi sts is unanimous that t he Fed Funds will remai n at 0 . 25% .

INVESTMENT STRATEGY - NEXT QUARTER

Operat i ng Portfolio

Rates f or the i nvestment pools remain l ow after what appears to be a bottom in mid-Februa r y. With t he i n c r ease i n cash flow during the second quarter due t o t he t ax revenue, 3 agenc i es were purchas ed t o imp rove the yie l d of the portfolio. As we look at the next quarter i t is d i fficult to justify purchasi ng any security t hat matures bef ore t he end of the 2010 when the rates available for s hort - term agenci es a nd treasu ries are not sufficiently higher than pool rates. We wil l cont i nue to l ook for opportu n i ties to purchase 2 secur i ties i n t h e t hird quarter to improve the yield of t he por tfolio and i nves t ing t o meet future cash needs in 2011.

Portfolio Diversity March 31, 2010

TexPool 27.09%

T exasDAILY 28 .85%

PORTFOLIO DIVERSITY

TexSTAR 2.11 %

Agency Securities 36.89%

Treasuries 5.06%

Safety of principal is the first priority of any public i nvesting portfolio . An important way to maintain safety i s to diversify by pu rchasing a variety of security types . Total investment pools decreased from 64% of the portfol io to 58% , as three Agency securities were purchased during the quarter. Agency percentage rose from 29% to 37%, and additional diversity is provided as they were issued by three different agencies, and the U. S. Government's

3

The Federal Funds rates have remained at O. 00-0 . 25% for the last five quarters, down from 2.00% at the beginning of the last fiscal year.

The longer maturities in Central Health's portfolio have continued to hold the yield well above the overnight funds, though the yields are continuing to decline. This decline b egan with the maturity of two higher yielding securities in November and December, and has continued with the influx of tax revenue, which must be i nvested at today's l ower rates.

The weighted average maturity (WAM) of Central Heal t h's portfolio increased from 126 days at the end of the first quarter on December 31, 2009, to 135 days at the end of the second quarter on March 31, 2010.

COLLATERAL ADEQUACY

Collateral coverage was more than the 102% of bank balances required by policy at all times during the first quarter.

Based on policy r equirements, the highest collateral coverage during the first quarter was 299.41% on February 24, 2010, and t he lowest was 106.91% on January 6, 2010 .

This report was prepared jointly by Mary E . Mayes, Investment Manager, Harvey L. Davis, Assistant Investment Manager, and Deborah Laudermilk, Investment Officer . The investment portfolio of the Travis County Healt hcare District dba Central Health complies with the investment strategies in t he Travis County Healthcare Di strict Investment and Collateral Policy and Procedures and with the Public Funds Investment Act of Texas .

~/ ~ .fvtu lf;__ Harvey L . Davis Deborah A. Laudermilk

Inves Asst . Investment Mgr. Investment Officer

5

CENTRAL HEAL TH QUARTERLY INVESTMENT REPORT

PORTFOLIO STATISTICS

DATE: March 31, 2010

B Securit T e Operating

TexasDAILY TexPool TexSTAR Treasury Securities Government Agencies Commercial Paper

Com~ared to Polict Limits Operating-

TexasDAILY TexPool TexSTAR

Total LGIPS

Treasury Securities Government Agencies Commercial Paper

Total

Investment Revenue & Accrued Interest Operating-

TexasDAILY TexPool TexSTAR Treasury Securities Government Agencies Commercial Paper

Discount Accretion & Accrued Interest Treasury Securities

-less previous accruals Government Agencies

-less previous accruals Commercial Paper

-less previous accruals

Total Investment Revenue & Accrued Interest

42,345,456.73 39,752,325.96

3,094,823.78 7,433,359.38

54, 135,899.60 0.00

$ 146,761,865.45

42,345,456.73 39,752,325.96

3,094,823.78 85, 192,606.47

7,433,359.38 54, 135,899.60

0.00

$ 146,761,865.45

2nd Quarter 201 O

17,089.07 14,891.24 2,872.42

0.00 462,500.00

0.00

$ 497,352.73

13,831.29 0.00

214,260.97 (439,347.22)

0.00 0.00

$ (211,254.96)

$ 286,097.77

28.85o/o 27.09%

2.11% 5.06%

36.89% 0.00%

100.00%

Actual 0/o

28.85% 27.09%1

2.11o/o 58.05%1

5.06°/o 36.89%

o.00°1o

100.00%

Fiscal YTD

36,497.95 25,260.78

9,060.61 0.00

1,082,600.00 0.00

$ 1, 153,419.34

14, 138.65 0.00

433,822.65 (1,000, 168.88)

0.00 0.00

$ (552,207.58)

$ 601,211.76

Portfolio Yield and WAM Yield Weighted Average Maturity

January, 201 O 0.89°/o 120 days

February, 2010 146 days

March, 2010 0.82°/o 135 days

WAMin March Yield to DaJ'.S Maturity

0.18%) 0.16% 0.16%

425 0.76%1 306 1.89o/o

135 0.82°/o

Guidelines

30.00o/o 50.00o/o 30.00o/o 70.00%

100.00% 75.00o/o 20.00o/o

Beg. Balance - All Funds Central Health - Cash Inv. Mgt.

Straight Line - Actual Life Receipts in Period

12131/2009

Fitzgerald Lehman Brothers Lehman Brothers Morgan Keegan & Company, Jnc.

3133XPWVVO Frost National Bank

naliibr?< :::pd~~;:~ :;fg~~f .. i ... •_r~.i.r.w.·:.•.• .•.. :.~.;r.·, •. ':.•.:,.. f;~:. :: -rlif!~lJfi(f:; ,'.~~~:~?ff<. -·-- .,, .. -- . -- " . ·- ,. .. . . . ;·. :x:- :: {M"''.·-::;;-:-;:;i·i;•"--1';'. ':-f::-o/'~'~::~,~-syy , t:)/} :'.)(paj!~~:<-< •:_'!f#,f.!\jki - " - .- __ fl\"'o.;'Yj : :··:c_,<·_~)'

· 6,284,623."86 0411e1oa oa102110 2.soso 6:012.106.sa· 6.142-.Soo.·oo 69,793.42 6,414,240.00 10!30/07 09/15!10 4.2941 6,101,658.90 6,271,860.00 170,201.10 6,339,780.00 03/25/08 10/18/10 2.6983 6,105,652.07 6,200,640.00 94,987.93 6,311,760.00 02113/08 12/15110 2.8309 6,104,936.83 6,236,280.00 131,343.17 7,224,117.32 06122109 03/11/11 1.3590 7,155,687.31 7,207,830.00 52,142.69

912828FH8 First Southwest Company 10-0005 7,000,000.00 -405,234.38 7,405,234.38 12130/09 05/31/11 0.7610 7,403,666.74 7,395,640.00 -8,026.74 38,000,000.00 -1,979,755.56 39,979,755.56 2.3443 38,944,308.43 39,454,750.00 510,441.57

Purchases Central Health - Cash Inv. Mgt.

Straight Line - Actual Life Receipts in Period

01/01/10- 03/31/10

31398AWQ1 FTN Financial ·• 3133XWCC1 SunTrust Capttal Markets -, 3133XTXH4 Coastal Securities

~~l«~~,~~l&l~~ii!iil~~·t·.·· .,. 7,000,000.00 -74,620.00 7,074,620.00 24,329.86 01/29/10 7,000,000.00 -3,361.12 7,003,361.12 6,076.39 02/05/10 7,000,000.00 -100,373.00 7, 100,373.00 1,895.83 02/03/10

21,000,000.00 -178,354.12 21,178,354.12 32,302.08

l>:.WliJllJ} i••li'f()';i'

t20'M~@t 04/28/11 0.5163 06/15/11 0.5895 07/27/11 0.6520

0.5844


April 22, 2010

Agenda Item C4 Approve a contract for appropriate referral and funding for support services related to women’s

health services contracts.

(Back-Up – Recommendation Summary)

BOARD OF MANAGERS MEETING

APRIL 15, 2010 Agenda Item #C4: Approve a contract for appropriate referral and funding for support services related to women’s health services contracts. Recommended Board Action: To contract with the YWCA of Greater Austin for options counseling services. Staff is proposing services be provided by the YWCA of Greater Austin, also known as the YW Counseling and Referral Center (YWCRC). YWCA is not a provider of medical services but rather offers comprehensive counseling support services to women.

TCHD Strategic Direction: SC03: Increase the availability of specialty care services. MAP03: Maintain the Central Health’s identity as a “community steward” by expanding the MAP payor network. Increase service contracts to expand the provider network. Resource Impact: Central Health has a total of $450,000 available for women’s health services in the FY 2010 healthcare services budget which includes funds for these proposed services. Anticipated Result: Central Health eligible women will have access to additional options counseling related to pregnancy termination decisions. The services provided reflect one component of the service continuum.

Background Summary: At the Board meeting on December 10, 2009, the Board directed staff to investigate the feasibility of providing additional pregnancy options counseling for Central Health eligible women who may seek pregnancy options or termination services. The YWCRC is staffed by licensed social workers and counselors who can provide counseling for women using a relational-cultural approach to counseling. They also provide bi-lingual services. These services would include:

• One-to-one counseling by a licensed staff within 24 hours of a request for options counseling. • Information and support for a pregnant woman who is considering options regarding the

continuation of the pregnancy. • Provision of plans for continuation of the pregnancy, by either self-parenting or adoption, or

for termination in a non-judgmental and non-biased manner including referrals to appropriate agencies and social services if the woman chooses to continue the pregnancy.

Information on how to obtain these services will be offered to Central Health eligible woman at the time a request is being made for an appointment. It will be a requirement for the contracted woman’s health services providers to offer these Central Health supported option counseling services.

Board Coordination: COMMITTEE CHAIR COMMENTS DATE

CONSIDERED Budget & Finance Frank Rodriguez Approved by the Budget &

Finance Committee 4/15/2010

Board of Managers Tom Coopwood, M.D.


April 22, 2010

Agenda Item 1 Receive and discuss a report on current activities

related to Graduate Medical Education (GME).

(No Back-Up)


April 22, 2010

Agenda Item 2 Receive and discuss a report of the March 2010

financial statements for Central Health.

(Back-Up – Financial Statements)

Central Health March 2010 Financial Statements Statement of Revenues, Expenses and Changes in Net Assets Operating Revenues: DSH/UPL – Received a UPL payment of $2.1 million and a DSH payment of about $700k for total additional rent revenue of $2.8 million. Operating Lease – March lease payment for Seton (Brackenridge) and UTMB (Austin Women’s Hospital). Operating Expenses: Healthcare delivery – This is $6.6 million for the month, slightly above recent months but within budget for the month, as well as for year-to-date. Salaries & Benefits- This area was about $140k higher in March than normal due mostly to retention payments of $88k and PTO payouts of $22k. Year to date we are still well within budget. Other Purchased Goods & Services-This area is also within budget. Non Operating Revenues: Tax Revenue- With our tax collections of $695k in March we are at $65 million for the year and at 99% of our budgeted FY 2010 revenue of $65.4 million. Investment Income-Investment income of $102k is up in March but still well below budget year to date. Other revenue of $67k is our first draw down on the ARRA grant we received to renovate the East and South CHCs. Change in net assets of negative $3.8 million reflects the fact that we peaked in property tax collections in February and our monthly expenditures will exceed monthly revenues for the remainder of the year – however, we expect to increase our net assets for the fiscal year. Statement of Net Assets (Balance Sheet) Assets: $8 million in restricted cash for the regional (private) UPL escrow account. The District had $145 million in cash and investments at March 31, but we separating these into current assets of $124.1 million and noncurrent assets of $20.9 million, restricted for capital acquisition. Ad valorem taxes receivable of $2 million reflects the 2010 tax levy less collections through the end of January. Other Receivables of $7.3 million is about $450k in interest and other receivables and $6.8 million in due from CommUnityCare – short term. There is another $4 million in a long-term receivable from CommUnityCare in the noncurrent asset section. Liabilities: Private UPL Payable – $8 million, offsetting the restricted cash for the Regional UPL program. Deferred tax revenue of $2 million is the amount of current year property tax yet to be collected. It offsets the taxes receivable in the current asset account, since tax revenue must be reported on a cash basis, as it is received.

Travis County Healthc.are District Statement of Revenues, Expenses&. Changes in Net Assets

From 3/1/2010 Through 3/31/2010 (In Whole Numbers)

Actual - This Actual - Fiscal Budget - Fiscal Budget - Fiscal Actual - Prior Month Year to Date Year to Date Year Total Year to Date

Operating revenues: Additional Rent/Seton 2,762,664 18,349,217 13,934,122 28,389,113 15,167,637 Operating lease revenue 96,283 577,698 577,698 1,155,396 577,698

Total Operating revenues: 2,858,947 18,926,915 14,511,820 29,544,509 15,745,335

Operating expenses: Health care delivery 6,618,633 38,914,445 43,300,391 86,579,571 36,734,000 Salaries and benefits 511,086 2,355,811 2,721,265 5,233,439 1,558,642 Other purchased goods and services 170,810 945,935 1,589,034 3,178,046 862,000 Depreciation 194,597 1,169,586 1,140,620 2,281,241 958,820

Total Operating expenses: 7,495,126 43,385,777 48,751,310 97,272,297 40,113,462

Operating income (loss) (4,636,179) (24,458,861) (34,239,490) (67,727,788) (24,368,127)

Nonoperating revenues (expenses): Ad valorem tax revenue 695,435 65,056,616 64,240,352 65,403,436 63,005,817 Tax assessment and collection expense (60,994) (368,082) (377,824) (755,648) (355,020) Tobacco settlement revenue 0 0 0 1,280,000 0 Investment income 101,829 538,857 900,000 1,800,000 1,139,302 Other revenue 67,607 67,795 0 0 125

Total Nonoperating revenues (expenses): 803,876 65,295,185 64,762,528 67,727,788 63,790,224

Changes in net assets (3,832,302) 40,836,324 30,523,038 0 39,422,097

Total net assets - end of year (3,832,302) 40,836,324 30,523,038 0 39,422,097

Dab!: 4/12/10 ~:J0:3S PM Page: l

Central Health Statement of Net Assets As of March 31, 2010 and 2009 Unaudited

ASSETS Current assets:

Cash and cash equivalents Restricted cash - Medicaid Regional UPL Program Short-term investments Ad valorem taxes receivable Other receivables Prepaid expenses

Total current assets

Noncurrent assets: Short-term investments restricted for capital acquisition Long-term receivables Capital assets:

Land Buildings and improvements

Equipment and furniture Less accumulated depreciation

Total capital assets

Total non current assets

Total assets

LIABILITIES Current liabilities

Accounts payable Regional UPL payable Salaries and benefrts payable Deferred tax revenue

Total current liabilities

Total liabilities

NET ASSETS Unrestricted

Investment in capital assets

Total net assets

T:\Attalntfng\Ml)nth End\FY201()\14ardl 20111\draft: llnandals\ MAA2010 llillal'ICJ! sheet 1.lds Belal'ICJ! gm MAR2010

FY 2010

$ 7,336 8,040,871

124,120,572 2,065,094 7,289,327

296,144

141 ,819,344

20,942,358 4,000,000

10,345,124 92,243,361

2,446,433 (10,805,068)

94,229,849

119, 172,207

260,991 ,551

2,005,214 8,040,871

388,338 2,032,619

12,467,042

12,467,042

154,294,660

94,229,849

$ 248,524,509

FY 2009

(58,007) 9,253,747

144,423,693 1,918,319 2,808,766

276,921

158,623,638

9,884,124 90,198,114

2,235,370 (6,524, 798)

93,792,810

93,792,810

252,416,448

4,561 ,742 9,253,747

283,071 1,981,430

16,079,990

16,079,990

142,543,648

93,792,810

236,336,458

Expenditures:

Salaries and Benefits Operating Expenses (exduding depreciation)

Healthcare Delivery FFS-Primary Care FFS-Specialty Care

FFS-Mental Health FFS-Women's Services FFS-Pharmacy FFS-Dental Medicaid Payments-Physicians Medicaid Payments-MAP Medical Administration Claims Administration

Total Healthcare Delivery Service Expansion

Medical Expansions - Enhancements Medical Expansions - Primary Care Medical Expansions - Specialty Care

Total Service Expansion Total Expenditures:

0.: ~/12/10 05:31:5'1 PM

Travis County Healthcare District TCHD Comparative Budget Report

From 3/1/2010 Through 3/31/2010 (In Whole Numbers)

Total Budget Total Budget -Revised Current Year Actual Variance - Revised

5,233,439 2,355,811 2,877,628 3,178,046 945,935 2,232,111

44,873,488 21,429,133 23,444,355 1,433,661 258,179 1,175,482 5,424,701 3,024,623 2,400,079

450,000 114,387 335,613 2,941,192 1,012,431 1,928,761

361,951 176,828 185,123 6,351,246 3,175,623 3,175,623

17,648,754 8,824,377 8,824,377 1,380,636 434,403 946,233

988,079 464,462 523,617 81,853,708 38,914,445 42,939,263

2,841,993 0 2,841,993

1,397,134 0 1,397,134 486,736 0 486,736

4,725,863 0 4,725,863

94,991,056 42,216,191 52,774,865

Percent Consumption of Annual Budget

45.01% 29.76%

47.75% 18.00% 55.75% 25.41% 34.42% 48.85% 50.00% 50.00%

31.46% 47.00% 47.54%

O.OOOA:i 0.00% 0.00% 0.00%

44.44%

Page: 1


April 22, 2010

Agenda Item 3 Discuss and take appropriate action on the

approval and implementation of a service payment policy for contracted safety net providers.

(Back-Up – Request for Action)

Memo To: Central Health Board of Managers

From: Larry Wallace, Central Health Chief Service Delivery Officer

CC: Trish Young Brown, Central Health President and CEO

Date: April 16, 2010

Re: Agenda Item #3: Discuss and take appropriate action on the approval and implementation of a service payment policy for contracted safety net providers.

Background: Central Health developed standard reimbursement rates using the prevailing Medicare Fee Schedule for contractors providing primary care services to self-pay and Medical Assistance Program enrollees. The current reimbursement rate for self-pay patients is $91.00 per encounter and 115 % of the Medicare Fee Schedule for MAP enrollees. Recommendation: Central Health continues to implement a systematic approach for better utilization and coordination of primary care services for eligible Travis County residents. To be successful, Central Health must negotiate competitive reimbursement rates to increase access to quality health care. We are proposing to increase our self-pay encounter reimbursement rate from $91.00 to $133.00 and increase MAP reimbursement rate from 115% to 133% of the Medicare Fee Schedule, effective July 1, 2010. The contracts amended accordingly include El Buen Samaritano Episcopal Mission, Samaritan Health Ministries, Volunteer Healthcare Clinic, Blackstock (CTMF, Inc. d/b/a Austin Medical Education Program), Lone Star Circle of Care, Paul Bass Internal Medicine (CTMF, Inc.), and People’s Community Clinic. Lone Star Circle of Care, a Federally Qualified Health Center (FQHC), will continue to be paid at the prevailing Prospective Payment System (PPS) rate for MAP enrollee and $133.00 for self pay patients.


April 22, 2010

Agenda Item 4 Participate in and discuss a healthcare visioning

exercise related to focus group feedback.

(No Back-Up)


April 22, 2010

Agenda Item 5 Receive and discuss an update to the Community

Planning Initiative.

(Back-Up – Summary Update)

Community Planning Initiative Board of Managers Update April 22, 2010 During the first two weeks of April, SUMA/Orchard Social Marketing conducted 8 focus groups. The purpose of these groups was to begin collecting information about perspectives on the healthcare system in Travis County. The groups were selected in a way to gain perspectives from a variety of people. Subcategories for participation included geographic region, race, age, gender and income. Initial findings from the focus groups will be presented to the Board of Managers at the Board Retreat on 4/24/10. As part of the Board Retreat, the Board of Managers and the President/CEO will participate in a quick exercise that was used during the focus groups. Plans are in process to begin a telephone survey of Travis County residents the first week of May. Development of the survey instrument will take place during the last two weeks of April. We anticipated that results from the Community Planning Initiative would be coming in later months; however, we are finding that information gathered in the focus groups is already informing the current strategic planning process.


April 22, 2010

Agenda Item 6 Receive and discuss a report on changing

demographics in Travis County.

(No Back-Up)


April 22, 2010

Agenda Item 7 Receive and discuss a matrix of service delivery

and financing mechanisms.

(Back-Up – Matrix)

Draft Tools Matrix

Access Technology/Data Quality Leadership

Financial Tools Taxation X X Real Estate Ownership (such as UMCB and North Central)

X

X Bonds/Certificates of Obligation

X

Condemnation Joint Ventures X X

Role Tools Neutral Party X Local Government X

Data Tools Demographic Projections

X

X

Community/Client Input

X

X

X

X

I-Care/HIT X X Service Tools

HMO X X X X UMCB X Federally Qualified Health Center status

X

X

Seton Lease X Accountable Care Organization

X

TexHealth Central Texas

X

Graduate Medical Education

X

X

Academic Medicine X X


April 22, 2010

Agenda Item 8 Receive and discuss reports from the Board

committees: Audit and Compliance Committee; Budget and Finance Committee; and ad hoc

Legislative Committee.

(Back-Up – Committee Minutes)


April 22, 2010

Agenda Item 9 Receive and discuss the CEO’s report on the following Central Health activities: (a) procurement activity; (b) current communications/outreach statistics; (c) a status report on North Central Health Center Project; (d) the MAP Program, including April enrollment and activities; (e) an update on the Community Planning Initiative; and (f) the March Psychiatric Stakeholders meeting minutes.

(Back-Up – Reports)

Travis County Healthcare District Procurement Activity Report

Page 1 of 1

Through its purchasing policy (PUR001), the Board of Managers has authorized the District President and CEO to execute District contracts with a value of less than $100,000 without requiring board action or approval and to execute certain contracts on its behalf that meet the pre-authorization criteria outlined in policy.

Table 1: Contract actions from March 18, 2010 through April 14, 2010 CONTRACT

ACTION VENDOR NAME DESCRIPTION OF CONTRACT AMOUNT NOTES / COMMENTS Agreement Austin Women’s Health Center Agreement for Women’s Health Services $450,000

Fourth Amendment and

Renewal Fulbright & Jaworski LLC Professional Legal Services Agreement $46,500 Agreement George & Brothers LLP Professional Legal Services Agreement $50,000

First Amendment and Second

Renewal

ATCHMHMR, CTMF d/b/a Austin Medical Education Program, Horizon Health Austin, Inc. d/b/a Austin Lakes Hospital,

and Seton Healthcare Inpatient Mental Health Services continuation Agreement

Temporary holdover through April, pending new agreement

Purchase Order Apex Construction estimate for Austin South Clinic $4,612.50

Agreement Flynn Construction Agreement for Design Build Services – North Central Community Health Center $12,640,000

Conflict-of-Interest Statement Information:

Chapter 176 of the Local Government Code requires that local government officers file a conflict-of-interest statement disclosing certain relationships with a vendor within seven (7) days of becoming aware of facts that give rise to the conflict. The District has contracted with the following new vendors:

• Flynn Construction

• George & Brothers LLP

Please ensure that you have no conflict-of-interest with this vendor that would require the filing of a conflict-of-interest statement. You do not need to do anything if you have no conflict. Completed conflict-of-interest statements should be filed with the District Administrative Supervisor (Kay Williams) using the form found in your Board packet. If you have any questions about whether you have a conflict, please contact Sarah Churchill.

Communications/Outreach Report March - April 2010

Government Affairs & Community Relations Presentations Date Venue/Topic Presenter ~# in

attendance 4/14 Travis/Williamson Service Committee of the ICC/Healthcare

reform Stacy 20

4/14 Southwest Key East Austin Children’s Promise Breakfast Ed 75 4/12 Chamber of Commerce Golf Tournament Ed 84 4/1 Chamber of Commerce Networking Breakfast Ed 87

3/31 Healthy People subcommittee of the Community Health Access Committee sponsored by St. David’s Foundation/Healthcare reform Stacy 10

3/23 AISD Mendez Middle School – Family Resource Center Ed 12 Web Site Statistics

Month Visits Unique Visitors

Page views

*

Bounce Rate

**

Time on

Site Top 3 Pages

March 2010 5,121 3,105 16,944 52.51% 2:12 1) traviscountyhd.org – 23.51%

2) medical_assistance_program - 12.69% 3) healthcare_services – 8.24% Feb. 2010 4,191 2,490 14,710 49.63% 2:33 1) traviscountyhd.org - 21.79% *Pageviews is the total number of pages viewed on your site and is a general measure of how much your site is used. 2) medical_assistance_program - 12.53% **Bounce Rate is the percentage of single-page visits (i.e. visits in which the person left your site from the entrance page). 3) healthcare_services – 7.99%

Earned Media

4/9 Austin Chronicle, Jordan Smith Making 'Pregnancy Centers' Tell the Truth

4/8 Pflugerville Pflag, James Rincon Community eyes health care bill

3/24 Univision interview w/Ed Gomez Healthcare reform’s impact on immigrants

Special Projects Community Planning initiative, 5-year report card & community planning event planning, continued identity & branding product rollout, employee appreciation luncheon planning

1

Community Relations Report Ed Gomez April 15, 2010 The following report contains relationship-building initiatives, dialogues, investigations and conversations with the intent to increase health care access and grow community engagement in our Travis County service area. Austin Promise Neighborhood Initiative Working with community betterment stakeholders I attend regular meetings in the St. Johns and Govalle/Johnston Terrace. Part of this initiative includes health care access. Auxanomen (Dr. Susan Dubois), UT School of Health Education and Kinesiology (Dr. Mary Steinhardt and the Family and Wellness Center at UT Designing a collaborative with the above parties, to expand the delivery of a comprehensive model of health care for diabetic African American patients that include (or which includes?) greater access to specialty care, mental health support groups and exercise. Delete unless Trish knows about this… Childrenʼs Optimal Health Serving on this board I participate in linking the data from the GIS mapping to existing assets and resources in the community to address pockets of unmet healthcare needs, i.e. Los Padrinos. CommUnityCare

• Responding to the Dove Springs and South Austin areas concerning delivery of service and capacity issues. I work with community leaders and CommUnityCare management and staff to seek ways to create solutions. Evaluating application of Promotoras, (community health workers) to create a healthier chronic disease patient panel.

• Working with executive CommUnityCare leadership to develop and create a fund raising and development department and further their community engagement program.

Huston Tillotson/ CommUnityCare Health Centers Working with CommUnityCare staff and the development team at Huston Tillotson (HT) for the proposed collaboration for the establishment of a CommUnityCare Health Center to be built as part of a larger capital campaign by HT. Levander Loop Project In conversation with the COA Health and Human Services Department, Community leaders in the Govalle/Johnston Terrace neighborhood for the solicited future site of a developed complex that may include a health care center. Los Padrinos PRN Working with this associated group of stakeholders in the Hispanic community I am working to form a collaborative program to address the high obesity and overweight children problem at Mendez Middle School through the Family Resource Center at the school. Stakeholders include AISD, Seton, and YMCA etc.

2

Neighborhood Association Meetings I regularly attend local neighborhood association meetings to participate in their neighborhood concerns, make presentations about Central Health and CommUnityCare and answer questions about our role and eligibility program. North Central Project I am engaged with neighborhood association leaders and citizens during the pre-construction process responding to issues concerning the property. I have also begun providing weekly updates to the community leaders in this area. Once the design build team comes on board officially, I will continue to serve as liaison with the community. Renovation of Central Health Administrative Offices I have met with local neighborhood businesses, organizations and neighborhood associations to inform them about our remodeling plans. I will maintain these relationships to keep them updated on the progress. Renovations of South and East CommUnityCare Clinics I am working with Central Health facility management and CommUnityCare to communicate to the community neighborhoods about the remodeling projects for these locations. Southwest Key In conversation with Southwest Key leadership to explore partnership opportunities. SW Key is considering purchasing an existing site on the corner of Ed Bluestein and Martin Luther King Blvd to expand their non-profit. SW Key is conducting a feasibility study to determine whether they should invite CommUnityCare to occupy their space for a clinic or open a health center under their non-profit programs. Tex Health Central Texas As chair of the Greater Austin Hispanic Chamber of Commerce’s Health and Wellness Committee I am working to create a health and wellness portal on the GAHCC Web site that would offer health information resources and include and on-line “qualifier” for small business owners to determine if they qualify for insurance through Tex Health Central Texas. Once this portal is functioning, I plan to do the same with the Austin Chamber of Commerce and the African American and Asian Chambers, Austin Business Journal and other business focused organization sites. Other Community Engagement I regularly attend events and fund raisers to have a Central Health and CommUnityCare presence in community organizations. i.e., Celebrando Austin, Hispanic Physicians Association Gala, African American Leaders Luncheon, Austin Chamber events and others. See list below: (list taken from comms report. Only presentations go there. Spanish speaking Media Respond to interview requests from this media in regards to current issues as they arise. When did you do the Univision interview?

1

Government Affairs Report Stacy Wilson April 15, 2010 Listed below are the activities, grouped by category, in which I have been involved during the prior month. Community Action Network (CAN) I have been working on two initiatives that are being led by the Community Action Network. One is an intergovernmental stimulus workgroup comprised of AISD, the City of Austin, Travis County, Central Health, ACC, and CapMetro. That workgroup is investigating opportunities for collaboration to seek federal stimulus funds and is hoping to continue the collaborative after the stimulus funds are no longer available to work together to bring additional resources to Central Texas. I have also been attending the CAN meetings and meeting with CAN’s new legislative consultant regarding Central Health’s legislative goals and objectives. Greater Austin Chamber of Commerce I represent Central Health and CommUnityCare at the Greater Austin Chamber of Commerce on the federal, state, and local issues committees. I am serving on the federal issues healthcare subcommittee, of which Dr. Tom McHorse is chair. As part of that subcommittee, I will be attending the Chamber trip to Washington, D.C. in May to meet with our local delegation. Hays County Healthy Communities Collaborative I have been attending meetings of the Hays County Healthy Communities Collaborative in which stakeholders in Hays County are working together to determine how to address their healthcare needs. I participated in a strategic planning session with this collaborative in which the members assessed their current and future needs and next steps to begin addressing these needs. Health Information Technology and Health Information Exchanges As the President and CEO’s delegate to the Texas Health Information Exchange Coalition (THIEC), which is a collaborative of local and regional health information exchanges (HIEs) like the ICC, I have attended THIEC organizational meetings and, together with the Central Health President and CEO and Lone Star Circle of Care (the two organizations assigned by the ICC to work on HIE issues) met with Tony Gilman, Executive Officer Texas Health Care Policy Council, Office of the Governor, one of the individuals primarily responsible for HIE implementation in Texas, to discuss the activities of the ICC and the ICare System. As one of only two active HIE models in Texas, we believe that the ICare System should serve as a model for the state. We previously met with Stephen Palmer, Director of the Office of E-Health Coordination for the Texas Health and Human Services Commission, to have the same conversation.

2

Integration of Health and Behavioral Health Workgroup This workgroup is mandated by state legislation from last session and is analyzing how health and behavioral health can be integrated and delivered. It is headed by the Hogg Foundation, and Beth Peck, Senior Healthcare Planner, has been attending the meetings. I arranged for Andrés Guariguata, LCSW, Director, Integrated Behavioral Health Services, to be invited to a workgroup meeting in which he presented information about how the E-merge program is a model of how these services are being clinically integrated and delivered at CommUnityCare. Relationship Development In addition to these activities and other activities for CommUnityCare, which are not included in this report, I maintain regular contact with our local state and federal delegation on matters of interest to Central Health. As part of this relationship development, I, along with a few Board members, attended a reception for Lieutenant Governor David Dewhurst and will be attending another reception with several Board members for Senator Kirk Watson. Presentations I made two presentations, both on federal health reform: Healthy People subcommittee of the Community Health Access Committee

sponsored by St. David’s Foundation; and Travis/Williamson Service Committee of the ICC

MAP Enrollment FY09 and FY10

9,83410,175 10,334 10,438

10,66311,096

11,975

12,830

13,443

13,979 14,08614,397

14,71115,146

15,74916,121

17,13317,615

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10

Psychiatric Services Stakeholder Meeting March 22, 2010

4:00 p.m. Cesar Chavez Building (1111 East Cesar Chavez)

MEETING NOTES

Attendees: Guy Herman – Travis County Nancy Hohengarten – Travis County Sherry Fleming – Travis County Health and Human Services and Veterans Services Ana Almaguel – Travis County Health and Human Services and Veterans Services Toni Inglis – ATCIC Board David Evans – ATCIC Dr. Jim VanNorman – ATCIC Dawn Handley -- ATCIC Diana Resnik – Seton Family of Hospitals Alan Isaacson – Seton Shoal Creek Hospital Chris Ziebell – University Medical Center Brackenridge Kari Wolf – AMEP Becky Pastner – St. David’s Foundation Tom Coopwood – Travis County Healthcare District Board Manager Brenda Coleman-Beattie – Travis County Healthcare District Board Manager Patricia A. Young Brown –Travis County Healthcare District Lisa Glenn – Travis County Healthcare District Beth Peck – Travis County Healthcare District Karen Hale – Health Management Associates Kim McPherson – Health Management Associates Agenda/Notes: 1. Welcome

Dr. Coopwood welcomed everyone and began the meeting.

2. State Budget Issues Dr. VanNorman discussed three potential reductions to the ATCIC budget. Competitive State Crisis Funds Dr. VanNorman noted that the state over committed the amount of funds they awarded through the competitive state crisis funding process a couple of years ago. Since that time, they have covered this shortage with lapsed funds, but it does not appear that they will be able to continue to do this. One option the state is considering to resolve the issue is to take back the amount of over-committed funds from the competitive grant recipients. For ATCIC, this would mean an estimated reduction of $65,000 annually. ATCIC has sent a letter to the state to appeal. Dr. Coopwood asked whether the Stakeholder group should also send a letter to the state. David Evans stated that would be helpful and that Jim could draft a letter for consideration.

Page 1 of 4

State Request for 5% Budget Cuts Due to the current budget environment, each state agency has been requested to propose a 5% cut for the next biennium. To this end, DSHS has proposed the elimination of funding for 200 state hospital beds. While none of the ASH beds would be cut, the total amount of funding available for inpatient services would be reduced which would reduce the number of beds for which each local mental health agency is funded. Federal Medicaid Assistance Percentage At the time the federal stimulus package was approved, the federal matching rate for Medicaid services was increased. This was a temporary increase, so the increased matching rate currently being received by ATCIC for rehabilitation services will be reduced to the former level which will have an estimated $100,000-$200,000 negative impact on ATCIC’s annual budget.

3. NAMI Handout The group discussed the concept of Involuntary Outpatient Commitment (IOPC) services that are being conducted in San Antonio and were to be the topic of the National Alliance on Mental Illness (NAMI) Austin meeting later in the day. Judge Herman stated that this program is able to work in Bexar County as they have a facility to house the individuals while they attend the mandated day treatment program. It was noted that outpatient services are difficult for the homeless population. In response to a question from Dr. Coopwood about the availability of intensive outpatient services for District-eligible clients, Dr. VanNorman noted that these services are available through Seton Shoal Creek and Austin Lakes. Individuals served through The Inn and the crisis respite program receive programming through those services so have not been referred to the IOP service.

4. Update on MCOT Activities in Hospitals Dawn Handley noted that there is still a need to have MCOT staff working in hospital EDs be credentialed and that this issue is not yet resolved.

5. Update on CIC Activities and Dashboard Karen Hale led the discussion on the activity around the various CIC projects. Triage System Karen noted that the triage principles are completed and are being communicated to hospital staff to ensure that everyone is aware of how triage will be conducted. Real-Time Bed Data Karen reported that there is no update on this issue. Lesa-Brown Valades, with ATCIC, has created a draft tool for consideration, but a meeting to discuss this with staff from the psychiatric hospitals still needs to be scheduled.

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HIPAA-Compliant Data Sharing This is an effort to ensure that all participating providers have the same understanding of what data is allowed to be shared under HIPAA for client care. Diana Resnik is coordinating this effort and has received the names of the respective legal counsels or other staff most knowledgeable about HIPPA and just needs to get a meeting scheduled. It was noted that there may be some precedent in Houston for this that we could use as a template. Community Peer Review Dr. VanNorman noted that he is reviewing the Seton Health Plan’s process for peer review and vetting with the Tejas Behavioral Health attorney to see how this can help inform the process being established for the community. MMHTF Indicators Project Karen noted that the role of the Mayor’s Mental Health Task Force has evolved and is receiving new grant funding to work on an Indicator’s Project. This project is looking at impacting five community indicators. They will be working with the CIC to try to lower the community readmission rate. The CIC will act as the steering committee for this indicator. The MMHTF continues to be led by Dr. Sharon Stone, and she will be presenting on this new project at the next Stakeholder’s meeting. Linkages Between Physical Healthcare and Behavioral Healthcare Dr. Lisa Glenn noted that there is a small group working on this to flowchart the process for identification of a current medical home (if any) of client referred to inpatient psychiatric hospital and to determine other medical home options prior to discharge for those clients not currently established with a medical home. Training of Medical Staff on Psychiatric Issues Dr. VanNorman noted that this is still under development. Dashboard Beth Peck reviewed the current status of the dashboard (see attached). She noted that a group had recently worked to discuss targets for each of the measures. Some of these targets are finalized, and some are still being developed. Status is only indicated on the dashboard for those measures that have an established target. Some suggestions made regarding the dashboard included –

• Clarifying that the year-to-date average is a monthly average • Adding the prior year average instead of just the percent increase • Ensuring that the measures accurately indicate what is being measured.

6. Announcements

It was noted that locally $7 million was received to impact tobacco cessation efforts. Alan Isaacson noted that his staff were being informed that District-eligible patients were not being referred to the psychiatric hospitals due to a “lack of Central Health funds.” Trish noted that there is not a lack of funds available from Central Health for

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Page 4 of 4

these services and asked that Dr. VanNorman and David Evans resolve this issue with their staff.

7. Next Meeting

Date and Location The next meeting of the Psychiatric Stakeholder group will be Monday, May 17, 2010, at 4:00 p.m. Beth noted that the May meeting may be the last meeting that can be held in the Central Health offices for awhile, as the building will be undergoing a renovation that is anticipated to last approximately 18 months. Becky Pastner noted that St. David’s Foundation may be able to host the meetings during this time. Beth is to follow-up with Becky on this.

Suggested Agenda Items

• Key findings from the statewide Crisis Review report • Update on the state Continuity of Care taskforce


April 22, 2010

Agenda Item 10 Confirm the next regular Board meeting date, time,

and location.

Documents

APR-16-2010 15:32 TRAVIS COUNTY ATTORNEY P.001 1+1 ... · APR-16-2010 15:32 TRAVIS COUNTY ATTORNEY P.002 3. Discuss and take appropriate action on the approval and implementation