Agenda Item   

AGENDA STAFF REPORT

 

                                                                                                                        ASR Control  09-000665

 

MEETING DATE:

04/28/09

legal entity taking action:

Board of Supervisors

board of supervisors district(s):

All Districts

SUBMITTING Agency/Department:

Health Care Agency   (Approved)

Department contact person(s):

David L. Riley (714) 834-6021 

 

 

 

 

 

Subject:  Recommended Policies Regarding Community Clinic TSR

 

      ceo Concur

County Counsel Review

Clerk of the Board

Concur

N/A

Discussion

 

 

3 Votes Board Majority

 

 

 

    Budgeted: N/A

Current Year Cost: N/A

Annual Cost: N/A

 

 

 

    Staffing Impact: No

# of Positions:

Sole Source: N/A

    Current Fiscal Year Revenue: N/A

    Funding Source: N/A

 

    Prior Board Action: N/A

 

RECOMMENDED ACTION(S)

 

The Health Care Agency recommends that the Board consider the following:

 

1.

Rescind the March 10, 2009 Board action directing staff to provide a 30-day notice of intent to suspend a portion of funding to the Coalition of Orange County Community Clinics for provision of  Planned Parenthood services and reinstate funding through June 30, 2009.

 

2.

 

Approve the recommended policies regarding community clinic Tobacco Settlement Revenue.

 

3.

Direct the Health Care Agency to implement the new policies on July 1, 2009 for the community clinic agreements for fiscal year 2009-10.

 

 

 

 

 

SUMMARY:

 

The Health Care Agency requests approval of new policies regarding community clinic Tobacco Settlement Revenue to be implemented July 1, 2009.

 

 

 

 

 

BACKGROUND INFORMATION:

 

This Agenda Staff Report (ASR) provides a general discussion on the use of Community Clinic Tobacco Settlement Revenue (TSR) and recommends new policies for the use of these funds.

 

Measure H

 

In 2001, the Orange County voters passed Measure H which delineated how the County of Orange portion of National Tobacco Settlement Funds would be used.  Measure H delineated six categories:

 

Measure H Category

FY2009-10 Budget*

 

 

·        Senior and Disabled Healthcare Services

$  6.3 million

·        Emergency Medical Services

$  8.0 million

·        Tobacco Prevention and Control

$  4.3 million

·        Hospitals

$  3.8 million

·        Community Clinics

$  7.3 million

·        Sheriff’s Department

$  7.2 million

TOTAL:

$36.9 million

           *Includes rollover funds

 

Measure H specified that the community clinic category shall be used for “non-profit community clinics, mobile health clinics, university and hospital-affiliated clinics so that children and families receive immunizations, primary, specialty, and dental health care services.”  Your Honorable Board has the discretion to manage, allocate and limit the use of TSR in a manner consistent with Measure H.

 

Community Needs

 

The community clinics are one of the few sources of primary medical, mental health, and dental care for the poor and uninsured people of Orange County.  For many, the only alternative to a community clinic is a hospital emergency room.

 

The need for primary medical, dental, and mental health care for the uninsured far exceeds the available resources. The 2008 the Ray and Associates Report on the Orange County community clinics found that “a significant gap exists between resources to meet the needs of the targeted underserved populations and resources available.”  It went on to estimate that almost 800 additional medical, dental, and mental health professionals would be required to meet the community’s needs.

 

With respect to dental care, the 2007 California Health Interview Survey found that 14% of Orange County children (0-17) had never been to a dentist.  For mental health services, the same survey found that 17% of Orange County Adults needed help for emotional/mental health problems or use of alcohol/drugs - of those, 44% had sought but did not receive treatment.

 

A more complete description of unmet medical, mental health and dental needs is provided in the attachment to this ASR.

 

 

 

 

 

Recommended Policies

 

Due to the unmet needs for basic clinical services for the uninsured, which are growing due to the current economic conditions, the Health Care Agency (HCA) recommends that your Board approve policies targeting TSR funding from the community clinic category to direct medical, dental, and mental health clinical services at the community clinics.

 

Accordingly, the following policies are recommended for the community clinic category of Measure H Tobacco Settlement Revenue (TSR) funding:

 

q          Restrict expenditure of community clinic TSR funds allocated to the individual clinics to direct medical, mental health and dental services for uninsured persons.

 

q          Allow the Coalition and/or HCA to expend community clinic TSR for contract administration, for functions more effectively provided centrally, and for improvement of the community clinic system.

 

q          Prohibit use of any community clinic TSR for abortions, abortion counseling, or promotion or advocacy of abortion as a method of family planning.

 

The recommended policies are discussed in detail as follows:

 

               Restrict expenditure of community clinic TSR funds allocated to the individual clinics to direct medical, mental health and dental services for uninsured persons.

 

As described above and on the attachment, there is strong evidence of the need for community clinics to provide additional direct medical, mental health and dental services for uninsured and low-income persons in Orange County.  HCA recommends that TSR for individual community clinics be focused on direct clinical services for these persons.  Over 90% of TSR for community clinics is already being spent in a manner consistent with this approach.

 

Specifically, the guidelines HCA recommends are:

 

            Restrict TSR to direct medical, mental health and dental services. 

 

Direct services would be those providing specific treatment benefits to individual patients.  This would exclude the following types of services for which TSR is now being used:

 

*    Health education activities, including family planning education, at the Laguna Beach Community Clinic, Orange County Rescue Mission, Planned Parenthood, and Vietnamese Community of Orange County Clinic.  Education as a part of direct clinical service, such as treatment of diabetes or hypertension, would still be permitted; however, group information programs, health education classes, or group education activities including media productions and publications would not be permitted to be funded with community clinic TSR.

 

*   Language translation services at UCI Clinics, except as a part of direct services.

 

Where reallocation into direct services at the same clinic is possible, HCA staff would meet with the Coalition and the individual clinic to develop a revised budget to move funds from the activities inconsistent with the recommended policies into direct service categories.

 

            Restrict TSR to persons who have no private health insurance and are not eligible for any public health insurance

 

The limited TSR funds should not be used for persons who have private health insurance, or who are eligible for governmental health insurance programs such as Med-Cal or Healthy Families.  This would be similar to the limitation of the County’s Medical Services Initiative (MSI) program, under which no person with private health insurance, or actual or potential other governmental insurance, is eligible for MSI.  This limitation would be consistent with Measure H’s requirement that the funds supplement and not supplant existing federal, state and local funding.

 

Most of the community clinics already attempt to seek reimbursement from patient insurance where it exists, but this policy guideline would make it clear that private or governmental insurance must always be pursued before applying TSR funds.

 

               Allow the Coalition and/or HCA to expend community clinic TSR for contract administration, for functions more effectively provided centrally, and for improvement of the community clinic system.

 

This policy would allow a portion of community clinic TSR funds to be set aside for the Coalition to provide contract administration and centralized services on behalf of clinics when such services can be provided more effectively centrally than by each of the individual clinics.  Also permitted would be HCA administration of community clinic TSR funds designated for improvement of the overall community clinic system. 

 

               Prohibit use of any community clinic TSR for abortions, abortion referrals, abortion counseling, or promotion or advocacy of abortion as a method of family planning

 

No community clinic has ever used TSR to pay for abortions.  However, since abortions could be considered a direct service they still could be provided within the restriction limiting TSR to direct services.  To assure that abortions would not be funded by TSR in the future, HCA recommends that the use of Measure H Community Clinic funds for abortions be specifically prohibited.  HCA further recommends that community clinic TSR not be used to fund abortion counseling, abortion referrals, or to engage in promotion or advocacy of abortion as a method of family planning.  If a clinic were to elect to engage in any of these activities that would be impermissible uses for the limited TSR funds, HCA recommends that the clinic be required to physically and financially separate them from any activities funded by community clinic TSR to avoid the possibility that Measure H funds would indirectly support these activities.

 

Effective Date

 

HCA recommends that your Board adopt the recommended policies for the community clinic agreements effective July 1, 2009 for fiscal year 2009-10. 

 

On March 10, 2009, your Board directed staff to provide a 30-day notice of intent to suspend a portion of funding to the Coalition for provision of Planned Parenthood services.  The notice was provided to the Coalition on March 11, 2009 to suspend funding for Planned Parenthood/Orange and San Bernardino Counties for the period from April 11, 2009 through June 30, 2009, the expiration date of the current TSR agreement.  HCA review of Planned Parenthood reports indicates that the use of TSR funds has been consistent with FY 2008-09 contract requirements.  HCA recommends that your Board consider rescinding its March 10, 2009 Board action and reinstate funding through June 30, 2009.

 

 

 

FINANCIAL IMPACT:

 

N/A

 

 

STAFFING IMPACT:

 

N/A

 

EXHIBIT(S):

 

Attachment:  Unmet Health Needs Related to Community Clinics