1222 N. Post St. | Spokane, WA 99201 | TEL 509-458-2509 | FAX 509-458-2003

SERVING: Northern Ferry, Pend Oreille, Spokane, Stevens & Whitman counties

WWW.ALTCEW.ORG | ADVOCACY. ACTION . ANSWERS.

PLANNING AND MANAGEMENT COUNCIL

EXECUTIVE COMMITTEE

Agendas & Attachments

OCTOBER 17, 2017

Executive Committee Members:

Marty Johnston

Aruna Bhuta

Barry Lamont

Dan Mortensen

Hal Balzert

Jean Kindem

October 2017

Review nine-month financial report on ALTCEW administration and direct services

Complete plans for combined November/December PMC meeting

Participate in W4A Area Agency on Aging Advisory Councils meeting and Senior LobbyConference

Review September financial report on administration and in-house direct services

EC 17-31

AGING & LONG TERM CARE OF EASTERN WASHINGTON Executive Committee

Memorandum EC17-31 MEETING NOTICE

Executive Committee Meeting Tuesday, October 17, 2017 10:00 a.m. to 12:00 p.m.

ALTCEW Office, Rock Pointe III Building 2nd Floor Conference Room (office in Tower Building Suite 659) 316 W Boone, Spokane –

See map on reverse side of this agenda AGENDA

1. Call to Order and Welcome. Marty Johnston

Action Item 2. Review/Action on meeting Agenda. Marty

Action Item 3. Review/Action on the minutes of the September 21, 2017 meeting. Marty(Refer to page 5)

4. Executive Director’s Briefing. Lynn Kimball

Action Item 5. Review /Action on financial statements for the period of January 1 toSeptember 30, 2017. (Handout) John Beck

Action Item 6. Review/Action on 2018 budget for administration and direct services. (Refer topage 9 and PMC Attachment H, page 50) Lynn & John

Action Item 7. Review/Action on proposed PMC meeting dates for 2018. (Refer to PMCAttachment I, page 58)

8. Report on Health Home Plan Do Study Act Cycle. (Refer to page 14) Teresa Michielli

9. Discuss strategic planning session feedback process.

10. Finalize November PMC Meeting format and agenda. (Refer to page 16)

11. Robert’s Rules. Marty

12. Review PMC Committee Agendas. (Refer to PMC Attachment A, page 7)

13. Other

14. Adjournment

316 W Boone Ave #659

Spokane, WA 99201

E = Entrance A = ALTCEW

P = 2 hour guest parking

316 W Boone Ave #659 – Rock Pointe Corporate Center

To enter complex (total of 4 office buildings):

Enter off of N Washington St (see E on map above)

Veer right to the “Tower” Building

Look for “2 hour guest parking signs” as you drive past the entrance of Rock Pointe

Tower (see P on map above)

When you enter the Tower building, you are on the 3rd floor

ALTCEW office is on 6th floor, suite 659

The meeting will be in the Tower Conference Room on the 2nd floor (left when coming

off the elevator)

Direct phone number to the ALTCEW Rock Pointe Office is 509-326-1274 (not a public

number).

We look forward to seeing you here!

ALTCEW Rock Pointe Staff

E

A

P

PMC Committees\Executive\2016\EC Minutes\Ecmins17-Sept21

AGING & LONG TERM CARE OF EASTERN WASHINGTON

Planning and Management Council Executive Committee

Minutes of the September 21, 2017 Executive Committee Meeting

Present: Marty Johnston, PMC Chair; Aruna Bhuta, Vice Chair (Planning); Hal Balzert (Services Quality Assurance); Dan Mortensen (Advocacy) Absent: Barry Lamont (Excused), Jean Kindem (Excused) Staff: Lynn Kimball, John Beck, Yolanda Lovato, Khristina Scheideler (Recorder) 1. Call to Order and Welcome: Marty Johnston called the meeting to order at 10:01 a.m., and welcomed everyone. 2. Consideration of acceptance of the September 21, 2017 Executive Committee meeting agenda (Memorandum EC17-22): After presentation by Marty Johnston, Lynn Kimball clarified that action is not required for Item 7 Older Americans Act funding for “Special Projects” as the amount total met the threshold requiring Governing Board approval. Lynn added that it has been signed by Governing Board Chair, Whitman County Commissioner, Art Swannack, and will be ratified at the November Governing Board meeting. Following the amendment, Hal Balzert moved, Aruna Bhuta seconded, acceptance of the September 21, 2017 Executive Committee meeting agenda. The motion carried with no objections and/or abstentions. 3. Consideration of acceptance of the July 20, 2017 Executive Committee meeting minutes: After presentation by Marty Johnston, Aruna Bhuta moved, Hal Balzert seconded, acceptance of the minutes of the July 20, 2017 Executive Committee meeting. The motion carried with no objections and/or abstentions. 4. Executive Director’s Briefing: Lynn Kimball began by announcing that Planning and Management Council (PMC) members will have access to a password protected webpage on the Aging & Long Term Care of Eastern Washington (ALTCEW) website that is devoted to relevant information and resources for PMC members. In response to a question that came up during the July PMC meeting, Lynn stated that Mike Piccolo was contacted regarding whether or not a quorum is required at PMC Committee meetings. Lynn reported that Mike responded clarifying that the Executive Committee is the only committee that is required to have a quorum for meetings as it is the only committee that makes recommendations directly to the Governing Board. Lynn explained that if any committee other than the Executive Committee does not have a quorum, the committee can discuss items and make decisions to be ratified by the PMC. Lynn added that the committee meeting minutes should also reflect that a quorum was not present for the meeting. Lynn stated that fifty percent of the membership establishes a quorum for committee meetings and 30 percent establishes a quorum for the PMC. Lynn

PMC Committees\Executive\2016\EC Minutes\Ecmins17-Sept21

announced that the Executive Committee meeting on October 17 will be held in the Rock Pointe Tower Conference Room rather than at the Post Street building. Lynn also distributed copies of directions to Rock Pointe. Turning to the Medicaid Transformation Demonstration, Lynn reported that the services began on September 11, 2017. Lynn stated that Gail Pratt, ALTCEW Contracts Manager is offering support to contractors as they work through implementation. Lynn added that the agency will monitor enrollment and that targets for enrollment numbers can be added to contracts if needed. Yolanda Lovato reviewed the language developed for the outreach materials. Regarding Medicaid Transformation Demonstration Initiative 1, Lynn reported that Accountable Communities of Health is aiming to have project plans approved by November. Lynn announced that W4A is in the process of hiring a director. Lynn added that W4A is also working on the legislative agenda and preparing for the Senior Lobby Conference. In closing, Lynn shared that the Arcora Foundation, formerly Washington Dental Services Foundation, is looking to expand dental access for adult Medicaid clients with diabetes and pregnant women in Spokane, Thurston and Cowlitz counties. The legislature has approved enhanced Medicaid payments for these populations and Acora is investing additional funding to increase access and coordination. Lynn explained that the agency is in discussions with Arcora regarding its role in supporting the work in Spokane County. 5. Consideration of acceptance of financial statements for the period of January 1 to August 31, 2017 (Refer to ALTCEW Program Services and Administrative Expenses through August 31, 2017 Handout): After presentation by John Beck, Hal Balzert moved, Aruna Bhuta seconded, that the Executive Committee accept the financial statements for the period of January 1 to August 31, 2017, as presented. The motion carried with no objections/abstentions. 6. Consideration of approval of Proposed Revised 2018 Wage Scale and Tentative 2018 Salary and Benefit Assumptions (Refer to Memorandum EC17-24): After presentation by Lynn Kimball and John Beck, Hal Balzert moved, Dan Mortensen seconded, that the Executive Committee approve the revised 2018 Wage Scale and reclassifications along with a 2% cost of living adjustment, continued 2.5% step increases and proposed increase in employee health and dental plan benefits, to be incorporated into the 2018 budget proposal, as presented in Memorandum EC17-24. The motion carried with no objections/abstentions. During the discussion, it was noted that there may be a fourth medical benefit plan option that ALTCEW staff are eligible to select if interested. John Beck stated that staff will review the plan options and incorporate it as an option if applicable. 7. Discussion regarding an Aging and Long Term Support Administration (ALTSA) Older Americans Act (OAA) funding amendment including OAA funding for “Special Projects” of $36,700 which can be used in 2017 and/or 2018: Lynn Kimball and John Beck stated that Governing Board Chair, Whitman County Commissioner, Art Swannack reviewed and accepted $36,795 in OAA funding for “Special Projects” which can be used in 2017 and/or in 2018. Lynn and John explained that the funds will be incorporated into the proposed budget. Since it can be used in 2017 and/or 2018, the agency will have options to utilize it for budget priorities and/or a program such as A Matter of Balance.

PMC Committees\Executive\2016\EC Minutes\Ecmins17-Sept21

8. Discussion regarding the 2017 Staff Departure Analysis (Refer to Memorandum EC17-23): Lynn Kimball reviewed an analysis of reasons staff have left the agency and feedback from the exit surveys. 9. Discussion Regarding National Association of Area Agencies on Aging (N4A) Conference Report (Refer to Memorandum EC17-26): Lynn attended the N4A Conference July 30 through August 1, 2017 and shared key takeaways from the conference. 10. Consideration of approval of strategic planning process (Refer to Memorandum EC17-30): After presentation by Lynn Kimball, Aruna Bhuta moved, Hal Balzert seconded, that the Executive Committee recommend that the Planning and Management Council approve to pursue scheduling and obtaining a facilitator to hold a strategic planning session in January 2018, as presented in Memorandum EC17-30. The motion carried with no objections/abstentions. 11. Consideration of approval of Direct Service Reports – 6 month reports (Refer to September 21, 2017 Packet Insert): After presentation by Lynn Kimball, Yolanda Lovato and John Beck, Dan Mortensen moved, Hal Balzert seconded, approval of the Direct Service Reports – 6 month reports, as presented. The motion carried with no objections/abstentions. 12. Appointment of PMC member attendance for State Council on Aging/Washington Association of Area Agencies on Aging at Senior Lobby Conference: Lynn Kimball reported that Sandra Boudreaux, Nancy Gillard and Jean Kindem have expressed interest. Lynn added that Fran Bessermin and Hal Balzert have also expressed interest in attending if needed. Hal Balzert stated that he and Fran have attended for the past two years and were willing to attend again if needed. Given the interest from the five PMC members, the Executive Committee appointed Sandra Boudreaux, Nancy Gillard and Jean Kindem to attend the event. 13. Discussion regarding November PMC Meeting format and agenda (Refer to page 21 of the September 21, 2017 Executive Committee Meeting Packet): The Executive Committee discussed ideas for presentations during the November PMC meeting to include: Kaiser, rural health/services, and a review of 2017 accomplishments. Yolanda Lovato added that work regarding the Area Plan Update can help identify 2017 accomplishments. Regarding the agenda, the group decided to have two presentations in the morning and the business meeting after the lunch break. 14. Consideration of acceptance of September 22, 2017 PMC Committee agendas (Refer to PMC Attachment A, page 5):

a. Advocacy Committee: Lynn Kimball stated that she will have information regarding the proposed federal health care legislation and a new proposed rate increase from Avista.

PMC Committees\Executive\2016\EC Minutes\Ecmins17-Sept21

b. Planning and Resources Committee: Aruna Bhuta stated that the Needs Assessment Item will be for Adult Day Care rather than Adult Day Health.

15. Other:

a. Outcome of Fall Prevention Grant Application: Responding to a question regarding the outcome of the fall prevention grant application, Yolanda Lovato reported that the application that ALTCEW assisted in submitting received a high score but it was not chosen to receive one of the grants. Yolanda added that there were 7 recipients but no applicants from Washington State were selected.

16. Adjournment: There being no further business to come before the Executive Committee, the meeting was adjourned at 12:19 p.m.

EC17-28/PMC17-28

AGING & LONG TERM CARE OF EASTERN WASHINGTON PMC Executive Committee Memo EC17-28

PMC Memo PMC17-28 October 13, 2017

TO: Planning and Management Council FROM: PMC Executive Committee RE: Revised 2018 ALTCEW General Operating Budget for Administration and Direct Program Services REQUESTED ACTION The PMC Executive Committee recommends that the Planning and Management Council approve the 2018 Revised ALTCEW General Operating Budget and revised wage scale as presented for submission to the Governing Board. BACKGROUND ALTCEW’s General Operating Budget covers that portion of the Agency’s revenue and expenditures needed for both general administration of the Agency and for those services operated directly, i.e., provide through ALTCEW staff, rather than through contracts with other organizations. The attached budget includes contracted services as well. The general administration portion of the budget includes those expenses that provide for staff that support several Agency functions. These include 1) PMC and Governing Board; 2) Area Plan on Aging, planning and resource development; 3) contract procurement, monitoring, and evaluation; 4) financial, information technology, and office space; 5) public information and coordination; 6) advocacy; and 7) insurance, supplies, equipment, printing, etc. Services directly provided by ALTCEW staff include: 1) Title XIX case management (Spokane County only); 2) RN Services for Title XIX (both DSHS aging and developmental disabilities clients); 3) Caregiver Training; 4) State Health Insurance Benefits Advisors (SHIBA) program, and the Senior Medicare Patrol; 5) Home Care Referral Registry program; 6) Dental Outreach program; 7) Title V, Senior Employment program; 8) Community Living Connections; 9) Health Home Care Coordination; 10) Dementia Options Counseling; 11) Veteran’s Directed Home Care; and 12) Consumer Training, including A Matter of Balance falls prevention. The administration and direct services expenditures proposed for 2018 are guided by the Area Plan on Aging, and policies such as the Agency Bylaws, and contract requirements from the programs noted in the previous paragraph.

EC17-28/PMC17-28

DISCUSSION The current projection for 2017 revenue and expenses for the General Operating budget, including both general administration and direct services, are estimated to be $6,460,700. For 2018, the proposed General Operating Budget for administration and directly operated services totals $6,789,465 with a total agency budget of $14,104,011 in revenues and expenses. Staff has prepared this revised budget proposal as our best estimate of anticipated funding for 2018. Detailed budgets were prepared by accounting staff and program managers for those programs with bottom lines that can fluctuate. These programs include Community Living Connections, Health Homes, Caregiver Training and SHIBA. Staff will revise this budget in early 2018, if necessary. Staff proposes, for your review and recommendation to the Governing Board for adoption, a 2018 Budget with significant line item changes described in the following paragraphs: Revenue Line Items Older Americans Act Funding is estimated to be flat at best. The State of Washington

funding including SCSA and Family Caregiver are up about 2% overall and includes a discretionary “special projects” funding of $33,115, with $17,810 to be used in “A Matter of Balance” classes. The balance of $15,305 is left as uncommitted other expenses. There is also new state funding for Home Delivered Meals for contracted service expansion of $56,343.

Title XIX Case Management funding increased significantly in 2017 due to negotiated

Medicaid waiver system changes between the state and federal contracts and continued client growth. This client base is expected to grow slightly in 2018 and is projected conservatively in income. Another growth source is the Medicaid Transformation Demonstration (MTD) 1115 Waiver pertaining to pre-Medicaid services. This adds new revenue to our administrative and to our contracted services budgets.

Health Homes is projected to grow slowly with a projected funding of $768,990 for direct service. Some plans are offering financial incentives for engaging more duals eligible (Medicaid/Medicare) clients, but the projected 2018 budget shows a $20,258 deficit.

Conexus Health Resources is removed in this 2018 Agency budget due to inactivity of this consortium effort as national and state health care is revamped.

Caregiver Training Revenue is budgeted to remain flat, but at break-even based on continuing classes both locally and throughout Central and Eastern Washington.

EC17-28/PMC17-28

Expense Line Items: Staffing expenses are relatively flat. This budget includes a cost of living adjustment of

2% at the first of the year and 2.5% step increases based on merit. The 2018 staff budget has 79 positions, which are up from 75 in the initial 2017 budget. There is also a modification of the ALTCEW wage scale with a salary adjustment for nursing staff and HR staff. The net adjustments were about $40,000 in a $4 million salary budget.

Employee Benefits increases proportionally in 2018. Health/dental insurance is up in 2018 by 7%. Retirement benefit contribution remains flat but is at a historically high rate of 12.7%. The actual 2016 fringe (payroll taxes and benefits) rate was 37.2%. For 2017 the fringe rate is budgeted to be around 37.95%. The 2018 budgeted fringe rate is 39.75%. Health/Dental Insurance Benefits are up from $764 in 2017 to $818.37 per person per month for health/dental insurance. This covers all of single person medical insurance for the midlevel plan and full family dental insurance.

Other administrative and program expenses are relatively flat with 2017. This is detailed in the attached budget reports. Rent is up 2.5% on our leases as renegotiated in 2014. The overall administrative rate in this budget is 8.04%.

This proposed 2018 budget shows a break-even year based on current projections of revenue and expenses.

Enclosure: 2018 proposed budget, revised Wage Scale

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AGING & LONG TERM CARE OF EASTERN WASHINGTON Executive Committee

Memorandum EC17-33 TO: Members, Executive Committee FROM: Teresa Michielli, Care Services Director SUBJECT: Health Home Quality Assurance and Improvement Process DATE: October 17, 2017 BACKGROUND: The Health Home Program, implemented at ALTCEW in 2013, has undergone numerous changes as new processes and expectations evolve ensuring the programs viability. PDSA WITH HEALTH HOME PROGRAM: Throughout these years, ALTCEW’s Health Home Program has identified strategies to ensure quality, compliance and fiscal stability using a tried and tested method that helps the team plan a chosen intervention, test it on a small scale and then reviewing results prior to the actually implementation and/or deciding how to proceed. This strategy is broken down into four components: Plan, Do, Study, Act (PDSA). The Health Home model incorporates the following elements of the PDSA . The first component, planning, begins by define our objectives. This is accomplished through a series of questions on what is working well and where do we need improvement. Our current objective is reducing no shows and cancelations to improve the quality of our product and increase our bottom line. We discuss the challenges in our current approach, scheduling cancelations at any cost, and deliberate on potential solutions. Asking how and why questions aids in developing our improvement plan. Our current improvement theory is to identify those repeat offenders, complete a telephonic visit as they call to reschedule, and schedule a home visit the following month. We predict letting the client know the value of the appointment, our inability to reschedule unless another appointment opens up, and completing the visit telephonically, will decrease the rates of no shows and cancelations. Next, we implement the second component, doing. At this time, we test the theory for improvements. Currently we have developed an excel spreadsheet to track each of the care coordinator’s no shows and cancelations. Baseline data began during the last 2 weeks in June. Changes to the current process are monitored for the next 90 days. Bi-monthly discussions are scheduled to identify problems, surprises and make observations. Next, the Study component begins when the data is analyzed. Our current study reveals a spike in no shows, reschedules and cancelations the first few weeks after implementation, yet is steadily being reduced at the end of the 90-day period. Staff feel more in control of the daily routine, and they are able to focus on month end billing audits.

Finally, the last component is to Act. The team makes recommendations to either adopt the process into daily practice, to adapt or modify the implementation, or to abandon the change and develop a new theory. NEXT STEPS: The Health Home team has chosen to adapt the implementation to fit with the newest Health Care Authority ruling stating that clients not engaged after 90 days will be returned to the Lead entity as inactive.

TO: Members, Planning and Management Council (PMC) FROM: Marty Johnston, Chair, Planning and Management Council SUBJECT: ALTCEW Planning and Management Council Meeting Notice, Agenda, and Background Information

for the November 17, 2017 Planning and Management Council Meeting The combined November/December meeting of the ALTCEW Planning and Management Council and Holiday Luncheon is scheduled on Friday, November 17, 2016, from 9:00 a.m. to 12:00 p.m. in the Jim Snider Training Room, and includes special presentations and agency business. At 12:00 p.m., we will have our Holiday lunch in the Nick Beamer Conference rooms B & C, provided by the Silver Café. Donations will be accepted and will be given to Greater Spokane County Meals on Wheels to support the nutrition program in Spokane County. No Committee meetings are scheduled this month. Meetings take place at the ALTCEW office, 1222 N. Post, Spokane, WA. In accordance with ALTCEW bylaws, any member unable to attend a meeting, please call Khristina Scheideler at (509) 458-2509, Ext. 215.

NOTICE: This meeting is open to the public. AMERICANS WITH DISABILITIES ACT (ADA) INFORMATION: ALTCEW is committed to providing equal access to its facilities, programs and services for persons with disabilities. Individuals

requesting reasonable accommodations or further information may contact Yolanda Lovato, ADA Coordinator, at least 5 days before the meeting date, at (509) 458-2509 or at action@altcew.org. Persons who are deaf or hard of hearing may

contact the Washington Relay Service at 7-1-1.

AGING & LONG TERM CARE OF EASTERN WASHINGTON Planning and Management Council

Memorandum PMC16-39

MEETING NOTICE

Planning and Management Council Meeting Friday, November 17, 2017

9:00 a.m. to 12:00 p.m. ALTCEW Jim Snider Training Rooms

1222 N. Post, Spokane, WA

AGENDA 9:00 AM

9:15 AM

9:30 AM

10:30 AM

11:45 AM

Action Item

Coffee, Tea, and Muffins

I. Opening Comments, Introductions –Marty Johnston, PMC Chair

II. Special Presentations

A. Providence Rural Aging Priorities, Providence Health Care

B. Kaiser Community Priorities, Kaiser

III. Essential Agency Business

A. Review/Action on minutes of the October 20, 2017 PMC meeting (Refer to PMC

Attachment A, page 5)

B. November Governing Board Report – Marty Johnston

C. Other

D. Adjournment

Lunch will be provided by Greater Spokane County Meals on Wheels’ Silver Café.

Donations will be accepted and will be given to support the senior nutrition

program.